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Sample records for physician-controlled wire-guided cannulation

  1. Wire-guided cannulation over a pancreatic stent versus double guidewire technique in patients with difficult biliary cannulation.

    PubMed

    Yang, Min Jae; Hwang, Jae Chul; Yoo, Byung Moo; Kim, Jin Hong; Ryu, Hyoung-Kyu; Kim, Soon Sun; Kang, Joon Koo; Kim, Min Kyeong

    2015-10-28

    In cases of difficult bile duct cannulation, the use of wire-guided cannulation over a pancreatic stent (WGC-PS) or the double guidewire technique (DGT) may facilitate biliary cannulation. The aim of this study was to compare the outcomes of WGC-PS and DGT in patients with difficult biliary cannulation. We conducted a retrospective cohort study of all endoscopic retrograde cholangiopancreatographies (ERCPs) performed between July 2009 and November 2014 at a single tertiary referral center. WGC-PS or DGT was performed in patients for whom biliary cannulation was difficult and guidewire insertion into the pancreatic duct (PD) was inadvertently achieved while attempting the standard WGC technique. In those cases, we used the WGC-PS technique from July 2009 to January 2012 (WGC-PS group), and the DGT technique from February 2012 to November 2014 (DGT group). In the DGT group, WGC-PS was sequentially performed if successful biliary cannulation was not achieved during the DGT attempt. Consecutive patients who underwent DGT and/or WGC-PS with the aim of selective biliary cannulation were enrolled. The primary outcome parameter was the rate of initial successful biliary cannulation. During the study period 3270 ERCPs were performed and a total of 177 patients were enrolled. The rate of initial successful cannulation was 66.7 % (60/90) in the WGC-PS group and 70.1 % (61/87) in the DGT group (P = 0.632). In 26 cases of failed DGT, WGC-PS was sequentially performed in the DGT group, and cannulation was successful in 14 of these patients. The rate of successful cannulation without the needle-knife precut technique was significantly higher in the DGT group compared with the WGC-PS group (75/87, 86.2 % vs. 60/90, 66.7 %, P = 0.003). The incidence of post-ERCP pancreatitis was 3.3 % (3/90) in the WGC-PS group and 10.3 % (9/87) in the DGT group (P = 0.077). In patients for whom biliary cannulation was difficult and PD access was inadvertently achieved while attempting

  2. Newly designed J-shaped tip guidewire: A preliminary feasibility study in wire-guided cannulation

    PubMed Central

    Omuta, Shigefumi; Maetani, Iruru; Shigoka, Hiroaki; Gon, Katsushige; Saito, Michihiro; Tokuhisa, Junya; Naruki, Mieko

    2013-01-01

    AIM: To perform wire-guided cannulation using a newly designed J-shaped tip guidewire, and to verify feasibility and safety for use. METHODS: The study was conducted on endoscopic retrograde cholangiopancreatography (ERCP) patients with naïve papilla undergoing diagnosis and treatment of biliary diseases between September 2011 and July 2012. We performed ERCP in a succession of 50 cases with a J-shaped tip guidewire. The first insertion attempt began with a trainee who had 5 min to complete cannulation, followed if necessary by the trainer for another 5 min. We assessed the primary success rate of selective biliary cannulation within 10 min and adverse events such as post-ERCP pancreatitis (PEP), bleeding or perforation. RESULTS: The primary success rate was 90% (45/50) within 10 min, the initial success rate within 5 min by trainee staff was 76% (38/50). The rate of PEP was 6% (3/50), but all 3 cases were mild pancreatitis. All patients were managed successfully with conservative treatment. There was no bleeding or perforation. CONCLUSION: A newly designed J-shaped tip guide-wire has the possibility to facilitate selective biliary cannulation for ERCP and appears to be safe. PMID:23901229

  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. 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.

  5. Current situation of endoscopic biliary cannulation and salvage techniques for difficult cases: Current strategies in Japan.

    PubMed

    Yasuda, Ichiro; Isayama, Hiroyuki; Bhatia, Vikram

    2016-04-01

    In the pancreatobiliary session at Endoscopic Forum Japan (EFJ) 2015, current trends of routine biliary cannulation techniques and salvage techniques for difficult biliary cannulation cases were discussed. Endoscopists from nine Japanese high-volume centers along with two overseas centers participated in the questionnaires and discussion. It was concluded that, currently, in Western countries, the wire-guided cannulation (WGC) technique is favored during initial cannulation attempts. However, the conventional technique using an endoscopic retrograde cholangiopancreatography catheter with contrast medium injection is still used as first choice at most Japanese high-volume centers. The WGC technique is used as the second choice at some institutions only. After failed biliary cannulation attempts, the initial salvage option preferred in most centers includes pancreatic guidewire placement, followed by precut techniques as the second salvage choice. Among several precut techniques, the free-hand needle knife sphincterotomy with cutting upwards from the pancreatic duct is most popular. Endoscopic ultrasonography-guided rendezvous technique is also carried out as a final salvage option at select institutions.

  6. 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

  7. Minimally invasive wire-guided balloon catheter puncture for voice prosthesis insertion.

    PubMed

    Tobed Secall, Marc; Bores, Toni; Sambola, Ignacio; Lop, Joan; García Rica, Eduardo; Lluansi, Jordi

    2017-07-01

    Tracheoesophageal puncture is an effective and reliable method for voice restoration after total laryngectomy that may be performed as a primary or secondary procedure. We describe our technique for secondary tracheoesophageal puncture using a wire-guided balloon catheter in an office setting. A 72-year-old patient with a total laryngectomy performed 2 years ago was selected for wire-guided balloon catheter puncture and voice prosthesis insertion. Successful tracheoesophageal puncture placement was achieved without complications and the patient tolerated the procedure well. The voice result was satisfactory and immediate. We conclude that balloon catheter tracheoesophageal puncture can be a simple and safe option for secondary voice prosthesis insertion in total laryngectomy for selected patients. It can be performed in an office setting using only local anesthetic for secondary puncture. © 2017 Wiley Periodicals, Inc.

  8. Wire-guided balloon coloplasty--a new treatment for colorectal strictures?

    PubMed Central

    Banerjee, A K; Walters, T K; Wilkins, R; Burke, M

    1991-01-01

    A new technique for dilatation of colorectal anastomotic strictures--wire-guided balloon coloplasty--is described. It is suitable for high strictures, may be performed without general anaesthetic and is repeatable. It does not require endoscopy and may be used to relieve obstructive symptoms in both benign and malignant strictures so avoiding the need for a defunctioning colostomy. Images Figure 1. Figure 2. Figure 3. PMID:2013892

  9. 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

  10. 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

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

    PubMed

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

    2014-03-15

    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 s/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 10(5)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.

  12. [Application of a self-made steel wire guide in the treatment of avulsion fractures of tibial posterior cruciate ligament].

    PubMed

    Gui, Jing-xiong; Ou, Ju-lun; Wang, Xiao-ping; Zhu, Xiao-hua; Guo, Sheng; Xu, Guo-tai; Deng, Zhi-cheng

    2016-05-01

    To explore the effect of a self-made guiding needle of steel wire in guiding the wire through the tibial tunnel for the treatment of avulsion fractures of tibial posterior cruciate ligament with open reduction and wire fixation. From February 2011 to June 2014, a total of 22 patients with avulsion fractures of tibial posterior cruciate ligament underwent surgical treatments were analyzed, including 14 males and 8 females with an average age of 35.6 years old (ranged, 17 to 63 years old). According to Meyers classification, 9 patients were classified as type II, 13 patients were classified as type III. All the patients underwent open reduction and wire fixation with medial knee "L" shape approach. A wire guiding needle was used to guide the wire through the tibial tunnel during operation. With the assistance of wire guidance needles, wires passed through the tibial tunnel rapidly during the operation in all the 22 patients. All the patients were followed up, X-ray imagings 6 months after operation showed the fractures healed well. The average follow-up time in all patients was 6 months (ranged, 6 to 12 months). The averaged Lysholm knee score in 22 knee was 92.7 +/- 3.4. All patients' posterior drawer test were negative. Self-made wire guiding needle can simplify the operation procedures in which the wires pass through the tibial tunnel, shorten the operation time, reduce the surgical trauma and complications, and be worthy of clinical application.

  13. Robotic Assisted Cannulation of Occluded Retinal Veins

    PubMed Central

    Meenink, Thijs C. M.; Janssens, Tom; Vanheukelom, Valerie; Naus, Gerrit J. L.; Beelen, Maarten J.; Meers, Caroline; Jonckx, Bart; Stassen, Jean-Marie

    2016-01-01

    Purpose To develop a methodology for cannulating porcine retinal venules using a robotic assistive arm after inducing a retinal vein occlusion using the photosensitizer rose bengal. Methodology Retinal vein occlusions proximal to the first vascular branch point were induced following intravenous injection of rose bengal by exposure to 532nm laser light delivered by slit-lamp or endolaser probe. Retinal veins were cannulated by positioning a glass catheter tip using a robotically controlled micromanipulator above venules with an outer diameter of 80μm or more and performing a preset piercing maneuver, controlled robotically. The ability of a balanced salt (BSS) solution to remove an occlusion by repeat distention of the retinal vein was also assessed. Results Cannulation using the preset piercing program was successful in 9 of 9 eyes. Piercing using the micromanipulator under manual control was successful in only 24 of 52 attempts, with several attempts leading to double piercing. The best location for cannulation was directly proximal to the occlusion. Infusion of BSS did not result in the resolution of the occlusion. Conclusion Cannulation of venules using a robotic microassistive arm can be achieved with consistency, provided the piercing is robotically driven. The model appears robust enough to allow testing of therapeutic strategies aimed at eliminating a retinal vein thrombus and its evolution over time. PMID:27676261

  14. New cannulation method for pancreatic duct cannulation-bile duct guidewire-indwelling method

    PubMed Central

    Sakai, Yuji; Ishihara, Takeshi; Tsuyuguchi, Toshio; Tawada, Katsunobu; Saito, Masayoshi; Kurosawa, Jo; Tamura, Ryo; Togo, Seiko; Mikata, Rintaro; Tada, Motohisa; Yokosuka, Osamu

    2011-01-01

    The patient was a 58-year-old male with symptomatic alcoholic chronic pancreatitis. Since a 10 mm calculus was observed in the pancreatic body and abdominal pain occurred due to congestion of pancreatic juice, endoscopic retrograde cholangiopancreatography was conducted for assessment of the pancreatic duct and treatment of pancreatic calculus. Pancreatogram was slightly and insufficiently obtained by injecting the contrast media via the common channel of the duodenal main papilla. We tried to cannulate selectively into the pancreatic duct for a clear image. However, the selective cannulation of the pancreatic duct was difficult because of instability of the papilla. On the other hand, selective cannulation of the bile duct was relatively easily achieved. Therefore, after the imaging of the bile duct, a guidewire was retained in the bile duct to immobilize the duodenal papilla and cannulation of the pancreatic duct was attempted. As a result, selective pancreatic duct cannulation became possible. It is considered that the bile duct guidewire-indwelling method may serve as one of the useful techniques for cases whose selective pancreatic duct cannulation is difficult (“selective pancreatic duct difficult cannulation case”). PMID:22110840

  15. 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

  16. Cannulation techniques for extracorporeal life support

    PubMed Central

    Pavlushkov, Evgeny; Berman, Marius

    2017-01-01

    The article reviews cannulation strategy for different modes of extracorporeal life support. Technical aspects, pitfalls and complications are discussed for central and peripheral extracorporeal membrane oxygenation (VA, VV, VAV, VVA), biventricular assist device support and extracorporeal CO2 removal. PMID:28275615

  17. 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.

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

    PubMed

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

    2013-01-01

    To evaluate the safety and efficacy of different methods of transconjunctival cannulated vitrectomy versus conventional non-cannulated vitrectomy in various vitreoretinal disorders. 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. 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. 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.

  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. Evaluation of ultrasound-guided radial artery cannulation in children.

    PubMed

    Ganesh, Arjunan; Kaye, Robin; Cahill, Anne Marie; Stern, Whitney; Pachikara, Reshma; Gallagher, Paul R; Watcha, Mehernoor

    2009-01-01

    To compare ultrasound (US)-guided radial artery cannulation with the traditional palpation technique. : Prospective randomized study. Operating room in a tertiary care pediatric center. One hundred fifty-two children under 18 yrs of age requiring radial artery cannulation. Patients were randomized to either 1) palpation or 2) US guidance technique for radial artery cannulation. The primary end point of the study was the time taken for attempted cannulation by the first operator at the first site. Secondary end points included the number of attempts at arterial cannulation, the number of cannulae used, and the need for additional assistance from another anesthesiologist. Eighty and 72 children were randomized to the palpation and the US-guided groups, respectively. There were no statistically significant differences in age, gender, weight, and systolic blood pressure between the two study groups. The designated first operator (20 pediatric subspecialty trainees and eight consultant anesthesiologists) had previous experience in US-guided arterial cannulation in <10 cases, with 94% having experience in <5 cases. Although the radial artery was eventually cannulated in all patients, the designated operator was successful at the first site of cannulation in only 66% and 69% in the palpation and US groups, respectively. There were no statistically significant differences between the groups in time to successful cannulation, total number of attempts, number of successful cannulations during the first attempt, or in the number of cannulae used for catheterization. US guidance did not facilitate faster cannulation of the radial artery in children in our study.

  1. What nephrologists need to know about vascular access cannulation.

    PubMed

    Dinwiddie, Lesley C; Ball, Lynda; Brouwer, Deborah; Doss-McQuitty, Sheila; Holland, Janet

    2013-01-01

    This article describes cannulation events, especially problems, common and rare, minor and major, to aid the nephrologist (and mid-level providers e.g. nurse practitioner and physician's assistant) in decision-making to prevent or treat cannulation-related adverse outcomes. The usual management, potential outcomes, nephrologist intervention, and prevention are discussed and include: assessment of arteriovenous (AV) access and readiness for cannulation; initial cannulation of both arteriovenous fistulas and grafts; needle size and adequacy; needle direction and potential for recirculation; limited cannulation sites/buttonhole; pain and fear of pain; prevention of bleeding; management of infiltrations/extravasations; prevention and management of "one-site-itis"; prevention and management of infection. It concludes with the importance of the medical director as the leader of the continuous quality improvement (CQI) team in preventing/reducing cannulation-related adverse events.

  2. Experimental fluid dynamics of transventricular apical aortic cannulation.

    PubMed

    Fukuda, Ikuo; Yanaoka, Hideki; Inamura, Takao; Minakawa, Masahito; Daitoku, Kazuyuki; Suzuki, Yasuyuki

    2010-03-01

    To clarify the flow pattern from a transventricular apical aortic cannula, hydrodynamic analysis of transventricular apical aortic cannulation (apical cannulation) was performed using particle-image velocimetry in a glass aortic model. Simulated apical cannulation using a 7-mm Sarns Soft-Flow cannula and the newly developed 7-mm apical aortic cannula was compared with standard aortic cannulation. The flow-velocity, streamline, and distribution of magnitude of the strain rate tensor (function of shear stress) were analyzed. Streamline analysis revealed a steady and organized flow profile in apical cannulation as compared with that in standard aortic cannulation. The magnitude of the strain rate tensor decreased within a few centimeters from the exit of the apical cannula.

  3. The peripheral cannulation technique in minimally invasive congenital cardiac surgery.

    PubMed

    Vida, Vladimiro L; Tessari, Chiara; Putzu, Alessandro; Tiberio, Ivo; Guariento, Alvise; Gallo, Michele; Stellin, Giovanni

    2016-08-19

    Congenital minimally invasive cardiac surgery has gained wide acceptance thanks to its favorable outcomes. The introduction of peripheral cannulation for cardiopulmonary bypass further reduces surgical trauma by decreasing surgical access and allowing the spectrum of surgical access for the correction of simple congenital heart defects to be widened. Right internal jugular vein percutaneous cannulation, together with the direct surgical cannulation of femoral vessels, proves to be a safe and effective tool in patients with body weight above 15 kg.

  4. Veno-venous extracorporeal membrane oxygenation: cannulation techniques

    PubMed Central

    Banfi, Carlo; Pozzi, Matteo; Siegenthaler, Nils; Brunner, Marie-Eve; Tassaux, Didier; Obadia, Jean-Francois; Bendjelid, Karim

    2016-01-01

    The development of extracorporeal membrane oxygenation (ECMO) technology allows a new approach for the intensive care management of acute cardiac and/or respiratory failure in adult patients who are not responsive to conventional treatment. Current ECMO therapies provide a variety of options for the multidisciplinary teams who are involved in the management of these critically ill patients. In this regard, veno-venous ECMO (VV-ECMO) can provide quite complete respiratory support, even if this highly complex technique presents substantial risks, such as bleeding, thromboembolic events and infection. While VV-ECMO circuits usually include the cannulation of two vessels (double cannulation) in its classic configuration, the use of a single cannula is now possible for VV-ECMO support. Recently, experienced centers have employed more advanced approaches by cannulating three vessels (triple cannulation) which follows veno-arterio-venous (VAV) or veno-arterio-pulmonary-arterial cannulation (VAPa). However, ‘triple’ cannulation expands the field of application but increases the complexity of ECMO systems. In the present review, the authors focus on the indications for VV-ECMO, patient assessment prior to cannulation, the role of ultrasound-guided vessel puncture, double lumen single bicaval cannulations, and finally triple cannulation in VV-ECMO. PMID:28149575

  5. Kirschner wire-guided technique for inserting a second needle into inadequately filled vertebrae in vertebroplasty: a technical report.

    PubMed

    Chen, Yen-Jen; Chen, Hui-Yi; Lo, Da-Fu; Chen, Hsien-Te; Hsu, Horng-Chaung

    2014-12-01

    Absence or inadequate filling of cement in the fractured vertebrae can cause unsatisfactory results in a vertebroplasty. Repeated needle insertion can reduce the incidence of recollapse at the cemented vertebrae. However, when inserting the second needle in the usual method, it takes the same time and radiation exposure as the first needle. To report a Kirschner wire-guided technique for inserting a second needle into inadequately filled vertebrae in vertebroplasty that can make the procedure simple, effective, and, most importantly, reduce the radiation exposure. Description of a modified surgical technique with retrospective data analysis. From January 2012 to December 2012, 87 percutaneous vertebroplasties were performed in our department to treat painful osteoporotic compression fractures. Seven adult patients (five women, two men; mean age: 75.7 years) had inadequate cement filling in the treated vertebrae that required the insertion of a second needle. Back pain was measured using the visual analog scale (VAS). The post-vertebroplasty anterior vertebral height and local kyphotic angle were used as the radiologic parameters. Intraoperative procedure time and fluoroscopy shots and postoperative complication were also evaluated. The stylus of the first needle was inserted into the trocar to push the cement out of the trocar. The stylus was removed, a small diameter K-wire was inserted into the trocar, and the trocar was then removed. A second (new) trocar was inserted into the vertebral body following the track of the K-wire. When the new trocar reached the posterior 1/4 of the vertebral body, the K-wire was removed, the stylus was inserted, and the new needle was advanced to the anterior third of the vertebra. Cement was then injected into the new area until the filling was adequate. The immediate post-vertebroplasty anterior vertebral height was 23.31±1.95 mm, changed to 22.20±3.72 mm at final follow-up. The VAS decreased from a mean of 8.4 before

  6. 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

  7. Accuracy of targeted wire guided tube thoracostomy in comparison to classical surgical chest tube placement - A clinical study.

    PubMed

    Protic, Alen; Barkovic, Igor; Ivancic, Aldo; Kricka, Ozren; Zuvic-Butorac, Marta; Sustic, Alan

    2015-11-01

    Chest tube malfunction, after the tube thoracostomy, is often the result of an inappropriate chest tube tip position. The aim of this study was to analyse the precision of chest tube placement using the targeted wire guide technique (TWG technique) with curve dilator and to compare it to the classical surgical technique (CS technique). In this clinical study 80 patients with an indication for thoracic drainage, due to pneumothorax or pleural effusion were included. Experimental group contained 39 patients whose chest tube was placed using the TWG technique. The control group contained 41 patients whose chest tube was placed using the CS technique. The comparison of the outcomes of the two techniques applied suggests that the TWG technique was significantly more successful in achieving adequate (precise) chest tube placement, irrespective of patient diagnosis (TWG vs. CS in all patients, 78.4% vs. 36.6%, p<0.001). In the pleural effusion group, TWG and CS had success rates of 78.2% and 37.5% (p=0.005), respectively, while in pneumothorax group, TWG and CS had success rates of 78.6% and 35.3% (p=0.029), respectively. Using a curved dilator and the TWG technique for the thoracic drainage procedure we found statistically significant advantage to the TWG technique in comparison to the CS technique (78% vs. 37%) regarding precise chest tube placement within the pleural cavity. Introducing the materials and technique used in this clinical trial into clinical practice may improve the quality of thoracic drainage, including residual volume of air and/or fluid, poor functioning of the chest tube, and, as a consequence of both, prolonged hospitalisation. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults.

    PubMed

    Napp, L Christian; Kühn, Christian; Hoeper, Marius M; Vogel-Claussen, Jens; Haverich, Axel; Schäfer, Andreas; Bauersachs, Johann

    2016-04-01

    Extracorporeal membrane oxygenation (ECMO) has revolutionized treatment of severe isolated or combined failure of lung and heart. Due to remarkable technical development the frequency of use is growing fast, with increasing adoption by interventional cardiologists independent of cardiac surgery. Nevertheless, ECMO support harbors substantial risk such as bleeding, thromboembolic events and infection. Percutaneous ECMO circuits usually comprise cannulation of two large vessels ('dual' cannulation), either veno-venous for respiratory and veno-arterial for circulatory support. Recently experienced centers apply more advanced strategies by cannulation of three large vessels ('triple' cannulation), resulting in veno-veno-arterial or veno-arterio-venous cannulation. While the former intends to improve drainage and unloading, the latter represents a very potent method to provide circulatory and respiratory support at the same time. As such triple cannulation expands the field of application at the expense of increased complexity of ECMO systems. Here, we review percutaneous dual and triple cannulation strategies for different clinical scenarios of the critically ill. As there is no unifying terminology to date, we propose a nomenclature which uses "A" and all following letters for supplying cannulas and all letters before "A" for draining cannulas. This general and unequivocal code covers both dual and triple ECMO cannulation strategies (VV, VA, VVA, VAV). Notwithstanding the technical evolution, current knowledge of ECMO support is mainly based on observational experience and mostly retrospective studies. Prospective controlled trials are urgently needed to generate evidence on safety and efficacy of ECMO support in different clinical settings.

  9. Intravenous cannulation of hens for long-term infusion.

    PubMed

    Hamilton, R M

    1978-12-01

    Intravenous cannulation was performed on the brachial vein of the hen. The cannulation system consisted of a jacket that fitted around the body of the hen. An external sheath passed through the top of the cage, over a small pulley and was counter-weighted with lead. A subcutaneous polyethylene sheath was extended from the wing near the site of cannulation to the mid-point of the back between the wings and into the external sheath. Once the polyethylene cannula was inserted into and attached to the brachial vein, the free end was passed through the subcutaneous sheath, into and through the external sheath, and attached to a syringe or pump. No special post-cannulation care was necessary. The hens were housed in wire cages and received feed and water ad libitum. Twenty-four hens were continuously or intermittently infused for up to 73 days after cannulation.

  10. Locating difficult veins for venepuncture and cannulation.

    PubMed

    Shaw, Sally Jane

    2017-02-15

    Vein location and assessment are essential to improve the success rates for vascular access. However, problems remain with first attempt success rates for peripheral cannulation and locating difficult veins. Practitioners may not be aware of developments in technology and aids to assist in the location and assessment of veins to achieve vascular access. This article provides an overview of two vein location aids that can be used to locate difficult veins: the IV-eye vein imager and the Vacuderm tourniquet. It discusses the patient factors that can increase the difficulty of vein assessment and location, and emphasises the importance of vessel health and preservation, and vein palpation. Practitioners should be experienced and skilled in the assessment of veins, and they are encouraged to revisit how they locate and assess veins.

  11. 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

  12. Difficult cannulation: what should I do before EUS guided access?

    PubMed

    Artifon, Everson L A; Moura, Renata N; Otoch, Jose P

    2014-01-01

    Selective cannulation of the common bile duct can be difficult, so multiple strategies have been developed to overcome the situation. In this review we analize the different strategies that can be used like different papillotome instead of the standard catheter, precut papillotomy using precut needle knives or precut papillotome, transpancreatic papillary septotomy, and stenting of the pancreatic duct. Bile duct cannulation remains an important benchmark of successful ERCP. Alternative biliary access indication and its use is very important If biliary cannulation remains unsuccessful.The suprapapillary puncture is a promissory technique. It's important to have in mind that the goal of all techniques is to provide acute pancreatitis decrease.

  13. Accidental Carotid Artery Cannulation Detected by Bedside Ultrasound

    PubMed Central

    Chiles, Kris; Nagdev, Arun

    2011-01-01

    This report highlights the importance of using bedside ultrasound in the emergency department to confirm guide-wire placement when performing central venous catheter placement prior to dilating and cannulating the vessel. PMID:21691480

  14. Internal jugular vein cannulation: A comparison of three techniques

    PubMed Central

    Ray, Bikash R; Mohan, Virender K; Kashyap, Lokesh; Shende, Dilip; Darlong, Vanlal M; Pandey, Ravindra K

    2013-01-01

    Context: Ultrasound-guided internal jugular vein (IJV) cannulation is known for increasing success rate and decreasing rate of complications. The ultrasound image can be used as a real time image during cannulation or to prelocate the IJV before attempting cannulation. Aims: This study compares both the ultrasound-guided technique with the classical anatomical landmark technique (central approach) for right IJV cannulation in terms of success rate, complications, and time for cannulation. Settings and Design: A prospective, randomized, observational study was conducted at a tertiary care hospital. Material and Methods: One hundred twenty patients requiring IJV cannulation were included in this study and were randomly allocated in three groups. Number of attempts, success rate, venous access time, catheterization time, and complications were observed in each group. Statistical Analysis Used: Statistical analysis was performed using STATA-9 software. Demographic data were compared using one-way analysis of variance (ANOVA). Nonparametric data were compared using the Kruskall–Wallis test, and multiple comparisons were done applying The Mann–Whitney test for individual pairs of groups. Nominal data were compared by applying the Chi-square test and Fisher exact test. Results: Successful cannulation (≤3 attempt) was achieved in 90.83% of patients without any statistical significant difference between the groups. Venous access time and catheterization time was found to be significantly less in both the ultrasound groups than the anatomical land mark group. Number of attempts and success in first attempt was similar between the groups. Conclusions: Both the ultrasound techniques are found to be better than the anatomical landmark technique. Further, ultrasound-guided prelocation was found to be as effective as ultrasound guided real-time imaging technique for right IJV cannulation. PMID:24106363

  15. Computational fluid dynamics simulation of the right subclavian artery cannulation.

    PubMed

    Numata, Satoshi; Itatani, Keiichi; Kawajiri, Hidetake; Yamazaki, Sachiko; Kanda, Keiichi; Yaku, Hitoshi

    2017-08-01

    The purpose of this study was to evaluate the efficacy of right subclavian artery cannulation using computational fluid dynamics. Patient-specific models of the aortic arch were made with 4 patterns (1: normal aorta, 2: ascending aorta aneurysm, 3: distal arch aneurysm, 4: bovine arch) based on the computed tomography images. Right subclavian artery and ascending aorta cannulation models were created to simulate the physiologic pulsatile flow. Perfusion flow through the arterial cannula was set to 2.50 L/min (50% flow), 3.75 L/min (75% flow), and 5.0 L/min (100%), respectively, and a 3-dimensional movie was made of 1 cardiac cycle to evaluate the blood flow. In both 50% and 75% flow simulation with right subclavian artery cannulation, the blood streamline from the right subclavian artery produced retrograde flow of the brachiocephalic artery and antegrade flow of the right common carotid artery throughout the cardiac cycle in all cases. Right subclavian artery flow deflected ascending aorta flow to the descending aorta. Left-side supra-aortic branches were perfused by blood flow from both the right subclavian artery cannula and the aortic valve. The ascending aortic cannulation model showed that blood flow from the aortic valve reached all 3 supra-aortic vessels in systole. Right subclavian artery cannulation was cerebroprotective, especially on the right side. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  16. [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.

  17. Pre-cannulation lung biopsy shortens ECMO course.

    PubMed

    Lohmann, Pablo; Lee, Timothy C; Kearney, Debra L; Fernandes, Caraciolo J

    2016-07-01

    We describe the clinical course of an infant with respiratory failure who underwent lung biopsy prior to cannulation for undergoing extracorporeal membrane oxygenation (ECMO). Pathology revealed alveolar capillary dysplasia, and ECMO was discontinued. Rapid diagnosis allowed for closure and saved resources. We recommend considering early biopsy in infants with atypical pulmonary hypertension.

  18. Complications Associated With Femoral Cannulation During Minimally Invasive Cardiac Surgery.

    PubMed

    Lamelas, Joseph; Williams, Roy F; Mawad, Maurice; LaPietra, Angelo

    2017-06-01

    Different types of cannulation techniques are available for minimally invasive cardiac surgery. At our institution, we favor a femoral platform for most minimally invasive cardiac procedures. Here, we review our results utilizing this cannulation approach. We retrospectively reviewed all minimally invasive valve surgeries that were performed at our institution between January 2009 and January 2015. Operative times, lengths of stay, postoperative complications, and mortality were analyzed. We identified 2,645 consecutive patients. The mean age was 69.7 ± 12.77 years, and 1,412 patients (53.4%) were male. Three hundred fifty-eight patients (13.5%) had a history of cerebrovascular accident, 422 (16%) had previous heart surgery, and 276 (10.4%) had a history of peripheral vascular disease. The procedures performed were isolated aortic valve replacements (42.1%), isolated mitral valve operations (40.6%), tricuspid valve repairs (0.57%), double valve surgery (15%), triple valve surgery (0.3%), and ascending aortic aneurysm resection with and without circulatory arrest (5%). Femoral cannulation and central cannulation were utilized in 2,400 patients (90.7%) and 244 patients (9.3%), respectively. The median aortic cross-clamp time and cardiopulmonary bypass time were 81 minutes (interquartile range, 65 to 105) and 113 minutes (interquartile range, 92 to 142), respectively. The median postoperative hospital length of stay was 6 days (interquartile range, 5 to 9). There were 31 cerebrovascular accidents (1.17%), no aortic dissections, two compartment syndromes, two femoral arterial pseudoaneurysms, and 174 (6.65%) groin wound seromas. The overall 30-day mortality was 57 patients (2.15%). Minimally invasive cardiac surgical procedures utilizing femoral cannulation techniques have a low risk of complications. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Randomized controlled clinical trial comparing radioguided occult lesion localization with wire-guided lesion localization to evaluate their efficacy and accuracy in the localization of nonpalpable breast lesions.

    PubMed

    Duarte, Carlos; Bastidas, Faustino; de los Reyes, Amelia; Martínez, María Cristina; Hurtado, Gloria; Gómez, María Constanza; Sánchez, Ricardo; Manrique, Jorge

    2016-04-01

    The aim of this study was to compare the radioguided occult lesion localization (ROLL) technique with the wire-guided lesion localization (WGLL) technique to assess their efficacy and accuracy in the localization of nonpalpable breast lesions in patients at a unique reference medical center. These patients' reports were negative for malignancy but included highly suspicious imaging findings. A controlled clinical trial was designed to compare the WGLL and ROLL techniques in women presenting with breast lesions diagnosed by mammography or ultrasonography at the Instituto Nacional de Cancerología in Bogotá, Colombia, from March 2006 to June 2011. This study examined 129 patients; 64 (49.6%) patients were treated with ROLL, and 65 (51.4%) were treated with WGLL. The ROLL technique achieved better median lesion centricity (ROLL = 11.7 and WGLL = 15.4; P = .038). No significant differences were found regarding demographic variables, operative specimen characteristics, the need to extend margins, operative complications, the degree of difficulty, or patient or surgeon satisfaction. The ROLL technique is as effective as WGLL for the localization of nonpalpable breast lesions. In our study, ROLL achieved better lesion centricity. Therefore, we propose that this technique could be used as a standard procedure in the detection of nonpalpable breast lesions at experienced centers. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Endovascular cannulation with a microneedle for central retinal vein occlusion.

    PubMed

    Kadonosono, Kazuaki; Yamane, Shin; Arakawa, Akira; Inoue, Maiko; Yamakawa, Tadashi; Uchio, Eiichi; Yanagi, Yasuo; Amano, Shiro

    2013-06-01

    We developed a new surgical treatment in which a microneedle is used for retinal endovascular cannulation to treat eyes with central retinal vein occlusion by flushing thrombus out of the central retinal vein as it passes through the lamina cribrosa. The eyes of 12 consecutive patients (12 eyes) with central retinal vein occlusion were successfully treated using this novel treatment. At 24 weeks after surgery, 9 of 12 eyes had gained more than 15 letters in best-corrected visual acuity, and the mean decrease in central foveal thickness was 271.1 μm. Few complications were observed. The microneedle is stiff and sharp enough to facilitate retinal endovascular cannulation in eyes with central retinal vein occlusion. This new technique is a promising treatment of macular edema due to central retinal vein occlusion.

  1. 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

  2. Minimally invasive treatment of clavicular fractures with cannulated screw.

    PubMed

    Sun, Jun-zhan; Zheng, Guo-hai; Zhao, Ke-yi

    2014-05-01

    To evaluate minimally invasive treatment of clavicular fractures with cannulated screw. Data of 65 patients who had undergone minimally invasive treatment with cannulated screws for clavicular fractures from April 2009 to October 2010 were retrospectively analyzed and compared with those of 65 patients with clavicular fractures who had been treated by the same surgeons with plates. In the study group, there were 41 males and 24 females, aged from 19-67 years (mean, 35.8 years). According to Craig's classification, there were 29 group 1 and 36 of group 2-II. Neer scores were used to evaluate shoulder function and radiographs to assess fracture union. The incision length was 4-5 cm in the cannulated screw group (CSG) and 10-11 cm in the reconstructive plate group (RPG). Radiographs showed bone union was achieved in both groups, the bone healing time being 13.2 ± 6.9 weeks in the CSG and 16.3 ± 8.7 weeks in the RPG. All patients were followed up for 6 to 20 months (average, 10.6 months). The average Neer score was 96.6 ± 3.4 in the CSG and 94.2 ± 5.8 in the RPG. In the CSG, screw loosening occurred in five, and fracture displacement in three. There was a significant difference in fracture healing time between two groups but not in Neer score. Minimally invasive treatment of clavicular fractures with cannulated screws has the advantages of minimal invasion, short bone healing time, good clinical outcomes, and being relatively inexpensive. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  3. Ultrasound Guidance as a Rescue Technique for Peripheral Intravenous Cannulation

    DTIC Science & Technology

    2006-09-14

    Leave blank) 12. REPORT DATE 14.Sep.06 13. REPORT TYPE AND DATES COVERED MAJOR REPORT 4. TITLE AND SUBTITLE 5. FUNDING NUMBERS ULTRASOUND GUIDANCE...OIOR, Oct 94 Ultrasound Guidance as a Rescue Technique for Peripheral Intravenous Cannulation Major Nancy L. Pappas, BSN, USAF, NC Captain Terese E...landmark or visual/palpation technique in patients with access difficulties such as deep, sclerotic, small, or fragile veins. Ultrasound guidance has

  4. [Minimal invasive osteosynthesis with cannulated screws in metacarpal fractures].

    PubMed

    Romo-Rodríguez, R; Arroyo-Berezowsky, C

    2017-01-01

    Metacarpal fractures comprise 18 to 44% of hand fractures. Fractures from the second to the fifth metacarpals are 88% of the metacarpal fractures and fractures of the fifth metacarpals are the most common. Fractures of the neck of the fifth metacarpal are about 20% of all the hand fractures. Most of these fractures can be treated conservatively with good functional results. However, for those neck and shaft unstable fractures that need surgical treatment, there is no gold standard for osteosynthesis. Recently, there have been reports of minimally invasive osteosynthesis using headless retrograde intramedullary cannulated screws with good functional results. We report our short term experience treating nine fifth metacarpal neck fractures, one fourth metacarpal neck fracture and a transverse fifth metacarpal shaft fracture that did not fulfill criteria for conservative treatment. We treated them with minimally invasive osteosynthesis using retrograde intramedullary headless cannulated screws. All patients showed radiographic healing and had full range of motion of the metacarpophalangeal joint at one month follow up except for one patient who suffered a dorsal mutilating hand injury along with a fifth metacarpal neck fracture. One patient had osteoporotic bone and we could not control height loss with screws, so we had to use k-wires. Minimally invasive osteosynthesis with cannulated headless retrograde screws is a good option to treat neck and transverse diaphyseal fractures of the metacarpals. It confers a stable construct that allows early range of motion and return to activities.

  5. 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

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

    PubMed

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

    2015-09-01

    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.

  7. 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

  8. Femoral cannulation: a safe vascular access option for cardiopulmonary bypass in minimally invasive cardiac surgery.

    PubMed

    Saadat, Siavash; Schultheis, Molly; Azzolini, Anthony; Romero, Joseph; Dombrovskiy, Victor; Odroniec, Karen; Scholz, Peter; Lemaire, Anthony; Batsides, George; Lee, Leonard

    2016-03-01

    Femoral cannulation during cardiopulmonary bypass has become a common approach for many cardiac procedures and serves as an important access option, especially during minimally invasive cardiac surgery. Opponents, however, argue that there is significant risk, including site-specific and overall morbidity, which makes the use of this modality dangerous compared to conventional aortoatrial cannulation techniques. We analyzed our institutional experience to elucidate the safety and efficacy of femoral cannulation. All data were collected from a single hospital's cardiac surgery database. A total of 346 cardiac surgeries were evaluated from September 2012 to September 2013, of which 85/346 (24.6%) utilized a minimally invasive approach. Of the 346 operations performed, 72/346 (20.8%) utilized femoral cannulation while 274/346 (79.2%) used aortoatrial cannulation. Stroke occurred in 1/72 (1.39%) after femoral cannulation, specifically, in a conventional sternotomy patient, while it occurred in 6/274 (2.19%) [p=0.67] after aortoatrial cannulation. When comparing postoperative complications between the femoral cannulation and aortoatrial cannulation groups, the rates of atrial fibrillation [10/72 (13.9%) versus 46/274 (16.8%), p=0.55], renal failure [2/72 (2.78%) versus 11/274 (4.01%), p=0.62], prolonged ventilation time [4/72 (5.56%) versus 27/274 (9.85%), p=0.26] and re-operation for bleeding [3/72 (4.17%) versus 13/274 (4.74%), p=0.84] showed no significant difference. Selective femoral cannulation provides a safe alternative to aortoatrial cannulation for cardiopulmonary bypass and is especially important when performing minimally invasive cardiac surgery. When comparing aortoatrial and femoral cannulation, we found no significant difference in the postoperative complication rates and overall mortality.

  9. Guidewire-assisted transpancreatic sphincterotomy for difficult biliary cannulation: a prospective randomized controlled trial.

    PubMed

    Zang, Jinfeng; Zhang, Chi; Gao, Junye

    2014-10-01

    Precut techniques have been used to facilitate biliary cannulation during difficult endoscopic retrograde cholangiopancreatography. Presently, needle-knife sphincterotomy (NKS) is a commonly used precut technique. Since its first description, transpancreatic sphincterotomy, as an alternative method for bile duct entry when conventional biliary cannulation failed, has been debated on its success rate of cannulation and its complications, such as increased incidence of pancreatitis. Guidewire techniques are another effective method to improve the success rate of selective bile duct cannulation. This is a single-center prospective randomized controlled trial aimed to compare success rate, cannulation time, and complications of guidewire-assisted transpancreatic sphincterotomy (GATS) and NKS for difficult biliary cannulation. Between July 2010 and October 2013, consecutive patients who failed in the standard biliary cannulation were randomly assigned to the GATS and NKS groups. The outcome measures included success rate, cannulation time, and complications. A total of 149 patients were enrolled and analyzed: 73 in the GATS group and 79 in the NKS group. The characteristics of the 2 groups were similar. Bile duct cannulation was successful in 70 patients (95.9%) in the GATS group and 64 (84.2%) in the NKS group (P=0.018). The median cannulation time spent in precut was 193 seconds in the GATS group and 485 seconds in the NKS group (P<0.001). There was no difference between the groups for the incidence of complications, pancreatitis, and hemorrhage (9.6% vs. 10.5%, 6.8% vs. 6.6%, 1.4% vs. 3.9%, respectively). No perforation occurred. GATS compared with NKS increases biliary cannulation rate and requires less cannulation time during difficult biliary access. This technique is not associated with an increased risk for complications. It seems to be an effective and safe alternative for biliary access during difficult endoscopic retrograde cholangiopancreatography.

  10. Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation

    PubMed Central

    Yoo, Young Wook; Cha, Sang-Woo; Lee, Woong Cheul; Kim, Sae Hee; Kim, Anna; Cho, Young Deok

    2013-01-01

    AIM: To compare the outcomes between double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) in patients with difficult biliary cannulation. METHODS: This was a prospective, randomized study conducted in single tertiary referral hospital in Korea. Between January 2005 and September 2010. A total of 71 patients, who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved, were randomized into DGT (n = 34) and TPS (n = 37) groups. DGT or TPS was done for selective biliary cannulation. We measured the technical success rates of biliary cannulation, median cannulation time, and procedure related complications. RESULTS: The distribution of patients after randomization was balanced, and both groups were comparable in baseline characteristics, except the higher percentage of endoscopic nasobiliary drainage in the DGT group (55.9% vs 13.5%, P < 0.001). Successful cannulation rate and mean cannulation times in DGT and TPS groups were 91.2% vs 91.9% and 14.1 ± 13.2 min vs 15.4 ± 17.9 min, P = 0.732, respectively. There was no significant difference between the two groups. The overall incidence of post- endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis was 38.2% vs 10.8%, P < 0.011 in the DGT group and the TPS group; post-procedure pancreatitis was significantly higher in the DGT group. But the overall incidence of post-ERCP hyperamylasemia was no significant difference between the two groups; DGT group vs TPS group: 14.7% vs 16.2%, P < 1.0. CONCLUSION: When free bile duct cannulation was difficult and selective pancreatic duct cannulation was achieved, DGT and TPS facilitated biliary cannulation and showed similar success rates. However, post-procedure pancreatitis was significantly higher in the DGT group. PMID:23326171

  11. Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation.

    PubMed

    Yoo, Young Wook; Cha, Sang-Woo; Lee, Woong Cheul; Kim, Sae Hee; Kim, Anna; Cho, Young Deok

    2013-01-07

    To compare the outcomes between double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) in patients with difficult biliary cannulation. This was a prospective, randomized study conducted in single tertiary referral hospital in Korea. Between January 2005 and September 2010. A total of 71 patients, who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved, were randomized into DGT (n = 34) and TPS (n = 37) groups. DGT or TPS was done for selective biliary cannulation. We measured the technical success rates of biliary cannulation, median cannulation time, and procedure related complications. The distribution of patients after randomization was balanced, and both groups were comparable in baseline characteristics, except the higher percentage of endoscopic nasobiliary drainage in the DGT group (55.9% vs 13.5%, P < 0.001). Successful cannulation rate and mean cannulation times in DGT and TPS groups were 91.2% vs 91.9% and 14.1 ± 13.2 min vs 15.4 ± 17.9 min, P = 0.732, respectively. There was no significant difference between the two groups. The overall incidence of post- endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis was 38.2% vs 10.8%, P < 0.011 in the DGT group and the TPS group; post-procedure pancreatitis was significantly higher in the DGT group. But the overall incidence of post-ERCP hyperamylasemia was no significant difference between the two groups; DGT group vs TPS group: 14.7% vs 16.2%, P < 1.0. When free bile duct cannulation was difficult and selective pancreatic duct cannulation was achieved, DGT and TPS facilitated biliary cannulation and showed similar success rates. However, post-procedure pancreatitis was significantly higher in the DGT group.

  12. [Preliminary results of three different cannulations for percutaneous transhepatic cholecystic drainage in the interventional gallstone dissolutions].

    PubMed

    Li, R; Hu, X D; Zhu, X G

    1994-02-01

    Three different methods of percutaneous transhepatic gallbladder cathetering drainage were applied in 33 patients undergoing interventional gallstone dissolution. Among them, sheathed needle was used in 6 cases with a success rate of 33%; wire-guided in 16 with a success rate of 50%; and double-sheathed inner needle was successfully used in all the 11 cases. The authors believe that this last method could safely be used in the nonoperative drainage of acute cholecystitis as well as the interventional gallstone dissolutions.

  13. Very quick reverse transcription polymerase chain reaction for detecting 2009 H1N1 influenza A using wire-guide droplet manipulationst.

    PubMed

    You, David J; Tran, Phat L; Kwon, Hyuck-Jin; Patel, Deepa; Yoon, Jeong-Yeol

    2011-01-01

    Reverse transcription polymerase chain reaction (RT-PCR) is currently a gold standard in identifying influenza A virus, especially H1N1 flu. Typical RT-PCR assays take about 1-2 h for thermocycling, and there is a growing need to further speed up the thermocycling to less than 30 min. Additionally, the PCR assay system should be made portable as a point-of-care detection tool. There have been attempts to further speed up the PCR assays by reducing its volume. There have also been attempts to use droplet microfluidics technology to PCR, primarily to automate the PCR enrichment processes and take advantage of its small volume. In all these attempts, heating and cooling is made by conduction heat transfer. Rapid movements of droplets (immersed in oil) over three different temperature zones make very quick PCR possible, as heating/cooling will be made by convection heat transfer, whose heat transfer coefficients are much higher than that of conduction. We used our newly-invented method of wire-guide droplet manipulations towards very quick RT-PCR. Computational fluid dynamics (CFD) simulation of our system revealed that heating/cooling for each temperature change takes 1-4 s for a 10 microL droplet, as compared to >30 s in the other quick PCRs. Theoretically a 30-cycle process can take as short as 13 s x 30 cycles = 6 min 30 s. The entire system was made as a single instrument, with the components made by a milling machine and a rapid prototyping device. No additional equipment and external computers are required. With this newly developed system, 160 bp gene sequence was amplified from 2009 H1N1 influenza A (human origin). The 30-cycle process took as short as 6 min 50 s for a 10 microL droplet (with additional 4 min for reverse transcription). Its product was confirmed by traditional gel electrophoresis, subsequent imaging as well as gene sequencing, which has been very difficult with the other stationary droplet/nanodrop approaches. The proposed system has a

  14. Efficacy of 'radioguided occult lesion localisation' (ROLL) versus 'wire-guided localisation' (WGL) in breast conserving surgery for non-palpable breast cancer: a randomised controlled multicentre trial.

    PubMed

    Postma, E L; Verkooijen, H M; van Esser, S; Hobbelink, M G; van der Schelling, G P; Koelemij, R; Witkamp, A J; Contant, C; van Diest, P J; Willems, S M; Borel Rinkes, I H M; van den Bosch, M A A J; Mali, W P; van Hillegersberg, R

    2012-11-01

    For the management of non-palpable breast cancer, accurate pre-operative localisation is essential to achieve complete resection with optimal cosmetic results. Radioguided occult lesions localisation (ROLL) uses the radiotracer, injected intra-tumourally for sentinel lymph node identification to guide surgical excision of the primary tumour. In a multicentre randomised controlled trial, we determined if ROLL is superior to the standard of care (i.e. wire-guided localisation, WGL) for preoperative tumour localisation. Women (>18 years.) with histologically proven non-palpable breast cancer and eligible for breast conserving treatment with sentinel node procedure were randomised to ROLL or WGL. Patients allocated to ROLL received an intra-tumoural dose of 120 Mbq technetium-99 m nanocolloid. The tumour was surgically removed, guided by gamma probe detection. In the WGL group, ultrasound- or mammography-guided insertion of a hooked wire provided surgical guidance for excision of the primary tumour. Primary outcome measures were the proportion of complete tumour excisions (i.e. with negative margins), the proportion of patients requiring re-excision and the volume of tissue removed. Data were analysed according to intention-to-treat principle. This study is registered at ClinincalTrials.gov, number NCT00539474. In total, 314 patients with 316 invasive breast cancers were enrolled. Complete tumour removal with negative margins was achieved in 140/162 (86 %) patients in the ROLL group versus 134/152 (88 %) patients in the WGL group (P = 0.644). Re-excision was required in 19/162 (12 %) patients in the ROLL group versus 15/152 (10 %) (P = 0.587) in the WGL group. Specimen volumes in the ROLL arm were significantly larger than those in the WGL arm (71 vs. 64 cm(3), P = 0.017). No significant differences were seen in the duration and difficulty of the radiological and surgical procedures, the success rate of the sentinel node procedure, and cosmetic outcomes. In this first

  15. Cannulation of the axillary artery for cardiopulmonary bypass: safeguards and pitfalls.

    PubMed

    Sinclair, Michael C; Singer, Raymond L; Manley, Norman J; Montesano, Ralph M

    2003-03-01

    The ascending aorta is the customary site for arterial cannulation for cardiopulmonary bypass. Favorable experience at our institution and elsewhere using axillary artery cannulation in treating type A aortic dissections has caused us to broaden our indications for using this site for arterial cannulation for cardiopulmonary bypass. Medical records, operative notes, and perfusion records were reviewed in all patients in whom the axillary artery was cannulated directly or by a graft for cardiopulmonary bypass from January 1, 2000 through August 30, 2002. Seventy-five patients underwent axillary artery cannulation during the 32-month interval. Eleven patients had ascending aortic dissections, 20 had extensively diseased ascending aortas, and 44 were individuals undergoing repeat cardiac procedures. The right axillary artery was used in 72 patients and the left in 3. In 16 patients the artery was cannulated directly, and in 59 the arterial cannula was inserted into a prosthetic graft that had been anastomosed to the axillary artery. Axillary artery cannulation was satisfactory in 95% (71 of 75) of the cases in which it was used. Cannulation of the axillary artery for cardiopulmonary bypass is a dependable approach for procedures including reoperations, aortic dissections, and extensively diseased ascending aortas.

  16. Relationship between Years Elapsed after Initial Buttonhole Cannulation and Frequency of Vascular Access-Related Infections.

    PubMed

    Toma, Shigeki

    2015-01-01

    A reason for the higher frequency of vascular access-related infections in buttonhole cannulation patients remains to be elucidated. If the higher frequency of infections is associated with a factor(s) inherent to the buttonhole method (e.g. existence of a buttonhole track or other factors), the frequency of such infections is expected to increase upon starting buttonhole cannulation. On the other hand, if the higher frequency of the infections is associated with a factor(s) developing secondarily while performing buttonhole cannulation for months or years (e.g. deformity of the buttonhole entry site or other factors), the frequency is expected to rise after a certain time elapses from initiation of buttonhole cannulation. In case the higher frequency of the infections is associated with a factor(s) developing secondarily, the problem may potentially be solved. Thus, the present study is to clarify whether there is 'an infection calm period' after buttonhole cannulation is started. The relationship between the time (in years) after buttonhole cannulation is started and frequency of vascular access-related infections was investigated. Frequency of access-related infections was almost constant for 6 years after buttonhole cannulation was started. At the sixth year from initiation of buttonhole cannulation, however, the frequency of access-related infections started rising. The rise in frequency of vascular access-related infections in buttonhole cannulation may not be directly associated with inherent factor(s) of the method, but rather a factor(s) developing secondarily while performing buttonhole cannulation over a period of years. © 2015 S. Karger AG, Basel.

  17. Evaluation of dorsal aorta cannulation for immunological studies of grouper (Epinephelus malabaricus).

    PubMed

    Lo, Wan-Yu; Chang, Ching-Fong; Song, Yen-Ling

    2003-04-01

    Blood is often withdrawn to study the immune responses of fish. However, netting, handling and anaesthetising the experimental fish, and drawing blood samples cause severe stress that may alter the effects of immune study protocols and treatments. We evaluated the effect of aorta cannulation, for use in immune studies, on grouper (Epinephelus malabaricus) plasma cortisol, total red and white blood cell counts and phagocytosis. Plasma cortisol increased from 30 to 88 ng/ml 1 day after insertion of the cannula, to a maximum of 951 ng/ml 3 to 5 days after surgery, indicating the groupers were stressed by cannulation and post-cannulation inflammation. Total RBC count decreased, and total WBC count increased after surgery. Following cannulation, the phagocytic index of peripheral blood leukocytes decreased from 100% to 46%. The adverse effects of cannulation were mitigated by continuously immersing groupers in oxytetracycline (OTC), which decreased the recovery period for treated fish. In contrast, OTC-treatment did not markedly improve the recovery of groupers subjected to caudal vessel puncture. Cortisol levels in OTC-treated grouper with caudal vessel puncture were significantly higher than in OTC-treated, cannulated grouper, and remained at a high level until day 13 of the experiment. From day 7 to 13, total RBC and WBC counts in OTC-treated, cannulated groupers were significantly different from those in OTC-treated groupers with caudal vessel puncture. OTC treatment improved the phagocytic index of groupers subjected to caudal vessel puncture, but the phagocytic index was lower than that of groupers subjected to cannulation. Cannulation minimises visual and handling disturbances, and facilitates standardisation of experimental conditions and quick and easy sampling via the dorsal aorta cannula. Therefore, dorsal aorta cannulation minimises the stress of blood sampling and should prove useful for immune studies in fish.

  18. Technique for long-term ileal cannulation in ponies.

    PubMed Central

    Peloso, J G; Schumacher, J; McClure, S R; Crabill, M R; Hanselka, D V; Householder, D D; Potter, G D

    1994-01-01

    A T-cannula was fitted permanently into the ileum of ten mature ponies to quantify the role of the prececal and postileal segments of the digestive tract in equine nutrition studies. The ponies were anesthetized, positioned in left lateral recumbency, and the distal small intestine was exteriorized through a right paralumbar incision. A silastic T-cannula was inserted through a 2-cm longitudinal incision into the lumen of the ileum, on the antimesenteric surface, and sutured to the ileum. The stem of the cannula was exteriorized through a 2-cm circular skin incision, 6 cm caudal to the 16th rib. Nine ponies were alive with functional cannulas after six months. Primary complications associated with cannulation of the ileum were clinical signs of depression and dehydration produced by leakage of intestinal contents around the stem of the cannula. These complications were resolved with fluid and electrolyte therapy. Images Fig. 1. Fig. 2. PMID:7954119

  19. Needle-knife fistulotomy vs double-guidewire technique in patients with repetitive unintentional pancreatic cannulations

    PubMed Central

    Kim, Su Jin; Kang, Dae Hwan; Kim, Hyung Wook; Choi, Cheol Woong; Park, Su Bum; Song, Byeong Jun; Hong, Young Mi

    2015-01-01

    AIM: To compare the success rates and adverse events of early needle-knife fistulotomy (NKF) and double-guidewire technique (DGT) in patients with repetitive unintentional pancreatic cannulations. METHODS: From a total of 1650 patients admitted for diagnostic or therapeutic endoscopic retrograde cholangiopancreatography (ERCP) at a single tertiary care hospital (Pusan National University Yangsan Hospital, Yangsan, South Korea) between January 2009 and December 2012, 134 (8.1%) patients with unsuccessful biliary cannulation after 5 min trial of conventional methods, together with 5 or more repetitive unintentional pancreatic cannulations, were enrolled in the study. Early NKF and DGT groups were assigned 67 patients each. In the DGT group, NKF was performed for an additional 7 min if successful cannulation was not achieved. RESULTS: The success rates with early NKF and the DGT were 79.1% (53/67) and 44.8% (30/67) (P < 0.001), respectively. The incidence of post-ERCP pancreatitis (PEP) was lower in the early NKF group than in the DGT group [4.5% (3/67) vs 14.9% (10/67), P = 0.041]. The mean cannulation times in the early NKF and DGT groups after assignment were 257 s and 312 s (P = 0.013), respectively. CONCLUSION: Our data suggest that early NKF should be considered as the first approach to selective biliary cannulation in patients with repetitive unintentional pancreatic cannulations. PMID:26019456

  20. Needle-knife fistulotomy vs double-guidewire technique in patients with repetitive unintentional pancreatic cannulations.

    PubMed

    Kim, Su Jin; Kang, Dae Hwan; Kim, Hyung Wook; Choi, Cheol Woong; Park, Su Bum; Song, Byeong Jun; Hong, Young Mi

    2015-05-21

    To compare the success rates and adverse events of early needle-knife fistulotomy (NKF) and double-guidewire technique (DGT) in patients with repetitive unintentional pancreatic cannulations. From a total of 1650 patients admitted for diagnostic or therapeutic endoscopic retrograde cholangiopancreatography (ERCP) at a single tertiary care hospital (Pusan National University Yangsan Hospital, Yangsan, South Korea) between January 2009 and December 2012, 134 (8.1%) patients with unsuccessful biliary cannulation after 5 min trial of conventional methods, together with 5 or more repetitive unintentional pancreatic cannulations, were enrolled in the study. Early NKF and DGT groups were assigned 67 patients each. In the DGT group, NKF was performed for an additional 7 min if successful cannulation was not achieved. The success rates with early NKF and the DGT were 79.1% (53/67) and 44.8% (30/67) (P < 0.001), respectively. The incidence of post-ERCP pancreatitis (PEP) was lower in the early NKF group than in the DGT group [4.5% (3/67) vs 14.9% (10/67), P = 0.041]. The mean cannulation times in the early NKF and DGT groups after assignment were 257 s and 312 s (P = 0.013), respectively. Our data suggest that early NKF should be considered as the first approach to selective biliary cannulation in patients with repetitive unintentional pancreatic cannulations.

  1. Axillary Versus Femoral Arterial Cannulation During Repair of Type A Aortic Dissection?

    PubMed Central

    Stamou, Sotiris C.; Gartner, Derek; Kouchoukos, Nicholas T.; Lobdell, Kevin W.; Khabbaz, Kamal; Murphy, Edward; Hagberg, Robert C.

    2016-01-01

    Background The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation. Methods A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality, and Cox regression hazard ratios were calculated to determine predictors of long-term mortality. Results Operative mortality was not influenced by cannulation site (16% for axillary cannulation vs. 19% for femoral cannulation, p = 0.64). In multivariate logistic regression analysis, hemodynamic instability (p < 0.001) and prolonged cardiopulmonary bypass time (>200 min; p = 0.05) emerged as independent predictors of operative mortality. Stroke rates were comparable between the two techniques (14% for axillary and 17% for femoral cannulation, p = 0.52). Five-year actuarial survival was comparable between the groups (55.1% for axillary and 65.7% for femoral cannulation, p = 0.36). In Cox regression analysis, predictors of long-term mortality were: age (p < 0.001), stroke (p < 0.001), prolonged cardiopulmonary bypass time (p = 0.001), hemodynamic instability (p = 0.002), and renal failure (p = 0.001). Conclusions The outcomes of femoral versus axillary arterial cannulation in patients with acute Type A aortic dissection are comparable. The choice of arterial cannulation site should be individualized based on different patient risk profiles. PMID:28097193

  2. A Randomized Parallel Study for Simulated Internal Jugular Vein Cannulation Using Simple Needle Guide Device

    ClinicalTrials.gov

    2017-08-14

    Doctors Attending a Central Line Insertion Training Courses for New Residents of a University Hospital From March 2017 to June 2017; Physicians Who Had Less Than 10 Ultrasound Guided Internal Jugular Vein Cannulation Participate in This Study

  3. Peripheral Cannulation for Cardiopulmonary Bypass in Resection of Renal Cell Carcinomas with Level 3 Tumour Thrombus.

    PubMed

    Xu, Robert B; Pese, Kim; Stuklis, Robert; Edwards, James

    2016-03-01

    In renal cell carcinomas with tumour thrombus involving the intrahepatic vena cava or above (Level 3+), the urologist will often require the assistance of a cardiothoracic surgeon to establish cardiopulmonary bypass to safely perform a cavotomy for complete resection - this is traditionally through a sternotomy and central cannulation approach. We present two cases of patients with Level 3 tumour thrombus involvement, in whom resection was performed with bypass established through peripheral cannulation, thus avoiding the added morbidity of a sternotomy. The cases were performed without any major adverse events, with bypass times of 55 and 200minutes respectively. Peripheral cannulation is a useful tool in the cardiothoracic surgeon's armamentarium, whose utility should be remembered outside of its traditional setting. We describe two cases, where peripheral cannulation for CPB has been shown to be a safe and minimally invasive alternative to sternotomy for resection of locally advanced renal cell carcinomas. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

  4. Force-Sensing Microneedle for Assisted Retinal Vein Cannulation*

    PubMed

    Gonenc, Berk; Gehlbach, Peter; Handa, James; Taylor, Russell H; Iordachita, Iulian

    2014-11-01

    Retinal vein cannulation (RVC) is a challenging procedure proposed for drug delivery into the very small retinal veins. The available glass cannulas for this procedure are both hard to visualize and fragile thereby limiting the feasibility of both robot-assisted and manual RVC approaches. In this study, we develop and test a new force-sensing RVC instrument that can be easily integrated with the existing manual and robotic devices. The tool enables (1) the measurement of the forces required for puncturing retinal veins in vivo and (2) an assistive method to inform the operator of the needle piercing the vessel wall. The fiber Bragg grating based sensor can be inserted into the eye through a small (∅ 0.9 mm) opening and provides a quantitative assessment at the tool tip with a resolution smaller than 0.25 mN. Assessment of forces during vessel penetration in the chorioallantoic membranes of chicken embryos have revealed a consistent sharp drop in tool tip force upon vessel puncture that has been used as a signature to provide auditory feedback to the user to stop needle advancement and begin drug delivery.

  5. Force-Sensing Microneedle for Assisted Retinal Vein Cannulation*

    PubMed Central

    Gonenc, Berk; Gehlbach, Peter; Handa, James; Taylor, Russell H.; Iordachita, Iulian

    2014-01-01

    Retinal vein cannulation (RVC) is a challenging procedure proposed for drug delivery into the very small retinal veins. The available glass cannulas for this procedure are both hard to visualize and fragile thereby limiting the feasibility of both robot-assisted and manual RVC approaches. In this study, we develop and test a new force-sensing RVC instrument that can be easily integrated with the existing manual and robotic devices. The tool enables (1) the measurement of the forces required for puncturing retinal veins in vivo and (2) an assistive method to inform the operator of the needle piercing the vessel wall. The fiber Bragg grating based sensor can be inserted into the eye through a small (∅ 0.9 mm) opening and provides a quantitative assessment at the tool tip with a resolution smaller than 0.25 mN. Assessment of forces during vessel penetration in the chorioallantoic membranes of chicken embryos have revealed a consistent sharp drop in tool tip force upon vessel puncture that has been used as a signature to provide auditory feedback to the user to stop needle advancement and begin drug delivery. PMID:25580178

  6. The culture of vascular access cannulation among nurses in a chronic hemodialysis unit.

    PubMed

    Wilson, Barbara; Harwood, Lori; Oudshoorn, Abe; Thompson, Bonita

    2010-01-01

    The native arteriovenous fistula (AVF) is the vascular access of choice for patients on chronic hemodialysis (HD) because of its longevity and lower complication rate. Yet from 2001 to 2004 in Canada, there has been a notable increase in both incident and prevalent central venous catheter (CVC) use with a corresponding decrease in AVF use over the same time period (Moist, Trpeski, Na, & Lok, 2008). A similar trend has been found in other countries (Moist, Chang, Polkinghorne, & McDonald, 2007). There are a number of contributing factors to low AVF use in patients on chronic hemodialysis. While some of these factors may be patient-related, nursing interventions specific to cannulation may be a contributor. To date, little is known about HD nurses' attitudes and experiences regarding cannulation. The purpose of this study was to describe the culture and everyday practices of vascular access cannulation of the AVF from the perspective of the HD nurse. An ethnographic research design was employed, utilizing qualitative methods. Ten HD nurses were interviewed using a semi-structured interview tool, and a number of themes were generated from the interviews. One overarching theme of "perpetual novice" was evident, acknowledging the failure to transition from novice to expert cannulator despite working in HD for a number of years. Other common themes that emerged from the interviews were a) the lack of fistulas, b) the fistula as a "hard sell" to patients, c) the skill of cannulation, and d) the assembly-line approach to care. As a result of a number of factors, HD nurses were unable to acquire the skills necessary to become an expert cannulator. Moreover, the decrease in opportunities to practise cannulation has resulted in wide variation in skill level among HD nurses. To improve cannulation skills and achieve successful cannulation of AV fistulas, HD nurses identified a number of educational strategies that should take place. They also identified the need for an

  7. Accidental arterial puncture during right internal jugular vein cannulation in cardiac surgical patients

    PubMed Central

    Maddali, Madan Mohan; Arun, Venkitaramanan; Wala, Al-Ajmi Ahmed; Al-Bahrani, Maher Jaffer; Jayatilaka, Cheskey Manoj; Nishant, Arora Ram

    2016-01-01

    Background: The primary aim of this study was to compare the incidence of accidental arterial puncture during right internal jugular vein (RIJV) cannulation with and without ultrasound guidance (USG). The secondary end points were to assess if USG improves the chances of successful first pass cannulation and if BMI has an impact on incidence of arterial puncture and the number of attempts that are to be made for successful cannulation. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Material and methods: 255 consecutive adult and pediatric cardiac surgical patients were included. In Group I (n = 124) USG was used for the right internal jugular vein cannulation and in Group II (n = 81) it was not used. There were 135 adult patients and 70 pediatric patients. Statistical analysis: Demographic and categorical data were analyzed using Student ‘t’ test and chi- square test was used for qualitative variables. Results: The overall incidence of accidental arterial puncture in the entire study population was significantly higher when ultrasound guidance was not used (P < 0.001). In subgroup analysis, incidence of arterial puncture was significant in both adult (P = 0.03) and pediatric patients (P < 0.001) without USG. First attempt cannulation was more often possible in pediatric patients under USG (P = 0.03). In adult patients USG did not improve first attempt cannulation except in underweight patients. Conclusions: USG helped in the avoidance of inadvertent arterial puncture during RIJV cannulation and simultaneously improved the chances of first attempt cannulation in pediatric and in underweight adult cardiac surgical patients. PMID:27716688

  8. Predicting native papilla biliary cannulation success using a multinational Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network

    PubMed Central

    2013-01-01

    Background Success in deep biliary cannulation via native ampullae of Vater is an accepted measure of competence in ERCP training and practice, yet prior studies focused on predicting adverse events alone, rather than success. Our aim is to determine factors associated with deep biliary cannulation success, with/ without precut sphincterotomy. Methods The ERCP Quality Network is a unique prospective database of over 10,000 procedures by over 80 endoscopists over several countries. After data cleaning, and eliminating previously stented or cut papillae, two multilevel fixed effect multivariate models were used to control for clustering within physicians, to predict biliary cannulation success, with and without allowing “precut” to assist an initially failed cannulation. Results 13018 ERCPs were performed by 85 endoscopists (March 2007 - May 2011). Conventional (without precut) and overall cannulation rates were 89.8% and 95.6%, respectively. Precut was performed in 876 (6.7%). Conventional success was more likely in outpatients (OR 1.21), but less likely in complex contexts (OR 0.59), sicker patients (ASA grade (II, III/V: OR 0.81, 0.77)), teaching cases (OR 0.53), and certain indications (strictures, active pancreatitis). Overall cannulation success (some precut-assisted) was more likely with higher volume endoscopists (> 239/year: OR 2.79), more efficient fluoroscopy practices (OR 1.72), and lower with moderate (versus deeper) sedation (OR 0.67). Conclusion Biliary cannulation success appears influenced by both patient and practitioner factors. Patient- and case-specific factors have greater impact on conventional (precut-free) cannulation success, but volume influences ultimate success; both may be used to select appropriate cases and can help guide credentialing policies. PMID:24112846

  9. 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

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

    PubMed

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

    2016-04-01

    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/m(2), 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.

  11. 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

  12. Outcome with peripheral versus central cannulation in acute Type A dissection †.

    PubMed

    Klotz, Stefan; Heuermann, Kathrin; Hanke, Thorsten; Petersen, Michael; Sievers, Hans-Hinrich

    2015-06-01

    Acute aortic dissection type A (AADA) is still an emergency operation with high morbidity and mortality. In this acute situation quick cannulation to the heart-lung machine and systemic cooling is often life-saving. However, the often easy access to the femoral vessels for cannulation leads to an arterial backflow in the descending aorta with the likelihood of plaque rupture and cerebral embolism. We analysed the outcome after initial femoral versus central cannulation for AADA. All patients with acute aortic dissection type A operated between January 2003 and December 2012 were evaluated for the type of arterial cannulation (femoral vs central) for initial bypass. Demographic data and outcome parameters were accessed. No patient was excluded. One hundred and seventy-seven patients were operated on with acute type A dissection in the last 10 years; 94 (53.1%) were initially cannulated in the central aortic vessels and 83 (46.9%) in the femoral artery. The patients were comparable with regard to age (61.1 ± 14.9 vs 62.2 ± 15.0 years, P = 0.607), gender (male, 62 vs 69%, P = 0.348), EuroSCORE (11.5 ± 4.0 vs 12.8 ± 4.3, P = 0.057) and previous sternotomy (17% in both groups). Bypass (243 ± 105 vs 233 ± 83 min, P = 0.471), cross-clamp (160 ± 86 vs 150 ± 66 min, P = 0.381) and circulatory arrest times (47.8 ± 24.7 vs 42.5 ± 21.7 min, P = 0.130) were similar as were lowest temperatures (17.7 ± 1.8 vs 17.6 ± 1.3, P = 0.652). Postoperative cerebral infarction and 30-day mortality were comparable between the cannulation groups (13 vs 9%, P = 0.449 and 20 vs 17%, P = 0.699, central vs peripheral cannulation). Only postoperative need for dialysis was borderline significantly higher in the femoral cannulation group (28 vs 40%, P = 0.073). This single-centre study with 177 patients could show that an acute aortic dissection type A can be operated on with central and peripheral cannulation with similar results. Risk for early mortality was driven by the preoperative

  13. Guide wire-assisted cannulation for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis.

    PubMed

    Tse, F; Yuan, Y; Moayyedi, P; Leontiadis, G I

    2013-08-01

    Cannulation techniques are recognized to be important in causing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, considerable controversy exists about the usefulness of the guide wire-assisted cannulation technique for the prevention of PEP. This systematic review of randomized controlled trials (RCTs) aimed to compare the guide wire-assisted cannulation technique with the contrast-assisted cannulation technique. CENTRAL, MEDLINE, EMBASE, CINAHL, and abstracts from Digestive Disease Week and the United European Gastroenterology Week were searched up to February 2012 for RCTs comparing the guide wire-assisted ERCP cannulation technique with the conventional contrast-assisted ERCP cannulation technique. The risk of bias was assessed, and outcomes were pooled by meta-analysis (random-effects model). The primary outcome measure was PEP. Secondary outcome measures included severity of PEP, primary common bile duct (CBD) cannulation success, overall CBD cannulation success, precut sphincterotomy, and other ERCP-related complications. In total, 12 RCTs (3450 patients) were included. The guide wire-assisted cannulation technique significantly reduced PEP compared with the contrast-assisted cannulation technique (risk ratio [RR] 0.51, 95 % confidence interval [CI] 0.32 - 0.82). In addition, the guide wire-assisted cannulation technique was associated with greater primary cannulation success (RR 1.07, 95 %CI 1.00 - 1.15), fewer precut sphincterotomies (RR 0.75, 95 %CI 0.60 - 0.95), and no increase in other ERCP-related complications. Subgroup analyses indicated that this significant risk reduction in PEP with the guide wire-assisted cannulation technique existed only in "non-crossover" trials (RR 0.22, 95 %CI 0.12 - 0.42). The results were robust in sensitivity analyses. Compared with the contrast-assisted cannulation technique, the guide wire-assisted cannulation technique increases the primary cannulation rate and reduces the risk of

  14. Moving beyond the "perpetual novice": understanding the experiences of novice hemodialysis nurses and cannulation of the arteriovenous fistula.

    PubMed

    Wilson, Barbara; Harwood, Lori; Oudshoorn, Abe

    2013-01-01

    Cannulation of the arteriovenous fistula (AVF) is an essential skill for hemodialysis (HD) nurses. With declining rates of AVFs, opportunities to develop expert cannulation skills have become limited. This study explored the concept of perpetual novice and AVF cannulation from the perspective of the novice cannulator. Nine hemodialysis nurses were interviewed using ethnographic methodology. The study identified the interplay between personal and environmental/contextual factors that hindered skill acquisition. Personal attributes identified by participants included HD nurses' approach to learning and previous experience, emotional reaction to stress, and interpersonal relationships with colleagues. Environmental/contextual factors identified as impediments to cannulation skill development included limited learning opportunities, attitudes and demands from patients, unit flow and time pressures, and limitations imposed by the current model of nursing care. This study will be helpful in directing future educational, operational, and supportive interventions for novice HD nurses around cannulation skill development.

  15. 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

  16. 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

  17. HEADPLAY Personal Cinema System Facilitates Intravenous Cannulation in Children: A Randomized Controlled Trial

    PubMed Central

    Lim, Evangeline; Fabila, Teddy; Sze Ying, Thong; Tan, Josephine

    2013-01-01

    HEADPLAY personal cinema system (PCS) is a portable visual headset/visor through which movie clips may be viewed. We studied the use of HEADPLAY PCS as a distraction tool in facilitating intravenous cannulation in children undergoing anaesthesia. 60 children were enrolled into the study and randomized into 2 groups. EMLA local anaesthetic cream was used to reduce the pain associated with intravenous cannulation. Children in group 1 wore the HEADPLAY visor whereas children in group 2 were subject to conventional distraction therapy. Children were asked to rate their anxiety, pain, and satisfaction scores after intravenous cannulation. Periprocedural anxiety was also determined using the modified Yale Preoperative Anxiety Scale (mYPAS). There were no statistically significant differences in terms of pain and anxiety scores between the 2 groups. Although the satisfaction score of the children in the HEADPLAY PCS group was marginally higher compared to the conventional group, this did not hit statistical significance. 86.6% of children in group 1 reported that they would want to use the visor again for their next intravenous cannulation. We conclude that HEADPLAY PCS is a distraction tool that is acceptable to most children and can contribute towards satisfaction of the intravenous cannulation process in children. PMID:23840223

  18. Technique of right lymphatic duct cannulation for pulmonary lymph collection in an acute porcine model.

    PubMed

    Chuang, G J; Gao, C X; Mulder, D S; Chiu, R C

    1986-12-01

    The pig is an increasingly preferred model for biomedical research, including studies for pulmonary pathophysiology. However, in piglets, the technique for cannulating the right lymphatic duct, which is subject to more anatomical variations and technically more demanding than that in dogs, has not been described. Our technique evolved to enable this collection of porcine lung lymph in acute experiments. The lymphatic ampulla is cannulated via one of the cervical lymphatics. The right lymphatic duct is invariably dorsal to the cranial vena cava and classically leads to the lymphatic ampulla. Yet in 18% of our pigs, cannulation was difficult or not feasible because the lymphatic duct either drained directly into the cranial vena cava at a distance from the lymphatic ampulla, or into the axillary lymph node of the first rib or the caudal deep cervical lymph nodes. Gently squeezing back regurgitated blood in the lymphatic ampulla before tying the suture and frequently withdrawing lymph with a syringe when the flow is small enabled us to collect clear lymph, usually immediately after completing the cannulation. The rate of lymph flow varied widely (1.7 +/- 0.6 ml/hr) and increased when the left atrial pressure was raised. The lymph protein was 2.8 +/- 0.2 g% with lymph/plasma protein ratio at 0.55 +/- 0.04. The anatomical variations encountered in our 34 dissections, as well as the technical maneuvers found to be useful in the successful cannulation and collection of the porcine lung lymph, are described in detail.

  19. Effects of arterial cannulation stress on regional cerebral blood flow in major depressive disorder.

    PubMed

    Savitz, Jonathan; Nugent, Allison C; Cannon, Dara M; Carlson, Paul J; Davis, Rebecca; Neumeister, Alexander; Rallis-Frutos, Denise; Fromm, Steve; Herscovitch, Peter; Drevets, Wayne C

    2012-01-01

    Individuals with major depressive disorder (MDD) display abnormal neurophysiological responses to psychological stress but little is known about their neurophysiological responses to physiological stressors. Using [(15)O-H(2)O] positron emission tomography we assessed whether the regional cerebral blood flow (rCBF) response to arterial cannulation differed between patients with MDD and healthy controls (HCs). Fifty-one MDD patients and 62 HCs were scanned following arterial cannulation and 15 MDD patients and 17 HCs were scanned without arterial cannulation. A region-of-interest analysis showed that a significantly increased rCBF of the anterior cingulate cortex and right amygdala was associated with arterial cannulation in MDD. A whole brain analysis showed increased rCBF of the right post-central gyrus, left temporopolar cortex, and right amygdala during arterial cannulation in MDD patients. The rCBF in the right amygdala was significantly correlated with depression severity. Conceivably, the limbic response to invasive physical stress is greater in MDD subjects than in HCs.

  20. An outcome study on complications using routine ultrasound assistance for internal jugular vein cannulation.

    PubMed

    Lamperti, M; Cortellazzi, P; D'Onofrio, G; Subert, M; Falcone, C; Filippini, G; Caldiroli, D

    2007-11-01

    Ultrasound guidance for central venous cannulation is advised by recent guidelines, but is not being applied in everyday practice. The purpose of this study was to determine the reduction in complications when applying an ultrasound locating device for internal jugular vein catheterization. An observational study was conducted from November 2004 to October 2005 in a tertiary neurosurgical hospital on 300 patients undergoing internal jugular vein cannulation using an ultrasound technique. Patients were not randomized and operators were trained using theoretical and practical courses. Prior to the study, the investigators, who were consultant anaesthesiologists, had to perform at least 20 successful supervised cannulations. Cannulation was successful in all cases. The incidence of arterial puncture was 2.7%, and multiple venous punctures represented the main minor complication (14%). Bivariate analysis of the overall complications revealed no significant correlation with age group, American Society of Anesthesiologists' (ASA) classification, body mass index, or position and diameter of the vein. Ultrasound cannulation of the internal jugular vein minimized complications. These could be avoided when new ultrasound probes and specific needles are introduced.

  1. HEADPLAY Personal Cinema System Facilitates Intravenous Cannulation in Children: A Randomized Controlled Trial.

    PubMed

    Lim, Evangeline; Fabila, Teddy; Sze Ying, Thong; Tan, Josephine

    2013-01-01

    HEADPLAY personal cinema system (PCS) is a portable visual headset/visor through which movie clips may be viewed. We studied the use of HEADPLAY PCS as a distraction tool in facilitating intravenous cannulation in children undergoing anaesthesia. 60 children were enrolled into the study and randomized into 2 groups. EMLA local anaesthetic cream was used to reduce the pain associated with intravenous cannulation. Children in group 1 wore the HEADPLAY visor whereas children in group 2 were subject to conventional distraction therapy. Children were asked to rate their anxiety, pain, and satisfaction scores after intravenous cannulation. Periprocedural anxiety was also determined using the modified Yale Preoperative Anxiety Scale (mYPAS). There were no statistically significant differences in terms of pain and anxiety scores between the 2 groups. Although the satisfaction score of the children in the HEADPLAY PCS group was marginally higher compared to the conventional group, this did not hit statistical significance. 86.6% of children in group 1 reported that they would want to use the visor again for their next intravenous cannulation. We conclude that HEADPLAY PCS is a distraction tool that is acceptable to most children and can contribute towards satisfaction of the intravenous cannulation process in children.

  2. Ultrasound-Guided Cannulation: Time to Bring Subclavian Central Lines Back

    PubMed Central

    Rezayat, Talayeh; Stowell, Jeffrey R.; Kendall, John L.; Turner, Elizabeth; Fox, J. Christian; Barjaktarevic, Igor

    2016-01-01

    Despite multiple advantages, subclavian vein (SCV) cannulation via the traditional landmark approach has become less used in comparison to ultrasound (US) guided internal jugular catheterization due to a higher rate of mechanical complications. A growing body of evidence indicates that SCV catheterization with real-time US guidance can be accomplished safely and efficiently. While several cannulation approaches with real-time US guidance have been described, available literature suggests that the infraclavicular, longitudinal “in-plane” technique may be preferred. This approach allows for direct visualization of needle advancement, which reduces risk of complications and improves successful placement. Infraclavicular SCV cannulation requires simultaneous use of US during needle advancement, but for an inexperienced operator, it is more easily learned compared to the traditional landmark approach. In this article, we review the evidence supporting the use of US guidance for SCV catheterization and discuss technical aspects of the procedure itself. PMID:26973755

  3. Biomechanical testing of bioabsorbable cannulated screws for slipped capital femoral epiphysis fixation.

    PubMed

    Kroeber, Markus W; Rovinsky, David; Haskell, Andrew; Heilmann, Moira; Llotz, Jeff; Otsuka, Norman

    2002-06-01

    This study compared cannulated 4.5-mm bioabsorbable screws made of self-reinforced poly-levolactic acid to cannulated 4.5-mm steel and titanium screws for resistance to shear stress and ability to generate compression in a polyurethane foam model of slipped capital femoral epiphysis fixation. The maximum shear stress resisted by the three screw types was similar (self-reinforced poly-levolactic acid 371 +/- 146 MPa, steel 442 +/- 43 MPa, and titanium 470 +/- 91 MPa). The maximum compression generated by both the self-reinforced poly-levolactic acid screw (68.5 +/- 3.3 N) and the steel screw (63.3 +/- 5.9 N) was greater than that for the titanium screw (3 +/- 1.4 N, P <.05). These data suggest cannulated self-reinforced poly-levolactic acid screws can be used in the treatment of slipped capital femoral epiphysis because of their sufficient biomechanical strength.

  4. Ultrasound-Guided Cannulation: Time to Bring Subclavian Central Lines Back.

    PubMed

    Rezayat, Talayeh; Stowell, Jeffrey R; Kendall, John L; Turner, Elizabeth; Fox, J Christian; Barjaktarevic, Igor

    2016-03-01

    Despite multiple advantages, subclavian vein (SCV) cannulation via the traditional landmark approach has become less used in comparison to ultrasound (US) guided internal jugular catheterization due to a higher rate of mechanical complications. A growing body of evidence indicates that SCV catheterization with real-time US guidance can be accomplished safely and efficiently. While several cannulation approaches with real-time US guidance have been described, available literature suggests that the infraclavicular, longitudinal "in-plane" technique may be preferred. This approach allows for direct visualization of needle advancement, which reduces risk of complications and improves successful placement. Infraclavicular SCV cannulation requires simultaneous use of US during needle advancement, but for an inexperienced operator, it is more easily learned compared to the traditional landmark approach. In this article, we review the evidence supporting the use of US guidance for SCV catheterization and discuss technical aspects of the procedure itself.

  5. Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP

    PubMed Central

    Xinopoulos, Dimitrios; Bassioukas, Stefanos P; Kypreos, Dimitrios; Korkolis, Dimitrios; Scorilas, Andreas; Mavridis, Konstantinos; Dimitroulopoulos, Dimitrios; Paraskevas, Emmanouil

    2011-01-01

    AIM: To investigate the technical success and clinical complication rate of a cannulated pancreatic duct with guidewire for biliary access. METHODS: During a five-year study period, a total of 2843 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique (SGT) for up to 5 attempts, followed by double-guidewire technique (DGT) when repeated unintentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when DGT had failed or no pancreatic duct cannulation had been previously achieved. Main outcome measurements were defined as biliary cannulation success and post-endoscopic retrograde cholangiopancreatography (ERCP) complication rate. RESULTS: SGT (92.3% success rate) was characterized by statistically significant enhanced patient outcome compared to either the DGT (43.8%, P < 0.001), pre-cut failed DGT (73%, P < 0.001) or pre-cut as first step method (80.6%, P = 0.002). Pre-cut as first step method offered a statistically significantly more favorable outcome compared to the DGT (P < 0.001). The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner between either method (SGT: 5.3%, DGT: 6.1%, Pre-cut failed DGT: 7.9%, Pre-cut as first step: 7.5%) or with patients’ gender. CONCLUSION: Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases. PMID:21528077

  6. Sequential Double-Guidewire Technique and Transpancreatic Precut Sphincterotomy for Difficult Biliary Cannulation

    PubMed Central

    Kim, Chang W.; Chang, Jae H.; Kim, Tae H.; Han, Sok W.

    2015-01-01

    Background/Aims: The double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) are introduced as alternative biliary cannulation techniques for difficult biliary cannulation. This study aimed to evaluate the sequential use of DGT and TPS compared with a needle-knife precut papillotomy (NK). Patients and Methods: Six hundred and thirty-five consecutive patients with naοve papilla and who underwent endoscopic retrograde cholangiopancreatography (ERCP) for biliary cannulation from March 2010 to April 2014 in a single institute were analyzed. When standard techniques were unsuccessful, DGT or NK was performed. TPS was sequentially performed if DGT failed. Results: DGT and NK were attempted in 65 and 58 patients, respectively. A sequential DGT-TPS was performed in 38 patients after a failed DGT. Biliary cannulations were successful in 42%, 74%, and 66% of the DGT, sequential DGT-TPS, and NK patients, respectively (P = 0.002). The cannulation rate was higher in the DGT ± TPS patients (85%) than in the NK patients (P = 0.014). Post-ERCP pancreatitis (PEP) developed in 26% of the successful DGT patients, 37% of the sequential DGT-TPS patients, and 10% of the NK patients (P = 0.008). Of the sequential DGT-TPS patients, the incidence of PEP was significantly reduced in patients with a pancreatic duct (PD) stent compared with patients without a PD stent (24% vs. 62%, P = 0.023). Conclusions: Sequential DGT-TPS is a useful alternative method compared with NK for patients in whom biliary cannulation is difficult. In the sequential DGT-TPS patients, the incidence of PEP was significantly reduced with the use of a PD stent. PMID:25672234

  7. Sequential double-guidewire technique and transpancreatic precut sphincterotomy for difficult biliary cannulation.

    PubMed

    Kim, Chang W; Chang, Jae H; Kim, Tae H; Han, Sok W

    2015-01-01

    The double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) are introduced as alternative biliary cannulation techniques for difficult biliary cannulation. This study aimed to evaluate the sequential use of DGT and TPS compared with a needle-knife precut papillotomy (NK). Six hundred and thirty-five consecutive patients with naοve papilla and who underwent endoscopic retrograde cholangiopancreatography (ERCP) for biliary cannulation from March 2010 to April 2014 in a single institute were analyzed. When standard techniques were unsuccessful, DGT or NK was performed. TPS was sequentially performed if DGT failed. DGT and NK were attempted in 65 and 58 patients, respectively. A sequential DGT-TPS was performed in 38 patients after a failed DGT. Biliary cannulations were successful in 42%, 74%, and 66% of the DGT, sequential DGT-TPS, and NK patients, respectively (P = 0.002). The cannulation rate was higher in the DGT ± TPS patients (85%) than in the NK patients (P = 0.014). Post-ERCP pancreatitis (PEP) developed in 26% of the successful DGT patients, 37% of the sequential DGT-TPS patients, and 10% of the NK patients (P = 0.008). Of the sequential DGT-TPS patients, the incidence of PEP was significantly reduced in patients with a pancreatic duct (PD) stent compared with patients without a PD stent (24% vs. 62%, P = 0.023). Sequential DGT-TPS is a useful alternative method compared with NK for patients in whom biliary cannulation is difficult. In the sequential DGT-TPS patients, the incidence of PEP was significantly reduced with the use of a PD stent.

  8. Vapocoolant Spray Versus Lidocaine Infiltration for Radial Artery Cannulation: A Prospective, Randomized, Controlled Clinical Trial.

    PubMed

    Rüsch, Dirk; Koch, Tilo; Seel, Florian; Eberhart, Leopold

    2017-02-01

    Local infiltration with lidocaine is a frequently used measure to prevent pain during arterial cannulation. Its administration is associated with pain. Vapocoolants like ethyl chloride or alkanes also affect rapid-onset anesthesia. However, their administration causes less discomfort compared with administration of lidocaine. The effectiveness of vapocoolants in mitigating discomfort associated with arterial cannulation never has been studied. The authors therefore compared vapocoolant with lidocaine for reducing discomfort caused by arterial cannulation. Prospective, randomized, controlled study. University hospital, single center. One hundred sixty adult patients requiring arterial cannulation before induction of general anesthesia for cardiac surgery or carotid endarterectomy. Patients received either lidocaine infiltration or vapocoolant spray prior to arterial cannulation. Overall discomfort resulting from the whole procedure (applying local/topical anesthesia followed by arterial puncture) was rated on a 0 to 10 numerical rating scale. Puncture failure rate and time required for the intervention also were recorded. One hundred forty-three patients were included in the per-protocol analysis. Mean pain scores in the vapocoolant group were 3.4 (±1.58) compared with 4.5 (±2.29) in the lidocaine group (difference 1.1±0.33; p = 0.032; Mann-Whitney U-test). The higher puncture failure rate in the lidocaine group (n = 11 v 4) was not significant (p = 0.06; Fisher's exact test). The time required for the intervention was longer in the lidocaine group (138±44 s v 128±44 s; p = 0.019; Mann-Whitney U-test). Vapocoolant spray is an alternative to lidocaine infiltration to mitigate discomfort associated with arterial cannulation. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Effects on Subtalar Joint Stress Distribution After Cannulated Screw Insertion at Different Positions and Directions.

    PubMed

    Yuan, Cheng-song; Chen, Wan; Chen, Chen; Yang, Guang-hua; Hu, Chao; Tang, Kang-lai

    2015-01-01

    We investigated the effects on subtalar joint stress distribution after cannulated screw insertion at different positions and directions. After establishing a 3-dimensional geometric model of a normal subtalar joint, we analyzed the most ideal cannulated screw insertion position and approach for subtalar joint stress distribution and compared the differences in loading stress, antirotary strength, and anti-inversion/eversion strength among lateral-medial antiparallel screw insertion, traditional screw insertion, and ideal cannulated screw insertion. The screw insertion approach allowing the most uniform subtalar joint loading stress distribution was lateral screw insertion near the border of the talar neck plus medial screw insertion close to the ankle joint. For stress distribution uniformity, antirotary strength, and anti-inversion/eversion strength, lateral-medial antiparallel screw insertion was superior to traditional double-screw insertion. Compared with ideal cannulated screw insertion, slightly poorer stress distribution uniformity and better antirotary strength and anti-inversion/eversion strength were observed for lateral-medial antiparallel screw insertion. Traditional single-screw insertion was better than double-screw insertion for stress distribution uniformity but worse for anti-rotary strength and anti-inversion/eversion strength. Lateral-medial antiparallel screw insertion was slightly worse for stress distribution uniformity than was ideal cannulated screw insertion but superior to traditional screw insertion. It was better than both ideal cannulated screw insertion and traditional screw insertion for anti-rotary strength and anti-inversion/eversion strength. Lateral-medial antiparallel screw insertion is an approach with simple localization, convenient operation, and good safety.

  10. Ultrasound-guided vascular cannulation in critical care patients: A practical review.

    PubMed

    Blanco, P

    2016-12-01

    Vascular cannulation is common practice in critical care, and is traditionally performed using the landmark technique - though failures and complications are not uncommon. In this regard, ultrasound guided vascular cannulation (USGVC) has been shown to improve the procedure success rate and reduce its associated complications. This review addresses the fundamental aspects of USGVC and discusses some training issues related to this technique which is currently regarded as essential for intensivists. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  11. 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.

  12. Entering the duodenal diverticulum: A method for cannulation of the intradiverticular papilla

    PubMed Central

    Wang, Bao-Can; Shi, Wei-Bin; Zhang, Wen-Jie; Gu, Jun; Tao, Yi-Jing; Wang, Yu-Qin; Wang, Xue-Feng

    2012-01-01

    Successful cannulation of the common bile duct may be difficult in patients in whom the papilla is located entirely within a diverticulum. In this study, we report successful biliary cannulation in three patients following intubation of the distal tip of the duodenoscope into the duodenal diverticulum and locating the major papilla. No complications occurred during the operation or during the postoperative period. This method didn’t need second incubation an endoscope and might lower the burden of patients. So this skill is useful to deal with the papilla hidden inside the large diverticulum because of its safety and convenience. PMID:23326150

  13. Effects of albendazole nanoparticles in mice with hepatic echinococosis: Portal vein cannulation versus intravenous administration.

    PubMed

    Zhu, Di-Wen; Zhang, Ming-Xing; Bao, Ying-Jun; Gu, Jun-Peng; Ji, Wei-Zheng; Zhang, Hai-Xiao; Ren, Wei-Xin

    2015-07-01

    To compare the ABZ and its metabolites concentration in cyst tissue of hepatic alveolar echinococcosis administered by different routes, forty male Wistar rats receiving albendazole nanoparticles from tail vein and portal vein were divided into two groups, the concentration of ABZ and its metabolites ABZSO, ABZSO2, in the cyst tissue, were analyzed by HPLC at 2, 4, 8, 24, 36 h after administration. The parent drug and its metabolites were detected in plasm and the cyst tissue after portal cannulation and intravenous administration. The last results were the concentration of ABZ in the portal cannulation group was higher than in the intravenous group at every time point (p < 0.05). Compared to the intravenous group, the portal cannulation administration of ABZ led to a lower plasm concentration of ABZ. The concentration of ABZ and the active ABZSO were significantly higher in the portal cannulation group than that of the intravenous group. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Non-surgical cannulation of the vena cava for chronic blood collection in mature swine.

    PubMed

    Smith, C A; Ficken, M D

    1991-06-01

    A nonsurgical cannulation technique for blood collections from mature swine was evaluated. Primiparous Yorkshire-Landrace sows (n = 6) received an indwelling jugular vein cannulae for 7 days duration. Recannulation was performed at monthly intervals for a total of 14 months. During cannulation, sows were restrained in a standing position using a rope snout snare. A 12-gauge by 10 cm needle was inserted into the jugular vein. Sterilized polyvinyl chloride tubing was advanced through the needle into the vein and a blunted 18-gauge needle and attached intermittent injection hub was inserted into the free end of the tubing. Surgical tape was used to form a butterfly on the tubing by suturing the tape to the animals' skin. Foam padding, livestock cement, and elastic tape helped to keep the tubing in position. Problems with cannulae patency and maintenance were few. No behavioral problems or systemic signs of illness were noted and necropsy examinations performed after the final cannulation revealed few abnormalities associated with chronic intermittent cannulation. This technique provides a safe, quick, effective means for multiple and repeated cannulae placement for blood collection from mature swine with minimal effects on the animal and without the risks associated with surgical techniques.

  15. Cannulation of the extrathoracic left common carotid artery for thoracic aorta operations through left posterolateral thoracotomy.

    PubMed

    Veron, Sebastien; Neri, Eugenio; Buklas, Dimitrios; Pula, Giorgio; Benvenuti, Antonio; Massetti, Massimo; Bizzarri, Federico; Sassi, Carlo

    2004-11-01

    The femoral artery is the usual site of arterial cannulation in thoracic aorta operations through left posterolateral thoracotomy that require cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA). The advantage of this perfusion route is in limiting the duration of circulatory arrest. It is associated, however, with the risk of retrograde embolization or, in cases involving aortic dissection, malperfusion of vital organs. To prevent these risks, we have used the extrathoracic left common carotid artery as the perfusion route. From December 1999 to January 2003, we used cannulation of the left extrathoracic common carotid artery in 42 thoracic aorta operations through posterolateral thoracotomy with an open proximal anastomosis technique during DHCA. The indication for thoracic aortic repair was atherosclerotic ulcer in 7 cases, chronic aortic aneurysm in 18, acute type B dissection in 5, and chronic type B dissection in 12. Cannulation of the extrathoracic left common carotid artery was successful in all patients. Postoperative recovery was uneventful, with no cerebrovascular events in all cases. No cannulation-related complications were observed. One patient died from cardiac insufficiency on postoperative day 5. No peripheral neurological deficits (paraplegia or paraparesis) were observed. Postoperative complications included atrial fibrillation in five patients, reoperation to control hemorrhage in six, respiratory insufficiency in nine, and renal insufficiency in six. These results indicate that cannulation of the left extrathoracic common carotid artery is a useful, reliable method for proximal perfusion during CPB in patients undergoing repair of the descending thoracic aorta through left posterolateral thoracotomy. By providing effective perfusion of the brain, this technique can prolong safe DHCA time. Another advantage is the prevention of cerebral emboli, ensuring retrograde flow to the aortic arch.

  16. [Ultrasound-guided cannulation of the brachiocephalic vein in neonates and infants].

    PubMed

    Oulego-Erroz, Ignacio; Alonso-Quintela, Paula; Domínguez, Patricia; Rodríguez-Blanco, Silvia; Muñíz-Fontán, Manoel; Muñoz-Lozón, Ana; López-Blanco, Gloria; Rodríguez-Nuñez, Antonio

    2016-06-01

    Central venous catheter (CVC) insertion in neonates and small infants is a challenging and high risk procedure. Ultrasound (US) guided cannulation increases the success rate and reduces procedural-related complications. The internal jugular vein is the most frequent site for US-guided CVC insertion. However this approach is technically demanding in neonates and small infants. US-guided supraclavicular cannulation of the brachiocephalic vein (BCV) is a new approach that may be advantageous in case of difficult central venous catheterization. We present our preliminary experience with this technique in a case series of neonates and small infants. Case series of neonates and small infants weighing less than 5kg, in whom US-guided supraclavicular cannulation of the BCV was attempted. A longitudinal "in plane" supraclavicular approach to the BCV was performed using a 12Hz linear or a 8Hz microconvex transducer. All cannulations were performed by the same operator, a pediatrician with previous experience in US-guided central venous catheterization. The study included 6 patients with a median (range) weight of 2.1 (0.94-4.1) kg and age of 1.9 (0.6-4) months. Two cases required 2 punctures, while cannulation was achieved at the first attempt in the remaining 4 cases. There were no procedural or catheter-related complications. CVCs were withdrawn after 9 (6-15) days. The US-guided supraclavicular approach to the BCV is a feasible and safe alternative in neonates and very small infants. More studies are needed to define the role of this new venous access before its routine application in daily practice. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  17. Design and application of model for training ultrasound-guided vascular cannulation in pediatric patients.

    PubMed

    Pérez-Quevedo, O; López-Álvarez, J M; Limiñana-Cañal, J M; Loro-Ferrer, J F

    2016-01-01

    Central vascular cannulation is not a risk-free procedure, especially in pediatric patients. Newborn and infants are small and low-weighted, their vascular structures have high mobility because of tissue laxity and their vessels are superficial and with small diameter. These characteristics, together with the natural anatomical variability and poor collaboration of small children, make this technique more difficult to apply. Therefore, ultrasound imaging is increasingly being used to locate vessels and guide vascular access in this population. (a) To present a model that simulates the vascular system for training ultrasound-guided vascular access in pediatrics patients; (b) to ultrasound-guided vascular cannulation in the model. The model consisted of two components: (a) muscular component: avian muscle, (b) vascular component: elastic tube-like structure filled with fluid. 864 ecoguided punctures was realized in the model at different vessel depth and gauge measures were simulated, for two medical operators with different degree of experience. The average depth and diameter of vessel cannulated were 1.16 (0.42)cm and 0.43 (0.1)cm, respectively. The average number of attempts was of 1.22 (0.62). The percentage of visualization of the needle was 74%. The most frequent maneuver used for the correct location, was the modification of the angle of the needle and the relocation of the guidewire in 24% of the cases. The average time for the correct cannulations was 41 (35.8)s. The more frequent complications were the vascular perforation (11.9%) and the correct vascular puncture without possibility of introducing the guidewire (1.2%). The rate of success was 96%. The model simulates the anatomy (vascular and muscular structures) of a pediatric patient. It is cheap models, easily reproducible and a useful tool for training in ultrasound-guided puncture and cannulation. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  18. Effect of different inner core diameters on structural strength of cannulated pedicle screws under various lumbar spine movements.

    PubMed

    Chang, Chia-Ming; Lai, Yu-Shu; Cheng, Cheng-Kung

    2017-08-15

    Currently, cannulated pedicle screws have been widely used in minimal invasive or navigation techniques. However, the stress distribution and the strength of different core diameters of cannulated screw are not clear. This study aimed to investigate the mechanical strength of cannulated screws with different inner core diameter under various lumbar spine movements using finite element analysis. The results showed that the von-Mises stress of a cannulated screw was larger than that of a solid screw in all loading conditions, especially above 2 mm in cannulated core diameter. In lateral bending, extension, and flexion, the maximum von-Mises stress was found approximate to the proximal thread for all types of screws. In rotation condition, the maximum von-Mises stress was located at the middle of the screw. Additionally, the difference in stiffness of instrumented levels was not significant among four screws under the same loading condition. Cannulated screws could provide enough stability for the vertebral body fusion comparing to solid screws. The diameter of cannulated core is suggested not to exceed 2.0 mm.

  19. A multicenter randomized trial comparing the use of touch versus no-touch guidewire technique for deep biliary cannulation: the TNT study.

    PubMed

    Bassi, Marco; Luigiano, Carmelo; Ghersi, Stefania; Fabbri, Carlo; Gibiino, Giulia; Balzani, Lucio; Iabichino, Giuseppe; Tringali, Alberto; Manta, Raffaele; Mutignani, Massimiliano; Cennamo, Vincenzo

    2017-05-18

    There are 2 techniques described for selective bile duct guidewire cannulation, the touch (T) technique (engaging the papilla with a sphincterotome and then advancing the guidewire) and the no-touch (NT) technique (engaging the papilla only with the guidewire). The aim of this prospective, multicenter randomized study was to compare the outcomes of the 2 guidewire cannulation techniques. Three hundred consecutive patients with naïve papillae were enrolled in 2 groups (150 to T group and 150 to NT group). A maximum of 15 biliary cannulation attempts, for no longer than 5 minutes, or a maximum of 5 unintentional cannulations of the pancreatic duct for each group were performed. If biliary cannulation failed, the patient was crossed over to the other technique with the same parameters. The primary outcome was the guidewire cannulation success rate using either the T or NT technique. Secondary outcomes were the number of attempts and cannulation duration, number of pancreatic duct cannulations, and adverse events. The primary cannulation rate was significantly higher in the T group compared with the NT group (88% vs 54%, P < .001), and the cannulation rate was significantly higher using the T technique compared with the NT technique also after crossover (77% vs 17%, P < .001). The mean number of cannulation attempts was 4.6 in the T group versus 5.5 in the NT group (P = .006), and the duration of cannulation before crossover (P < .001) and overall cannulation duration after crossover (P < .001) were significantly lower in the T group. The number of unintended pancreatic duct cannulations was statistically higher using the T technique compared with the NT technique (P = .037). The rates of adverse events did not significantly differ between the 2 groups. Our results clearly indicated that the T technique is superior to the NT technique for biliary cannulation. (Clinical trial registration number: NCT01954602.). Copyright © 2017 American Society for

  20. Incidence of posterior wall penetration during internal jugular vein cannulation: A comparison of two techniques using real-time ultrasound

    PubMed Central

    Srinivasan, Shrikanth; Govil, Deepak; Gupta, Sachin; Patel, Sweta; Jagadeesh, KN; Tomar, Deeksha Singh

    2017-01-01

    Background and Aims: The true incidence of penetration of the posterior wall (through-and-through puncture) of the internal jugular vein (IJV) during cannulation is unknown. This may have implications if there is hematoma formation, penetration and/or inadvertent cannulation of an underlying carotid artery. This study compared the incidence of posterior wall puncture during IJV cannulation using ultrasound guidance versus traditional landmarks-guided technique. Methods: One hundred and seventy adult patients admitted to a gastro-liver Intensive Care Unit who required central venous lines were randomly divided into Group A: IJV cannulation using anatomical landmark-guided technique and Group B: IJV cannulation using real-time ultrasound guidance. In both groups, a second investigator followed the needle path using real-time ultrasound. The incidence of posterior wall puncture, number of attempts for successful cannulation, incidence of inadvertent arterial punctures and occurrence of complications such as hematoma formation and pneumothorax were recorded. Results: Significantly more (37/80, 46%) patients in Group A had posterior wall puncture compared to 19/90 (21%) in Group B. Incidence of arterial puncture was 8/80 (10%) in Group A, 5/90 (5.5%) in Group B. The number of attempts for venous cannulation and hematoma formation was significantly less in Group B. Conclusion: Real-time ultrasound-guided IJV cannulation significantly reduces but does not wholly eliminate the incidence of posterior venous wall penetrations. It also significantly reduces the incidence of inadvertent arterial punctures and number of attempts for successful cannulation. PMID:28405038

  1. 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

  2. The impact of arterial cannulation strategy on operative outcomes in aortic surgery: evidence from a comprehensive meta-analysis of comparative studies on 4476 patients.

    PubMed

    Benedetto, Umberto; Raja, Shahzad G; Amrani, Mohamed; Pepper, John R; Zeinah, Mohamed; Tonelli, Euclide; Biondi-Zoccai, Giuseppe; Frati, Giacomo

    2014-12-01

    There is a growing perception that peripheral cannulation through the femoral artery, by reversing the flow in the thoracoabdominal aorta, may increase the risk of retrograde brain embolization in aortic surgery. Central cannulation sites, including the right axillary artery, have been reported to improve operative outcomes by allowing antegrade blood flow. However, peripheral cannulation still remains largely used because a consensus for the routine use of central cannulation approaches has not been reached. A meta-analysis of comparative studies reporting operative outcomes using central cannulation versus peripheral cannulation was performed. Pooled weighted incidence rates for end points of interest were obtained using an inverse variance model. A total of 4476 patients were included in the final analysis. Central cannulation was used in 2797 patients, and peripheral cannulation was used in 1679 patients. Central cannulation showed a protective effect on in-hospital mortality (risk ratio, 0.59; 95% confidence interval, 0.48-0.7; P < .001) and permanent neurologic deficit (risk ratio, 0.71; 95% confidence interval, 0.55-0.90; P = .005) when compared with peripheral cannulation. A trend toward an increased benefit in terms of reduced in-hospital mortality was observed when only the right axillary artery was used as the central cannulation approach (risk ratio, 0.35; 95% confidence interval, 0.22-0.55; P < .001; I(2) = 0%). Central cannulation was superior to peripheral cannulation in reducing in-hospital mortality and the incidence of permanent neurologic deficit. This superiority was particularly evident when the axillary artery was used for central cannulation. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  3. 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.

  4. Thoracic aortic cannulation with antegrade perfusion for the procurement of abdominal organs.

    PubMed

    González Rodríguez, Francisco Javier; Fernández Pérez, Aquilino; Conde Freire, Rogelio; Martínez, Jorge; Pérez, Evaristo Varo; Bustamante Montalvo, Manuel

    2015-01-01

    The definitive acceptance of an organ as valid for transplant depends on the surgical team performing the multiorgan recovery; and unexpected difficulties can occur. The demographic characteristics of donors has changed, and some accepted donors can present difficulties in surgical technique and risky decisions on the validity of the retrieved organ or organs. An alternative method to the cannulation of the abdominal aorta is proposed when there is evidence of disease in the infrarenal aorta during the multiorgan procurement. The retrocardiac descending thoracic aorta is cannulated using an antegrade perfusion; this technique allows an increase in organ recovery. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Cannulated screw and hexapodal fixator reconstruction for compound upper tibial fractures

    PubMed Central

    Uzun, Metin; Bilen, Fikri Erkal; Eralp, Levent

    2014-01-01

    Objectives: The aim of the treatment of tibial plateau fractures is to obtain a pain-free and fully functional knee with closed reduction, percutaneous cannulated screw fixation and hexapodal external fixator reconstruction for high energy compound upper tibial fractures. Methods: Patients with comminuted tibial plateau fractures underwent closed reduction, percutaneous fixation with cannulated screws, and reconstruction with hexapodal external fixator. The follow-up period was 24 months. Results: The clinical and radiological results were good or excellent. The average knee flexion was 125°. Conclusion: Our results are successful in the initial stage, however, it should be pointed out that during the long term follow-up osteoarthritis may develop leading to worsening of the condition. Level of Evidence IV, Case Series. PMID:24644420

  6. Does EMLA cream application interfere with the success of venipuncture or venous cannulation? A prospective multicenter observational study.

    PubMed

    Schreiber, S; Ronfani, L; Chiaffoni, G P; Matarazzo, L; Minute, M; Panontin, E; Poropat, F; Germani, C; Barbi, E

    2013-02-01

    Venipuncture and intravenous cannulation are the most common painful procedures performed on children. The most widely used topical anesthetic is eutectic mixture of local anesthetics (EMLA). EMLA use is associated with a transient cutaneous vasoconstriction which can make it difficult to identify veins. We assessed with a prospective, multicenter, observational study whether EMLA interferes with venipuncture and intravenous cannulation. The primary study outcome was a success at first attempt in the course of venipuncture or venous cannulation. The study enrolled 388 children; 255 of them received EMLA and 133 did not. Eighty-six percent of procedures were successful at the first attempt in the EMLA group and 76.7 % in the no EMLA group. In this study, EMLA use did not interfere with the success of venipuncture or venous cannulation in children.

  7. Ambulatory extracorporeal membrane oxygenation with subclavian venoarterial cannulation to increase mobility and recovery in a patient awaiting cardiac transplantation

    PubMed Central

    Jacob, Samuel; MacHannaford, Juan C.; Chamogeorgakis, Themistokles; Gonzalez-Stawinski, Gonzalo V.; Felius, Joost; Rafael, Aldo E.; Malyala, Rajasekhar S.

    2017-01-01

    Venoarterial extracorporeal membrane oxygenation (ECMO) can provide temporary cardiopulmonary support for patients in hemodynamic extremis or refractory heart failure until more durable therapies—such as cardiac transplantation or a left ventricular assist device—can be safely implemented. Conventional ECMO cannulation strategies commonly employ the femoral artery and vein, constraining the patients to the supine position for the duration of ECMO support. We have recently adopted a modified cannulation approach to promote patient mobility, rehabilitation, and faster recovery and to mitigate complications associated with femoral arterial cannulation, such as limb ischemia and compartment syndrome. This technique involves cannulation of the subclavian artery and vein. The current case report details our recent experience with this approach in a critically ill patient awaiting cardiac transplantation.

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

    PubMed

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

    2014-04-01

    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.

  9. Osler's nodes, pseudoaneurysm formation, and sepsis complicating percutaneous radial artery cannulation.

    PubMed

    Cohen, A; Reyes, R; Kirk, M; Fulks, R M

    1984-12-01

    Percutaneous arterial cannulation is useful for hemodynamic monitoring and frequent arterial blood gas determinations in selected intensive care patients. However, this procedure is not without risk. We report a case of localized Osler node formation, distal to a radial artery catheter, associated with sepsis, pseudoaneurysm formation, and thrombosis at the site of catheterization. Complications of this technique require aggressive medical and, in selected cases, surgical intervention.

  10. Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires.

    PubMed

    Hoshino, C Max; Tran, Wesley; Tiberi, John V; Black, Mary Helen; Li, Bonnie H; Gold, Stuart M; Navarro, Ronald A

    2013-04-03

    Displaced patellar fractures are commonly stabilized with a modified anterior tension-band construct. The goal of the current study was to compare the incidence of complications after tension-band fixation of the patella with Kirschner wires as compared with cannulated screws. We performed a retrospective cohort study of consecutive, surgically treated patellar fractures. Patients were divided into two cohorts: fractures fixed with use of Kirschner wires and fractures fixed with use of cannulated screws. The primary outcome measure was early loss of fixation that necessitated revision surgery. Secondary outcomes included early postoperative infection and the need for implant removal. Four hundred and forty-eight patellar fractures were studied. Kirschner wires were used for fixation in 315 (70%), and cannulated screws were used for fixation in 133 (30%). The incidence of fixation failure was 3.5% in the Kirschner-wire group and 7.5% in the screw group (p = 0.065). A postoperative infection occurred in 4.4% of patients in the Kirschner-wire group and 1.5% of patients in the screw group (p = 0.17). One hundred sixteen (37%) patients in the Kirschner-wire group and 30 (23%) in the screw group underwent elective implant removal (p = 0.003). After adjusting for confounding variables, a trend toward increased incidence of fixation failure with screws as compared with Kirschner wires was present (p = 0.083). Patients treated with Kirschner wires were twice as likely to undergo implant removal compared with those treated with screws (p = 0.002). Serious complications are uncommon following treatment of patellar fractures with a modified tension-band technique, with use of either Kirschner wires or cannulated screws. In both groups the rate of fixation failure was low, as was the rate of postoperative infection. Symptomatic implants, the most common complication observed, were twice as frequent in patients treated with Kirschner wires.

  11. The Effect of Preintervention Preparation on Pain and Anxiety Related to Peripheral Cannulation Procedures in Children.

    PubMed

    Tunç-Tuna, Pinar; Açikgoz, Ayfer

    2015-12-01

    This study was performed to determine the effect of several preintervention preparation practices on pain and anxiety related to the peripheral cannulation procedure in children ages 9-12 years. The study included 60 Turkish children (28 female, 32 male, randomly selected by lot), 30 of whom were included in the intervention group and 30 of whom were included in the control group. The children's demographic data were collected by a data collection form prepared by the researcher. The children in the intervention group read the training manual before peripheral cannulation, and the procedure was demonstrated on a teddy bear. Their level of pain was assessed using the Wong-Baker Faces Rating Scale, and their level of anxiety was determined by the Spielberger State-Trait Anxiety Inventory for Children, before and during the procedure in both groups. Results showed that while anxiety and pain scores increased during the actual procedure compared to the preparatory procedure in the control group (anxiety t = -4.957, pain Z(a) = -4.048), anxiety and pain scores decreased during the actual procedure in the intervention group compared to the preparatory procedure (anxiety t = 7.896, pain t = 6.196). When the pain and anxiety scores were examined, it was found that both anxiety and pain scores in the intervention group were significantly lower than in the control group. In conclusion, children in this study experienced pain and situational anxiety during peripheral cannulation, and this pain can be reduced by preparing the child in advance of the procedure. It is suggested that children should be informed about and able to practice the procedure on a toy or model before peripheral cannulation. Preparation of the children to painful procedures in accordance with their cognitive development can reduce anxiety and pain. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  12. Mitral valve surgery using right anterolateral thoracotomy: is the aortic cannulation a safety procedure?

    PubMed

    Guedes, Marco Antonio Vieira; Pomerantzeff, Pablo Maria Alberto; Brandão, Carlos Manuel de Almeida; Vieira, Marcelo Luiz Campos; Grinberg, Max; Stolf, Noedir Antonio Groppo

    2010-01-01

    The right anterolateral thoracotomy is an alternative technique for surgical approach of mitral valve. In these cases, femoral-femoral bypass still has been used, rising occurrence of complications related to femoral cannulation. Describe the technique and results of mitral valve treatment by right anterolateral thoracotomy using aortic cannulation for cardiac pulmonary bypass (CPB). From 1983 e 2008, 100 consecutive female patients, with average age 35 ±13 years, 96 (96%) underwent mitral valve surgical treatment in the Heart Institute of São Paulo. A right anterolateral thoracotomy approach associated with aortic cannulation was used for CPB. Eighty (80%) patients had rheumatic disease and 84 (84%) patients presented functional class III or IV. Were performed 45 (45%) comissurotomies, 38 (38%) valve repairs, 7(7%) mitral valve replacements, seven (7%) recomissurotomies and three (3%) prosthesis replacement. Sparing surgery was performed in 90 (90%) patients. The average CPB and clamp time were 57 ± 27 min e 39 ± 19 min, respectively. There were no in-hospital death, reoperation due to bleeding and convertion to sternotomy. Introperative complications were related to heart harvest (5%), especially in reoperations (3%). The most important complications in postoperative period were related to pulmonary system (11%), followed by atrial fibrilation (10%) but without major systemic repercussions. The mean inhospital length of stay was 8 ± 3 days. Follow-up was 6.038 patients/month. Actuarial survival was 98.0 ± 1.9% and freedom from reoperation was 81.4 ± 7.8% in 180 months. The right anterolateral thoracotomy associated with aortic cannulation in mitral valve surgery is a simple technique, reproducible and safety.

  13. Extracorporeal circulation by peripheral cannulation before redo sternotomy: indications and results.

    PubMed

    Luciani, Nicola; Anselmi, Amedeo; De Geest, Raphael; Martinelli, Lorenzo; Perisano, Mario; Possati, Gianfederico

    2008-09-01

    Cardiac reoperations are challenging and time-consuming, and have a high risk for reentry injuries. We discuss the indications, advantages, and technologic features of cardiopulmonary bypass by peripheral cannulation before resternotomy. Of 610 redo cardiac interventions from 2000 to 2006, 158 (25.9%) were performed with peripheral cannulation and ongoing cardiopulmonary bypass before resternotomy. This was indicated in the following: close adhesions between the sternum and the anterior cardiac surface; ascending aorta or bypass grafts (computed tomography scan); and patients with functional tricuspid regurgitation, hemodynamic/electric instability, previous mediastinitis, or depressed ejection fraction. Intraoperative transesophageal echocardiography was always performed. Venous drainage was obtained by cannulation of the common femoral vein (Seldinger technique) and right internal jugular vein (percutaneously). Arterial nonocclusive cannula was placed in the femoral artery (Seldinger technique). Cardiopulmonary bypass time before cardiotomy was 35 +/- 14.7 minutes. There were 5 perioperative deaths, none due to reentry injury. Damage to mediastinal structures at resternotomy occurred in 4 cases. In all cases, peripheral cardiopulmonary bypass allowed adequate and comfortable repair. The operative time was 296 +/- 60 minutes. The average total postoperative bleeding was 264 +/- 38 mL/m(2). No patient experienced complications related to femoral cannulation. The Seldinger method allowed little vascular trauma and intraoperative patency of femoral vessels. In selected patients, cardiopulmonary bypass before resternotomy is a valid and reproducible option to render cardiac reoperations safer and more expeditious in the reentry phase. The absence of cannulae in the operating field makes the procedure more comfortable. The liberal use of this strategy is recommended in redo cases.

  14. Factors affecting difficult peripheral intravenous cannulation in adults: a prospective observational study.

    PubMed

    Piredda, Michela; Biagioli, Valentina; Barrella, Beatrice; Carpisassi, Ilaria; Ghinelli, Roberta; Giannarelli, Diana; De Marinis, Maria Grazia

    2017-04-01

    This study aimed to identify risk factors for difficult intravenous cannulation in relation to characteristics of patients, healthcare providers and devices in adult patients accessing a radiology service. Early recognition of patients at risk for difficult peripheral intravenous catheterisation is important to adopt strategies able to increase the likelihood of success in intravenous cannulation, as well as to critically evaluate the use of alternative administration routes or venous devices. A prospective observational study was conducted in the radiology service of an Italian university hospital from January to August 2013. Thirteen nurses observed 763 patients during intravenous insertion (53% were female, the mean age was 63 years and 65% had a diagnosis of cancer). For each patient, nurses collected data about potential predictors of difficult intravenous cannulation, which was defined as a procedure lasting more than one minute. Data included characteristics of patient, cannula required, venepuncture performed and operator(s) involved. Logistic regression was performed as univariate and multivariate analysis. The intravenous insertion time ranged from 45 seconds to 125 minutes. Overall, variables identified as significant independent predictors were chemotherapy received via peripheral cannula (OR = 1·42), veins with many valves (OR = 3·67), fragility (OR = 3·29), visibility (OR = 0·87) and palpability (OR = 0·79) as perceived by nurses. Although many risk factors were identified, the overall success rate was very high, suggesting that nurses' attention during cannulation protected at-risk patients from multiple attempts. Multicentre studies should further investigate risk factors across different radiology services and clinical settings. These results can help nurses to recognise risk factors for difficult intravenous access and pay appropriate attention when attempting a venepuncture to preserve patients' peripheral veins. © 2016 John

  15. A randomized crossover study comparing a novel needle guidance technology for simulated internal jugular vein cannulation.

    PubMed

    Auyong, David B; Yuan, Stanley C; Rymer, Alyse N; Green, Cynthia L; Hanson, Neil A

    2015-09-01

    Despite ultrasound guidance for central line placement, complications persist, as exact needle location is often difficult to confirm with standard two-dimension ultrasound. A novel real-time needle guidance technology has recently become available (eZono, Germany) that tracks the needle during insertion. This randomized, blinded, crossover study examined whether this needle guidance technology improved cannulation of a simulated internal jugular (IJ) vein in an ultrasound phantom. One hundred physicians were randomized to place a standard needle in an ultrasound neck phantom with or without the needle guidance system. Video cameras were placed externally and within the lumens of the vessels to record needle location in real time. The primary outcome measured was the rate of posterior wall puncture. Secondary outcomes included number of carotid artery punctures, number of needle passes, final needle position, time to cannulation, and comfort level with this new technology. The incidence of posterior vessel wall puncture without and with needle guidance was 49 and 13%, respectively (P < 0.001, odds ratio [OR] = 7.33 [3.44 to 15.61]). The rate of carotid artery puncture was higher without needle navigation technology than with needle navigation 21 versus 2%, respectively (P = 0.001, OR = 12.97 [2.89 to 58.18]). Final needle tip position being located within the lumen of the IJ was 97% accurate with the navigation technology and 76% accurate with standard ultrasound (P < 0.001, OR = 10.42 [2.76 to 40.0]). Average time for successful vessel cannulation was 1.37 times longer without guidance technology. This real-time needle guidance technology (eZono) shows significant improvement in needle accuracy and cannulation time during simulated IJ vein puncture.

  16. Tissue reaction to implants of different metals: a study using guide wires in cannulated screws.

    PubMed

    Devine, D M; Leitner, M; Perren, S M; Boure, L P; Pearce, S G

    2009-10-20

    Cannulated screws, along with guide wires, are typically used for surgical fracture treatment in cancellous bone. Breakage or bending deformation of the guide wire is a clinical concern. Mechanically superior guide wires made of Co-Cr alloys such as MP35N and L605 may reduce the occurrence of mechanical failures when used in combination with conventional (316L stainless steel) cannulated screws. However the possibility of galvanic or crevice corrosion and adverse tissue reaction, exists when using dissimilar materials, particularly in the event that a guide wire breaks, and remains in situ. Therefore, we designed an experiment to determine the tissue reaction to such an in vivo environment. Implant devices were designed to replicate a clinical situation where dissimilar metals can form a galvanic couple. Histological and SEM analyses were used to evaluate tissue response and corrosion of the implants. In this experiment, no adverse in vivo effects were detected from the use of dissimilar materials in a model of a broken guide wire in a cannulated screw.

  17. The Shape of the Foramen Ovale: A Visualization Aid for Cannulation Procedures.

    PubMed

    Zdilla, Matthew J; Fijalkowski, Kristen M

    2017-03-01

    Several neurosurgical procedures, including rhizotomy for the management of trigeminal neuralgia, cannulate the foramen ovale (FO) to access intracranial structures. Cannulation procedures, including those utilizing neuronavigational technology, are occasionally complicated by anatomical variation of the FO, sometimes resulting in miscannulation and subsequent adverse events. The FO, while commonly thought of as oval-shaped, has also been described as "almond," "banana," "D shape," "pear," and "triangular." Because of the importance of the FO in neurosurgical procedures and the misunderstanding of FO shape, the aim of this study is to objectively describe the shape of the FO and its most likely shape variation. A total of 211 FO were evaluated by geometric morphometric analysis. A consensus shape is presented for the FO. No significant difference was found between the shapes of left- and right-sided FO. The most likely shape variation of the FO occurs as an inverse relationship between the anteromedial-posterolateral and anterolateral-posteromedial aspects of the foramen. The capacity to visualize the average FO shape and understand the most likely shape variance, as illustrated by this report, will aid neurosurgeons in their approach to procedures requiring cannulation of the FO.

  18. Internal Jugular Vein Cannulation: An Ultrasound-Guided Technique Versus a Landmark-Guided Technique

    PubMed Central

    Turker, Gurkan; Kaya, Fatma Nur; Gurbet, Alp; Aksu, Hale; Erdogan, Cuneyt; Atlas, Ahmet

    2009-01-01

    OBJECTIVES To compare the landmark-guided technique versus the ultrasound-guided technique for internal jugular vein cannulation in spontaneously breathing patients. METHODS A total of 380 patients who required internal jugular vein cannulation were randomly assigned to receive internal jugular vein cannulation using either the landmark- or ultrasound-guided technique in Bursa, Uludag University Faculty of Medicine, between April and November, 2008. Failed catheter placement, risk of complications from placement, risk of failure on first attempt at placement, number of attempts until successful catheterization, time to successful catheterization and the demographics of each patient were recorded. RESULTS The overall complication rate was higher in the landmark group than in the ultrasound-guided group (p < 0.01). Carotid puncture rate and hematoma were more frequent in the landmark group than in the ultrasound-guided group (p < 0.05). The number of attempts for successful placement was significantly higher in the landmark group than in the ultrasound-guided group, which was accompanied by a significantly increased access time observed in the landmark group (p < 0.05 and p < 0.01, respectively). Although there were a higher number of attempts, longer access time, and a more frequent complication rate in the landmark group, the success rate was found to be comparable between the two groups. CONCLUSION 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 immediate complications. PMID:19841706

  19. Hemodialysis catheter insertion: is increased PO2 a sign of arterial cannulation? A case report

    PubMed Central

    2014-01-01

    Background Ultrasound-guided Central Venous Catheterization (CVC) for temporary vascular access, preferably using the right internal jugular vein, is widely accepted by nephrologists. However CVC is associated with numerous potential complications, including death. We describe the finding of a rare left-sided partial anomalous pulmonary vein connection during central venous catheterization for continuous renal replacement therapy (CRRT). Case presentation Ultrasound-guided cannulation of a large bore temporary dual-lumen Quinton-Mahurkar catheter into the left internal jugular vein was performed for CRRT initiation in a 66 year old African-American with sepsis-related oliguric acute kidney injury. The post-procedure chest X-ray suggested inadvertent left carotid artery cannulation. Blood gases obtained from the catheter showed high partial pressure of oxygen (PO2) of 140 mmHg and low partial pressure of carbon dioxide (PCO2) of 22 mmHg, suggestive of arterial cannulation. However, the pressure-transduced wave forms appeared venous and Computed Tomography Angiography located the catheter in the left internal jugular vein, but demonstrated that the tip of the catheter was lying over a left pulmonary vein which was abnormally draining into the left brachiocephalic (innominate) vein rather than into the left atrium. Conclusion Although several mechanical complications of dialysis catheters have been described, ours is one of the few cases of malposition into an anomalous pulmonary vein, and highlights a sequential approach to properly identify the catheter location in this uncommon clinical scenario. PMID:25073708

  20. Simple cannulation procedure for serial blood sampling through cutaneous ulnar vein in chickens.

    PubMed

    Bayer, Darmel M; Mohan, K; Jayakumar, K; Manafi, Milad; Pavithra, B H

    2012-01-01

    The objective of the study was to collect repeated, low-stress blood samples from the ulnar vein of chickens required for pharmacokinetic studies or hormonal assays. The study used 5 apparently healthy, unsexed, commercial broiler chickens about 6 weeks old and weighing 1.7-1.9 kg for serial sampling of blood. The study prepared the birds prior to cannulation and penetrated the catheter through the skin and into the lumen of the ulnar vein. The study successfully carried out serial blood samplings in 4 of 5 cannulated birds. Heparin (10%) solution maintained patency and prevented blood clot formation inside the cannula. However, the study found repeated clotting occurring in 1 bird. Cannula failed to maintain patency; the study could not carry out blood sampling properly, which was attributed to air embolism that might have occurred during catheter manipulation or repeated filling of cannula with heparin solution. The study observed no hematoma or inflammation at the site of cannulation. Owing to the advantages and to facilitate compliance with nonhuman animal welfare, this technique seems simple and efficient, allowing adoption for serial blood collection in chickens.

  1. Direct innominate artery cannulation: An alternate technique for antegrade cerebral perfusion during aortic hemiarch reconstruction.

    PubMed

    Jassar, Arminder S; Vallabhajosyula, Prashanth; Bavaria, Joseph E; Gutsche, Jacob; Desai, Nimesh D; Williams, Matthew L; Milewski, Rita K; Hargrove, W Clark; Szeto, Wilson Y

    2016-04-01

    We describe an alternate technique for establishing antegrade cerebral perfusion (ACP) during hypothermic circulatory arrest via direct, central cannulation of the innominate artery. From 2009 to 2015, 100 elective hemiarch reconstructions for proximal aortic aneurysms were performed under moderate hypothermic circulatory arrest (MHCA). Cerebral perfusion was instituted with ACP via direct cannulation of the innominate artery. Mean patient age was 63 ± 13 years (72 men; 72%). Mean MHCA temperature was 27.3°C ± 1.0°C (median, 28°C). Mean ACP time was 17 ± 4 minutes and mean crossclamp time was 134 ± 42 minutes. Proximal reconstruction included root replacement with composite valved graft (n = 47), valve sparing root reimplantation (n = 16), and aortic valve replacement (n = 19). In-hospital 30-day mortality (n = 1; 1%), stroke (1; 1%), reversible ischemic neurologic deficit (n = 1; 1%), coma (n = 0), and renal failure (n = 1; 1%) rates were low. There was no incidence of injury or dissection of the innominate artery. Direct, central innominate artery cannulation for ACP yields excellent outcomes. This technique is safe, provides excellent cerebral protection during circulatory arrest and simplifies the circulatory management strategy for elective ascending aortic and hemiarch reconstruction. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  2. Optical wire guided lumpectomy: frequency domain measurements

    NASA Astrophysics Data System (ADS)

    Dayton, A. L.; Keränen, V. T.; Prahl, S. A.

    2009-02-01

    In practice, complete removal of the tumor during a lumpectomy is difficult; the published rates of positive margins range from 10% to 50%. A spherical lumpectomy specimen with tumor directly in the middle may improve the success rate. A light source placed within the tumor may accomplish this goal by creating a sphere surrounding the tumor that can serve as a guide for resection. In an optical phantom and a prophylactic mastectomy specimen, sinusoidally modulated light within the medium was collected by optical fiber(s) at fixed distance(s) from the source and used to measure the optical properties. These optical properties were then used to calculate the distance the light had traveled through the medium. The fiber was coupled to an 830nm diode laser that was modulated at 100, 200 and 300 MHz. A handheld optical probe collected the modulated light and a network analyzer measured the phase lag. This data was used to calculate the distance the light traveled from the emitting fiber tip to the probe. The optical properties were μa = 0.004mm-1 and μ1s = 0.38mm-1 in the phantom. The optical properties for the tissue were μa = 0.005mm-1 and μ1s = 0.20mm-1. The prediction of distance from the source was within 4mm of the actual distance at 30mm in the phantom and within 3mm of the actual distance at 25mm in the tissue. The feasibility of a frequency domain system that makes measurements of local optical properties and then extrapolates those optical properties to make measurements of distance with a separate probe was demonstrated.

  3. 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.

  4. 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.

  5. [Ultrasonic guided cannulation of the axillary vein in intensive care patients].

    PubMed

    Schregel, W; Höer, H; Radtke, J; Cunitz, G

    1994-10-01

    Cannulation of the axillary vein is claimed to be an effective and relatively safe access to the central venous (CV) system [2, 4, 5, 8]. However, anatomical landmarks recommended for venous location (Muskulus pectoralis minor, processus coracoideus) are probably hard to identify in the majority of intensive care (ICU) patients. This investigation evaluated unidirectional 8 MHz Doppler ultrasound (US) in locating the axillary vein. Success rates and complications of this CV access in ICU patients is analysed. METHODS. The experimental design was approved by the local ethical committee (RUB). In 50 patients from our ICU cannulation of the axillary vein was attempted; all were in need of a CV line. Other CV puncture sites (except for the subclavian vein) were associated with contraindications. Patients were placed in a 15 degrees Trendelenburg position (15 exceptions); the arm was abducted to 45 degrees [5, 8]. The course of the axillary vein was located by Doppler US and marked on the skin with a felt pen. Prior to puncture, US intensity was judged by a score ranging from 0 to 4. After skin desinfection, sterile draping, and local anaesthesia, puncture of the axillary vein was attempted. The puncture kit LeaderCath 11,515 (Vygon, Aachen, FRG) was used. When venous blood could be aspirated, the Seldinger guidewire was inserted and the definite catheter placed. The experimental design allowed up to ten punctures, slightly modified in angle and direction of the needle, if puncture of the axillary vein or guide-wire placement failed. The cannulation attempt was classified as unsuccessful in the following cases: malposition, axillary vein not encountered by the puncture needle, guide-wire placement unsuccessful, or if identification and cannulation of the vein lasted more than 20 min. The puncture attempts were evaluated in respect to success rate, time, relation of US intensity to puncture attempts and CV pressure, complications, and malposition. RESULTS. Of the 50

  6. Latarjet Fixation: A Cadaveric Biomechanical Study Evaluating Cortical and Cannulated Screw Fixation.

    PubMed

    Alvi, Hasham M; Monroe, Emily J; Muriuki, Muturi; Verma, Rajat N; Marra, Guido; Saltzman, Matthew D

    2016-04-01

    Attritional bone loss in patients with recurrent anterior instability has successfully been treated with a bone block procedure such as the Latarjet. It has not been previously demonstrated whether cortical or cancellous screws are superior when used for this procedure. To assess the strength of stainless steel cortical screws versus stainless steel cannulated cancellous screws in the Latarjet procedure. Controlled laboratory study. Ten fresh-frozen matched-pair shoulder specimens were randomized into 2 separate fixation groups: (1) 3.5-mm stainless steel cortical screws and (2) 4.0-mm stainless steel partially threaded cannulated cancellous screws. Shoulder specimens were dissected free of all soft tissue and a 25% glenoid defect was created. The coracoid process was osteomized, placed at the site of the glenoid defect, and fixed in place with 2 parallel screws. All 10 specimens failed by screw cutout. Nine of 10 specimens failed by progressive displacement with an increased number of cycles. One specimen in the 4.0-mm screw group failed by catastrophic failure on initiation of the testing protocol. The 3.5-mm screws had a mean of 274 cycles (SD, ±171 cycles; range, 10-443 cycles) to failure. The 4.0-mm screws had a mean of 135 cycles (SD, ±141 cycles; range, 0-284 cycles) to failure. There was no statistically significant difference between the 2 types of screws for cycles required to cause failure (P = .144). There was no statistically significant difference in energy or cycles to failure when comparing the stainless steel cortical screws versus partially threaded cannulated cancellous screws. Latarjet may be performed using cortical or cancellous screws without a clear advantage of either option.

  7. Percutaneous Cannulated Compression Screw Osteosynthesis in Phalanx Fractures: The Surgical Technique, the Indications, and the Results

    PubMed Central

    Kisch, Tobias; Wenzel, Eike; Mailänder, Peter; Stang, Felix

    2017-01-01

    Objective: Fractures of metacarpals and phalanges are very common fractures, and there are a lot of treatment modalities. The purpose of the study was to describe the technique of percutaneous fixation of phalangeal fractures using a cannulated compression screw fixation system and its results. Methods: We conducted a prospective clinical study on 43 patients with different types of phalangeal fractures undergoing a percutaneous cannulated compression screw osteosynthesis. Parameters such as average operation time and clinical outcome were evaluated postoperatively. Results: Forty-three patients were treated using a percutaneous cannulated compression screw fixation system for phalanx fractures of the proximal (n = 26), middle phalanx (n = 16), or distal phalanx (n = 1). All fractures healed after 6 to 8 weeks except in 1 patient with secondary loss of reduction occurring 2.5 weeks after surgery. No infections were observed. The mean total active motion values were 247.56° ±16.16° and 244.35° ± 11.61° for the intra-articular fracture and 251.25° ± 19.86° for the shaft fractures; the mean Disabilities of the Arm, Shoulder, and Hand (DASH) score 3 months after the surgery was 1.67 ± 2.74. Conclusions: The advantages of this technique are the avoidance of an open procedure requiring extensive soft-tissue dissection with the risks of tendon adhesions and the achievement of interfragmentary compression. Because of the interfragmentary compression, it is superior to simple K-wires. With regard to indications, our primary focus was on unicondylar proximal interphalangeal joint fractures, shaft fractures, and simple oblique 2-fragment fractures. PMID:28293333

  8. The Mesenteric Lymph Duct Cannulated Rat Model: Application to the Assessment of Intestinal Lymphatic Drug Transport

    PubMed Central

    Trevaskis, Natalie L.; Hu, Luojuan; Caliph, Suzanne M.; Han, Sifei; Porter, Christopher J.H.

    2015-01-01

    The intestinal lymphatic system plays key roles in fluid transport, lipid absorption and immune function. Lymph flows directly from the small intestine via a series of lymphatic vessels and nodes that converge at the superior mesenteric lymph duct. Cannulation of the mesenteric lymph duct thus enables the collection of mesenteric lymph flowing from the intestine. Mesenteric lymph consists of a cellular fraction of immune cells (99% lymphocytes), aqueous fraction (fluid, peptides and proteins such as cytokines and gut hormones) and lipoprotein fraction (lipids, lipophilic molecules and apo-proteins). The mesenteric lymph duct cannulation model can therefore be used to measure the concentration and rate of transport of a range of factors from the intestine via the lymphatic system. Changes to these factors in response to different challenges (e.g., diets, antigens, drugs) and in disease (e.g., inflammatory bowel disease, HIV, diabetes) can also be determined. An area of expanding interest is the role of lymphatic transport in the absorption of orally administered lipophilic drugs and prodrugs that associate with intestinal lipid absorption pathways. Here we describe, in detail, a mesenteric lymph duct cannulated rat model which enables evaluation of the rate and extent of lipid and drug transport via the lymphatic system for several hours following intestinal delivery. The method is easily adaptable to the measurement of other parameters in lymph. We provide detailed descriptions of the difficulties that may be encountered when establishing this complex surgical method, as well as representative data from failed and successful experiments to provide instruction on how to confirm experimental success and interpret the data obtained. PMID:25866901

  9. A lateral thoracotomy approach for thoracic duct cannulation and lymphatic fluid collection in a feline model.

    PubMed

    Hardie, Robert J; Sheehan, Nora K

    2016-10-01

    This study describes a lateral thoracotomy approach for thoracic duct cannulation and lymphatic fluid collection in a feline model. The thoracic duct was cannulated via a left lateral intercostal thoracotomy in 12 cats. Lymphatic fluid was collected for up to 16 days and analyzed on days 3, 9 and 16. The volume collected and duration of cannula patency were recorded. Contrast imaging of the thoracic duct was performed if fluid ceased to flow or at the end of the 16-day study period. In two cats, the cannula became dislodged within 24 h. For the remaining 10 cats, mean daily volume collected was 43.7 mL (median 41.0, range 2.3 to 152.4 mL), and mean duration of cannula patency was 8.2 days (median 6.5, range 3 to 16 days). Contrast imaging revealed that the cannula was patent in three cats, obstructed in two cats, and the thoracic duct had ruptured or had extravasation of contrast outside the duct in five cats. Cytological examination of lymphatic fluid from the three time points revealed normal appearing small lymphocytes (97%) and few (3%) non-degenerate neutrophils, macrophages, eosinophils, and plasma cells. Based on the results of this study, lateral thoracotomy approach for thoracic duct cannulation is a feasible technique for collecting lymphatic fluid in cats. This technique may have application as a model for short-term evaluation of thoracic fluid in cats; however, cannula patency was unpredictable and should be considered when utilizing this technique.

  10. Novel Ultrasound Guidance System for Real-time Central Venous Cannulation: Safety and Efficacy

    PubMed Central

    Ferre, Robinson M.; Mercier, Mark

    2014-01-01

    Introduction Real-time ultrasound guidance is considered to be the standard of care for central venous access for non-emergent central lines. However, adoption has been slow, in part because of the technical challenges and time required to become proficient. The AxoTrack® system (Soma Access Systems, Greenville, SC) is a novel ultrasound guidance system recently cleared for human use by the United States Food and Drug Administration (FDA). Methods After FDA clearance, the AxoTrack® system was released to three hospitals in the United States. Physicians and nurse practitioners who work in the intensive care unit or emergency department and who place central venous catheters were trained to use the AxoTrack® system. De-identified data about central lines placed in living patients with the AxoTrack® system was prospectively gathered at each of the three hospitals for quality assurance purposes. After institutional review board approval, we consolidated the data for the first five months of use for retrospective review. Results The AxoTrack® system was used by 22 different health care providers in 50 consecutive patients undergoing central venous cannulation (CVC) from September 2012 to February 2013. All patients had successful CVC with the guidance of the AxoTrack® system. All but one patient (98%) had successful cannulation on the first site attempted. There were no reported complications, including pneumothorax, hemothorax, arterial puncture or arterial cannulation. Conclusion The AxoTrack® system was a safe and effective means of CVC that was used by a variety of health care practitioners. PMID:25035764

  11. Early cannulation graft Flixene™ for conventional and complex hemodialysis access creation.

    PubMed

    Hinojosa, Carlos A; Soto-Solis, Saul; Olivares-Cruz, Sandra; Laparra-Escareno, Hugo; Gomez-Arcive, Zeniff; Anaya-Ayala, Javier E

    2017-03-21

    The Flixene™ (Atrium™, Hudson, NH) is a trilaminate composite polytetrafluoroethylene (PTFE) graft that allows access within 72 hours. We evaluate our initial experience with this device for conventional and complex hemodialysis access creation. Retrospective review in end-stage renal disease (ESRD) patients who underwent access creation with Flixene from January 2013 to July 2014. For our analysis, the patients were divided in two groups: those with complex access configurations tunneled in the chest and/or abdominal wall (thoraco-abdominal wall access [TAWA]), and those tunneled in conventional sites (extremity access [EA]). Patient's demographics, indications, complications, reinterventions, patency rates and factors influencing outcomes were evaluated. In 19 patients (54% men; mean age 44 years ± 18), 24 grafts were implanted, (13 EA [54%] vs. 11 TAWA), all patent after surgery. Central venous occlusive disease (CVOD) was present in all patients with TAWA and in 7/13 (54%) EA patients (p = 0.016). Early cannulation (within 72 hours) was successful in 12 EA and 5 TAWA grafts (p = 0.044). Complication rates including infection, thrombosis, bleeding and steal syndrome were 8/11 (73%) in TAWA and 5/13 (38%) in EA (p = 0.02). At 12 months, primary patency rates for EA and TAWA were 25% and 41%; secondary patency rates were 55% and 41%, respectively. Early cannulation (EC) grafts are viable alternatives for conventional and complex access creation that allowed early cannulation (<72 hours) in 17 (70%) of our cases. Primary and secondary patency rates at 12 months were equivalent to data reported on ePTFE grafts.

  12. Feasibility of sedation and analgesia interruption following cannulation in neonates on extracorporeal membrane oxygenation

    PubMed Central

    Wildschut, E. D.; Hanekamp, M. N.; Vet, N. J.; Houmes, R. J.; Ahsman, M. J.; Mathot, R. A. A.; de Wildt, S. N.

    2010-01-01

    Purpose In most extracorporeal membrane oxygenation (ECMO) centers patients are heavily sedated to prevent accidental decannulation and bleeding complications. In ventilated adults not on ECMO, daily sedation interruption protocols improve short- and long-term outcome. This study aims to evaluate safety and feasibility of sedation interruption following cannulation in neonates on ECMO. Methods Prospective observational study in 20 neonates (0.17–5.8 days of age) admitted for ECMO treatment. Midazolam (n = 20) and morphine (n = 18) infusions were discontinued within 30 min after cannulation. Pain and sedation were regularly assessed using COMFORT-B and visual analog scale (VAS) scores. Midazolam and/or morphine were restarted and titrated according to protocolized treatment algorithms. Results Median (interquartile range, IQR) time without any sedatives was 10.3 h (5.0–24.1 h). Median interruption duration for midazolam was 16.5 h (6.6–29.6 h), and for morphine was 11.2 h (6.7–39.4 h). During this period no accidental extubations, decannulations or bleeding complications occurred. Conclusions This is the first study to show that interruption of sedatives and analgesics following cannulation in neonates on ECMO is safe and feasible. Interruption times are 2–3 times longer than reported for adult ICU patients not on ECMO. Further trials are needed to substantiate these findings and evaluate short- and long-term outcomes. PMID:20508914

  13. Catheter malplacement during central venous cannulation through arm veins in pediatric patients.

    PubMed

    Chaturvedi, Arvind; Bithal, Parmod K; Dash, Harihar; Chauhan, Rajendra S; Mohanty, Bibekanand

    2003-07-01

    For successful catheter placement, central venous cannulation (CVC) through internal jugular vein and subclavian vein has been recommended in both adult and pediatric patients. But it carries a risk of serious complications, such as pneumothorax, carotid, or subclavian artery puncture, which can be life-threatening, particularly in critically ill children. So a prospective study was carried out to determine the success rate of correct catheter tip placement during CVC through antecubital veins in pediatric neurosurgical patients. A total of 200 pediatric patients (age 1-15 years) of either sex were studied. Basilic or cephalic veins of either arm were selected. All the patients were cannulated in the operation room under general anesthesia. Single lumen, proper size catheters (with stillete) were used for cannulation. The catheter was inserted in supine position with the arm abducted at right angle to the body and neck turned ipsilaterally. The length of insertion was determined from cubital fossa to the right second intercostal space. The exact position of the tip of the catheter was confirmed radiologically in ICU. Correct catheter tip placement was achieved in 98 (49%) patients. Multivariate logistic regression analysis of data shows that there was no statistically significant difference among correct and incorrect catheter tip placement in relation to factors including sex, side of cannulation (left or right), and type of vein (basilic or cephalic). The analysis of correct catheter tip placement in relation to age showed that the highest success rate was achieved in children of age group 6 to 10 years (60.2%) followed by 30.6% in the 11 to 15 year group. The lowest success rate of tip placement of only 9.2% was observed in younger children of age 1 to 5 years, which is statistically significant (P = 0.001). Of 102 incorrect placements reported, 37% were in 1 to 5 year age group versus 9.2% correct tip placements. The most common unsatisfactory placements were

  14. 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

  15. Infection resistance of unreamed solid, hollow slotted and cannulated intramedullary nails: an in-vivo experimental comparison.

    PubMed

    Horn, J; Schlegel, U; Krettek, C; Ito, K

    2005-07-01

    Infection continues to be a problematic complication of fracture treatment, particularly in severe open fractures. The implant design and material as well as implantation technique play an important role in the pathogenesis of local infection. The aim of our study was to determine if the local resistance to infection of a cannulated IM nail is less than that of a solid nail and more similar to that of a hollow nail. In 65 female White Zealand rabbits, the intramedullary cavity was inoculated with matching concentrations of Staphylococcus aureus, and one of the three nails was inserted. The solid nail had a greater than twofold higher resistance to infection (23%) compared to that of the other two nails (hollow, 65%; cannulated, 61%) which was statistically significant (p<0.02). No difference in infection resistance was detected between the hollow slotted and cannulated nail designs (p=1). Although these experimental results may be clinically considered, direct extrapolation to clinical infection rates is ill advised.

  16. Measuring intravenous cannulation skills of practical nursing students using rubber mannequin intravenous training arms.

    PubMed

    Jones, Robert S; Simmons, Angela; Boykin, Gary L; Stamper, David; Thompson, Jennifer C

    2014-11-01

    This study examined the effectiveness of two training methods for peripheral intravenous (IV) cannulation; one using rubber mannequin IV training arms, and the other consisting of students performing the procedure on each other. Two hundred-sixty Phase II Army Practical Nursing students were randomized into two groups and trained to perform an IV cannulation procedure. All students watched a 12-minute training video covering standard IV placement procedures. Afterward, both groups practiced the procedure for an hour according to their assigned group. Students were then tested on IV placement in a live human arm using a 14-item testing instrument in three trials that were scored pass/fail. There was no difference in the groups' performance of the IV procedure on the first attempt: 51.7% (n = 92) of the human arm group passed the test, and 48.3% (n = 86) of the rubber mannequin group passed the test (p = 0.074). These data suggest that using rubber mannequin IV arms for IV skills training may be just as effective as training students using traditional methods. In addition, using simulation provides an extra benefit of reducing risks associated with learning the procedure on a fellow student.

  17. Treatment of delayed/nonunion of scaphoid waist with Synthes cannulated scaphoid screw and bone graft.

    PubMed

    Inaparthy, P K; Nicholl, J E

    2008-12-01

    Fracture of the scaphoid bone is the most common fracture of the carpus, and frequently, diagnosis is delayed. The unique anatomy and blood supply of the scaphoid itself predisposes to delayed union or nonunion. The Synthes scaphoid screw is a cannulated headed screw, which provides superior compression compared with some other devices used to internally fix scaphoid nonunions. Our aim was to conduct a retrospective study looking at the union rate, time to union, and complications and correlating the outcome of treatment against the delay between injury and surgery and location of the fracture within the bone. This study is a review of a cohort of 30 patients treated with a cannulated Synthes scaphoid screw and corticocancellous bone grafting for scaphoid waist delayed union and nonunion at our center. We achieved 86% overall union rate. The patients with delayed union achieved a 100% union rate. Three out of four patients with persistent nonunion after surgery reported no pain and improved function. The failure rate was 75% in patients who had sustained their fracture more than 5 years previously. Our study demonstrates that delayed union of scaphoid waist fractures and scaphoid waist nonunions present for less than 5 years can be successfully treated by fracture compression and bone grafting.

  18. Treatment of Delayed/Nonunion of Scaphoid Waist with Synthes Cannulated Scaphoid Screw and Bone Graft

    PubMed Central

    Nicholl, J. E.

    2008-01-01

    Fracture of the scaphoid bone is the most common fracture of the carpus, and frequently, diagnosis is delayed. The unique anatomy and blood supply of the scaphoid itself predisposes to delayed union or nonunion. The Synthes scaphoid screw is a cannulated headed screw, which provides superior compression compared with some other devices used to internally fix scaphoid nonunions. Our aim was to conduct a retrospective study looking at the union rate, time to union, and complications and correlating the outcome of treatment against the delay between injury and surgery and location of the fracture within the bone. This study is a review of a cohort of 30 patients treated with a cannulated Synthes scaphoid screw and corticocancellous bone grafting for scaphoid waist delayed union and nonunion at our center. We achieved 86% overall union rate. The patients with delayed union achieved a 100% union rate. Three out of four patients with persistent nonunion after surgery reported no pain and improved function. The failure rate was 75% in patients who had sustained their fracture more than 5 years previously. Our study demonstrates that delayed union of scaphoid waist fractures and scaphoid waist nonunions present for less than 5 years can be successfully treated by fracture compression and bone grafting. PMID:18780015

  19. Surgical Treatment of Calcaneal Avulsion Fracture in Elderly Patients Using Cannulated Cancellous Screws and Titanium Wire.

    PubMed

    Miyamura, Satoshi; Ota, Haruka; Okamoto, Michio; Namba, Jiro; Yamamoto, Koji

    2016-01-01

    Avulsion fractures of the calcaneus are relatively uncommon and are seen most frequently in elderly or osteoporotic patients. A surgical method that avoids displacement of the avulsed fragment after fixation has not been developed. We report the cases of 3 patients (a 73-year-old male, an 85-year-old male, and an 81-year-old female) treated by open reduction and internal fixation using titanium wire and cannulated cancellous screws. The posterior approach was used by way of a vertical midline incision. The fracture was fixed with 2 screws, and then a titanium wire was passed through the holes of the cannulated screws. A small incision on the lateral side of planter was added for the exit and return of the wire. The wire knot was bent inside the proximal Achilles tendon bursa in 2 patients and was directed to the plantar side in 1 to avoid irritation. Bony union was achieved without repeat displacement of the fragment in all 3 patients. Normal ankle function was restored, and the patients recovered the activities of daily living almost to the original level. Although an additional plantar incision is required, this surgical technique provides strong internal fixation. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  20. [Clinical efficacy of subtalar joint arthrodesis with percutaneous opposite parallel cannulated screws].

    PubMed

    Yuan, Cheng-song; Tang, Kang-lai; Chen, Cheng; Hu, Chao; Zhou, Bing-hua; Xu, Jian-zhong

    2013-06-04

    To explore the clinical efficacy of subtalar joint arthrodesis with percutaneous opposite parallel cannulated screws for severe subtalar joint arthritis. A total of 88 patients with 90 feet underwent subtalar joint fusion under four different incisions from April 2008 to April 2012. There were 56 males and 32 females with a mean age of 43.7 (15-74) years. All of them were evaluated by radiography or computed tomography (CT) scan and assessed by the rating scores of visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS). Among them, 68 cases were followed up for an average of 18.5 (6-48) months. Fusion was confirmed on radiography or CT in 67 cases with a fusion rate of 98.5%. The mean duration of fusion was 13.8 (6-28) weeks, the mean VAS score decreased from 6.00 to 1.03 points (P < 0.05) and the mean AOFAS score improved from 57.0 to 80.6 points (P < 0.05) with a good-and-excellent rate of 80.8%. Subtalar joint arthrodesis with percutaneous opposite parallel cannulated screws is recommend for severe subtalar joint arthritis. Such a procedure has a high fusion rate, excellent clinical outcomes and fewer complications.

  1. 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.

  2. 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.

  3. Comparative Evaluation of Volatile Anaesthetic Agents for Attenuation of Venous Cannulation Pain: A Prospective, Randomized Controlled Study

    PubMed Central

    Das, Pravin K; Gautam, Sujeet KS; Jaisawal, Parineeta; Kadiyala, Venkat N.; Rambhad, Sonal

    2016-01-01

    Introduction Topical application of volatile anaesthetic agents has been found to attenuate the response to a mechanical stimulus; however, this effect of volatile anaesthetic on perception of pain during venous cannulation is not known. Aim To compare the efficacy of topically administered volatile anaesthetic agents for attenuating venous cannulation pain. Materials and Methods This prospective, randomized, placebo controlled and double blind study was conducted on 120 patients, aged 20-60years. They were of American Society of Anaesthesiologists (ASA) I or II physical status, of either sex, planned for elective surgeries. These patients were randomized into 4 groups, of 30 each. Equipotent doses of halothane (1ml), isoflurane (1.5ml), sevoflurane (2.7ml) and sterile water (2.5ml; Control) were topically administered on the volar surface of forearm wrapped with cotton and aluminium foil; venous cannulation was performed with 18G intravenous cannula after 30 min. These patients were assessed for the incidence and severity of pain upon venous cannulation {visual analog scale (VAS), 0-100mm; 0 = no pain and 100 = worst imaginable pain}. Data were analysed by one-way ANOVA, Chi-square test and Kruskal-Wallis test. The p<0.05 was considered as significant. Results A significant reduction in the incidence of venous cannulation pain was observed in the halothane (79%) group as compared to control (100%; p<0.05), isoflurane (100%; p<0.05) and sevoflurane (100%; p<0.05) groups. The severity of venous cannulation pain as assessed by median (interquartile range, Q1-Q3). VAS scores was reduced in the halothane {10 (10-20); p<0.001}, isoflurane {20 (10-30); p<0.001} and sevoflurane {20 (20-30); p<0.001} groups as compared to the control group {40 (30-40)}; VAS score in the halothane group was significantly less as compared to isoflurane (p<0.05) and sevoflurane (p<0.05) groups. Conclusion Topical application of halothane is most effective in reducing incidence and severity of

  4. Outcome of 20-gauge transconjunctival cannulated sutureless vitrectomy using silicone oil or air tamponade

    PubMed Central

    Mohamed, Ahmed Abdel Alim; Abdrabbo, Mohamed

    2013-01-01

    Background The purpose of this study was to assess the outcome of pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system with air or silicone oil tamponade in cases of retinal detachment of different etiologies. Methods A prospective study was performed in 60 eyes from consecutive 60 patients who underwent 20-gauge transconjunctival cannulated sutureless vitrectomy (30 eyes with air tamponade and 30 eyes with silicone oil tamponade), with the inclusion of a further 30 patients who underwent conventional 20-gauge vitrectomy and served as a control group. The main outcome measures were intraocular pressure, wound leakage, and comfort score. Results Preoperative intraocular pressure increased from 17.67 ± 5.6 mmHg preoperatively to 18.78 ± 6.1 mmHg on the first postoperative day in group A and decreased from 16.97 ± 4.9 mmHg to 15.88 ± 5.3 mmHg in group B. These changes were not statistically significant (P > 0.05). The comfort score ranged from 1 to 5 (1 = very bad, 2 = bad, 3 = good, 4 = very good, and 5 = excellent), with a mean of 4.4 ± 0.94 in group A and 4.35 ± 0.99 in group B on the first postoperative day, and no significant difference in scores between the groups at any follow-up visit. There was intraoperative wound leakage in two cases (6.7%) in group A which required suturing and one case (3.3%) in group B, but the difference was not statistically significant (P > 0.05). There was no wound leakage at follow-up in either group. No cases of hypotony, endophthalmitis, or unsealed sclerotomies were noted. Conclusion Pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system combines the advantages of smaller-gauge vitrectomy systems with the economic advantage of not needing to purchase any additional handheld instruments. It can be used with both air and silicone oil tamponade in most cases of retinal detachment. PMID:23450243

  5. Outcome of 20-gauge transconjunctival cannulated sutureless vitrectomy using silicone oil or air tamponade.

    PubMed

    Mohamed, Ahmed Abdel Alim; Abdrabbo, Mohamed

    2013-01-01

    The purpose of this study was to assess the outcome of pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system with air or silicone oil tamponade in cases of retinal detachment of different etiologies. A prospective study was performed in 60 eyes from consecutive 60 patients who underwent 20-gauge transconjunctival cannulated sutureless vitrectomy (30 eyes with air tamponade and 30 eyes with silicone oil tamponade), with the inclusion of a further 30 patients who underwent conventional 20-gauge vitrectomy and served as a control group. The main outcome measures were intraocular pressure, wound leakage, and comfort score. Preoperative intraocular pressure increased from 17.67 ± 5.6 mmHg preoperatively to 18.78 ± 6.1 mmHg on the first postoperative day in group A and decreased from 16.97 ± 4.9 mmHg to 15.88 ± 5.3 mmHg in group B. These changes were not statistically significant (P > 0.05). The comfort score ranged from 1 to 5 (1 = very bad, 2 = bad, 3 = good, 4 = very good, and 5 = excellent), with a mean of 4.4 ± 0.94 in group A and 4.35 ± 0.99 in group B on the first postoperative day, and no significant difference in scores between the groups at any follow-up visit. There was intraoperative wound leakage in two cases (6.7%) in group A which required suturing and one case (3.3%) in group B, but the difference was not statistically significant (P > 0.05). There was no wound leakage at follow-up in either group. No cases of hypotony, endophthalmitis, or unsealed sclerotomies were noted. Pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system combines the advantages of smaller-gauge vitrectomy systems with the economic advantage of not needing to purchase any additional handheld instruments. It can be used with both air and silicone oil tamponade in most cases of retinal detachment.

  6. Cannulation Strategies in Adult Veno-arterial and Veno-venous Extracorporeal Membrane Oxygenation: Techniques, Limitations, and Special Considerations

    PubMed Central

    Jayaraman, Arun L; Cormican, Daniel; Shah, Pranav; Ramakrishna, Harish

    2017-01-01

    Extracorporeal membrane oxygenation (ECMO) refers to specific mechanical devices used to temporarily support the failing heart and/or lung. Technological advances as well as growing collective knowledge and experience have resulted in increased ECMO use and improved outcomes. Veno-arterial (VA) ECMO is used in selected patients with various etiologies of cardiogenic shock and entails either central or peripheral cannulation. Central cannulation is frequently used in postcardiotomy cardiogenic shock and is associated with improved venous drainage and reduced concern for upper body hypoxemia as compared to peripheral cannulation. These concerns inherent to peripheral VA ECMO may be addressed through so-called triple cannulation approaches. Veno-venous (VV) ECMO is increasingly employed in selected patients with respiratory failure refractory to more conventional measures. Newer dual lumen VV ECMO cannulas may facilitate extubation and mobilization. In summary, the pathology being addressed impacts the ECMO approach that is deployed, and each ECMO implementation has distinct virtues and drawbacks. Understanding these considerations is crucial to safe and effective ECMO use. PMID:28074818

  7. Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: Techniques, limitations, and special considerations.

    PubMed

    Jayaraman, Arun L; Cormican, Daniel; Shah, Pranav; Ramakrishna, Harish

    2017-01-01

    Extracorporeal membrane oxygenation (ECMO) refers to specific mechanical devices used to temporarily support the failing heart and/or lung. Technological advances as well as growing collective knowledge and experience have resulted in increased ECMO use and improved outcomes. Veno-arterial (VA) ECMO is used in selected patients with various etiologies of cardiogenic shock and entails either central or peripheral cannulation. Central cannulation is frequently used in postcardiotomy cardiogenic shock and is associated with improved venous drainage and reduced concern for upper body hypoxemia as compared to peripheral cannulation. These concerns inherent to peripheral VA ECMO may be addressed through so-called triple cannulation approaches. Veno-venous (VV) ECMO is increasingly employed in selected patients with respiratory failure refractory to more conventional measures. Newer dual lumen VV ECMO cannulas may facilitate extubation and mobilization. In summary, the pathology being addressed impacts the ECMO approach that is deployed, and each ECMO implementation has distinct virtues and drawbacks. Understanding these considerations is crucial to safe and effective ECMO use.

  8. Stridor and Horner's syndrome, weeks after attempted right subclavian vein cannulation.

    PubMed

    van der Werf, T S; Drijver, Y; Stegeman, C A; Boonstra, P W; Ligtenberg, J J M; Tulleken, J E; Zijlstra, J G

    2005-01-01

    A 23-year-old woman presented with renal failure resulting from polycystic kidney disease (PKD) aggravated by tubulo-interstitial nephritis. Emergency haemodialysis was planned, and cannulation of the right subclavian vein was attempted, but failed. During this procedure, inadvertent arterial puncture occurred. Transient mild ischaemia of the right arm, and a transient Horner's syndrome were noted. Seven weeks later she presented with severe stridor with impending respiratory failure necessitating emergency intubation; the right-sided Horner's syndrome had recurred. CT imaging showed a large pseudo-aneurysm of the brachiocephalic artery resulting in severe compression of the trachea. Using a prosthetic graft, the operation for the pseudo-aneurysm was successful; there were mild neurological sequelae. Although her family history was negative, autosomal dominant PKD should be considered, and we discuss the possible role of a pre-existing PKD-associated aneurysm.

  9. Reentrant cannulation of the small intestine in sheep: cannula and surgical method.

    PubMed

    Ivan, M; Johnston, D W

    1981-04-01

    The function, design and production of a reentrant cannula for the small intestine of sheep and the corresponding surgical procedure are described. The cannula is molded in one piece from polyvinylchloride plastisol. It consists of a curved intestinal tube joined to a stem with an external elliptical ring on the distal end and a perforated flange that encircles the stem above the intestinal tube. A circular perspex valve with two curved channels was made to fit into the interior of the cannula, making it capable of either a "maintenance" or a "collection" function. The cannula was inserted into the proximal duodenum and(or) terminal ileum of sheep via a 5-cm incision on the antimesenteric side of the intestine. The intestine was attached to the cannula by a Dacron straight arterial graft. This reentrant cannulation method does not require an intestinal transection and a mesenteric incision under the transection. Therefore, little damage was done to the blood and nervous system.

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

    PubMed

    Watson, Timothy; Pope, Adele; van Pelt, Niels; Ruygrok, Peter N

    2015-10-01

    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.

  11. The effect of buttonhole cannulation vs. rope-ladder technique on hemodialysis access patency.

    PubMed

    Chan, Micah R; Shobande, Olatokunbo; Vats, Hemender; Wakeen, Maureen; Meyer, Xinliu; Bellingham, Janet; Astor, Brad C; Yevzlin, Alexander S

    2014-03-01

    The rope-ladder (RL) technique is the most common technique used for cannulation of arteriovenous fistulae (AVF). Buttonhole cannulation (BHC), or constant-site technique, is recommended by the National Kidney Foundation's Kidney Disease Outcome Quality Initiative (NKF/KDOQI) vascular access guidelines. We compared outcomes of primary patency, episodes of bacteremia, access blood flow (Qa), and quality of life (QoL) scores between RL and BHC patients. Using a prospectively collected, vascular access database, a total of 45 prevalent dialysis patients using BHC were compared with 38 patients using the RL technique over a median of 12 months (inter-quartile range: 4-27 months). The two groups did not differ significantly in demographics except that diabetes was more common in those using BHC as compared to rope-ladder (69% vs. 34%; p = 0.002). Risk factors associated with lack of primary patency were age (hazards ratio [HR] = 1.02 per decade; 95% CI: 1.00-1.03; p = 0.04) and female gender (HR = 1.92; 95% CI: 1.08-3.40; p = 0.03). Use of the buttonhole technique was not associated with improved primary patency (HR = 1.22, 95% CI: 0.65-2.28; p = 0.53). Episodes of bacteremia and mean scores from KDQOL-36 did not differ significantly between the groups. This study demonstrates for the first time that BHC use is not associated with improved access patency.

  12. Head rotation during internal jugular vein cannulation and the risk of carotid artery puncture.

    PubMed

    Sulek, C A; Gravenstein, N; Blackshear, R H; Weiss, L

    1996-01-01

    We undertook a prospective laboratory study to examine the effect of head position on the relative positions of the carotid artery and the internal jugular vein (IJV). Volunteers (n = 12) from departmental staff, 18-60 yr of age, who had never undergone cannulation of the IJV underwent imaging of their IJV and carotid artery. With the subject in a 15 degrees Trendelenburg position, two-dimensional ultrasound images of the IJV and the carotid artery were obtained on the left and right sides of the neck at 2 and 4 cm from the clavicle along the lateral border of the sternal head of the sternocleidomastoid muscle at 0 degrees, 40 degrees, and 80 degrees of head rotation from the midline. The percent overlap of the carotid artery and IJV increased significantly at 40 degrees and 80 degrees head rotation to both the right and left (P < 0.05). Data from 2 and 4 cm above the clavicle did not differ and were pooled. The percent overlap was larger on the left than the right only with 80 degrees of head rotation (P < 0.05). The increased overlap of carotid artery and IJV with head rotation > 40 degrees increases the risk of inadvertent puncture of the carotid artery associated with the common occurrence of transfixion of the IJV before it is identified during needle withdrawal. The IJV frequently collapses with needle insertion. This may result in puncture of the posterior wall of the vessel, and thus of the carotid artery when the two vessels overlap. To decrease this risk, the head should be kept in as neutral a position as possible, that is < 40 degrees rotation, during IJV cannulation.

  13. Prolactin correction for adequacy of petrosal sinus cannulation may diminish diagnostic accuracy in Cushing's disease.

    PubMed

    De Sousa, Sunita M C; McCormack, Ann I; McGrath, Shaun; Torpy, David J

    2017-06-19

    Petrosal venous prolactin concentrations have been promoted to improve the diagnostic accuracy of inferior petrosal sinus sampling (IPSS), beyond that achieved with ACTH measurement alone, in diagnosing a pituitary ACTH source and determining corticotrophinoma side (L/R). Our objective was to assess the effect of using prolactin to confirm adequacy of petrosal cannulation in a cohort of patients with ACTH-dependent Cushing's syndrome. Retrospective cohort study. Thirteen patients with clinical and biochemical Cushing's syndrome who underwent IPSS. Serum prolactin and ACTH in peripheral and inferior petrosal sinus blood before and after corticotrophin-releasing hormone (CRH) injection. Thirteen consecutive patients were diagnosed with Cushing's disease using uncorrected ACTH ratios. The side of PRL excess was the same as the side of ACTH excess in all cases. Use of various published prolactin-related equations suggested that the ACTH non-dominant side was not cannulated in four, six or seven patients depending on the equation used. The equations generally decreased the central-to-peripheral gradient on the uncorrected ACTH dominant side, increased the central-to-peripheral gradient on the contralateral side and diminished or even reversed the ACTH intersinus gradient. Consistent co-lateralisation of prolactin and ACTH in IPSS strongly suggests that prolactin cannot act as an independent guide to the diagnosis and lateralisation of Cushing's disease. All patients with Cushing's disease had a prolactin intersinus gradient towards the tumourous side of the pituitary, for likely biological reasons. PRL-corrected ACTH concentrations may threaten the sensitivity and specificity of IPSS in diagnosing Cushing's disease and conceal lateralisation. © 2017 John Wiley & Sons Ltd.

  14. Sonohysterography: is the hysterosalpingographic vacuum cup a valid alternative device for cannulation of the cervical Os?

    PubMed

    Porfiri, L M; Drudi, F M; Savelli, S; de Felice, C

    2006-12-01

    To determine whether sonohysterography (SHG) should be performed with Plexiglas hysterosalpingographic vacuum cups instead of standard catheters. In a prospective setting, 226 women randomly classified into 2 groups underwent SHG. The method used for cervical cannulation was a two-way catheter in the first group (n = 108) and a Plexiglas hysterosalpingographic vacuum cup in the second one (n = 118). Diagnostic reliability, easy applicability for the physician, discomfort for the patients and cost of the instruments were assessed for both devices. 226/226 (100 %) complete sonohysterographic examinations were performed. As regards uterine cavity distension the same diagnostic reliability was reported for vacuum cups and two-way catheters. The standard catheter obscured the cervical canal because of the dilation of the balloon. Both methods were judged as easy to use, and no statistically significant difference was found as far as the time required for cervical cannulation (p > 0.05). A little more discomfort was recorded by women who underwent sonohysterography with standard balloon catheters but a greater interpersonal variability was noticed in this group (SD 3.65 vs. 1.13 in the vacuum cup group). Vacuum cups were by far the most economical devices (unit cost: 16.70 euro vs. catheter unit cost 46.20 euro). Vacuum cups allow sonohysterography to be correctly performed. As they are inexpensive, easy to use, better tolerated by the patients and more helpful for visualisation of the lower third of the uterine cavity, vacuum cups should be considered a serious alternative to standard catheters in the performance of SHG.

  15. Comparison of rates of union and hardware removal between large and small cannulated screws for calcaneal osteotomy.

    PubMed

    Sayres, Stephanie C; Gu, Yang; Kiernan, Samuel; DeSandis, Bridget Ann; Elliott, Andrew J; O'Malley, Martin J

    2015-01-01

    The calcaneal osteotomy is a common procedure to correct hindfoot malalignment. Reported union rates are high, utilizing fixation methods including staples, plates, and most commonly cannulated screws. We began our practice using 6.5 mm and 7.3 mm cannulated screws, but complaints of postoperative posterior heel pain led to hardware removal in many patients. A switch to smaller 4.5 mm cannulated screws resulted in fewer symptoms, thus we hypothesized that using a smaller screw would decrease screw removal while maintaining an equally high union rate. The records of patients who underwent a calcaneal osteotomy by 2 surgeons between January 1996 and April 2012 were retrospectively reviewed. The rates of hardware removal and union were compared between osteotomies held with two 7.3 mm, 6.5 mm, and 4.5 mm cannulated screws. There were 272 feet that met the inclusion criteria. The hardware removal rate for 130 osteotomies held with two 7.3 mm screws was 29.2% and the removal rate for 115 osteotomies held with 4.5 mm screws was 13.0%, which was significantly different (P < .05). The removal rate for 27 osteotomies with 6.5 mm screws was 33.3%. The union rate for all groups was 100%. Fixation of calcaneal osteotomies with two 4.5 mm screws is advantageous over larger screws with respect to future hardware removal. There was no loss of position from the smaller screws and we feel that the 4.5mm cannulated screw provides sufficient compression and achieves a high rate of union equal to that of the larger screws. Level IV, retrospective case series. © The Author(s) 2014.

  16. A Randomized Controlled Trial Evaluating the Efficacy of Oral Sucrose in Infants 1 to 3 Months Old Needing Intravenous Cannulation.

    PubMed

    Desjardins, Marie Pier; Gaucher, Nathalie; Curtis, Sarah; LeMay, Sylvie; Lebel, Denis; Gouin, Serge

    2016-09-01

    The objective was to compare the efficacy of an oral sucrose versus placebo in reducing pain in infants 1 to 3 months of age during intravenous (IV) cannulation in the emergency department. A randomized, double-blind, placebo clinical trial was conducted. Participants were randomly allocated to receive 2 mL of an oral 88% sucrose solution or 2 mL of a placebo solution orally. The outcome measure were mean difference in pain score at 1 minute post-IV cannulation assessed by the Face, Legs, Activity, Cry, and Consolability Pain Scale (FLACC) and the Neonatal Infant Pain Scale (NIPS), crying time, and variations in heart rate. Eighty-seven participants completed the study, 45 in the sucrose group and 42 in the placebo group. There was no statistical difference in variations in both the FLACC score (p = 0.49) and the NIPS score (p = 0.36) between the two groups as per the Mann-Whitney U-test. With the same test, median crying times following IV cannulation were statistically significantly different between both groups (17 seconds in the sucrose group vs. 41 seconds in the placebo group, p = 0.04). Mean changes in heart rate 1 minute after IV cannulation were similar in both groups (16 ± 4 beats/min for sucrose vs. 18 ± 4 beats/min for placebo, p = 0.74). Side effects were similar for both groups and no adverse events were reported. Administration of an oral sucrose solution in infants 1 to 3 months of age during IV cannulation did not lead to statistically significant changes in pain scores. However, the cry time was significantly reduced. © 2016 by the Society for Academic Emergency Medicine.

  17. An Endovascular Cannulation Needle with an Internal Wire for the Fragmentation of Thrombi in Retinal Vein Occlusion.

    PubMed

    Asami, Tetsu; Kaneko, Hiroki; Miyake, Kensaku; Ota, Ichiro; Miyake, Goichiro; Kato, Seiichi; Yasuda, Shunsuke; Iwase, Takeshi; Ito, Yasuki; Terasaki, Hiroko

    2016-09-01

    We report a newly developed device to fragment thrombi in retinal vein occlusion. The new instrument consists of a 23-gauge (G) pipe and a 37-G needle with an internal wire. A total of 40 porcine eyes were used; 20 eyes for experiments in the branch retinal vein (BRV group) and 20 eyes for experiments in the central retinal vein (CRV group). We placed 25-G 3-port trocars, and core vitrectomy was performed. Another 23-G scleral incision was performed for insertion of the needle. The needle pierced the retinal vein at a distance of three- to four- or one-disc diameters from the optic disc (BRV or CRV group, respectively), and the internal wire was advanced toward the disc. The success rates of needle piercing and cannulation of the internal wire were recorded in each group. In the CRV group, the cannulation was deemed successful when the tip reached inside the optic disc. Real-time optical coherence tomography imaging also was performed using the Zeiss Rescan 700 device in porcine eyes. Histologic examination of the retinal vessel inserted with the internal wire was performed. The success rates of needle piercing into the BRV and CRV were 85% and 95%, respectively. The success rates of cannulation of the internal wire into the BRV and CRV were 85% and 0%, respectively. The process of cannulation was recorded successfully with the Rescan 700. Histologic examination showed no damages to the endothelial cell layer. The needle and internal wire intended to be used for recanalization of BRV occlusion were successfully pierced and cannulated into the BRV. This newly developed device could become a treatment modality for retinal vein occlusion to fragment thrombi that present treatment methods cannot reach and remove directly.

  18. Vascular access cannulation in hemodialysis patients - a survey of current practice and its relation to dialysis dose.

    PubMed

    Gauly, Adelheid; Parisotto, Maria Teresa; Skinder, Aleksandra; Schoder, Volker; Furlan, Andreja; Schuh, Erika; Marcelli, Daniele

    2011-01-01

    The appropriate use of vascular access is of fundamental importance in the treatment of hemodialysis (HD) patients. This survey entailed collecting data on current practice of vascular access cannulation to assess its relation to dialysis dose. This international, multicenter, observational, cross-sectional survey was performed in 171 dialysis centers of the European dialysis network of Fresenius Medical Care in Europe and South Africa during April 2009. Practice patterns of vascular access cannulations were documented by means of a 24-item questionnaire. Dialysis dose from the documented hemodialysis treatments was derived from the clinical database EuCliD®. In total, 10,807 cannulations in hemodialysis patients with either arteriovenous fistula (91%) or arteriovenous graft (9%) were documented. For the puncture, the area technique was applied most frequently using 15G and 16G needles. Blood flow rates were mostly between 300 and 400 mL/min and adjusted to the needle size used. In two-thirds of cases the arterial needle was placed first, mostly in an antegrade direction, with an average distance to the venous needle of 7.0±3.7 cm. More than two-thirds of the cannulations were performed by nurses with more than 5 years of experience in dialysis. A logistic regression model revealed a significantly higher odds ratio to attain Kt/V = 1.2 for retrograde placement of the arterial needle, and for using needles with bigger diameter. This survey covered a broad number of countries and centers and provides information on current practice of vascular access cannulation, their effect on dialysis dose, and serves as feedback to the dialysis centers for their quality management process.

  19. An Endovascular Cannulation Needle with an Internal Wire for the Fragmentation of Thrombi in Retinal Vein Occlusion

    PubMed Central

    Asami, Tetsu; Kaneko, Hiroki; Miyake, Kensaku; Ota, Ichiro; Miyake, Goichiro; Kato, Seiichi; Yasuda, Shunsuke; Iwase, Takeshi; Ito, Yasuki; Terasaki, Hiroko

    2016-01-01

    Purpose We report a newly developed device to fragment thrombi in retinal vein occlusion. Methods The new instrument consists of a 23-gauge (G) pipe and a 37-G needle with an internal wire. A total of 40 porcine eyes were used; 20 eyes for experiments in the branch retinal vein (BRV group) and 20 eyes for experiments in the central retinal vein (CRV group). We placed 25-G 3-port trocars, and core vitrectomy was performed. Another 23-G scleral incision was performed for insertion of the needle. The needle pierced the retinal vein at a distance of three- to four- or one-disc diameters from the optic disc (BRV or CRV group, respectively), and the internal wire was advanced toward the disc. The success rates of needle piercing and cannulation of the internal wire were recorded in each group. In the CRV group, the cannulation was deemed successful when the tip reached inside the optic disc. Real-time optical coherence tomography imaging also was performed using the Zeiss Rescan 700 device in porcine eyes. Histologic examination of the retinal vessel inserted with the internal wire was performed. Results The success rates of needle piercing into the BRV and CRV were 85% and 95%, respectively. The success rates of cannulation of the internal wire into the BRV and CRV were 85% and 0%, respectively. The process of cannulation was recorded successfully with the Rescan 700. Histologic examination showed no damages to the endothelial cell layer. Conclusions The needle and internal wire intended to be used for recanalization of BRV occlusion were successfully pierced and cannulated into the BRV. Translational Relevance This newly developed device could become a treatment modality for retinal vein occlusion to fragment thrombi that present treatment methods cannot reach and remove directly. PMID:27730009

  20. Is cannulated-screw fixation an alternative to plate osteosynthesis in open book fractures? A biomechanical analysis.

    PubMed

    Lázaro Gonzálvez, Ángel; Martínez Reina, Javier; Cano Luis, Pedro; Jiménez Baquero, Juan; Sueiro Fernández, José; Giráldez Sánchez, Miguel Ángel

    2016-09-01

    The current biomechanical work compares the symphyseal and sacroiliac stability obtained with two systems of bone osteosynthesis. The two methods of fixation compared were the 6-hole suprapubic non-locked plate and pubic fixation with two cannulated screws, a novel technique that can be applied percutaneously in the clinical practice. The aim of this study was to examine the validity of the use of two-cannulated-screws osteosynthesis in order to minimize the secondary effects of open fixation, especially in patients in whom an open reduction is contraindicated. A biomechanical study was designed in 9 fresh, human pelvis specimens, simulating an AO B1.1 type injury, using both fixation systems sequentially in each specimen. In both parts of the test, the specimens were subjected to an axial load of 300N. Displacements and rotations between the different pelvic elements were studied by means of a discrete set of points. The absence of differences between the two systems has been set as the null hypothesis. There were significant differences in favor of the cross-cannulated screws in most of the displacements measured at the pubic symphysis and sacroiliac joint. Fixation of the AO B1.1 type fractures with cross cannulated screws restores the biomechanical behavior of the pubic symphysis, obtaining better stability than fixation with the 6-hole non-locked plate. To date, no comparative, biomechanical studies have been conducted with these two systems of osteosynthesis. This study demonstrates that cross-cannulated screws fixation of the pubic symphysis in AO B1.1 pelvic fractures should be considered as an alternative to the conventional plating system. © 2016 Elsevier Ltd. All rights reserved.

  1. Guide wire-a sisted cannulation versus conventional contrast to prevent pancreatitis. A systematic review and meta-analysis based on randomized control trials.

    PubMed

    de Moura, Eduardo T; de Moura, Eduardo G; Bernardo, Wanderley; Cheng, Spencer; Kondo, Andre; de Moura, Diogo T; Bravo, Jose; Artifon, Everson L

    2016-01-01

    Through this systematic review and meta-analysis, we aim to clarify the differences between these two techniques, thus improving primary success cannulation and reducing complications during endoscopic retrograde cholangiopancreatography, primarily pancreatitis. A comprehensive search was conducted to search for data available up until June2015from the most important databases available in the health field: EMBASE, MEDLINE (via PubMed), Cochrane, LILACS and CENTRAL (via BVS), SCOPUS, the CAPES database (Brazil), and gray literature. Nine randomized clinical trialsincluding2583 people were selected from20,198 studies for meta-analysis. Choledocholithiasis had been diagnosed in mostly (63.8%) of the patients, who were aged an average of 63.15 years. In those patients treated using the guide wire-assisted cannulation technique, provided a significantly lower instance of pancreatitis (RD=0.03; 95% CI: 0.01-0.05; I2= 45%) and greater primary success cannulation (RD=0.07; 95% CI: 0.03-0.12; I2=12%) than conventional contrast cannulation. The guide wire-assisted technique, when compared to the conventional contrast technique, reduces the risk of pancreatitis and increases primary success cannulation rate. Thus, guide wire-assisted cannulation appears to be the most appropriate first-line cannulation technique.

  2. Perceived Difficulty and Success Rate of Standard Versus Ultrasound-Guided Peripheral Intravenous Cannulation in a Novice Study Group: A Randomized Crossover Trial.

    PubMed

    Vitto, Michael J; Myers, Melissa; Vitto, Christina M; Evans, David P

    2016-05-01

    To our knowledge, no previous studies have evaluated the perceived levels of difficulty between traditional and ultrasound (US)-guided peripheral intravenous (IV) access in the novice provider. We attempt to show that, in a group of medical students who have limited peripheral IV experience, US-guided peripheral IV cannulation can be achieved more effectively and with a lesser degree of difficulty than standard peripheral IV cannulation. We performed a randomized crossover study of 61 first- and second-year medical students. After a 1-hour training session, participants were randomized to either standard cannulation on a standard peripheral IV trainer or US-guided cannulation on a standard US IV trainer. One hundred percent (61 of 61) of the participants in the US-guided IV group successfully achieved cannulation versus 56% (34 of 61) of the participants in the standard IV group (P < .001). The average number of attempts to obtain access in the US-guided IV group was 1.31 versus 2.16 in the standard IV group (P < .001). The average difficulty score assigned to US-guided cannulation was 2.81 of 10 versus 3.90 of 10 in the standard IV group (P = .003). Our study shows a decrease in perceived difficulty and a concomitant increased ability to cannulate a vein using US versus traditional landmark guidance techniques, even in the novice phlebotomist. © 2016 by the American Institute of Ultrasound in Medicine.

  3. Effect of ultrasonography and fluoroscopic guidance on the incidence of complications of cannulation in extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a retrospective observational study.

    PubMed

    Kashiura, Masahiro; Sugiyama, Kazuhiro; Tanabe, Takahiro; Akashi, Akiko; Hamabe, Yuichi

    2017-01-06

    It remains unclear which cannulation method is best in cases of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest. We assessed the effect of ultrasound- and fluoroscopy-guided percutaneous cannulation on complication incidence, compared with that using only ultrasound guidance. This single-center retrospective observational study was conducted between February 2011 and December 2015. In the comparison group, cannulation was performed percutaneously using only ultrasound guidance. In the exposure group, cannulation was performed percutaneously using fluoroscopy and ultrasound guidance. The primary outcome assessed was whether complications were associated with cannulation. The secondary outcome assessed was the duration from hospital arrival to extracorporeal circulation start. In addition to univariate analysis, multivariate logistic-regression analysis for cannulation complications was performed to adjust for several presumed confounders. Of the patients who underwent ECPR, 73 were eligible; the comparison group included 50 cases and the exposure group included 23 cases. Univariate analysis showed that the complication incidence of the exposure group was significantly lower than that of the comparison group (8.7 vs. 36.0%, p = 0.022). Duration from hospital arrival to extracorporeal circulation start was almost the same in both groups (median, 17.0 min vs. 17.0 min, p = 0.92). After multivariate logistic regression analysis, cannulation using fluoroscopy and ultrasound was independently associated with a lower complication incidence (adjusted odds ratio, 0.14; p = 0.024). Ultrasound- and fluoroscopy-guided cannulation may reduce the complication incidence of cannulation without delaying extracorporeal circulation start.

  4. The VeinViewer vascular imaging system worsens first-attempt cannulation rate for experienced nurses in infants and children with anticipated difficult intravenous access.

    PubMed

    Szmuk, Peter; Steiner, Jeffrey; Pop, Radu B; Farrow-Gillespie, Alan; Mascha, Edward J; Sessler, Daniel I

    2013-05-01

    The VeinViewer (Luminetx, Memphis, TN) helps identify veins by projecting an image of subcutaneous vasculature on the skin surface. We tested the primary hypothesis that VeinViewer use improves cannulation success by skilled nurses in pediatric patients with anticipated difficult IV access. A secondary goal was to evaluate the relationship between obesity and cannulation success. Patients aged 0 to 18 years were included. Anticipated cannulation difficulty was evaluated with the difficult IV access score. All cannulations were performed by members of the Intravenous Access Team. Patients were randomized to: (1) routine IV catheter insertion; or (2) insertion facilitated by the VeinViewer. The primary outcome was first-attempt insertion success. The proportion of successful insertions was evaluated using Cochran-Mantel-Haenszel χ(2) analysis to adjust for any imbalanced baseline variables. The effect of obesity on cannulation success was evaluated with multivariable logistic regression. Two hundred ninety-nine patients (49%) were randomly assigned to VeinViewer and 301 (51%) to routine cannulation. First-attempt cannulation success was 47% in patients assigned to VeinViewer vs 62% in patients assigned to routine cannulation, with an adjusted relative "risk" (95% confidence interval), of 0.76 (0.63-0.91). The Z-statistic of -3.6 crossed the "harm" boundary (Z < -2.41), with corresponding P value of 0.0003. The trial was stopped on statistical grounds since the harm boundary for the primary outcome was crossed. There was no association between first-attempt success and the 4-level categorization of obesity after adjusted for baseline variables (P = 0.94). The VeinViewer worsened first-attempt IV insertion success by skilled nurses. Surprisingly, first-attempt success for IV cannulation was not worsened by obesity.

  5. Double-guidewire technique in difficult biliary cannulation for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis.

    PubMed

    Tse, Frances; Yuan, Yuhong; Moayyedi, Paul; Leontiadis, Grigorios I; Barkun, Alan N

    2017-01-01

    Background and study aims Difficult cannulation is a risk factor for pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). The double-guidewire technique (DGT) may improve cannulation success and reduce the risk of post-ERCP pancreatitis (PEP) in patients with difficult cannulation. This systematic review compared the DGT with persistent conventional cannulation or other advanced techniques in patients with difficult cannulation. Patients and Methods CENTRAL, MEDLINE, EMBASE, and CINAHL databases and DDW and UEGW abstracts up to March 2016 were searched for randomized controlled trials (RCTs) comparing DGT with persistent conventional cannulation or other advanced techniques (precut, pancreatic duct [PD] stenting). The primary outcome was PEP. Secondary outcomes included severity of PEP, successful cannulation of the common bile duct (CBD) with the randomized technique, overall CBD cannulation success, and ERCP-related complications. Results 7 RCTs (577 patients) were included. Use of the DGT significantly increased PEP compared to other endoscopic techniques (risk ratio [RR] 1.98, 95 % confidence interval [95 %CI] 1.14 - 3.42). There was no significant difference in CBD cannulation success with the randomized technique (RR 1.04, 95 %CI 0.87 - 1.24) or in overall cannulation success (RR 1.04, 95 %CI 0.91 - 1.18) between DGT and other techniques. There was also no significant difference in the risk of other ERCP-related complications (bleeding, perforation, cholangitis, and mortality). The results were robust in sensitivity analyses. Conclusions In patients with difficult cannulation, sole use of the DGT appears to increase the risk of PEP without any superiority in achieving biliary cannulation compared to other techniques. PD stenting may reduce the risk of PEP when the DGT is used. The influence of co-intervention in the form of per-procedural nonsteroidal anti-inflammatory drug (NSAID) administration is unclear

  6. Endoscopic ultrasound-guided biliary access versus precut papillotomy in patients with failed biliary cannulation: a retrospective study.

    PubMed

    Lee, Alexander; Aditi, Anupam; Bhat, Yasser M; Binmoeller, Kenneth F; Hamerski, Chris; Sendino, Oriol; Kane, Steve; Cello, John P; Day, Lukejohn W; Mohamadnejad, Medi; Muthusamy, V Raman; Watson, Rabindra; Klapman, Jason B; Komanduri, Sri; Wani, Sachin; Shah, Janak N

    2017-02-01

    Background and aims Precut papillotomy is widely used after failed biliary cannulation. Endoscopic ultrasound (EUS)-guided biliary access techniques are newer methods to facilitate access and therapy in failed cannulation. We evaluated the impact of EUS-guided biliary access on endoscopic retrograde cholangiopancreatography (ERCP) success and compared these techniques to precut papillotomy. Patients and methods We retrospectively compared two ERCP cohorts. One cohort consisted of biliary ERCPs (n = 1053) attempted in patients with native papillae and surgically unaltered anatomy in whom precut papillotomy and/or EUS-guided biliary access were routinely performed immediately after failed cannulation. This cohort was compared with a similar ERCP cohort (n = 1062) in which only precut papillotomy was available for failed cannulation. The following outcomes were compared: conventional cannulation success, rates of attempted advanced access techniques (precut or EUS), precut success, EUS-guided biliary access success, and ERCP failure rates. Results Although conventional cannulation success, rates of attempted advanced access technique (precut or EUS), and precut success were similar, the ERCP failure rate was lower when both EUS-guided biliary access and precut were available (1.0 % [95 % confidence interval (CI) 0.4 - 1.6]), compared with when only precut was possible for failed access (3.6 % [95 %CI 2.5 - 4.7]; P < 0.001). Success for EUS-guided biliary access (95.1 % [95 %CI 89.7 - 100]) was significantly higher than for precut (75.3 % [95 %CI 68.2 - 82.4]; P < 0.001), and mainly due to superiority in malignant obstruction (93.5 % vs. 64 %; P < 0.001). Conclusions EUS-guided biliary access decreases the rate of therapeutic biliary ERCP failure. Our results support the use of EUS-guided biliary access to optimize single-session ERCP success. In experienced hands, these techniques appear as effective, if

  7. Unrecognised guide wire migration during internal jugular cannulation and its retrieval--a case report.

    PubMed

    Adenekan, A T; Onakpoya, U U; Faponle, A F; Olateju, S O

    2013-03-01

    The objective of this article is to report a case of unrecognised missed guide wire diagnosed two months after right internal jugular cannulation and which was successfully retrieved from the right femoral vein. The case record of a patient that had retained intravenous guide wire was reviewed with relevant literature. A 40-yr-old female had an emergency left thoracotomy on account of haemorrhagic pleural effusion. A right internal jugular central venous catheter (CVC) insertion was performed for resuscitation and haemodynamic monitoring before induction of anaesthesia. A follow-up thoraco-abdominal Computed tomography (CT) scan taken after 8 weeks showed a pigtail intravascular metallic foreign body traversing the distal superior vena cava, right atrium, inferior vena cava, and ending at the right femoral vein. The guide wire was successfully removed via a right femoral venotomy under local anaesthesia. Intravascular loss of a guide wire is a rare complication of CVC insertion. If basic precautionary measures were taken, the loss of guide wire would have been avoided.

  8. Duration of Venodilation for Peripheral Intravenous Cannulation, as Induced by a Thermal Stimulus on the Forearm.

    PubMed

    Tokizawa, Yuki; Tsujimoto, Tomomi; Inoue, Tomoko

    2017-03-01

    Application of a thermal stimulus is a common procedure used to promote venodilation for peripheral intravenous cannulation (PIVC); however, the effects of thermal stimulation on the duration of venodilation and skin temperature of the forearm are unclear. To investigate the duration of venodilation induced by a thermal stimulus on the forearm. Healthy female adults ( N = 40) from Japan participated in this study from November to December 2013. A heat pack was warmed to 40°C ± 2°C and placed over the forearm for 15 min. Vein diameter was measured via ultrasound and skin temperature via temperature sensor at six time points: before application of the thermal stimulus and at 1-min intervals for 5 min upon removal of the thermal stimulus. The main outcomes were vein diameter, proportional change in vein diameter, and skin temperature. We calculated proportional change in vein diameter after application of the thermal stimulus using vein diameter before the thermal stimulus to represent 100%. Compared with vein diameter before thermal stimulus, the diameter at each time point after thermal stimulus was significantly increased ( p < .05) as were proportional change in vein diameter ( p < .05) and skin temperature. A thermal stimulus of 40°C ± 2°C on the forearm dilated veins significantly for PIVC, and the effect persisted for at least 5 min.

  9. Management of Cannulated Screw Failure and Recurrent SCFE Displacement – Case Report

    PubMed Central

    Jacobson, Nathan A; Feierabend, Siegfried P; Lee, Christopher L

    2014-01-01

    Introduction: SCFE occurs in 10 per 100,000 in some regions of the United States with the incidence continuing to increase. Percutaneous screw fixation is a well-accepted treatment for this disorder for over 20 years but management of complications is not well elucidated in the literature. Case Report: We describe a case where a traumatic unstable SCFE that was initially treated with closed reduction and fixation with a single transphyseal screw went on to hardware failure with recurrence of the deformity. The complication was successfully treated with closed reduction and re-cannulating the fractured screw within the epiphysis and extracting it using a conical extraction screw commonly referred to as an “easy out.” Three trans physeal screws were then placed for improved fixation strength. Follow-up at 9 months demonstrates a fused physis and no signs of avascular necrosis of the femoral head. Conclusion: Percutaneous management of SCFE screw breakage is possible utilizing specialized instruments and a precise and gentle manipulation preventing the need for more invasive treatments with their obligatory potential complications profile. PMID:27298941

  10. Multiple venous thrombosis complicating central venous cannulation in a non cancer patient - a case report.

    PubMed

    Peters, Ce; Menkiti, Id; Desalu, I; Thomas, Mo

    2013-01-01

    Central venous catheterization is a common procedure for critically ill patients. Like all procedures, it has its complications, one of which is thrombosis. Reports of thrombosis are commoner among cancer patients. We present a 37 year old non cancer patient who developed thrombi in both right and left internal jugular veins, 10 and 13 days respectively after insertion of central venous catheter. This was detected by ultrasound scans of the neck while attempting re-cannulation for parenteral feeding. She also had left lower limb deep venous thrombosis, confirmed by doppler scan, which was managed with low molecular weight heparin and warfarin. The patient was subsequently treated with streptokinase. A repeat scan of the internal jugular veins 4 days after thrombolysis revealed a reduction in size of the thrombi. Symptoms of deep venous thrombosis improved and she was transferred to the wards where she made remarkable improvement. This case illustrates the potential usefulness of ultrasound guided-central line insertion in patients who have had central venous lines inserted previously in order to detect thrombi.

  11. Veno-arterial extracorporeal membrane oxygenation: an overview of different cannulation techniques

    PubMed Central

    Banfi, Carlo; Pozzi, Matteo; Brunner, Marie-Eve; Rigamonti, Fabio; Murith, Nicolas; Mugnai, Damiano; Obadia, Jean-Francois; Bendjelid, Karim

    2016-01-01

    Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has known a widespread application over the last decade and is now an effective and valuable therapeutic option in refractory cardiogenic shock of various etiologies. In this subgroup of critically ill and unstable patients in cardiogenic shock, VA-ECMO allows, on the one hand, temporary hemodynamic stabilization with improvement of end-organ function and, on the other hand, gives the time to perform complementary diagnostic exams and to decide the therapeutic strategy in these high-risk candidates for immediate long-term mechanical circulatory support (MCS) implantation. VA-ECMO could also be suggested as a rescue therapeutic option for refractory cardiac arrest. It showed promising results in the specific setting of in-hospital cardiac arrest and survival rates with good neurological outcome are reported between 20% and 40%. Conversely, there are contrasting data in the literature about survival after VA-ECMO for out-of-hospital cardiac arrest, as results are highly dependent on low-flow time. The aim of the present report is to offer an overview of different cannulation techniques of VA-ECMO. PMID:27747024

  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. Improving arteriovenous fistula patency: Transdermal delivery of diclofenac reduces cannulation-dependent neointimal hyperplasia via AMPK activation.

    PubMed

    MacAskill, Mark G; Watson, David G; Ewart, Marie-Ann; Wadsworth, Roger; Jackson, Andrew; Aitken, Emma; MacKenzie, Graeme; Kingsmore, David; Currie, Susan; Coats, Paul

    2015-08-01

    Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the modality of choice. However neointimal hyperplasia and loss of the luminal compartment result in AVF patency rates of ~60% at 12months. The exact cause of neointimal hyperplasia in the AVF is poorly understood. Vascular trauma has long been associated with hyperplasia. With this in mind in our rabbit model of AVF we simulated cannulation autologous to that undertaken in vascular access procedures and observed significant neointimal hyperplasia as a direct consequence of cannulation. The neointimal hyperplasia was completely inhibited by topical transdermal delivery of the non-steroidal anti-inflammatory (NSAID) diclofenac. In addition to the well documented anti-inflammatory properties we have identified novel anti-proliferative mechanisms demonstrating diclofenac increases AMPK-dependent signalling and reduced expression of the cell cycle protein cyclin D1. In summary prophylactic transdermal delivery of diclofenac to the sight of AVF cannulation prevents adverse neointimal hyperplasic remodelling and potentially offers a novel treatment option that may help prolong AVF patency and flow rates. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Improving arteriovenous fistula patency: Transdermal delivery of diclofenac reduces cannulation-dependent neointimal hyperplasia via AMPK activation

    PubMed Central

    MacAskill, Mark G.; Watson, David G.; Ewart, Marie-Ann; Wadsworth, Roger; Jackson, Andrew; Aitken, Emma; MacKenzie, Graeme; Kingsmore, David; Currie, Susan; Coats, Paul

    2015-01-01

    Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the modality of choice. However neointimal hyperplasia and loss of the luminal compartment result in AVF patency rates of ~ 60% at 12 months. The exact cause of neointimal hyperplasia in the AVF is poorly understood. Vascular trauma has long been associated with hyperplasia. With this in mind in our rabbit model of AVF we simulated cannulation autologous to that undertaken in vascular access procedures and observed significant neointimal hyperplasia as a direct consequence of cannulation. The neointimal hyperplasia was completely inhibited by topical transdermal delivery of the non-steroidal anti-inflammatory (NSAID) diclofenac. In addition to the well documented anti-inflammatory properties we have identified novel anti-proliferative mechanisms demonstrating diclofenac increases AMPK-dependent signalling and reduced expression of the cell cycle protein cyclin D1. In summary prophylactic transdermal delivery of diclofenac to the sight of AVF cannulation prevents adverse neointimal hyperplasic remodelling and potentially offers a novel treatment option that may help prolong AVF patency and flow rates. PMID:25866325

  15. Robot-assisted retinal vein cannulation with force-based puncture detection: Micron vs. the steady-hand eye robot.

    PubMed

    Gonenc, Berk; Tran, Nhat; Gehlbach, Peter; Taylor, Russell H; Iordachita, Iulian

    2016-08-01

    Retinal vein cannulation is a demanding procedure where therapeutic agents are injected into occluded retina veins. The feasibility of this treatment is limited due to challenges in identifying the moment of venous puncture, achieving cannulation and maintaining it throughout the drug delivery period. In this study, we integrate a force-sensing microneedle with two distinct robotic systems: the handheld micromanipulator Micron, and the cooperatively controlled Steady-Hand Eye Robot (SHER). The sensed tool-to-tissue interaction forces are used to detect venous puncture and extend the robots' standard control schemes with a new position holding mode (PHM) that assists the operator hold the needle position fixed and maintain cannulation for a longer time with less trauma on the vasculature. We evaluate the resulting systems comparatively in a dry phantom, stretched vinyl membranes. Results have shown that modulating the admittance control gain of SHER alone is not a very effective solution for preventing the undesired tool motion after puncture. However, after using puncture detection and PHM the deviation from the puncture point is significantly reduced, by 65% with Micron, and by 95% with SHER representing a potential advantage over freehand for both.

  16. Revision rates and cumulative financial burden in patients treated with hemiarthroplasty compared to cannulated screws after femoral neck fractures.

    PubMed

    Shields, Edward; Kates, Stephen L

    2014-12-01

    This study compares re-operation rates and financial burden following the treatment of femoral neck fractures treated with hemiarthroplasty compared to non-displaced femoral neck fractures treated with cannulated screws. Data was retrospectively analyzed from a prospective database at a university hospital setting on patients undergoing hemiarthroplasty after femoral neck fractures and those with non-displaced femoral neck fractures treated with cannulated screws over a 7-year period. Re-operation rates were determined and financial data was analyzed. Charges refer to amounts billed by the hospital to insurance carriers, while costs refer to financial burden carried by the hospital during treatment. There were 491 femoral neck fractures (475 patients) that underwent hemiarthroplasty (HA) and 120 non-displaced fractures (119 patients) treated with cannulated screw (CannS) fixation. Both groups had similar age, sex, Charlson co-morbidity scores, pre-operative Parker mobility scores, and 12-month mortality. There were 29 (5.9 %) reoperations in the HA group and 16 (13.3 %) in the CannS group (P = 0.007). The majority of re-operations occurred within 12 months for both groups [21/29 (72 %) HA group; 15/16 (94 %) CannS group; P = 0.13]. Average hospital charges per patient for the index procedure were higher in the HA group ($17,880 ± 745) compared to the CannS group ($14,104 ± 5,047; P < 0.001). After accounting for additional procedures related to their initial surgical fixation, average hospital charges and costs remained higher in the HA group. Patients treated with hemiarthroplasty for femoral neck fractures have lower re-operation rates than patients treated with cannulated screws for non-displaced femoral neck fractures, with 80 % of re-operations occurring in the first 12 months. Hospital charges and costs to the hospital for treating patients undergoing hemiarthroplasty were higher than patients treated with cannulated screws for the index procedure alone

  17. Effectiveness of IV Cannulation Skills Laboratory Training and Its Transfer into Clinical Practice: A Randomized, Controlled Trial

    PubMed Central

    Lund, Frederike; Schultz, Jobst-Hendrik; Maatouk, Imad; Krautter, Markus; Möltner, Andreas; Werner, Anne; Weyrich, Peter; Jünger, Jana; Nikendei, Christoph

    2012-01-01

    Background The effectiveness of skills laboratory training is widely recognized. Yet, the transfer of procedural skills acquired in skills laboratories into clinical practice has rarely been investigated. We conducted a prospective, randomised, double-blind, controlled trial to evaluate, if students having trained intravenous (IV) cannulation in a skills laboratory are rated as more professional regarding technical and communication skills compared to students who underwent bedside teaching when assessed objectively by independent video assessors and subjectively by patients. Methodology and Principal Findings 84 volunteer first-year medical students were randomly assigned to one of two groups. Three drop-outs occurred. The intervention group (IG; n = 41) trained IV cannulation in a skills laboratory receiving instruction after Peyton's ‘Four-Step Approach’. The control group (CG; n = 40) received a bedside teaching session with volunteer students acting as patients. Afterwards, performance of IV cannulation of both groups in a clinical setting with students acting as patients was video-recorded. Two independent, blinded video assessors scored students' performance using binary checklists (BC) and the Integrated Procedural Protocol Instrument (IPPI). Patients assessed students' performance with the Communication Assessment Tool (CAT) and a modified IPPI. IG required significantly shorter time needed for the performance on a patient (IG: 595.4 SD(188.1)s; CG: 692.7 SD(247.8)s; 95%CI 23.5 s to 45.1 s; p = 0.049) and completed significantly more single steps of the procedure correctly (IG: 64% SD(14) for BC items; CG: 53% SD(18); 95%CI 10.25% to 11.75%; p = 0.004). IG also scored significantly better on IPPI ratings (median: IG: 3.1; CG: 3.6; p = 0.015;). Rated by patients, students' performance and patient-physician communication did not significantly differ between groups. Conclusions Transfer of IV cannulation-related skills acquired in a

  18. First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis.

    PubMed

    Bond, Mary; Crathorne, Louise; Peters, Jaime; Coelho, Helen; Haasova, Marcela; Cooper, Chris; Milner, Quentin; Shawyer, Vicki; Hyde, Christopher; Powell, Roy

    2016-10-01

    Peripheral venous cannulation is an everyday practice in hospitals, which many adults find painful. However, anaesthesia for cannulation is usually only offered to children. Inadequate pain relief is not only unpleasant for patients but may cause anxiety about further treatment and deter patients from seeking medical care in the future. The aim of this study is to discover the most effective local anaesthetic for adult peripheral venous cannulation and to find out how the pain of local anaesthetic application compares with that of unattenuated cannulation. These aims are addressed through a systematic review, network meta-analysis and random-effects meta-analysis. Searching covered 12 databases including MEDLINE and EMBASE from 1990 to August 2015. The main included study design was RCTs. The primary outcome measure is self-reported pain, measured on a 100 mm visual analogue scale. The systematic review found 37 includable studies, 27 of which were suitable for network meta-analysis and two for random-effects meta-analysis. The results of the network meta-analysis indicate that none of the 17 anaesthetic considered had a very high probability of being the most effective when compared to each other; 2 % lidocaine had the highest probability (44 %). When the anaesthetics were compared to no treatment, the network meta-analysis showed that again 2 % lidocaine was estimated to be the most effective (mean difference -25.42 (95 % CI -32.25, -18.57). Other members of the 'caine' family were also estimated to be more effective than no treatment as were Ametop(®), EMLA(®) and Rapydan(®) patch. The meta-analysis compared the pain of anaesthetic application with the unattenuated pain of cannulation. This found that all applications of local anaesthetic were less painful than cannulation without local anaesthetic. In particular a 1 % lidocaine injection was estimated to be -12.97 (95 % CI -15.71, -10.24) points (100 mm VAS) less painful than unattenuated cannulation

  19. Axillo-iliac arteriovenous hemodialysis graft creation with an early cannulation device.

    PubMed

    Hinojosa, Carlos A; Anaya-Ayala, Javier E; Lopez-Mendez, Alejandra; Gomez-Arcive, Zeniff; Laparra-Escareno, Hugo; Cuen-Ojeda, Cesar; Lizola, Rene; Torres-Machorro, Adriana

    2017-03-01

    Exhaustion of superficial veins coupled with the presence of intrathoracic central venous occlusions remains a significant obstacle for hemodialysis access creation; complex arteriovenous graft (AVG) configurations have been described. The axillary-iliac AVG was first reported in 1987, and few authors have explored this access. We evaluated our experience with this AVG configuration utilizing the early cannulation (EC) graft Flixene™ (Atrium ™, Hudson, NH, USA). Eight patients (75 % men; mean age 37 ± 10 years) with End-Stage Renal Disease (ESRD) underwent axillo-iliac AVG creation with Flixene™ grafts; all had exhausted peripheral veins, occluded thoracic central veins, and inadequate femoral veins. Inflow from the axillary artery and outflow in iliocaval system was assessed prior to access creation. An axillary-to-common iliac AVG was constructed using a 6 mm (mm) EC graft and tunneled in the chest and abdominal wall. Eight grafts were implanted; all were patent after placement. Seven (88 %) were successfully used for hemodialysis within 72 h and one (12 %) within 96. During the mean follow-up of 6 months, 5 (62 %) patients underwent thrombectomy, 1 (12 %) of them had balloon angioplasty at the vein anastomosis, and 2 (25 %) grafts were removed secondary to infection. The remaining grafts are still functioning. Complications as high-output heart failure, steal syndrome and venous hypertension were not observed. Construction of axillo-iliac AVG with EC grafts in the setting of exhausted veins, occluded intrathoracic central veins and hostile groins, is a viable arteriovenous access alternative while avoiding central venous catheters.

  20. Comparison of cannulated screws versus compression staples for subtalar arthrodesis fixation.

    PubMed

    Herrera-Pérez, Mario; Andarcia-Bañuelos, Cesar; Barg, Alexej; Wiewiorski, Martin; Valderrabano, Victor; Kapron, Ashley L; De Bergua-Domingo, Josep Maria; Pais-Brito, Jose Luis

    2015-02-01

    Different fixation techniques have been described in the literature for isolated subtalar arthrodesis (ISA). The purpose of this study was to compare the fusion rate and clinical outcome of ISA using cannulated compression screws or compression staples. Thirty-three patients (33 feet) underwent ISA using screw (17 feet) or staples (16 feet) fixation. Patients were followed for 42.7 ± 16.4 months (range, 24.5-84.3 months). The subtalar fusion was assessed radiographically and clinically. Clinical outcome measures included the visual analog scale (VAS) for pain and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. The average pain score decreased significantly from 6.4 ± 1.1 (range, 5-9) to 0.8 ± 1.3 (range, 0-4) (P < .001). In the screws group, the average AOFAS hindfoot score increased significantly from 54.6 ± 8.8 (range, 37-67) preoperatively to 86.1 ± 7.1 (range, 71-91) postoperatively (P < .001). In the staples group, the average AOFAS hindfoot score increased significantly from 53.4 ± 11.1 (range, 33-69) preoperatively to 83.4 ± 6.9 (range, 71-91) postoperatively (P < .001). The AOFAS hindfoot score was comparable in both groups (P = .149). Only the AOFAS hindfoot score function subgroup in the screw fixation was significantly higher than in the staples fixation group (P = .005). There were 4 cases of nonunion at the site of subtalar arthrodesis (2 from screws group, 2 from staples group). The complication rate was comparable in both groups. The fusion rate was comparable in both groups, while the postoperative functional outcome was significantly better in the screw fixation group. Level III, retrospective comparative cohort study. © The Author(s) 2014.

  1. Impact of radial artery cannulation for coronary angiography and angioplasty on radial artery function.

    PubMed

    Burstein, Jason M; Gidrewicz, Dominica; Hutchison, Stuart J; Holmes, Kate; Jolly, Sanjit; Cantor, Warren J

    2007-02-15

    The radial artery is commonly used as a conduit in coronary artery bypass grafting. No data exist on the effects of radial sheath insertion on radial artery function. Because many patients considered for coronary artery bypass grafting have had previous radial procedures, it is important to understand any effects radial sheath insertion may have on radial artery function. Twenty-two patients who underwent elective coronary angiography or angioplasty with a 6Fr sheath through the right radial artery were studied. Radial artery function was assessed using ultrasound to measure flow-mediated dilation (FMD). Reactive hyperemia was produced by 5-minute cuff inflation on the arm to suprasystolic pressures. Radial artery diameter was measured at rest and 1 minute after cuff deflation. FMD was expressed as percent change in radial diameter compared with at rest. In all cases, the left radial artery was studied as a control. Patients were studied before sheath insertion, immediately after sheath insertion, and 6 weeks after sheath insertion. The FMD of the cannulated arm was 13.2% before sheath insertion versus 3.6% immediately after sheath insertion (p <0.01) and 0.2% (p <0.01) 9 weeks after sheath insertion. In contrast, there were no significant changes in the noncannulated arm at either time point. In conclusion, radial artery sheath insertion for coronary angiography or angioplasty results in immediate and persistent blunting of FMD, suggesting severe vasomotor dysfunction. Radial artery sheath insertion has important effects on radial artery function that must be considered when selecting radial conduits for coronary artery bypass grafting.

  2. Newborn aortic arch reconstruction with descending aortic cannulation improves postoperative renal function.

    PubMed

    Hammel, James M; Deptula, Joseph J; Karamlou, Tara; Wedemeyer, Elesa; Abdullah, Ibrahim; Duncan, Kim F

    2013-11-01

    A clinically driven transition in perfusion technique occurred at Children's Hospital and Medical Center, Omaha, Nebraska, from primarily selective cerebral perfusion bracketed by brief periods of deep hypothermic circulatory arrest to a technique of dual arterial perfusion including innominate artery and descending aortic cannulation (DAC), with continuous mildly hypothermic (>30 °C) full-flow cardiopulmonary bypass to the entire body. This study retrospectively compared outcomes in a recent cohort of neonates undergoing aortic arch reconstruction with the two techniques. The clinical records of 142 consecutive neonates undergoing operations involving aortic arch reconstruction at a single institution between April 2004 and September 2012 were reviewed. Renal function changes were graded according to the pediatric RIFLE score (based on risk, injury, failure, loss, and end-stage kidney disease). Sixteen patients, 8 supported with selective cerebral perfusion bracketed by brief periods of deep hypothermic circulatory arrest and 8 with DAC, required immediate postoperative extracorporeal membrane oxygenation and were excluded from renal function analysis. Multivariable regression models evaluated predictors of pediatric RIFLE score. Patients with DAC had shorter median bypass support (113 versus 172 minutes; p < 0.001) and myocardial ischemic time (43 versus 81 minutes; p < 0.001). Patients with DAC had less median fluid gain at 24 hours (37 versus 69 mL/kg; p < 0.001), and lower incidence of acute kidney injury (5% versus 31%; p < 0.001). Fewer patients with DAC (31% versus 58%; p = 0.001) required open chest. Use of selective cerebral perfusion bracketed by brief periods of deep hypothermic circulatory arrest, single-ventricular physiology, and aortic cross-clamp time were found to be multivariable predictors of serious kidney dysfunction. Multisite arterial perfusion, including DAC, and maintenance of continuous mildly hypothermic full-flow cardiopulmonary bypass

  3. Kumar versus Olsen cannulation technique for intraoperative cholangiography: a randomized trial.

    PubMed

    Buddingh, K Tim; Bosma, Ben M; Samaniego-Cameron, Brenda; ten Cate Hoedemaker, Henk O; Hofker, H Sijbrand; van Dam, Gooitzen M; Ploeg, Rutger J; Nieuwenhuijs, Vincent B

    2013-03-01

    There is resistance to routine intraoperative cholangiography (IOC) during cholecystectomy because it prolongs surgery and may be experienced as cumbersome. An alternative instrument may help to reduce these drawbacks and lower the threshold for IOC. This trial compared the Kumar cannulation technique to the more commonly used Olsen clamp for IOC (KOALA trial; Dutch Trial Register NTR2582). Patients undergoing elective laparoscopic cholecystectomy were randomized between IOC using the Kumar clamp and the Olsen clamp. Primary end points were the time that the IOC procedure took and its perceived ease as measured on a visual analog scale from 0 (impossible) to 10 (effortless). To detect a difference of 33 % in IOC time, a total sample size of 40 patients was required. Fifty-nine patients were randomized. Nine were excluded because of conversion to open cholecystectomy before the IOC procedure. Twenty-eight patients underwent IOC with the Kumar clamp and 22 with the Olsen clamp. The success rate was 23 (82.1 %) of 28 for the Kumar clamp and 19 (86.4 %) of 22 for the Olsen clamp (p > 0.999). The mean IOC time was 10 min 27 s ± 6 min 17 s using the Kumar clamp and 11 min 34 s ± 7 min 27 s using the Olsen clamp (p = 0.537). Surgeons graded the ease of the Kumar clamp as 6.8 ± 2.7 and the Olsen clamp as 6.8 ± 2.1 (p = 0.977). IOC using the Kumar clamp was neither faster nor easier than using the Olsen clamp. Both clamps facilitated IOC in just over 10 min. Individual surgeon preference should dictate which clamp is used.

  4. Selective cerebral perfusion with aortic cannulation and short-term hypothermic circulatory arrest in aortic arch reconstruction.

    PubMed

    Turkoz, R; Saritas, B; Ozker, E; Vuran, C; Yoruker, U; Balci, S; Altun, D; Turkoz, A

    2014-01-01

    The deep hypothermic circulatory arrest (DHCA) technique has been used in aortic arch and isthmus hypoplasia for many years. However, with the demonstration of the deleterious effects of prolonged DHCA, selective cerebral perfusion (SCP) has started to be used in aortic arch repair. For SCP, perfusion via the innominate artery route is generally preferred (either direct innominate artery cannulation or re-routing of the cannula in the aorta is used). Herein, we describe our technique and the result of arch reconstruction in combination with selective cerebral and myocardial perfusion (SCMP) and short-term total circulatory arrest (TCA) (5-10 min) through ascending aortic cannulation. Thirty-seven cases with aortic arch and isthmus hypoplasia accompanying cardiac defects were operated on with SCMP and short TCA in Baskent University Istanbul Research and Training Hospital between January 2007 and Sep 2012. There were 17 cases with ventricular septal defect (VSD)-coarctation with aortic arch hypoplasia (CoAAH), 4 cases of transposition of the great arteries-VSD-CoAAH, 4 cases of Taussing Bing Anomaly-CoAAH, 2 cases complete atrioventricular canal defect-CoAAH, 3 cases single ventricle-CoAAH, 3 cases of type A interruption-VSD, 2 subvalvular aortic stenosis-CoAAH and 2 cases of isolated CoAAH. The aorta was cannulated in the middle of the ascending aorta in all cases. The cross-clamp was applied to the aortic arch distal to either the innominate artery or the left carotid artery. In addition, a side-biting clamp was applied to the descending aorta. The aorta between these two clamps was reconstructed with gluteraldehyde-treated autogeneous pericardium, using SCMP. The proximal arch and distal ascending aorta reconstructions were carried out under short TCA. The mean age of the patients was 2.5 ± 2 months. The mean cardiopulmonary bypass and cross-clamp times were 144 ± 58 and 43 ± 27 minutes, respectively. The mean SCMP and descending aorta ischemia times were 22

  5. Massive hemothorax due to subclavian vein tear during internal jugular vein cannulation in a 15-year-old boy scheduled for mitral valve replacement

    PubMed Central

    Mishra, Sandeep Kumar; Paulose, Deepak; Kundra, Pankaj; Parida, Satyen

    2015-01-01

    We present an unusual case of life-threatening hemothorax in a 15-year-old boy following subclavian vein tear during internal jugular vein (IJV) cannulation prior to initiation of surgery (mitral valve replacement). Successful IJV cannulation was done in the third attempt. However, we missed the subclavian tear which occurred during the first two initial attempts as there was no clinical evidence suggestive of it at that point of time. This undiagnosed hemothorax led to hemodynamic decompensation requiring high volume and inotropic support to wean the patient off cardiopulmonary bypass. This unusually high requirement of fluid and inotropes required the surgeon to look for noncardiac causes for the hemodynamic disturbance and he noticed a bulge in the right pleura, which on exploration had approximately 1.5 L of collected blood. It was then retrospectively analyzed that the cause of this hemothorax could have been the undue lateral orientation of the needle during IJV cannulation and the advancement of the dilator to its entire length could have injured the subclavian vein. Here, we also would like to discuss the safety precautions to be taken during the cannulation, like the needle orientation and the length to which the dilator must be advanced for safe central venous cannulation. PMID:26712992

  6. Computational Analysis of Pumping Efficacy of a Left Ventricular Assist Device according to Cannulation Site in Heart Failure with Valvular Regurgitation

    PubMed Central

    2016-01-01

    Mitral valve regurgitation (MR) causes blood to flow in two directions during contraction of the left ventricle (LV), that is, forward into the aorta and backward into the left atrium (LA). In aortic valve regurgitation (AR), leakage occurs from the aorta into the LV during diastole. Our objective is to analyze the contribution of a left ventricular assist device (LVAD) to MR and AR for the following two different cannulation sites: from the LA to the aorta (LAAO) and from the LV to the aorta (LVAO). Using a computational method, we simulated three ventricular conditions (normal [HF without valvular regurgitation], 5% MR, and 5% AR) in three groups (control [no LVAD], LAAO, and LVAO). The results showed that LVAD with LAAO cannulation is appropriate for recovery of the MR heart, and the LVAD with LVAO cannulation is appropriate for treating the AR heart. PMID:28115981

  7. Problems of long-term cannulation of cisterna magna and subarachnoid space in the conscious dog.--Technical note--.

    PubMed

    Richling, B; Takacs, F

    1982-01-01

    Studies on the influence of substances on the central nervous system and on the function of the blood-CSF-barrier made long-term cannulation of the CSF compartment interesting. This study was to test, whether a permanent CSF-drainage from any point of the subarachnoid space was possible with modified "tissue cages" (Guyton 1963). For that purpose a steel wire cage and a teflon cage were implanted subarachnoidally into beagle dogs. The two cages stopped draining on the second and on the third day respectively. Histological examination showed, that, because of the strong reaction of animal tissue to implanted material, direct cannulation of the CSF compartment does not seem feasible. In the second part the "Manuilov-system" was modified. An indwelling guiding tube was implanted and fixed with a horseshoe shaped plate to the occipital bone. Puncture can be made on the awake dog without local anaesthetic and produces samples of 1.5 to 2.0 ml CSF for up to 30 days without complications.

  8. Early human experience with use of a deflectable fiberoptic endocardial visualization catheter to facilitate coronary sinus cannulation.

    PubMed

    Anh, D J; Chen, Henry A; Eversull, Christian S; Mourlas, Nicholas J; Mead, R Hardwin; Liem, L Bing; Hsia, Henry H; Wang, Paul J; Al-Ahmad, Amin

    2006-08-01

    Despite improvements in cardiac resynchronization therapy (CRT) implantation techniques, a significant minority of CRT attempts are unsuccessful. Inability to cannulate the coronary sinus (CS) because of difficult anatomy is a major reason for unsuccessful CRT implantation. Direct visualization of intracardiac structures during the implant may facilitate access into the CS. The present study describes CRT implantation with the aid of an endocardial visualization catheter (EVC). Fifty-eight consecutive patients (mean age 72 +/- 12 years; ejection fraction 26.2% +/- 7.0%; New York Heart Association [NYHA] class 2.9) underwent CRT implantation using a steerable fiberoptic EVC (Acumen Medical, Inc., Sunnyvale, CA). The EVC was able to visualize the CS ostium in all cases. The CS was successfully cannulated in 57 (98.3%) of 58 patients. The time from vascular access to CS visualization was 6 +/- 5 minutes, and the total time to CS access was 8 +/- 6 minutes. Successful left ventricle (LV) lead implantation was accomplished in 55 (94.8%) of 58 patients. Three patients who had a previous history of failed LV lead implantation were successfully implanted using the EVC. Fiberoptic imaging of intracardiac structures during CRT implantation may be performed rapidly in a wide range of patients with an EVC. The ability to visualize right atrial anatomy may aid CS access and LV lead implantation.

  9. Evaluating the efficacy of lavender aromatherapy on peripheral venous cannulation pain and anxiety: A prospective, randomized study.

    PubMed

    Karaman, Tugba; Karaman, Serkan; Dogru, Serkan; Tapar, Hakan; Sahin, Aynur; Suren, Mustafa; Arici, Semih; Kaya, Ziya

    2016-05-01

    This study was designed to evaluate the effectiveness of lavender aromatherapy on pain, anxiety, and level of satisfaction associated with the peripheral venous cannulation (PVC) in patients undergoing surgery. One hundred and six patients undergoing surgery were randomized to receive aromatherapy with lavender essential oil (the lavender group) or a placebo (the control group) during PVC. The patients' pain, anxiety, and satisfaction scores were measured. There was no statistically significantly difference between the groups in terms of demographic data. After cannulation, the pain and anxiety scores (anxiety 2) of the patients in the lavender group were significantly lower than the control group (for p = 0.01 for pain scores; p < 0.001 for anxiety 2 scores). In addition, patient satisfaction was significantly higher in the lavender group than in the control group (p = 0.003). Lavender aromatherapy had beneficial effects on PVC pain, anxiety, and satisfaction level of patients undergoing surgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Fatigue strength of a wire passing through a cannulated screw: implications for closure of the sternum following cardiac surgery.

    PubMed

    Jutley, R S; Shepherd, D E T; Hukins, D W L

    2003-01-01

    It has been proposed that the incidence of sternal dehiscence can be decreased by passing the wires used for sternotomy closure through cannulated screws. However, there is a potential risk of fatigue failure as a result of the wire moving against the screw, e.g. during coughing and sneezing. The system of cannulated screws and wire was subjected to static tensile testing to failure. Five tests were performed and failure occurred at 388 +/- 34 N (mean +/- SD). Ten cyclic tests were then performed. Sinusoidal loading was applied at 10 Hz with peak forces in the range 10-90 per cent of the static failure force, at a constant load ratio R = 10. The test with the lowest peak force reached run-out at 6 x 10(6) cycles. The others failed by the ends of the wire closures becoming untwisted (one test), the wire fracturing at the twist (three tests) or the wire fracturing at the screw (five tests). However, calculations based on these results suggest that fatigue failure is unlikely to occur as a result of regular breathing or continuous coughing or sneezing.

  11. Updated cannulation technique for tissue plasminogen activator injection into peripapillary retinal vein for central retinal vein occlusion.

    PubMed

    van Overdam, Koen A; Missotten, Tom; Spielberg, Leigh H

    2015-12-01

    To update the surgical technique in which a vitrectomy is performed and a retinal branch vein is cannulated and infused with recombinant tissue plasminogen activator (RTPA) to treat central retinal vein occlusion (CRVO) in patients who present with very low visual acuity (VA). Twelve consecutive patients (12 eyes) with CRVO and low VA (logMAR >1.00) at presentation were treated using this method. Cannulation of a peripapillary retinal vein and stable injection of RTPA was successfully performed without surgery-related complications in all 12 eyes. At 12 months after surgery, 8 of the 12 patients (67%) experienced at least one line of improvement in best corrected visual acuity; 6 of the 12 (50%) improved ≥5 lines and 2 (17%) improved ≥8 lines. After additional grid laser and/or subconjunctival or intravitreal corticosteroids, the mean decrease in central foveal thickness was 260 μm, and the mean total macular volume decreased from 12.10 mm(3) to 9.24 mm(3) . Four patients received panretinal photocoagulation to treat either iris neovascularization (n = 2) or neovascularization of the retina and/or disc (n = 2). Administration of RTPA via a peripapillary vein using this updated technique provides an alternative or additional treatment option for patients with very low VA after CRVO. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  12. Doppler-guided cannulation of internal jugular vein, subclavian vein and innominate (brachiocephalic) vein--a case-control comparison in patients with reduced and normal intracranial compliance.

    PubMed

    Schummer, Wolfram; Schummer, Claudia; Niesen, Wolf-Dirk; Gerstenberg, Hendrik

    2003-09-01

    A case-control comparison of Doppler guidance on the success rate of central venous cannulation in patients with normal or reduced intracranial compliance. A single operator performed central venous access procedures with continuous wave Doppler guidance. It was used on patients on a ventilator. The position of patients with reduced intracranial compliance (RIC) was not changed for the procedure. Patients with normal intracranial compliance (NIC) were put in the Trendelenburg position. We prospectively evaluated 249 Doppler-guided central venous access procedures performed over a 12-month period at our 10-bed neuro-intensive care unit at a university hospital. The group with RIC included 26 males and 35 females (n=61) aged 16-79 years. In this group 155 Doppler-guided cannulation procedures (62%) were performed. The group with NIC (n=52) comprised 29 males and 23 females aged 34-76 years; 94 Doppler-guided cannulation procedures (38%) were carried out. The veins cannulated in RIC and NIC, respectively, were: right innominate vein: 24/18, left innominate vein 26/12, right subclavian vein 12/7, left subclavian vein 25/14, and right internal jugular vein 33/18 and left internal jugular vein 35/24. The absence of one left internal jugular vein was identified in the NIC group. The success rate of first needle pass in patients with RIC was 92% and in patients with NIC 89%. This study showed that Doppler guidance allows the cannulation of central veins in patients with RIC placed in head-up position. Cannulation can be ensured and first-pass needle placement maximised.

  13. Subclavian artery cannulation provides better myocardial protection in conventional repair of acute type A aortic dissection: experience from a single medical centre in Taiwan

    PubMed Central

    Hsu, Po-Shun; Tsai, Chien-Sung; Tsai, Yi-Ting; Lin, Chih-Yuan; Lee, Chung-Yi; Ke, Hong-Yan; Lin, Yi-Chang; Tsai, Chien-Suang; Chen, Jia-Lin

    2016-01-01

    Summary Background Although many reports have detailed the advantages and disadvantages between femoral and subclavian arterial cannulations for acute aortic dissection type A (AADA), the confounding factors caused by disease severity and surgical procedures could not be completely eliminated. We compared femoral and subclavian artery cannulation and report the results for reconstruction of only the ascending aorta. Methods From January 2003 to December 2010, 51 AADA cases involving reconstruction of only the ascending aorta were retrospectively reviewed and categorised on the basis of femoral (n = 26, 51%) or subclavian (n = 25, 49%) arterycannulation. Bentall’s procedures, arch reconstruction and hybrid operations with stent-grafts were all excluded to avoid confounding factors due to dissection severity. Surgical results, postoperative mortality, and short- and mid-term outcomes were compared between the groups. Results Subclavian cannulation had a lower incidence of cerebral and myocardial injury and lower hospital mortality than femoral cannulation (8 vs 34%, p = 0.04). Ventilation duration as well as intensive care unit (ICU) and hospital stay were also shorter with subclavian cannulation. Risk factors for hospital mortality included pre-operative respiratory failure (odds ratio: 12.84), peri-operative cardiopulmonary bypass (CPB) time > 200 minutes (odds ratio: 13.49), postoperative acidosis (pH < 7.2, odds ratio: 88.63), and troponin I > 2.0 ng/ml (odds ratio: 20.08). The overall hospital mortality rate was 21%. The 40 survivors were followed up for three years with survival of 75% at one year and 70% at three years. Conclusions Our results show that subclavian cannulation had a lower incidence of cerebral and myocardial injury as well as better postoperative recovery and lower hospital mortality rates for reconstruction of only the ascending aorta. PMID:27841900

  14. [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

    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.

  15. [Polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar diseases with osteoporosis].

    PubMed

    Sun, H L; Li, C D; Yang, Z C; Yi, X D; Liu, H; Lu, H L; Li, H; Wang, Y

    2016-12-18

    To describe the application of polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar diseases with osteoporosis. Observation group included 14 cases of degenerative lumbar diseases with osteoporosis received polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws from November 2014 to July 2015, control group included 12 cases of degenerative lumbar diseases with osteoporosis received polymethylmethacrylate augmentation with traditional pedicle screws.The operation time, blood loss, number of pedicle screws and number of augmented pedicle screws in the two groups were compared. The bone cement leakage and pulmonary bone cement embolism in the two groups were also compared. The fusion rate and pedicle screws loosening by lumbar X ray and dynamic X ray were evaluated. The clinical results were assessed by visual analog scale (VAS) of pain on lumbar and lower limbers, lumbar Japanese Orthopaedic Association scores (JOA), Prolo functional scores and Oswestry disability (ODI) scores. Differences of operation time and blood loss in the two groups were not statistically significant. The average number of pedicle screws was 9.9±4.7 and the average number of augmented pedicle screws was 5.9±2.6 in observation group while the average number of pedicle screws was 7.1±2.8 and the average number of augmented pedicle screws was 3.0±1.9 in control group. The ratio of augmented pedicle screws was higher in observation group than in control group (0.69±0.30 vs.0.47±0.30,P<0.05). The bone cement leakage rate was lower in observation group than in control group (5/83 vs. 12/42, P<0.01). All the cases in observation group were without leakage to the interspinal canal while one case in control group suffered from bone cement leakage to the interspinal canal with augmentation of 3 pedicle screws. The follow up period was (10.6±2.3) months in observation group and (36.5±7

  16. Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes.

    PubMed

    Sorokin, Vitaly; MacLaren, Graeme; Vidanapathirana, Puwalani C; Delnoij, Thijs; Lorusso, Roberto

    2017-05-01

    Extracorporeal membrane oxygenation (ECMO) is becoming a common procedure to support patients with severe cardio-circulatory or respiratory failure as well as in case of combined compromise of the two systems. Deciding which ECMO configuration and proceeding with an uneventful implantation, however, may present minor or major shortcomings. Cannulation techniques should be tailored to specific patient conditions to provide sufficient regional and systemic perfusion, both of which must be comprehensively monitored. Changes in the patient's status or suboptimal ECMO-related support, however, may occur and should trigger re-appraisal of the cannulation strategy and circuit configuration. This dynamic management, based around the adequacy of end organ perfusion and patient requirements, may dictate ECMO configuration and cannulation changes. In these circumstances, adjunct of a cannula in the venous or arterial vasculature may represent a mandatory procedure to solve unfavorable hemodynamic status or enhance ECMO efficiency. These type of ECMO configurations, different from basic one, and called hybrid configurations, may represent, therefore, a critical aspect of optimal ECMO management towards optimized and successful temporary support. The aim of this review is to critically appraise and summarize the existing literature on adult ECMO configuration including cannulation strategies and circuit arrangement, and highlighting more complex pattern required in some specific clinical settings. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  17. 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

  18. The microbial fermentation characteristics depend on both carbohydrate source and heat processing: a model experiment with ileo-cannulated pigs.

    PubMed

    Nielsen, Tina Skau; Jørgensen, Henry; Knudsen, Knud Erik Bach; Lærke, Helle Nygaard

    2017-11-01

    The effects of carbohydrate (CHO) source and processing (extrusion cooking) on large intestinal fermentation products were studied in ileo-cannulated pigs as a model for humans. Pigs were fed diets containing barley, pea or a mixture of potato starch:wheat bran (PSWB) either raw or extrusion cooked. Extrusion cooking reduced the amount of starch fermented in the large intestine by 52-96% depending on the CHO source and the total pool of butyrate in the distal small intestine + large intestine by on average 60% across diets. Overall, extrusion cooking caused a shift in the composition of short-chain fatty acids (SCFA) produced towards more acetate and less propionate and butyrate. The CHO source and processing highly affected the fermentation characteristics and extrusion cooking generally reduced large intestinal fermentation and resulted in a less desirable composition of the fermentation products. The latter outcome is non-conducive to a healthy large intestinal environment and its resulting metabolic health.

  19. A Cannulated Tri-Tapered Femoral Stem for Total Hip Arthroplasty: Clinical and Radiological Results at Ten Years.

    PubMed

    Rajakulendran, Karthig; Strambi, Francesco; Ruggeri, Riccardo; Field, Richard E

    2015-10-01

    We report the ten-year clinical and radiological outcomes of a novel cannulated, tri-tapered femoral stem, used in primary total hip arthroplasty (110 stems in 98 patients). At ten years, two Tri-taper stems had been revised for infection and dislocation. The mean Oxford Hip Score improved from 13.46 pre-operatively, to 37.04. Radiological analysis revealed radiolucent lines in 57 cases, but none exceeded 2 mm thickness. Stem subsidence was identified in 63 cases, with mean distal tip migration of 3.8 mm. Survivorship with revision for aseptic loosening as the end point was 100% at 10 years. Stem survival with revision for any cause was 98.2% (95% CI, 92.9% to 99.5%). The ten-year results of the Tri-taper stem are comparable to other polished, tapered femoral stems. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Back to the roots? Dual cannulation strategy for ambulatory ECMO in adolescent lung transplant candidates: An alternative?

    PubMed

    Schmidt, F; Jack, T; Sasse, M; Mueller, C; Schwerk, N; Bobylev, D; Beerbaum, P; Koeditz, H

    2017-03-01

    Bridging critically ill pediatric patients to lung transplantation still remains a major challenge. Although still controversial, within the last 5 years, ECMO has been increasingly used as a bridge to lung transplantation concept in adult and pediatric patients with acceptable outcomes. The outstanding developments in the field of extracorporeal devices and the introduction of awake ECMO concepts with the avoidance of mechanical ventilation have led to a real paradigm shift in the ICU management of pretransplant candidates with severe respiratory failure. Therefore, ECMO is no longer seen as a contraindication for lung transplantation at least at our center. Nevertheless, how to bridge these patients on ECMO still remains controversial. Thus, we introduced an ambulatory ECMO approach in adolescent lung transplant candidates with acute respiratory failure using a dual cannulation strategy and hereby present first results from this procedure.

  1. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures.

    PubMed

    Wang, Chen; Xu, Gui-Jun; Han, Zhe; Jiang, Xuan; Zhang, Cheng-Bao; Dong, Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2015-11-01

    The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation.One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head.Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH.There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications.

  2. Limited precut sphincterotomy combined with endoscopic papillary balloon dilation for common bile duct stone removal in patients with difficult biliary cannulation.

    PubMed

    Kuo, Chung-Mou; Chiu, Yi-Chun; Liang, Chih-Ming; Lu, Lung-Sheng; Tai, Wei-Chen; Kuo, Yuan-Hung; Wu, Cheng-Kun; Chuah, Seng-Kee; Changchien, Chi-Sin; Kuo, Chung-Huang

    2016-07-12

    Difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) can result in failure of common bile duct (CBD) stone removal and pancreatitis. The present study aimed to report the efficacy and safety of limited precut sphincterotomy (PS) combined with endoscopic papillary balloon dilation (EPBD) for CBD stone removal in patients with difficult biliary cannulation, and the complications associated with this combined procedure. A total of 3305 patients underwent ERCP in our hospital between October 2009 and September 2014 and 258 were diagnosed with difficult biliary cannulation. Of these 258 patients, 58 underwent limited PS combined with EPBD for CBD stone removal, and these 58 patients were included in this retrospective study. The overall success rate was 94.8 % (55/58), and the success rate for single-session removal was 87.9 % (51/58). The mean procedure time was 41 ± 11.48 min (range, 20-72 min). Mechanical lithotripsy was needed in 10.3 % (6/58) of patients. Procedure-related complications included bleeding in 3.4 % (2/58), pancreatitis in 8.6 % (5/58) and biliary tract infection (BTI) in 1.7 % (1/58) of patients. The therapeutic outcome of limited PS combined with EPBD for CBD stone removal in patients with difficult biliary cannulation was good with an acceptable complication rate. It could be an alternative to PS and "early" limited PS should be used for prompt identification of the bile duct. Limited PS combined with EPBD is safe and effective for CBD stone removal in patients with difficult biliary cannulation.

  3. Intraoperative retinal tear formation and postoperative rhegmatogenous retinal detachment in transconjunctival cannulated vitrectomy systems compared with the standard 20-gauge system.

    PubMed

    Covert, Douglas J; Henry, Christopher R; Bhatia, Sandeep K; Croskrey, Jason; Sanchez, Cecilia R; Han, Dennis P

    2012-02-01

    To compare 20-gauge standard pars plana vitrectomy (PPV) with transconjunctival cannulated PPV in the development of intraoperative retinal breaks and postoperative rhegmatogenous retinal detachments (RRDs) in a large series of patients undergoing PPV for macular pucker or macular hole. This study was conducted at an academic tertiary care vitreoretinal practice in Milwaukee, Wisconsin. Patients undergoing 3-port PPV with standard 20-gauge instrumentation were compared with patients undergoing 3-port PPV with transconjunctival cannulated systems, including 20 gauge, 23 gauge, and 25 gauge, from January 1, 2003, through December 31, 2009. The main outcome measures were rates of intraoperative retinal breaks and postoperative RRD. Four hundred twenty-six unique eyes met inclusion criteria. Fifty-four of 426 eyes (12.7%) were diagnosed as having new retinal tears intraoperatively as follows: 47 of 204 patients (23.0%) undergoing the standard 20-gauge procedure developed intraoperative retinal tears compared with 7 of 211 patients (3.3%) undergoing the transconjunctival cannulated procedure (risk ratio [RR], 0.12; 95% CI, 0.05-0.26; P < .001). Patients experiencing intraoperative retinal tears were not at increased risk of developing postoperative RRD (RR, 1.4; 95% CI, 0.39-5.0; P = .61). Although a trend was present, transconjunctival cannulated vitrectomy was not significantly protective against the development of postoperative RRD (RR, 0.60; 95% CI, 0.17-1.3; P = .14). Transconjunctival cannulated PPV, including 20-gauge, 23-gauge, and 25-gauge systems, is associated with significantly reduced rates of intraoperative retinal tear formation compared with standard 20-gauge PPV.

  4. Backscattering particle immunoassays in wire-guide droplet manipulations

    PubMed Central

    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 μL 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°) 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

  5. The effect of SonoPrep® on EMLA® cream application for pain relief prior to intravenous cannulation.

    PubMed

    Kim, Do Kyun; Choi, Sae Won; Kwak, Young Ho

    2012-06-01

    The aim the study was to determine the effect of SonoPrep® on the delivery and analgesic effects of EMLA® cream prior to intravenous (iv) cannulation in a tertiary pediatric emergency department. Children aged between 5 and 10 years were enrolled. Patients were randomized to receive either sonophoresis with SonoPrep® or sham sonophoresis followed by application of EMLA® cream for 5 min prior to iv cannulation. The primary outcome measurement was the child's rating of pain immediately after iv placement, using a 10-cm visual analog scale (VAS). Parents or guardians and blinded researchers were additionally asked to rate their perception of the child's pain using the 10-cm VAS and the Wong-Baker Face scale. A total of 42 patients completed the study (21 in the study group, 21 in the control group). The baseline characteristics between the groups were similar. The VAS pain score was significantly lower in children treated with sonophoresis compared with the sham sonophoresis (median (percentiles 25th-75th), 20.0 (10.0-22.5) vs. 60.0 (31.0-87.5); p < 0.001). The parent's perception of the child's pain was significantly lower in the study group vs. the control group by the VAS (median (percentiles 25th-75th), 10.0 (10.0-20.0) vs. 50.0 (15.0-80.0); p < 0.001) and Wong-Baker Face scale (median (percentiles 25th-75th), 2.0 (2.0-2.0) vs. 4.0 (2.5-4.5); p < 0.001). The researcher's evaluation of the child's discomfort was also significantly lower in the study group (2.0 (1.0-3.0) vs. 4.0 (2.5-4.5); p < 0.001). The application of sonophoresis using SonoPrep® followed by the 5-min application of EMLA® cream showed significant benefit in young children in terms of pain reduction and patient satisfaction.

  6. Modification of the HeRO graft allowing earlier cannulation and reduction in catheter dependent days in patients with end stage renal disease: a single center retrospective review.

    PubMed

    Hart, Deirdre; Gooden, Christie; Cummings, L S; Wible, Brandt C; Borsa, John; Randall, Henry

    2014-01-01

    After creation of an arteriovenous fistula or placement of an arteriovenous graft, several weeks are required for maturation prior to first cannulation. Patients need an alternative way to receive hemodialysis during this time, frequently a catheter. After multiple failed access attempts, patients can run out of options and become catheter dependent. At our institution, we place HeRO grafts in eligible patients who have otherwise been told they would be catheter dependent for life. By combining the HeRO graft system with a Flixene graft, patients are able to remove catheters sooner or avoid placement as they can undergo cannulation for hemodialysis the next day. Utilizing this novel technique, twenty-one patients over a two-year period with various forms of central venous stenosis, catheter dependence, or failing existing arteriovenous access have been successfully converted to stable long term noncatheter based upper extremity access.

  7. Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis

    PubMed Central

    Hayashi, Shiro; Nishida, Tsutomu; Shimakoshi, Hiromi; Shimoda, Akiyoshi; Amano, Takahiro; Sugimoto, Aya; Takahashi, Kei; Mukai, Kaori; Matsubara, Tokuhiro; Yamamoto, Masashi; Nakajima, Sachiko; Fukui, Koji; Inada, Masami

    2016-01-01

    AIM To estimate the efficacy of 2 h post-endoscopic retrograde cholangiopancreatography (ERCP) serum amylase levels and other factors for predicting post-ERCP pancreatitis. METHODS This was a retrospective, single-center cohort study of consecutive patients who underwent ERCP from January 2010 to December 2013. Serum amylase levels were measured 2 h post-procedure, and patient- and procedure-related pancreatitis (PEP) risk factors were analyzed using a logistic model. RESULTS A total of 1520 cases (average age 72 ± 12 years, 60% male) were initially enrolled in this study, and 1403 cases (725 patients) were ultimately analyzed after the exclusion of 117 cases. Fifty-five of these cases developed PEP. We established a 2 h serum amylase cutoff level of two times the upper limit of normal for predicting PEP. Multivariate analysis revealed that a cannulation time of more than 13 min [odds ratio (OR) 2.28, 95%CI: 1.132-4.651, P = 0.0210] and 2 h amylase levels greater than the cutoff level (OR = 24.1, 95%CI: 11.56-57.13, P < 0.0001) were significant predictive factors for PEP. Forty-seven of the 55 patients who developed PEP exhibited 2 h amylase levels greater than the cutoff level (85%), and six of the remaining eight patients who developed PEP (75%) required longer cannulation times. Only 2 of the 1403 patients (0.14%) who developed PEP did not exhibit concerning 2 h amylase levels or require longer cannulation times. CONCLUSION These findings indicate that the combination of 2 h post-ERCP serum amylase levels and cannulation times represents a valuable marker for identifying patients at high risk for PEP. PMID:28042392

  8. Buttonhole Cannulation Is Not Associated with More AVF Infections in a Low-Care Satellite Dialysis Unit: A Long-Term Longitudinal Study.

    PubMed

    Béchade, Clémence; Goovaerts, Tony; Cougnet, Philippe; Labriola, Laura; Jadoul, Michel; Goffin, Eric

    2015-01-01

    Buttonhole cannulation (BHC) has been associated with a greater risk of arteriovenous fistula (AVF)-related infections and septicemia than the rope ladder cannulation (RLC) in in-center hemodialysis (HD). Such infections have never been studied in satellite HD units. Retrospective single center study. All patients in our satellite HD unit using a native AVF from 1 January, 1990, to 31 December, 2012. Two different kinds of cannulation have been used during the study period: From 1 January, 1990 to 1, January, 1998 RLC was used in the unit (period 1). After 1 January, 1998 onwards, all the patients were switched within 3 months to BHC (period 2). Three different infectious events were observed during the two periods: local AVF infection, bacteremia, and combined infection. The aim of this study was to evaluate the incidence of AVF-related infections in our low-care HD unit and to determine whether BHC is associated with an increased risk of infection in this population. 162 patients were analyzed; 68 patients participated to period 1 and 115 to period 2. Sixteen infectious events occurred. Incidences of AVF-related infectious events were 0.05 [95% CI, 0.02-0.16] and 0.13/1000 AVF-days [95% CI, 0.0.8-0.23], for period 1 and 2 (p = 0.44) respectively. Recurrence of AVF-related infection was observed only during period 2. Unadjusted incidence rate ratio (IRR) of all infections was 0.39 (95%CI 0.12-1.37). Two complicated infections occurred during the study period: one in period 1 and one in period 2. Observational retrospective single centre study. BHC is not associated with an increased infectious incidence in our HD population from a satellite dialysis unit. In the rare patients with AVF-related infection it seems necessary to change cannulation sites as recurrence of infection might be an event more frequent with BHC.

  9. Utility of near-infrared light devices for pediatric peripheral intravenous cannulation: a systematic review and meta-analysis.

    PubMed

    Park, Joon Min; Kim, Min Joung; Yim, Hyeon Woo; Lee, Won-Chul; Jeong, Hyunsuk; Kim, Na Jin

    2016-12-01

    We investigated the utility of near-infrared (NIR) light devices for peripheral intravenous cannulation (PIVC) in pediatric patients. We searched three databases, MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomized controlled trials that compared PIVC using NIR light devices and the "traditional" method (with no assistive device) were included. The primary outcome was a failure rate at the first attempt, and the effect size was measured by the risk ratio for failure. Subgroup analysis was performed according to control group risk for failure at first attempt as an indicator of difficult procedure (low vs. high). Eleven studies were included in the meta-analysis. There was no significant difference in the primary outcome between the two methods (risk ratio 1.03, confidence interval 0.89-1.20, I (2) = 48 %). In a subgroup analysis, the subgroup difference between subsets of low and high control group risk was significant (I (2) = 83 %). In the subset of the high control group risk, using NIR light devices showed a lower risk for failure than the traditional method (risk ratio 0.81, confidence interval 0.64-1.01, I (2) = 0 %).

  10. Exporting simulation technology to the Philippines: a comparative study of traditional versus simulation methods for teaching intravenous cannulation.

    PubMed

    Sotto, Juan Alejandro R; Ayuste, Eduardo C; Bowyer, Mark W; Almonte, Josefina R; Dofitas, Rodney B; Lapitan, Marie C M; Pimentel, Elisabeth A; Ritter, E Matthew; Wherry, David C

    2009-01-01

    This study examines effectiveness of a donated Laerdal Virtual I.V. simulator when compared with traditional methods of teaching intravenous (IV) cannulation to third year medical students in the Philippines. Forty novice Filipino medical students viewed an instructional video on how to start intravenous lines and were then randomly divided into two groups of twenty. The "Traditional" group observed an IV insertion on an actual patient performed by an experienced practitioner, and then subsequently performed an IV on an actual patient which was videotaped. The "Simulation" group practiced the Virtual I.V. simulator until they successfully completed level three using the "doctor" setting. These students then performed an IV on an actual patient which was videotaped. The videotapes for both groups were reviewed by two pre-trained (Inter-rater reliability of > or =0.84) observers who were blinded to the group using a previously validated checklist for IV insertion. Students trained on the Virtual I.V. showed significantly greater success in successfully starting an IV on an actual patient (40% VS. 15%, p<0.05), decreased constrictive band time (p<.05), increased raw score on the check list (p<.03), and decreased overall time to start an IV (p<.05). The technology was well received but wider application in the non western world is limited by lack of in country company support and the relative expense.

  11. In Vitro-In Vivo Extrapolation of Intestinal Availability for Carboxylesterase Substrates Using Portal Vein-Cannulated Monkey.

    PubMed

    Trapa, Patrick E; Beaumont, Kevin; Atkinson, Karen; Eng, Heather; King-Ahmad, Amanda; Scott, Dennis O; Maurer, Tristan S; Di, Li

    2017-03-01

    Prediction of intestinal availability (FaFg) of carboxylesterase (CES) substrates is of critical importance in designing oral prodrugs with optimal properties, projecting human pharmacokinetics and dose, and estimating drug-drug interaction potentials. A set of ester prodrugs were evaluated using in vitro permeability (parallel artificial membrane permeability assay and Madin-Darby canine kidney cell line-low efflux) and intestinal stability (intestine S9) assays, as well as in vivo portal vein-cannulated cynomolgus monkey. In vitro-in vivo extrapolation (IVIVE) of FaFg was developed with a number of modeling approaches, including a full physiologically based pharmacokinetic (PBPK) model as well as a simplified competitive-rate analytical solution. Both methods converged as in the PBPK simulations enterocyte blood flow behaved as a sink, a key assumption in the competitive-rate analysis. For this specific compound set, the straightforward analytical solution therefore can be used to generate in vivo predictions. Strong IVIVE of FaFg was observed for cynomolgus monkey with R(2) of 0.71-0.93. The results suggested in vitro assays can be used to predict in vivo FaFg for CES substrates with high confidence. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  12. A systematic review of vapocoolants for reducing pain from venipuncture and venous cannulation in children and adults.

    PubMed

    Hogan, Mary-Ellen; Smart, Sarah; Shah, Vibhuti; Taddio, Anna

    2014-12-01

    Studies of vapocoolants for pain reduction from venipuncture have demonstrated conflicting results. Our aim was to systematically review the literature regarding the analgesic effectiveness of vapocoolants in children and adults. We searched MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Trials using key words: vapocoolant, pain, venipuncture, and cannulation. We included randomized or quasi-randomized studies comparing vapocoolants to placebo or no treatment. Two authors reviewed titles and abstracts and extracted data. Quality was assessed by consensus using the Cochrane risk of bias tool. The primary outcome was self-reported pain using a 100-mm visual analog scale, a 0- to 10-point numerical scale, or observational scale for preverbal children. Data were pooled using a random effects model. Twelve studies including 1266 patients (509 children, 757 adults) were identified. No significant pain reduction was found in children receiving vapocoolants vs. placebo or no treatment (mean difference -10 mm; 95% confidence interval [CI] -26 to 6). In adults, less pain was reported when vapocoolants were compared with no treatment: -10 mm on a 100-mm scale (95% CI -17 to -4); but not when compared to placebo (-12 mm; 95% CI -26 to 2). Pain from application of vapocoolants was greater than placebo (8 mm; 95% CI 4 to 2). Vapocoolants were ineffective in children and adults when compared to placebo, and effective in adults only when compared to no treatment. The magnitude of effect was low and was offset by increased pain from application. They cannot be recommended for routine use in children or adults. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Influence of time to surgery on the incidence of complications in femoral neck fracture treated with cannulated screws.

    PubMed

    Araujo, Thiego Pedro Freitas; Guimaraes, Tales Mollica; Andrade-Silva, Fernando Brandao; Kojima, Kodi Edson; Silva, Jorge Dos Santos

    2014-11-01

    Osteosynthesis of femoral neck fractures is particularly indicated in patients aged under 60 years. A prolonged interval between the fracture and surgical fixation has been associated with avascular necrosis (AVN) of the femoral head. The primary objective of this study was to evaluate the association between the time to surgery and the development of complications in patients with femoral neck fractures. Patients with displaced fractures of the femoral neck (Garden III or IV) who underwent fixation with three cannulated screws in the inverted triangle configuration from January 2009 to December 2010 were evaluated retrospectively for the development of orthopaedic complications. Patients were divided into two groups according to the time to surgery (within 7 days or more than 7 days). Complication rates were compared between the two groups. Regression analyses were performed to assess the risk factors for complications. Thirty-one patients were included in the study; the duration of follow-up ranged from 24 to 50 months. The time from fracture to surgery ranged from 3 to 18 days. Fifteen patients underwent surgery within 7 days, and 16 patients underwent surgery after 7 days. There were four cases of femoral head necrosis. One patient had an associated infection; one patient experienced non-union, and another demonstrated osteosynthesis failure. There were no statistically significant differences in the overall rate of complications between the groups (p = 0.999). None of the preoperative parameters or fracture characteristics were predictive factors for complications. The only factor associated with the development of complications was inadequate fracture reduction in the anteroposterior (AP) view (odds ratio [OR] = 35.50, 95% confidence interval [CI] = 2.56 to 548.36, p = 0.008). The interval between the occurrence of the injury and surgical fixation is not associated with the development of complications in fractures of the femoral neck. Inadequate fracture

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

    PubMed

    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.

  15. Precise cannulation of the foramen ovale in trigeminal neuralgia complicating osteogenesis imperfecta with basilar invagination: technical case report.

    PubMed

    Hajioff, D; Dorward, N L; Wadley, J P; Crockard, H A; Palmer, J D

    2000-04-01

    Trigeminal neuralgia is a rare feature of basilar invagination, which is itself a complication of osteochondrodysplastic disorders. Microvascular decompression is an unattractive option in medically refractory cases. The conventional percutaneous approach to the trigeminal ganglion is anatomically impossible because the foramen ovale points inferiorly and posteromedially. We report a new technique for image-guided trigeminal injection in a patient with basilar invagination complicating osteogenesis imperfecta. A 26-year-old woman with osteogenesis imperfecta presented with a 3-year history of typical left maxillary division trigeminal neuralgia, which was poorly controlled by carbamazepine at the maximum tolerated dose. She had obvious cranial deformities, left optic atrophy, delayed left eye closure, tongue atrophy, but normal facial sensation and corneal reflexes. A computed tomographic scan and magnetic resonance imaging confirmed severe basilar invagination. Frameless stereotactic glycerol injection of the left trigeminal ganglion was performed under general anesthesia using the infrared-based EasyGuide Neuro system (Philips Medical Systems, Best, The Netherlands) with magnetic resonance imaging and computed tomographic registration. The displaced and distorted left foramen ovale was cannulated via a true frameless stereotactic method with the trajectory determined by virtual pointer elongation. The needle placement was confirmed with injection of contrast medium into the trigeminal cistern. The path needed to enter the foramen traversed the right cheek, soft palate, and left tonsil. The patient went home pain-free with a preserved corneal reflex and no complications. Frameless stereotaxy allows customization to individual patient anatomy and may be adapted to a variety of percutaneous procedures used in areas where the anatomy is complex.

  16. Effects of glycerides on the intestinal absorption of cyclosporine a using the in-situ mesenteric vein cannulated rat model.

    PubMed

    Ghorab, Mamdouh M; Abdel-Salam, Heba M; Abdel-Moate, Mohamed M

    2005-07-01

    The purpose of this study was to evaluate and compare the effect of glycerides with different fatty acid distributions (e.g. Arlacel 186, Capmul GMO and Captex 350) on Cyclosporine absorption in rat ileum segment using the modified single-pass intestinal perfusion with mesenteric vein cannulation. Drug concentration in the perfusate and blood plasma was analyzed by HPLC; and permeability coefficients were calculated from drug appearance in blood (P(blood)) and disappearance from perfusate (P(lumen)). Particle size was measured using Malvern Zetasaizer 1000HSA. Rheologic properties were measured using Brookfield viscometer. The results show that the average particle sizes after dilution (100 folds) of formulae containing Arlacel 186, Capmul GMO and Captex 350 and containing 0.8 mM CsA were 260+/-35.8, 130+/-11.4 and 37.5+/-6.0 nm, respectively. The polydispersity index was 0.6, 0.7 and 0.108 for formulations with Arlacel 186, Capmul GMO and Captex 350, respectively. CsA permeability coefficients (P(blood)) calculated from drug appearance in the blood in presence of Arlacel 186, Capmul GMO and Captex 350 were 0.3x10(-6), 1.0x10(-6) and 1.7x10(-6) cm2/sec, respectively. Phenol red was used as a water marker to determine net water absorption and secretion. Its constant concentration suggested that formulation did not alter intestinal water flux. From the results we can conclude that degree of glyceride esterification has a potential impact on the average particle size distribution and polydispersity of the formed micelles on dilution, which on turn contribute to the interaction between membrane and drug.

  17. Counterregulatory deficits occur within 24 h of a single hypoglycemic episode in conscious, unrestrained, chronically cannulated mice

    PubMed Central

    Jacobson, Lauren; Ansari, Tasneem; McGuinness, Owen P.

    2006-01-01

    Hypoglycemia-induced Counterregulatory failure is a dangerous complication of insulin use in diabetes mellitus. Controlled hypoglycemia studies in gene knockout models, which require the use of mice, would aid in identifying causes of defective counterregulation. Because stress can influence Counterregulatory hormones and glucose homeostasis, we developed glucose clamps with remote blood sampling in conscious, unrestrained mice. Male C57BL/6 mice implanted with indwelling carotid artery and jugular vein catheters were subjected to 2 h of hyperinsulinemic glucose clamps 24 h apart, with a 6-h fast before each clamp. On day 1,, blood glucose was maintained (euglycemia, 178 ± 4 mg/dl) or decreased to 62 ± 1 mg/dl (hypoglycemia) by insulin (20 mU·kg−1·min−1) and variable glucose infusion. Donor blood was continuously infused to replace blood sample volume. Baseline plasma epinephrine (32 ± 8 pg/ml), corticosterone (16.1 ± 1.8 μg/dl), and glucagon (35 ± 3 pg/ml) were unchanged during euglycemia but increased significantly during hypoglycemia, with a glycemic threshold of ~80 mg/dl. On day 2, all mice underwent a hypoglycemic clamp (blood glucose, 64 ± 1 mg/dl). Compared with mice that were euglycemic on day 1, previously hypoglycemic mice had significantly higher glucose requirements and significantly lower plasma glucagon and corticosterone (n = 6/group) on day 2. Epinephrine tended to decrease, although not significantly, in repeatedly hypoglycemic mice. Pre- and post-clamp insulin levels were similar between groups. We conclude that counterregulatory responses to acute and repeated hypoglycemia in unrestrained, chronically cannulated mice reproduce aspects of counterregulation in humans, and that repeated hypoglycemia in mice is a useful model of counterregulatory failure. PMID:16533951

  18. 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

  19. 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

  20. Internal bone transport using a cannulated screw as a mounting device in the treatment of a post-infective ulnar defect.

    PubMed

    Tsitskaris, Konstantinos; Havard, Heledd; Bijlsma, Paulien; Hill, Robert A

    2016-04-01

    Bone transport techniques can be used to address the segmental bone loss occurring after debridement for infection. Secure fixation of the bone transport construct to the bone transport segment can be challenging, particularly if the bone is small and osteopenic. We report a case of a segmental ulnar bone defect in a young child treated with internal bone transport using a cannulated screw as the mounting device. We found this technique particularly useful in the treatment of bone loss secondary to infection, where previous treatment and prolonged immobilisation had led to osteopenia. This technique has not been previously reported.

  1. 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

  2. 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.

  3. The impact of extended-hours home hemodialysis and buttonhole cannulation technique on hospitalization rates for septic events related to dialysis access.

    PubMed

    Van Eps, Carolyn L; Jones, Mark; Ng, Tsun; Johnson, David W; Campbell, Scott B; Isbel, Nicole M; Mudge, David W; Beller, Elaine; Hawley, Carmel M

    2010-10-01

    Few studies adequately document adverse events in patients receiving long, slow, and overnight hemodialysis (NHD). Concerns about high rates of dialysis access complications have been raised. This is an observational cohort study comparing hospital admission rates for vascular access complications between alternate nightly NHD (n=63) and conventional hemodialysis (n=172) patients established on chronic hemodialysis for at least 3 months. Overall, hospital admission rates and hospital admission rates for cardiac and all infective events are also reported. The NHD cohort was younger and less likely to be female, diabetic, or have ischemic heart disease than the conventional hemodialysis cohort. When NHD and buttonhole cannulation technique were used simultaneously, there was a demonstrated increased risk of septic dialysis access events: incidence rate ratio 3.0 (95% confidence interval 1.04-8.66) (P=0.04). The majority of blood culture isolates in NHD patients were gram-positive organisms, particularly Staphylococcus aureus. Alternate nightly NHD did not significantly change total hospital admissions or hospital admissions for indications other than dialysis access complications, compared with conventional hemodialysis. Our data suggest that buttonhole cannulation technique should be used with caution in patients performing extended-hours hemodialysis as this combination appears to increase the risk of septic access complications. Randomized-controlled trials are needed to confirm these findings. © 2010 The Authors. Hemodialysis International © 2010 International Society for Hemodialysis.

  4. Percutaneous internal jugular venous cannulation for extracorporeal circulation during minimally invasive technique in children with congenital heart disease: operative technique and results.

    PubMed

    Vida, Vladimiro L; Tiberio, Ivo; Gallo, Michele; Guariento, Alvise; Suti, Emirjeta; Pittarello, Demetrio; Stellin, Giovanni

    2016-10-01

    The aim of this study was to evaluate the safety and efficacy of the percutaneous cannulation of the internal jugular venous (PCIJV) for extracorporeal circulation during minimally invasive cardiac surgery (MICS) in children with simple congenital heart disease. From September 2007, 83 children (<16 years) underwent PCIJV for extracorporeal circulation. Primary outcome of the study was to evaluate the safety and advantages of PCIJV technique. Technical steps and pitfalls of PCIJV technique are described. Median age at surgery was 9 years (range 3.5-16 years) and median body weight was 31 kilograms (range 13-72 kilograms); 32 patients (40%) had a body weight less than 30 kilograms. The PCIJV was achieved with a 14 French cannula in 61 pts (73%), with a 17 Fr cannula in 22 (23%). The PIJVC was judged difficult in 2 patients (2.4%); in both of them cannulation was achieved at a different venous site There were no procedure-related complications and no flow disturbances during the extracorporeal circulation. The PCIJV during MICS is an effective and reproducible technique for achieving peripheral CPB in children with simple CHDs. We progressively expanded the use of this technique in smaller children and this allows us to further minimize surgical trauma without experiencing venous drainage's problems.

  5. A predictive method for subsequent avascular necrosis of the femoral head (AVNFH) by observation of bleeding from the cannulated screw used for fixation of intracapsular femoral neck fractures.

    PubMed

    Cho, Myung-Rae; Lee, Sang-Wook; Shin, Dong-Kyu; Kim, Shin-Kun; Kim, Shin-Yoon; Ko, Sang-Bong; Kwun, Koing-Woo

    2007-03-01

    To examine the validity of bleeding from the drill holes used for cannulated screw placement as a method for predicting any subsequent avascular necrosis of the femoral head (AVNFH) after the fixation of intracapsular femoral neck fractures. Retrospective study. University hospital. Forty-four patients (mean age, 51 years; range, 18-76 years) whose femoral neck fractures had been fixed with cannulated screws from March 1999 to January 2001 were enrolled in this study. The fractures were classified according to Garden and included 11 type I, 5 type II, 17 type III, and 11 type IV. The average delay between injury and surgery was 52 hours (< or =24 hours, 26; > or =24 hours, 18; range 7 to 504 hours). The follow-up period was more than 25 months (range, 25-57 months). 7.0 mm cannulated screws were used for fracture fixation. Three and 4 screws were used for fixation in 35 and 9 cases, respectively. The presence or absence of blood drainage from the holes of the proximal cannulated screws was determined by an independent observer and defined as bleeding or no bleeding throughout a 5 minute observation period. According to those findings, patients were classified into 2 groups: the bleeding group (38 cases), and the nonbleeding group (6 cases). The validity of the relationship between the 2 groups and the development of AVNFH was evaluated according to the sensitivity, specificity, positive predictive value, and negative predictive value. A chi test was used for univariate analysis of the relationship between the related factors with the development of AVNFH. The mean follow-up was 39 months (range, 25-57 months). AVNFH developed in 7 cases (16%). One patient of 38 in the bleeding group (2.6%) and all 6 patients in the nonbleeding group (100%) developed AVNFH. The sensitivity was 86%, specificity 100%, positive predictive value 100%, and negative predictive value 97%. Age (P < 0.734), sex (P < 0.587), the type of the fracture (P < 0.356), procedure interval (P < 0

  6. Needle-free powder lidocaine delivery system provides rapid effective analgesia for venipuncture or cannulation pain in children: randomized, double-blind Comparison of Venipuncture and Venous Cannulation Pain After Fast-Onset Needle-Free Powder Lidocaine or Placebo Treatment trial.

    PubMed

    Zempsky, William T; Bean-Lijewski, Jolene; Kauffman, Ralph E; Koh, Jeffrey L; Malviya, Shobha V; Rose, John B; Richards, Patricia T; Gennevois, Daniel J

    2008-05-01

    The Comparison of Venipuncture and Venous Cannulation Pain After Fast-Onset Needle-Free Powder Lidocaine or Placebo Treatment trial was a randomized, single-dose, double-blind, phase 3 study investigating whether a needle-free powder lidocaine delivery system (a sterile, prefilled, disposable system that delivers lidocaine powder into the epidermis) produces effective local analgesia within 1 to 3 minutes for venipuncture and peripheral venous cannulation procedures in children. Pediatric patients (3-18 years of age) were randomly assigned to treatment with the needle-free powder lidocaine delivery system (0.5 mg of lidocaine and 21 +/- 1 bar of pressure; n = 292) or a sham placebo system (n = 287) at the antecubital fossa or the back of the hand 1 to 3 minutes before venipuncture or cannulation. All patients rated the administration comfort of the needle-free systems and the pain of the subsequent venous access procedures with the Wong-Baker Faces Pain Rating Scale (from 0 to 5). Patients 8 to 18 years of age also provided self-reports with a visual analog scale, and parents provided observational visual analog scale scores for their child's venous access pain. Safety also was assessed. Immediately after administration, mean Wong-Baker Faces scale scores were 0.54 and 0.24 in the active system and sham placebo system groups, respectively. After venipuncture or cannulation, mean Wong-Baker Faces scale scores were 1.77 +/- 0.09 and 2.10 +/- 0.09 and mean visual analog scale scores were 22.62 +/- 1.80 mm and 31.97 +/- 1.82 mm in the active system and sham placebo system groups, respectively. Parents' assessments of their child's procedural pain were also lower in the active system group (21.35 +/- 1.43 vs 28.67 +/- 1.66). Treatment-related adverse events were generally mild and resolved without sequelae. Erythema and petechiae were more frequent in the active system group. The needle-free powder lidocaine delivery system was well tolerated and produced significant

  7. 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

  8. [An international comparison of physician control systems].

    PubMed

    Jian, Wei-yan; Xiong, Xian-jun; Li, Jing-hu; Ding, Yang; Wang, Li-li; Guo, Yan

    2011-04-18

    This study compares physicians' regulations set by the United Kingdom, the United States, Canada and Germany which have typical healthcare systems. Physicians' regulations are defined in this study as four aspects: physicians' training and qualifications, career pathways, payment methods and behavior regulations. Strict access rules, practicing with freedom, different training models between general and special practitioners, health services priced by negotiations and regulations by professional organizations are the common features of physicians' regulations in these four western countries. Three aspects--introducing contract mechanism, enhancing the roles of professional organizations and extending physicians' practice space should be taken into account in China's future reform of physicians' regulations.

  9. Safety and Efficacy of a Needle-free Powder Lidocaine Delivery System in Pediatric Patients Undergoing Venipuncture or Peripheral Venous Cannulation: Randomized Double-blind COMFORT-004 Trial.

    PubMed

    Schmitz, Michael L; Zempsky, William T; Meyer, James M

    2015-08-01

    The goal of this study was to determine if a lidocaine hydrochloride monohydrate powder intradermal system designed to provide cutaneous analgesia is efficacious, safe, and tolerable for pediatric subjects compared with a sham placebo system. COMFORT-004, A Phase III, Randomized, Double-Blind, Placebo-Controlled Study to Confirm the Effectiveness and Safety of ALGRX 3268 in Pediatric Subjects, was a single-dose, parallel group study of children undergoing venipuncture or peripheral venous cannulation at the antecubital fossa or back of the hand. Included were subjects (3-18 years) in 3 age groups: 3-7, 8-12, and 13-18 years. Excluded were those with recent similar procedures or with implantable devices or skin pathologies at the anatomical site, insufficient cognitive skills, or allergies to local anesthetics or adhesives. Subjects were randomized to receive the needle-free powder lidocaine delivery system (active system, 0.5 mg of lidocaine/21 ± 1 bar of pressure [n = 269]) or sham placebo (n = 266) 1-3 minutes before venipuncture or peripheral venous cannulation. Analgesic efficacy was assessed patient self-report of venous access pain (Wong-Baker FACES Pain Rating Scale [3-18 years] and visual analog scale [VAS; 8-18 years]) and parental observational VAS. Safety assessments included adverse events (AEs) and relationship to study treatment. Skin signs and symptoms were graded numerically. Wong-Baker FACES scores, VAS, and parental VAS were analyzed by using an ANOVA model. Responder ratings and success rates were compared by using a Cochran-Mantel-Haenszel test stratified according to center, age group, and body site. The active system group had significantly (P = 0.0022) less pain compared with the sham placebo in all age groups combined according to the modified Wong-Baker FACES scale. Secondary efficacy analyses found that the active system resulted in less pain as assessed by subjects' VAS pain assessments aged 8-18 years (P = 0.1856), responder analysis (P

  10. Age-related response to lidocaine-prilocaine (EMLA) emulsion and effect of music distraction on the pain of intravenous cannulation.

    PubMed

    Arts, S E; Abu-Saad, H H; Champion, G D; Crawford, M R; Fisher, R J; Juniper, K H; Ziegler, J B

    1994-05-01

    To compare the efficacy of a local anesthetic cream and music distraction in reducing or preventing pain from needle puncture (intravenous cannulation) in children. A secondary aim was to examine the influence of age on the pain report and behavior and on the therapeutic outcome. Children aged 4 to 16 years (N = 180) who were to undergo surgery under general anesthesia via intravenous cannulation were randomly allocated to one of three interventions. The comparison of lidocaine-prilocaine emulsion (EMLA, Astra) and a placebo emulsion was double-blind. Stratification by age group (4 to 6, 7 to 11, 12 to 16) ensured an equal number of children (20) in each intervention/age group category. A global assessment of the behavioral reaction to the procedure was made by the principal investigator, taking into account vocal, verbal, facial, and motor responses. The child was asked to assess pain severity on the Faces Pain Scale (FPS) and a visual analogue toy (VAT). The scales were applied conservatively as ordinal scales: FPS 0 to 6; VAT 0 to 10. Children who received lidocaine-prilocaine emulsion reported less pain (mean FPS score = 1.42) compared with placebo emulsion (mean FPS score = 2.58) and with music distraction (mean FPS = 2.62). There was a highly significant therapeutic effect (P < .001) on the self-report and behavioral scores. Younger children, regardless of intervention, reported significantly more pain than the older children (mean FPS scores: 2.85, 2.33, 1.43 for age groups 4 to 6, 7 to 11, and 12 to 16 respectively; P < .001). The superiority of the local anesthetic emulsion was maximal in the youngest age group (4 to 6) almost eliminating pain-related behavior, and multiple regression analysis confirmed significant age and treatment effects and revealed interaction between therapeutic effect and age. Although a trend favoring the active emulsion was evident in the older children (7 to 11, 12 to 16) the differences were not significant. The pain scores were

  11. Arsenic trioxide treatment of rabbit liver VX-2 carcinoma via hepatic arterial cannulation-induced apoptosis and decreased levels of survivin in the tumor tissue.

    PubMed

    Li, Hong; Gong, Jian; Jiang, Xuyuan; Shao, Haibo

    2013-02-01

    To investigate the role of tumor apoptosis-inhibitory protein survivin in arsenic trioxide-induced apoptosis in VX-2 carcinoma in the rabbit liver by means of transcatheter arterial chemoembolization. Sixteen rabbits with 32 implanted hepatic VX-2 tumors were randomly divided into two groups. The experimental group received 2 mg of arsenic trioxide and 1 mL of ultra-fluid lipiodol co-injected via hepatic arterial cannulation and the control group received only 1 mL of lipiodol. Animals were sacrificed 3 weeks after trans-catheterial arterial chemoembolization. Tumor tissue and tumor-peripheral tissue were collected for analysis. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end-labeling staining was used to assess tumor cells apoptosis. Immunohistochemistry was used to assess the presence of survivin protein. Reverse transcription polymerase chain reaction was used to determine the expression of survivin gene. The number of apoptotic cells significantly increased in the tumor tissue (5.20 ± 0.60%) compared to tumor-peripheral tissue (1.29 ± 0.42%) of the arsenic trioxide-treated group. Survivin expression levels in the tumor tissue were significantly reduced in arsenic trioxide-treated group (7.68 ± 0.65) compared to the control group (35.30 ± 4.63). Transcatheter arterial chemoembolization with arsenic trioxide induced apoptosis of VX-2 carcinoma, in which tumor apoptosis-inhibitory protein survivin may have played a role.

  12. Does the Application of Heat Gel Pack After Eutectic Mixture of Local Anesthetic Cream Improve Venipuncture or Intravenous Cannulation Success Rate in Children? A Randomized Control Trial.

    PubMed

    Schreiber, Silvana; Cozzi, Giorgio; Patti, Giuseppa; Taddio, Andrea; Montico, Marcella; Pierobon, Chiara; Barbi, Egidio

    2017-07-17

    Needle-related procedures are the most common sources of pain for children in the hospital setting. The most used topical anesthetic, eutectic mixture of local anesthetic (EMLA) cream, may cause transient vasoconstriction. It has been postulated that this vasoconstriction may decrease vein visualization. The application of heat gel pack after removal of EMLA cream in the site of venipuncture counteracts the vasoconstriction, improving vein visualization. We assessed using a prospective randomized controlled trial whether the application of heat gel pack increases the needle procedure success rate. The primary study outcome was procedural success rate at the first attempt. The study enrolled 400 children, 200 of whom applied heat gel pack after removing EMLA (treatment group) and 200 did not (control group). Procedural success rate at the first attempt, vein perception before procedure, procedural pain, and adverse events were recorded in both groups. Eighty-eight percent of the procedures were successful at the first attempt in the treatment group and 89% in the control group (P = 0.876). Vein perception was not significantly different in the 2 groups (P = 0.081). Pain score after the procedure was similar in the 2 groups. This study shows that the application of heat gel pack after removal of EMLA cream does not improve venipuncture or intravenous cannulation success rate.

  13. Arsenic trioxide treatment of rabbit liver VX-2 carcinoma via hepatic arterial cannulation-induced apoptosis and decreased levels of survivin in the tumor tissue

    PubMed Central

    Li, Hong; Gong, Jian; Jiang, Xuyuan; Shao, Haibo

    2013-01-01

    Aim To investigate the role of tumor apoptosis-inhibitory protein survivin in arsenic trioxide-induced apoptosis in VX-2 carcinoma in the rabbit liver by means of transcatheter arterial chemoembolization. Methods Sixteen rabbits with 32 implanted hepatic VX-2 tumors were randomly divided into two groups. The experimental group received 2 mg of arsenic trioxide and 1 mL of ultra-fluid lipiodol co-injected via hepatic arterial cannulation and the control group received only 1 mL of lipiodol. Animals were sacrificed 3 weeks after trans-catheterial arterial chemoembolization. Tumor tissue and tumor-peripheral tissue were collected for analysis. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end-labeling staining was used to assess tumor cells apoptosis. Immunohistochemistry was used to assess the presence of survivin protein. Reverse transcription polymerase chain reaction was used to determine the expression of survivin gene. Results The number of apoptotic cells significantly increased in the tumor tissue (5.20 ± 0.60%) compared to tumor-peripheral tissue (1.29 ± 0.42%) of the arsenic trioxide-treated group. Survivin expression levels in the tumor tissue were significantly reduced in arsenic trioxide-treated group (7.68 ± 0.65) compared to the control group (35.30 ± 4.63). Conclusion Transcatheter arterial chemoembolization with arsenic trioxide induced apoptosis of VX-2 carcinoma, in which tumor apoptosis-inhibitory protein survivin may have played a role. PMID:23444241

  14. Are early cannulation arteriovenous grafts (ecAVG) a viable alternative to tunnelled central venous catheters (TCVCs)? An observational "virtual study" and budget impact analysis.

    PubMed

    Aitken, Emma; Iqbal, Kashfa; Thomson, Peter; Kasthuri, Ram; Kingsmore, David

    2016-05-07

    Early cannulation arteriovenous grafts (ecAVGs) are advocated as an alternative to tunnelled central venous catheters (TCVCs). A real-time observational "virtual study" and budget impact model was performed to evaluate a strategy of ecAVG as a replacement to TCVC as a bridge to definitive access creation. Data on complications and access-related bed days was collected prospectively for all TCVCs inserted over a six-month period (n = 101). The feasibility and acceptability of an alternative strategy (ecAVGs) was also evaluated. A budget impact model comparing the two strategies was performed. Autologous access in the form of native fistula was the goal wherever possible. We found 34.7% (n = 35) of TCVCs developed significant complications (including 17 culture-proven bacteraemia and one death from line sepsis). Patients spent an average of 11.9 days/patient/year in hospital as a result of access-related complications. The wait for TCVC insertion delayed discharge in 35 patients (median: 6 days). The ecAVGs were a practical and acceptable alternative to TCVCs in over 80% of patients. Over a 6-month period, total treatment costs per patient wereGBP5882 in the TCVC strategy and GBP4954 in the ecAVG strategy, delivering potential savings ofGBP927 per patient. The ecAVGs had higher procedure and re-intervention costs (GBP3014 vs. GBP1836); however, these were offset by significant reductions in septicaemia treatment costs (GBP1322 vs. GBP2176) and in-patient waiting time bed costs (GBP619 vs. GBP1870). Adopting ecAVGs as an alternative to TCVCs in patients requiring immediate access for haemodialysis may provide better individual patient care and deliver cost savings to the hospital.

  15. Effects of dietary yeast inclusion and acute stress on post-prandial whole blood profiles of dorsal aorta-cannulated rainbow trout.

    PubMed

    Huyben, David; Vidakovic, Aleksandar; Nyman, Andreas; Langeland, Markus; Lundh, Torbjörn; Kiessling, Anders

    2017-04-01

    Yeast is a potential alternative to fish meal in diets for farmed fish, yet replacing more than 50 % of fish meal results in reduced fish growth. In a 4-week experiment, 15 rainbow trout (Oncorhynchus mykiss) were cannulated and fed three diets each week: 30 % fish meal as a control (FM); 60 % replacement of fish meal protein, on a digestible basis, with Saccharomyces cerevisiae (SC); and 60 % replacement with Wickerhamomyces anomalus and S. cerevisiae mix (WA). Blood was collected at 0, 3, 6, 12 and 24 h after feeding. In the final week, fish were exposed to a 1-min netting stressor to evaluate possible diet-stress interactions. Significant increases in pH, TCO2, HCO3 and base excess were found after fish were fed the SC and WA diets compared with FM, which elevated blood alkaline tides. Yeast ingredients had lower buffering capacity and ash content than fish meal, which explained the increase in alkaline tides. In addition, fish fed the WA diet had significantly reduced erythrocyte area and fish fed SC and WA diets had increased mean corpuscular haemoglobin levels, indicating haemolytic anaemia. Higher levels of nucleic acid in yeast-based diets and potentially higher production of reactive oxygen species were suspected of damaging haemoglobin, which require replacement by smaller immature erythrocytes. Acute stress caused the expected rise in cortisol and glucose levels, but no interaction with diet was found. These results show that replacing 60 % of fish meal protein with yeasts can induce haemolytic anaemia in rainbow trout, which may limit yeast inclusion in diets for farmed fish.

  16. 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

  17. 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

  18. 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

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

    PubMed

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

    2012-08-01

    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 [(3)H]sitosterol and [(14)C]cholesterol tracers in lymph after thoracic lymph duct cannulation. The average percentage (± SEM) absorption of [(14)C]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. [(3)H]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.

  20. A novel, double intra-carotid cannulation technique to study the effect of central nutrient sensing on glucose metabolism in the rat.

    PubMed

    Rijnsburger, M; Eggels, L; Castel, J; Cruciani-Guglielmacci, C; Ackermans, M T; Luquet, S; la Fleur, S E

    2017-10-01

    The hypothalamus plays a key role in central nutrient sensing and glucose homeostasis. Due to its position next to the third ventricle, intracerebroventricular (ICV) injections or osmotic minipumps are widely applied techniques in studying effects of hormones and other molecules on the hypothalamus and glucose metabolism. The intracarotid catheter technique in which a catheter is placed in the carotid artery, pointing towards the brain, provides a physiological route to centrally infuse blood-borne molecules in an undisturbed animal. To measure effects of central interventions on peripheral glucose metabolism, endogenous glucose production (EGP) and insulin sensitivity can be measured using a stable isotope technique. To combine both techniques, it is necessary to combine different catheters. We here describe a novel cannulation technique for the carotid artery, enabling stress-free infusions towards the brain and blood sampling from the carotid artery concomitantly, and infuse a stable isotope via the jugular vein. We showed accurate EGP measurements when intracarotically infusing saline towards the brain. The stress-hormone corticosterone, as well as energy expenditure, did not alter upon central infusion. ICV infusions bypass the blood-brain-barrier (BBB) and are thus a less physiological approach when studying central effects of blood-borne factors. Furthermore, ICV injections can elicit a stress response which can interfere with outcomes of glucose metabolism. We described a stress-free, physiological method to study effects of central infusions on peripheral parameters. This technique provides new opportunities for studying central effects of, for instance, hormones and nutrients, on glucose metabolism. Copyright © 2017 Elsevier B.V. All rights reserved.

  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

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

    2015-08-01

    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.

  2. 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.

  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

    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.

  4. A randomized controlled trial and cost-effectiveness analysis of early cannulation arteriovenous grafts versus tunneled central venous catheters in patients requiring urgent vascular access for hemodialysis.

    PubMed

    Aitken, Emma; Thomson, Peter; Bainbridge, Leigh; Kasthuri, Ram; Mohr, Belinda; Kingsmore, David

    2017-03-01

    Early cannulation arteriovenous grafts (ecAVGs) are proposed as an alternative to tunneled central venous catheters (TCVCs) in patients requiring immediate vascular access for hemodialysis (HD). We compared bacteremia rates in patients treated with ecAVG and TCVC. The study randomized 121 adult patients requiring urgent vascular access for HD in a 1:1 fashion to receive an ecAVG with or without (+/-) an arteriovenous fistula (AVF; n = 60) or TCVC+/-AVF (n = 61). Patients were excluded if they had active systemic sepsis, no anatomically suitable vessels, or an anticipated life expectancy <3 months. The primary end point was the culture-proven bacteremia rate at 6 months, with the trial powered to detect a reduction in bacteremia from 24% to 5% (α = .05, β = .8). Secondary end points included thrombosis, reintervention, and mortality. A cost-effectiveness analysis was also performed. Culture-proven bacteremia developed in 10 patients (16.4%) in the TCVC arm ≤6 months compared with two (3.3%) in the ecAVG+/-AVF arm (risk ratio, 0.2; 95% confidence interval, 0.12-0.56; P = .02). Mortality was also higher in the TCVC+/-AVF cohort (16% [n = 10] vs 5% [n = 3]; risk ratio, 0.3; 95% CI, 0.08-0.45; P = .04). The difference in treatment cost between the two arms was not significant (£11,393 vs £9692; P = .24). Compared with TCVC+/-AVF, a strategy of ecAVG+/-AVF reduced the rate of culture-proven bacteremia and mortality in patients requiring urgent vascular access for HD. The strategy also proved to be cost-neutral. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  5. Clinical results of treatment using a modified K-wire tension band versus a cannulated screw tension band in transverse patella fractures

    PubMed Central

    Tan, Honglue; Dai, Pengyi; Yuan, Yanhao

    2016-01-01

    Abstract It was a retrospective case–control study. The aim of this study was to explore the clinical efficacy and complication of treatment using a modified Kirschner wire tension band (MKTB) or a cannulated screw tension band (CSTB) in transverse patellar fractures. In total, 55 patients with transverse patellar fractures were retrospectively reviewed and divided into 2 groups according to the surgical technique: 29 patients were in the MKTB group and 26 patients in the CSTB group. Bǒstman's clinical grading scale, including range of movement (ROM), pain, ability to work, atrophy of quadriceps femoris, assistance in walking, effusion, giving way, and stair-climbing, was used to evaluate the clinical results. Complications including painful hardware, implant loosening or breakage, and bone nonunion were also assessed. Both groups were evaluated at the final follow-up before removing implant in the MKTB group. The Bǒstman's score of ROM, pain, atrophy of quadriceps femoris, and effusion were all higher in the CSTB group than in the MKTB group (P < 0.05). Twelve patients in the MKTB group underwent implant removal, and the score of ROM, pain, and effusion were higher than before removing implant (P < 0.05), but there was no difference compared to the CSTB group (P > 0.05). Seventeen patients achieved excellent results, 9 had good results, and 3 reported fair results in the MKTB group; the CSTB group had excellent results in 22 patients and good results in 4 patients, showing a significant difference in the excellent rate between the 2 groups (P = 0.021). Total Bǒstman scores in the MKTB and CSTB groups (26.96 ± 4.47 and 29.42 ± 1.47, respectively) were significantly different (P = 0.01). Total scores in the MKTB group after removing implant were higher than those before removing implant (P = 0.001), and similar to those in the CSTB group (P = 0.224). Eleven patients in the MKTB group reported painful hardware, including 4

  6. Tourniquet application after local forearm warming to improve venodilation for peripheral intravenous cannulation in young and middle-aged adults: A single-blind prospective randomized controlled trial.

    PubMed

    Yamagami, Yuki; Tomita, Kohei; Tsujimoto, Tomomi; Inoue, Tomoko

    2017-07-01

    Local forearm warming before tourniquet application is often used to promote venodilation for peripheral intravenous cannulation; however, few studies have compared the effect of tourniquet application with and without local warming on vein size. To evaluate the effectiveness of tourniquet application after local forearm warming with that of tourniquet application alone in young and middle-aged adults. A single-blind, prospective, parallel group, randomized controlled trial. A national university in Japan. Seventy-two volunteers aged 20-64 years. Participants were randomly allocated to one of two groups: tourniquet application for 30s after forearm application of a heat pack warmed to 40°C±2°C for 15min (active warming group; n=36) or tourniquet application for 30s after applying a non-warmed heat pack for 15min (passive warming group; n=36). The primary outcomes were vein cross-sectional area on the forearm, measured after the intervention by blinded research assistants using ultrasound. Secondary outcomes were shortest diameter, and longest diameter of vein on the forearm, forearm skin temperature, body temperature, pulse, systolic blood pressure, and diastolic blood pressure. All outcomes were assessed at the same site before and immediately after the intervention, once per participant. Vein cross-sectional area, shortest vein diameter, and longest vein diameter were significantly increased in the active warming group compared with the passive warming group (p <0.01). Tourniquet application after local warming was superior to tourniquet application alone in increasing vein cross-sectional, shortest diameter, and longest diameter (between-group differences of 2.2mm(2), 0.5mm, and 0.5mm, respectively), and in raising skin temperature (between-group difference: 5.2°C). However, there were no significant differences in body temperature, pulse, or systolic or diastolic blood pressure between the groups. There were no adverse events associated with either

  7. Nutrient digestibility of solvent-extracted Brassica napus and Brassica juncea canola meals and their air-classified fractions fed to ileal-cannulated grower pigs.

    PubMed

    Zhou, X; Zijlstra, R T; Beltranena, E

    2015-01-01

    Energy and nutrient digestibility of solvent-extracted canola meal (CM) is limited in pigs by its relatively high fiber content. The seed hull, which greatly contributes to the fiber content of CM, is denser than the oil-free cotyledon. By utilizing streams of air, air classification partially separates these seed components on the basis of their different sizes and densities to produce a low-fiber, light-particle fraction and a high-fiber, heavy-particle fraction. Compared with parent CM, ADF and NDF were reduced by 31.9% and 29.5% in the light-particle fraction and were enriched by 16.5% and 9.0% in the heavy-particle fraction (DM basis), respectively. Particle size was 638, 18.9, and 76.1 µm for the parent CM and light- and heavy-particle fractions, respectively. To determine the nutrient digestibility of CM and their air-classified fractions, Brassica napus and B. juncea CM and their 2 air-classified fractions were evaluated in a 2 × 3 factorial arrangement together with a basal diet and an N-free diet. The experiment was conducted as an 8 × 8 Latin square in which diets contained 40% B. napus or B. juncea CM or their air-classified fractions and 60% basal diet. Digesta data from pigs fed the N-free diet served to subtract basal endogenous AA losses. Eight ileal-cannulated barrows (32 kg initial BW) were fed the 8 diets at 2.7 times maintenance DE for eight 11-d periods. At the end of each period, feces were collected for 48 h, and ileal digesta were collected for two 12-h periods. The DE and calculated NE values and the apparent total tract digestibility (ATTD) of GE were 6.3%, 10.0%, and 7.8% greater (P < 0.001) for B. juncea CM than for B. napus CM; 6.1%, 10.8%, and 5.3% greater (P < 0.001) for the light-particle fraction than for parent CM; and 5.4%, 7.2%, and 3.8% lower (P < 0.001) for the heavy-particle fraction than for parent CM, respectively. The standardized ileal digestibilities (SID) of His, Ile, Val, Asp, and Tyr were greater (P < 0.05) for B

  8. Femtosecond-laser-driven wire-guided helical undulator for intense terahertz radiation

    NASA Astrophysics Data System (ADS)

    Tian, Ye; Liu, Jiansheng; Bai, Yafeng; Zhou, Shiyi; Sun, Haiyi; Liu, Weiwei; Zhao, Jiayu; Li, Ruxin; Xu, Zhizhan

    2017-02-01

    The capability of synchrotron radiation to produce ultrabright emission has attracted considerable interest over the last half a century. To date, magnetic undulators with a period of several centimetres are commonly used for wiggling relativistic electrons in a modulated field. Here, we propose a novel compact undulator with a period down to the submillimetre level based on a spontaneous electric field that is driven by a femtosecond laser. Both the guided energetic electrons and the gyrotron-like undulator are spontaneously produced by irradiating a thin metallic wire with an intense laser pulse. An intense radial electric field instantaneously created on the wire can guide the electrons' helical motion along the wire and induce periodic THz emission. We have demonstrated that this scheme can produce intense THz sources with a conversion efficiency of 1% that are frequency-tunable by adjusting the diameter of the wire. Amplified emission of THz radiation by more than tenfold has been observed.

  9. Easy route to superhydrophobic copper-based wire-guided droplet microfluidic systems.

    PubMed

    Mumm, Florian; van Helvoort, Antonius T J; Sikorski, Pawel

    2009-09-22

    Droplet-based microfluidic systems are an expansion of the lab on a chip concept toward flexible, reconfigurable setups based on the modification and analysis of individual droplets. Superhydrophobic surfaces are one suitable candidate for the realization of droplet-based microfluidic systems as the high mobility of aqueous liquids on such surfaces offers possibilities to use novel or more efficient approaches to droplet movement. Here, copper-based superhydrophobic surfaces were produced either by the etching of polycrystalline copper samples along the grain boundaries using etchants common in the microelectronics industry, by electrodeposition of copper films with subsequent nanowire decoration based on thermal oxidization, or by a combination of both. The surfaces could be easily hydrophobized with thiol-modified fluorocarbons, after which the produced surfaces showed a water contact angle as high as 171 degrees +/- 2 degrees . As copper was chosen as the base material, established patterning techniques adopted from printed circuit board fabrication could be used to fabricate macrostructures on the surfaces with the intention to confine the droplets and, thus, to reduce the system's sensitivity to tilting and vibrations. A simple droplet-based microfluidic chip with inlets, outlets, sample storage, and mixing areas was produced. Wire guidance, a relatively new actuation method applicable to aqueous liquids on superhydrophobic surfaces, was applied to move the droplets.

  10. Closed cannulation of subclavian vein vs open cut-down of cephalic vein for totally implantable venous access port (TIVAP) implantation: protocol for a systematic review and proportional meta-analysis of perioperative and postoperative complications.

    PubMed

    Klaiber, Ulla; Grummich, Kathrin; Jensen, Katrin; Saure, Daniel; Contin, Pietro; Hüttner, Felix J; Diener, Markus K; Knebel, Phillip

    2015-04-22

    Totally implantable venous access port (TIVAP) implantation is one of the most often performed operations in general surgery (over 100,000/year in Germany). The two main approaches for TIVAP placement are insertion into the cephalic vein through an open cut-down technique (OCD) or closed cannulation technique of the subclavian vein (CC) with Seldinger technique. Both procedures are performed with high success rates and very low complication frequencies. Because of the low incidence of complications, no single interventional trial is able to report a valid comparison of peri- and postoperative complication frequencies between both techniques. Therefore, the aim of this systematic review is to summarize evidence for peri- and postoperative complication rates in patients undergoing OCD or CC. A systematic literature search will be conducted in The Cochrane Library, MEDLINE, and Embase to identify randomized controlled trials (RCTs), observational clinical studies (OCS), or case series (CS) reporting peri- and/or postoperative complications of at least one implantation technique. A priori defined data will be extracted from included studies, and methodological quality will be assessed. Event rates with their 95% confidence intervals will be derived taking into account the follow-up time per study by patient-months where appropriate. Pooled estimates of event rates with corresponding 95% confidence intervals will be calculated on the base of the Freeman-Tukey double arcsine transformation within a random effect model framework. The findings of this systematic review with proportional meta-analysis will help to identify the procedure with the best benefit/risk ratio for TIVAP implantation. This may have influence on daily practice, and data may be implemented in treatment guidelines. Considering the impact of TIVAP implantation on patients' well being together with its socioeconomic relevance, patients will benefit from evidence-based treatment and health-care costs may

  11. Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures: a prospective randomized controlled trial.

    PubMed

    Feng, Yongzeng; Shui, Xiaolong; Wang, Jianshun; Cai, Leyi; Yu, Yang; Ying, Xiaozhou; Kong, Jianzhong; Hong, Jianjun

    2016-07-15

    The management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial. A prospective randomized controlled trial was conducted to compare percutaneous reduction, cannulated screw fixation and calcium sulfate cement (PR+CSC) grafting with minimally invasive sinus tarsi approach and plate fixation (MISTA) for treatment of DIACFs. Ultimately, 80 patients with a DIACFs were randomly allocated to receive either PR+CSC (N = 42) or MISTA (N = 38). Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores. Radiological results were assessed using plain radiographs and computed tomography (CT) scans, and postoperative wound-related complications were also recorded. The average time from initial injury to operation and the average operation time in the PR+CSC group were both significantly shorter than those in the MISTA group (p < 0.05). There were significantly fewer complications in the PR+CSC group than those in the MISTA group (7.1 % vs 28.9 %, p < 0.001). The calcaneal width immediate postoperatively and at the final follow-up in the MISTA group were obviously improved compared to those in the PR+CSC group (p < 0.001). The variables of sagittal motion and hindfoot motion of the AOFAS scoring system in the PR+CSC group were significantly higher than those in the MISTA group (p < 0.05). The good and excellent results in the two groups were comparable for Sanders Type-II calcaneal fractures, but the good to excellent rate in the MISTA group was significantly higher for Sanders Type-III fractures (p < 0.05). The clinical outcomes are comparable between the two minimally invasive techniques in the treatment of Sanders Type-II DIACFs. The PR+CSC grafting is superior to the MISTA in terms of the average time between initial injury and operation, operation time, wound-related complications and subtalar joint activity. However, the MISTA has its own

  12. Physician-controlled costs: the choice of equipment used for atrial fibrillation ablation.

    PubMed

    Winkle, Roger A; Mead, R Hardwin; Engel, Gregory; Kong, Melissa H; Patrawala, Rob A

    2013-03-01

    Atrial fibrillation (AF) ablation uses expensive technology and equipment. Physicians have considerable latitude over equipment choice. Average Medicare reimbursement is $10,338 for uncomplicated AF ablations. The purpose of this study is to evaluate the cost of special equipment chosen by physicians to perform AF ablation. We obtained the list price cost of special capital equipment and of disposable equipment (intracardiac ultrasound probes, transseptal needles/sheaths, and ablation/recording catheters) commonly used for radiofrequency (RF) AF ablation. We also evaluated the equipment cost of using robotic magnetic navigation and cryoablation. Then we evaluated costs for several physician equipment choice scenarios. Using open irrigated-tip catheters, the lowest estimated cost-per-case for manual RF ablation of AF was $6,637, and the highest estimated cost of manual RF ablation was $12,603. Assuming 200 AF ablations/year and a 6-year magnet life, the cost-per-case of using magnetic navigation ablation ranged from $12,261-$15,464. The cost-per-case using cryoballoons alone ranged from $12,847-$15,320, and if focal cryoablation or RF touch-up is needed, cryoablation cost increased to $15,942-$22,284. Physicians have many choices in AF ablation equipment. Equipment costs in our arbitrary scenarios range from $6,637 to $22,284 per case. More important than the specific cost of each scenario is the concept that these are physician-driven costs, and as such, physicians will need to determine if more expensive technologies increase procedural efficacy and/or patient safety enough to justify the greater procedural equipment costs.

  13. 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.

  14. Research into pain perception with arteriovenous fistula (avf) cannulation.

    PubMed

    Figueiredo, Ana E; Viegas, Ariani; Monteiro, Mara; Poli-de-Figueiredo, Carlos E

    2008-12-01

    Patients with end-stage renal failure (ESRF) undergoing haemodialysis (HD) are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula (AVF). Repeated AVF punctures lead to a considerable degree of pain, due to the calibre and length of the bevel of fistula needles. Pain is a sensitive, emotional and subjective experience. The objective of this study was to measure pain associated with AVF needling. The analogue visual scale (AVS) divided into 10 equal parts (0 indicating lack of pain, and 10 unbearable pain) was used. Patients(7) perceptions were measured in three different HD sessions. Pain was considered mild during AVF needling. The buttonhole technique caused a mean degree of pain of 2.4 (+/-1.7), compared to 3.1 (+/-2.3) using the conventional ropeladder technique. Although without reaching a statistically significant difference, diminished pain was associated with the buttonhole technique.

  15. A pilot/introducer needle for central vein cannulation.

    PubMed

    Suzuki, T; Kanazawa, M; Kinefuchi, Y; Fukuyama, H; Takiguchi, M; Yamamoto, M; Abe, K; Okuda, Y

    1995-12-01

    A kit for safe and easy insertion of a central vein cannula was devised. A small gauge (22 gauge) metal pilot needle was equipped with a Y-shaped hub which had a side-port to accept a small gauge (0.46 mm) Seldinger guide wire. Once the needle reached the vein, guidewire was threaded in through the side-port. There was no need to remove the pilot needle and no need to repeat vein puncture with a larger-bore needle. Three puncture methods were used with the kit: (1) the central approach via the internal jugular vein, (2) the supraclavicular approach via the junction of the internal jugular vein and subclavian vein, and (3) the infraclavicular approach via the subclavian vein. Each method was used on 20 patients, for total of 60 patients, with a high success rate. Less than 3 minutes were required from puncture to catheter insertion. No serious complications were encountered.

  16. Direct peroral cholangioscopy using an ultraslim upper endoscope for biliary lesions.

    PubMed

    Omuta, Shigefumi; Maetani, Iruru; Ukita, Takeo; Nambu, Tomoko; Gon, Katsushige; Shigoka, Hiroaki; Saigusa, Yoshinori; Saito, Michihiro

    2014-02-01

    The development of direct peroral cholangioscopy (DPOC) using an ultraslim endoscope simplifies biliary cannulation. The conventional techniques are cumbersome to perform and require advanced skills. The recent introduction of the guidewires and balloons has improved the therapeutic outcomes. Here we describe an effective and easier method for performing DPOC using an ultraslim upper endoscope. Indications for DPOC were the presence of stones on follow-up of patients who had previously undergone complete sphincteroplasty, including endoscopic sphincterotomy or endoscopic papillary large balloon dilatation. Fifteen patients underwent DPOC. An ultraslim endoscope was inserted perorally and was advanced into the major papilla. The ampulla of Vater was visualized by retroflexing the endoscope in the distal second portion of the duodenum, and then DPOC was performed using a wire-guided cannulation technique with an anchored intraductal balloon catheter. One patient failed in the treatment due to looping of the endoscope in the fornix of the stomach. Fourteen (93.3%) were successfully treated with our modified DPOC technique. Only one patient (6.7%) experienced an adverse event (pancreatitis) who responded well to conservative management. Residual stones of the common bile duct were completely removed in 3 patients. The modified method of DPOC is simple, safe and easy to access the bile duct.

  17. Cervical lymph cannulation to investigate the efflux and effects of intracerebroventricular cytokine infusions.

    PubMed

    Seabrook, T J; Dickstein, J B; Hay, J B

    2001-02-01

    It is well documented that there is communication between the cerebral spinal fluid (CSF) and cervical lymphatics. Recently, it has been demonstrated that tumor necrosis factor alpha (TNF-alpha) introduced into the CSF appears in the cervical lymph. However, the functional significance of this is less clear. Here we describe a protocol to quantitate the efflux of TNF-alpha from the CSF into cervical lymph. In addition, we describe a methodology to examine the effects of an intracerebroventricular (i.c.v.) infusion of TNF-alpha on lymph volume, cellularity and cell phenotype. While TNF-alpha was recovered in the cervical lymph following infusion of 125-I labeled TNF-alpha, the dosage of TNF-alpha used in this study had no effect on cervical lymph flow, cellularity or cell subsets. This protocol can be used to study the efflux of i.c.v. injected macromolecules and their effects on lymphocytes in cervical lymph and the regional lymph nodes.

  18. Metabolic Disposition of Labeled WR-158,122 in a Bile Duct Cannulated Rhesus Monkey.

    DTIC Science & Technology

    1980-02-18

    and diluted to 124.08 g. It contained 2.50 mg WR-158,122/ml and 1.86 ;Ci/ml. The suspension was stored at 4°C. Assay of the suspension gave the...of BF2* powder and nitrofurazone ointment. SMA 12/60 assays were run on plasma samples at I day after surgery, just prior to the first and second...penicillin G, 250 mg dihydrostreptomycin, 10 mg chlorpheniramine maleate, and 25 mg diphemanil- methylsulfate. Preservatives are 20 mg procaine HCl

  19. Pharmacological evidence for capacitative Ca(2+) entry in cannulated and pressurized skeletal muscle arterioles.

    PubMed

    Potocnik, S J; Hill, M A

    2001-09-01

    Arteriolar myogenic tone shows a marked dependency on extracellular Ca(2+). The contribution played by mechanisms such as intracellular Ca(2+) release and capacitative entry, however, are less certain. The present studies aimed to demonstrate functional evidence for involvement of such mechanisms in myogenic tone and reactivity. Single cremaster arterioles were denuded of endothelium, pressurized under no-flow conditions and loaded with fura 2-AM for measurement of changes in intracellular Ca(2+) [Ca(2+)](i). The cell permeable, putative, IP(3) receptor antagonist 2APB (2 aminoethoxydiphenyl borate) was used to determine the possible role of IP(3) receptor-mediated mechanisms in arteriolar myogenic tone and reactivity. Arterioles dilated in response to increasing concentrations of 2APB (1 - 300 microM) without a concomitant change in global [Ca(2+)](i). Also 2APB (50 microM) completely inhibited the myogenic constriction in response to a step change in luminal pressure (50 - 120 mmHg) with no apparent effect on pressure-mediated increases in [Ca(2+)](i). 2APB markedly attenuated the constrictor response and [Ca(2+)](i) increase stimulated by phenylephrine but not KCl. Capacitative Ca(2+) influx in arterioles was demonstrated either by re-addition of extracellular [Ca(2+)] following pre-treatment with 1 or 10 microM nifedipine in Ca(2+) free buffer or exposure of vessels to thapsigargin (1 microM) to induce store depletion. In both cases 2APB inhibited the increase in [Ca(2+)](i). Capacitative Ca(2+) entry showed an inverse relationship with intraluminal pressure over the range 10 - 120 mmHg. Consistent with an effect on a Ca(2+) entry pathway, 2APB had no effect on intracellular (caffeine releasable) Ca(2+) stores while decreasing the rate of Mn(2+) quench of fura 2 fluorescence. The results provide functional evidence for capacitative Ca(2+) entry in intact arteriolar smooth muscle. The effectiveness of 2APB in inhibiting both non-voltage gated Ca(2+) entry and responsiveness to an acute pressure step is consistent with the involvement of an axis involving IP(3)-mediated and or capacitative Ca(2+) entry mechanisms in myogenic reactivity. Given the lack of effect of 2APB on pressure-induced changes in global [Ca(2+)](i) it is suggested that such mechanisms participate on a localized level to couple the myogenic stimulus to contraction.

  20. Infraclavicular axillary vein cannulation using ultrasound in a mechanically ventilated general intensive care population.

    PubMed

    Glen, H; Lang, I; Christie, L

    2015-09-01

    Central venous catheter (CVC) insertion is commonly undertaken in the ICU. The use of ultrasound (US) to facilitate CVC insertion is standard and is supported by guidelines. Because the subclavian vein cannot be insonated where it underlies the clavicle, its use as a CVC site is now less common. The axillary vein, however, can be seen on US just distal to the subclavian vein and placement of a CVC at this site gives a result which is functionally indistinguishable from a subclavian CVC. We evaluated placement of US-guided axillary CVCs in mechanically ventilated intensive care patients. Data were collected for 125 consecutive US-guided axillary CVC procedures in ventilated patients in an adult intensive care setting. All lines were inserted using real-time US guidance with an out-of-plane technique. One hundred and twenty-five procedures occurred in 119 patients. Successful line placement was achieved in 117 out of 125 (94%) procedures. Complications included four procedures that required repeating due to catheter malposition and one arterial puncture. The median number of attempts per procedure was one (IQR 1 to 2). Thirty-nine (31%) patients had a body mass index of 30 or above, 43 (34%) patients had a coagulopathy and 70 (56%) patients had significant ventilator dependence (FiO2 of 0.5 or above, or positive end expiratory pressure 10 cmH20 or above). The technique of US-guided axillary CVC access can be undertaken successfully in ventilated intensive care patients, even in challenging circumstances. Taken together with existing work on the utility and safety of this technique, we suggest that it be adopted more widely in the intensive care population.

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

    USDA-ARS?s Scientific Manuscript database

    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...

  2. Metabolic Studies on WR-158,122 in Bile Duct Cannulated Rats and Monkeys.

    DTIC Science & Technology

    1980-02-15

    recovery was uneventful. On 12/11/79 the monkey was administered a single oral dose of WR-158,122 14 C (5 mg/kg) via a No. 8 French nasogastric tube . The...made caudal to the last rib. The muscle layer is lifted, using forceps, and cut with blunt tip scissors being careful to avoid cutting the underlying...with blunt tip scissors being careful to avoid cutting the underlying tissues. The liver is retracted cranially using a warm saline-moistened gauze pad

  3. [Pharyngeal hemorrhaging due to iatrogenic false aneurysm. Complication after cannulation of the internal jugular vein].

    PubMed

    Kreckel, V; Langwara, H

    2009-03-01

    Catheterization of the internal jugular vein is used for temporary access to the central vein in patients with acute or chronic renal failure. The most frequent problem is the arterial puncture and accidental placement of the large catheter in an artery. This case report describes a rare secondary complication by accidental catheterization of the right common carotid artery after intended dual lumen catheter insertion into the right internal jugular vein. A false aneurysm with pharyngeal hemorrhaging developed 2 weeks after the puncture. The diagnosis was made using colour-Doppler ultrasound and the aneurysm was treated with vascular surgery.

  4. Arthroscopic treatment of tibial spine fracture in children with a cannulated Herbert screw.

    PubMed

    Wiegand, N; Naumov, I; Vámhidy, L; Nöt, L G

    2014-03-01

    Avulsion fractures of the anterior tibial intercondylar eminence in childhood are rare and are severe injuries of the knee. Since the injury is equivalent in aetiology with ruptures of the anterior cruciate ligament, the treatment requires anatomic reduction and preservation of the stability of the joint. The aim of the study was to demonstrate our experiences with the arthroscopy-guided Herbert-screw fixation in the treatment of displaced tibial eminence fractures in children. Between January 2004 and December 2011, a total of eight children were treated surgically with Type II or Type III anterior tibial eminence fractures; another four children with undisplaced, Type I fractures were treated conservatively, applying with cast fixation for 6 weeks. Radiological consolidation, stability and functional outcome were assessed during the follow-up examinations. On the 12th postoperative week, we did not find instability in any of the patients by physical examination. There were only minimal differences found in the functional outcome, comparing the conservatively and operatively treated groups (Lysholm functional scale, average scores: Type I: 97, Type II: 95 and Type III: 94 points). The range of motion (ROM) of the injured knees was identical with healthy sides on the postoperative 6th week. Our results indicate that the presented method can successfully be applied in the treatment of displaced tibial spine fractures; providing excellent stability and preserving the function of the injured knee in the short-term. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. Early migration of a partially cemented fluted glenoid component inserted using a cannulated preparation system.

    PubMed

    Nuttall, D; Birch, A; Haines, J F; Watts, A C; Trail, I A

    2017-05-01

    Radiostereometric analysis (RSA) allows an extremely accurate measurement of early micromotion of components following arthroplasty. In this study, RSA was used to measure the migration of 11 partially cemented fluted pegged glenoid components in patients with osteoarthritis who underwent total shoulder arthroplasty using an improved surgical technique (seven men, four women, mean age 68). Patients were evaluated clinically using the American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores and by CT scans two years post-operatively. There were two patterns of migration, the first showing little, if any, migration and the second showing rotation by > 6° as early as three months post-operatively. At two years, these two groups could be confirmed on CT scans, one with osseointegration around the central peg, and the second with cystic changes. Patients with osteolysis around the central peg were those with early migration and those with osseointegration had minimal early migration. Both groups,however,had similar clinical results. Rapid early migration associated with focal lucency and absence of osseointegration was observed in three of 11 glenoid components, suggesting that lack of initial stability leads to early movement and failure of osseointegration. Cite this article: Bone Joint J 2017;99-B:674-9. ©2017 The British Editorial Society of Bone & Joint Surgery.

  6. A survey of the use of ultrasound guidance in internal jugular venous cannulation.

    PubMed

    McGrattan, T; Duffty, J; Green, J S; O'Donnell, N

    2008-11-01

    It has been that suggested the use of two dimensional (2D) ultrasound to facilitate placement of central venous cannulae in the internal jugular vein improves patient safety and reduces complications. Since the introduction of the National Institute for Clinical Excellence Technology Appraisal Guideline Number 49 in 2002, promoting the use of ultrasound in placement of internal jugular venous cannulae, utilisation of ultrasound has increased throughout the United Kingdom. We report the findings of a postal survey of 2000 senior anaesthetists in the United Kingdom which enquired about their use of ultrasound for internal jugular vein cannulae placement. Only 27% use 2D ultrasound as their first choice technique, although 35% use it as their first choice when teaching. There was no significant difference in practice between those working within a sub specialty in anaesthesia. There continues to be discrepancies between the application of the guideline and how senior anaesthetists both site and teach the placement of internal jugular vein central venous cannulae.

  7. Comparison of Iontophoretic Lidocaine to EMLA Cream for Pain Reduction Prior to Intravenous Cannulation in Adults

    DTIC Science & Technology

    2000-10-01

    iontophoresis of local anesthetics for the treatment of trigeminal neuralgia . Gibson and Cooke, in 1959, used lidocaine and pilocarpine iontophoresis to...throat, oral surgery, lithotripsy, and there are some anecdotal reports of its use for the treatment of postherpetic neuralgia . Hallen, Carlsson, and

  8. Remote cannulation and extracorporeal membrane oxygenation transport is safe in a newly established program

    PubMed Central

    Grenda, David S.; Moll, Vanessa; Kalin, Craig M.

    2017-01-01

    Extracorporeal membrane oxygenation (ECMO) has become an increasingly utilized modality for the support of patients with severe cardiac or pulmonary dysfunction. Unfortunately, the costs and expertise required to maintain a formal ECMO program preclude the vast majority of hospitals from employing such technology routinely. These barriers to implementation of an effective ECMO program highlight the importance of the safe transport of patients in need of extracorporeal support. While many centers with extensive expertise in the management of patients on extracorporeal support have demonstrated their ability to transport those same patients, the ability of new ECMO programs to provide such transportation remains poorly studied. We established an ECMO program at our institution and immediately provided equipment and personnel to transport patients in need of or receiving extracorporeal support to our institution. Overall, we found that 13 out of 28 patients transported to our institution on ECMO or for consideration of ECMO support during the first 15 months of the program survived to hospital discharge. During that period, four incidents associated with patient transport occurred but none were related to ECMO support or adversely affected patient outcome. These observations demonstrate that new ECMO programs can safely and reliably transport patients on or in need of extracorporeal support. PMID:28275616

  9. A Reusable Adapter for Collection of Cerebrospinal Fluid in Chronically Cannulated Goats

    DTIC Science & Technology

    1989-03-03

    implantation of the cisternal cannula, a 7mm hole was trephined ventrally through the base of the occipital bone to the dorsal surface of the dura mater in...cannula and over the screws used for anchoring the resin. The stereotaxic equipment was used to center the cannulas into the trephined holes as well as for...suture and extended 2cm laterally on each side of the midline. The lateral ventricular cannula (Figure 3) was introduced through a 9mm hole trephined

  10. Remote cannulation and extracorporeal membrane oxygenation transport is safe in a newly established program.

    PubMed

    Grenda, David S; Moll, Vanessa; Kalin, Craig M; Blum, James M

    2017-02-01

    Extracorporeal membrane oxygenation (ECMO) has become an increasingly utilized modality for the support of patients with severe cardiac or pulmonary dysfunction. Unfortunately, the costs and expertise required to maintain a formal ECMO program preclude the vast majority of hospitals from employing such technology routinely. These barriers to implementation of an effective ECMO program highlight the importance of the safe transport of patients in need of extracorporeal support. While many centers with extensive expertise in the management of patients on extracorporeal support have demonstrated their ability to transport those same patients, the ability of new ECMO programs to provide such transportation remains poorly studied. We established an ECMO program at our institution and immediately provided equipment and personnel to transport patients in need of or receiving extracorporeal support to our institution. Overall, we found that 13 out of 28 patients transported to our institution on ECMO or for consideration of ECMO support during the first 15 months of the program survived to hospital discharge. During that period, four incidents associated with patient transport occurred but none were related to ECMO support or adversely affected patient outcome. These observations demonstrate that new ECMO programs can safely and reliably transport patients on or in need of extracorporeal support.

  11. Metabolism Studies on WR-158,122 in Bile Duct Cannulated Rats and Monkeys.

    DTIC Science & Technology

    1981-02-16

    quantities of the 4 milled feces samples were placed in 15 ml grad- uated centrifuge tubes and extracted three tir.es with 5 ml THF as follows: tubes...were shaken for 15 min on an automatic shaker, centrifuged for 10 min and each solvent layer poured into a LSC vial. The TIC was evaporated wit N2 in a...were centrifuged for 30 min. The supernates were poured into LSC vials and counted in 15 ml of Biofluor. Results THF extracted almost the save dpm/mg

  12. Preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: What can be done?

    PubMed Central

    Hauser, Goran; Milosevic, Marko; Stimac, Davor; Zerem, Enver; Jovanović, Predrag; Blazevic, Ivana

    2015-01-01

    Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography. The incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis varies substantially and is reported around 1%-10%, although there are some reports with an incidence of around 30%. Usually, PEP is a mild or moderate pancreatitis, but in some instances it can be severe and fatal. Generally, it is defined as the onset of new pancreatic-type abdominal pain severe enough to require hospital admission or prolonged hospital stay with levels of serum amylase two to three times greater than normal, occurring 24 h after ERCP. Several methods have been adopted for preventing pancreatitis, such as pharmacological or endoscopic approaches. Regarding medical prevention, only non-steroidal anti-inflammatory drugs, namely diclofenac sodium and indomethacin, are recommended, but there are some other drugs which have some potential benefits in reducing the incidence of post-ERCP pancreatitis. Endoscopic preventive measures include cannulation (wire guided) and pancreatic stenting, while the adoption of the early pre-cut technique is still arguable. This review will attempt to present and discuss different ways of preventing post-ERCP pancreatitis. PMID:25632179

  13. The Electron Microscopy of the Effects of Treatment with Coumarin (Venalot) and by Thoracic Duct Cannulation on Thermal Injuries

    PubMed Central

    Casley-Smith, J. R.; Földi-Börcsök, E.; FÖldi, M.

    1973-01-01

    The effects of coumarin (Venalot) and of external lymphatic drainage were examined with the electron microscope in rat hind legs and mouse ears that were injured by heat. Coumarin, especially when lymph drainage was added, greatly reduced the amounts of protein in the tissues and the concomitant oedema fluid, lymphatic dilatation, open interendothelial junctions and lymph protein concentration. While there were crude indications that the increased blood vascular permeability was unchanged, it was considered that there was insufficient evidence to decide between the various hypotheses as to the modes of action of these treatments. ImagesFig. 1Fig. 2Fig. 7Fig. 8Fig. 5Fig. 6Fig. 3Fig. 4 PMID:4689821

  14. Endovascular repair of inadvertent subclavian artery perforation during cannulation for dialysis access: case report and review of the literature.

    PubMed

    Melas, Nikolaos; Saratzis, Athanasios; Saratzis, Nikolaos; Kiskinis, Dimitrios

    2009-12-01

    Central venous catheterization is a routine vascular-access procedure; however, it may be associated with life-threatening complications such as arterial puncture, leading to arterial occlusion, embolism, pseudoaneurysm formation, vessel laceration or dissection, haemopneumothorax or massive haemorrhage. We report a case of an accidental subclavian artery perforation with a wide dialysis catheter. A Jostent endovascular covered stent was deployed to seal the deficit. The specific device can easily conform to the anatomical configuration of most peripheral vessels, constituting a good alternative to open repair in cases of accidental vessel puncture.

  15. 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

  16. Human thoracic duct cannulation: manipulation of tumor-specific blocking factors in a patient with malignant melanoma.

    PubMed

    Isbister, W H; Noonan, F P; Halliday, W J; Clunie, G J

    1975-05-01

    Thoracic duct lymph was drained for 28 days from a patient with disseminated malignant melanoma. Lymphocytes were separated from the lymph by centrifugation, and returned to the patient daily. Biochemical and hematologic parameters were monitored in blood and lymph, and were maintained at satisfactory levels throughout the period. Cell-mediated immunity and specific blocking activity directed against melanoma antigens were examined by the leukocyte adherence inhibition test. Blocking factors in drained lymph fell to undetectable levels after 6 days' thoracic duct drainage, whereas it took 9 days for serum blocking factors to fall to similar levels. Peripheral blood leukocytes demonstrated cell-mediated immunity against melanoma antigens before and throughout the period of drainage, except for the immediate postoperative period. Within 24 hours of closure of the thoracic duct fistula, serum blocking activity had returned, and 17 days later the patient died.

  17. A Surgical Procedure for the Chronic Cannulation of the Carotid Artery and the Jugular Vein in Dogs,

    DTIC Science & Technology

    1986-05-01

    neck incision was closed with 3/0 chromic interrupted suture for the fascia and the subcutaneous layers, and 3/0 Prolene (Ethicon Sutures Limited...Peterborough) subcuticular for the skin. The back incision was closed with 3/0 Prolene subcuticular. Cannulae were wrapped in adhesive tape in a butterfly...fashion (about 2x3 cm) and the wings were anchored to the skin with 3/0 Prolene . The jacket (described below) was put on the dog and the cannulae

  18. 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

  19. Preventing the collapse of a peripheral vein during cannulation: an evaluation of various tourniquet techniques on vein compressibility.

    PubMed

    Kule, Amy; Hang, Bophal; Bahl, Amit

    2014-05-01

    Venous access can occasionally be difficult to obtain secondary to near-complete compressibility of peripheral veins in some patients. This study utilizes ultrasound to assess vein compressibility with different tourniquet techniques commonly available in the emergency department. After approval by the Institutional Review Board, a prospective single-center study was conducted assessing the compressibility of basilic veins with ultrasound. Compressibility was assessed at baseline, use of one proximal tourniquet, two tourniquets (one distal and one proximal), and a proximal blood pressure cuff inflated to 150 mm Hg. Vein compressibility was rated as complete, moderate, or mild after light pressure was applied with the ultrasound probe. One hundred healthy patients were recruited into the study. Ninety-eight subjects had completely compressible basilic veins at baseline. When one tourniquet and two tourniquets were applied, 62 and 31 participants, respectively, demonstrated completely compressible veins. Fisher's exact test comparing one vs. two tourniquets revealed no difference between these two techniques (p = 0.4614). Only two participants continued to have a completely compressible vein after application of the blood pressure cuff with statistical significance by Fisher's exact test compared to both tourniquet groups (p < 0.0001). Both tourniquets and blood pressure cuffs can decrease the compressibility of peripheral veins. Although no difference was identified between one and two tourniquets, utilization of blood pressure cuffs significantly decreased compressibility. The findings of this study can be utilized in the emergency department when attempting to obtain peripheral venous access, specifically supporting the use of blood pressure cuffs to decrease compressibility. Copyright © 2014. Published by Elsevier Inc.

  20. Removal of a femoral nail with osseous overgrowth at the end-cap: A navigated and cannulated minimally invasive technique.

    PubMed

    Marintschev, Ivan; Rausch, Sascha; Fujak, Albert; Klos, Kajetan; Hofmann, Gunther O; Gras, Florian

    2013-01-01

    Intramedullary nail removal can be demanding, especially in cases of implant breakage or bony overgrowth at the end-cap, if the exact insertion depth of the nail is neglected in the index surgery. In the presented case, two challenging nail removals were necessary. The first was performed in a re-nailing procedure due to a pseudarthrosis with implant breakage, and the second was performed during hardware removal after fracture healing in a situation where there was deep intramedullary placement of the exchange nail. For the second implant removal a minimally invasive approach based on instrument placements over a navigated guide-wire was used to reduce the iatrogenic morbidity associated with an extensive open approach to the nail and to decrease the radiation exposure for the patient and the operating team.

  1. Minimally Invasive Spinal Arthrodesis in Osteoporotic Population Using a Cannulated and Fenestrated Augmented Screw: Technical Description and Clinical Experience

    PubMed Central

    Lubansu, Alphonse; Rynkowski, Michal; Abeloos, Laurence; Appelboom, Geoffrey; Dewitte, Olivier

    2012-01-01

    We describe a percutaneous or minimally invasive approach to apply an augmentation of pedicle fenestrated screws by injection of the PMMA bone cement through the implant and determine the safety and efficiency of this technique in a clinical series of 15 elderly osteoporotic patients. Clinical outcome and the function were assessed using respectively the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI). Peri- and post-operative complications were monitored during a minimum of 2 years of follow-up. Radiographic follow-up was based on plain fluoroscopic control at 3, 6 and 12 months and every year. In this approach, four steps were considered with care: optimal positioning of the screws, correct alignment of the screw heads, waiting time before the injection of cement, fluoroscopic control of the cement injection. Using these precautions, only 2 minor complications occurred. VAS scores and ODI questionnaires showed a statistically significant improvement up to 13.3 months postoperatively. No radiological complications were observed. Based on this experience, PMMA augmentation technique through the novel fenestrated screws provided an effective and long lasting fixation in osteoporotic patients. Applying this procedure through percutaneous or minimally invasive approach under fluoroscopic control seems to be safe. PMID:22970360

  2. 78 FR 76825 - 36(b)(1) Arms Sales Notification

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-19

    ...-Tracked Wire-Guided (TOW) Radio-Frequency (RF) missiles, 4,145 BGM-71 2B Tube-Launched, Optically-Tracked... Delivered to Congress: 5 December 2013 * as defined in Section 47(6) of the Arms Export Control Act. Policy Justification The Kingdom of Saudi Arabia--Tube-Launched, Optically-Tracked Wire- Guided 2A/2B...

  3. Long-Term Bioeffects of 435MHz Radiofrequency Radiation on Selected Blood-Borne Endpoints in Cannulated Rats. Volume 2. Plasma ACTH (adrenocorticotropic Hormone) and Plasma Corticosterone

    DTIC Science & Technology

    1987-08-01

    stress hormone concentrations. In this study , an increase in plasma corticosterone was observed after barbiturate anesthesia (Fig. 5). Plasma ACTH...C.H., and Schindler, J. In vitro and vivo adrenal corticosterone secretion following stress. Am J Physiol 196:579-582 (1959). 16. Gale, G.C...related thereto. The animals involved in this study were procured, maintained, and used in accordance with the Animal Welfare Act and the "Guide for

  4. 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.

  5. In situ cannulation, microgrid follow-up and low-density plating provide first passage endothelial cell masscultures for in vitro lining.

    PubMed

    Zilla, P; Fasol, R; Dudeck, U; Siedler, S; Preiss, P; Fischlein, T; Müller-Glauser, W; Baitella, G; Sanan, D; Odell, J

    1990-08-01

    A rapid and reliable harvest and culture technique was developed to provide a sufficient number of autologous endothelial cells for the confluent in vitro lining of cardiovascular prostheses. Enzymatic endothelial cell detachment was achieved by the in situ application of collagenase to short vessel segments. This harvest technique resulted in a complete lack of contaminating smooth muscle cells in all of 124 cultures from nonhuman primates and 13 cultures from human adults. The use of a microgrid technique enabled the daily in situ quantification of available endothelial cells. To assess ideal plating densities after passage the population doubling time was continuously related to the cell density. Surprisingly, a low plating density of 1.5 X 10(3) endothelial cells/cm2 achieved 43% shorter cell cycles than the usual plating density of 1.0 X 10(4) endothelial cells/cm2. Moreover, low density plating enabled mass cultures after one single cell passage, thereby reducing the cell damaging effect of trypsin. When the growth characteristics of endothelial cells from five anatomically different vessel sites were compared, the external jugular vein--which would be easily accessible and dispensable in each patient--proved to be an excellent source for endothelial cell cultures. By applying in situ administration of collagenase, low density plating and microgrid follow-up to adult human saphenous vein endothelial cells, 14,000,000 first passage endothelial cells--sufficient for the in vitro lining of long vascular prostheses--were obtained 26.2 days after harvest. (95% confidence interval:22.3 to 32.2 days).

  6. Maturity of coastal bermudagrass and alfalfa affects ruminal in situ and total tract dry matter and phosphorus disappearance in cannulated steers.

    PubMed

    Riojas-McCollister, A V; Lambert, B D; Muir, J P

    2011-04-01

    Variability of phosphorus (P) availability among forage species and plant maturity is largely ignored when formulating ruminant diets. To determine if variability in P availability changes with forage species and/or maturity, ruminal in situ and total (ruminal+post-ruminal) dry matter (DM) and phosphorus disappearance (PD) from alfalfa (ALF; Medicago sativa) and coastal bermudagrass (CB; Cynodon dactylon) harvested at four stages of maturity was measured in cattle. Forages were hand clipped at 14, 21, 28 and 35 days after first cutting. Ruminal in situ DM disappearance (DMD) and PD were measured after 24 h ruminal incubation in Dacron bags. Total tract DMD and PD were measured using the mobile nylon bag technique. Disappearance of DM and P were greater (p≤0.05) in the rumen than post-rumen for both species regardless of maturity; however, 80 g PD/kg DM in 35-day ALF (9% of total PD) and 224 g PD/kg of 35-day CB (38% of total PD) occurred post ruminally. Alfalfa DM disappeared to a greater (p ≤ 0.05) extent than CB and showed 5% greater total tract PD at 14 days and 13% more at 35 days compared to the grass. Alfalfa total tract PD decreased (p ≤ 0.05) 5.4% from 14- to 35-day maturity while the decrease was far greater for CB, 12.4%. Results from this study indicate that ruminant nutritionists should take into account forage species and maturity when calculating PD in diets; these details can be used to aid in formulating more precise rations that reduce fecal-phosphorus excretion into the environment.

  7. The effect of lung deflation on the position of the pleura during subclavian vein cannulation in infants receiving mechanical ventilation: an ultrasound study.

    PubMed

    Jang, Y-E; Lee, J-H; Park, Y-H; Byon, H-J; Kim, H-S; Kim, C-S; Kim, J-T

    2013-10-01

    We evaluated the effect of lung deflation on the relative position of the pleura compared with a reference line during supra- and infraclavicular approaches to the right subclavian vein. The reference line was drawn relative to the predicted pathway of the needle. The distances between the pleura and the reference line for supra- and infraclavicular approaches were measured during inspiration and expiration in 41 infants. Measurements were repeated with the application of 5 cmH2O positive end-expiratory pressure (PEEP) and in the Trendelenburg position. Lung deflation during the supraclavicular approach significantly decreased the volume of lung crossing the reference line by a median (IQR [range]) of 1.0 (0.6 to 1.3 [0.0 to 4.8]) mm, p < 0.001, irrespective of the application of PEEP or patient position. However, during the infraclavicular approach, lung deflation showed no change in the distance of the pleura from the reference line regardless of PEEP or patient position. We conclude that lung deflation moves the lung apex caudally and can reduce the potential risk of pneumothorax during a supraclavicular approach to the right subclavian vein in infants.

  8. 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.

  9. Long-Term Bioeffects of 435-MHz Radiofrequency Radiation on Selected Blood-Borne Endpoints in Cannulated Rats. Volume 3. Plasma Prolactin.

    DTIC Science & Technology

    1987-06-01

    pulses are small, except curing sleeo when marxec rises in prolactin concentrations have been noted. Plasma prolactin level in indisturbed Intact...plasma prolactin can be used to measure the level of stress [123. intraventricular brain injection of 2-endorphin (aLPH51_,) in urethane- anesthetized...entire blood sampling period, there was considerable variance In the data, suggesting animal activity at the time of blood sampling. Since the sampling

  10. 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...

  11. 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.

  12. Welding skate with computerized controls

    NASA Technical Reports Server (NTRS)

    Wall, W. A., Jr.

    1968-01-01

    New welding skate concept for automatic TIG welding of contoured or double-contoured parts combines lightweight welding apparatus with electrical circuitry which computes the desired torch angle and positions a torch and cold-wire guide angle manipulator.

  13. 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.

  14. An unusual condition during internal jugular vein catheterisation: vertebral artery catheterisation.

    PubMed

    Korkmaz, Ozge; Göksel, Sabahattin; Söylemez, Burçak; Durmuş, Kasim; Işbir, Ahmet Cemil; Berkan, Öcal

    Vertebral artery cannulation is an unusual complication during internal jugular vein cannulation. We report a case of vertebral artery cannulation, which occurred during an attempt to cannulate the right internal jugular vein, and we discuss the management of such a rare complication.

  15. 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

    USDA-ARS?s Scientific Manuscript database

    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 ...

  16. Finding the sweet spot for non-apical RV pacing - "love's labor's lost or much ado about nothing:" a new angiographic technique to accomplish accurate physiological RV septal pacing in under 5 minutes from venous cannulation (or bust).

    PubMed

    Srivatsa, Sanjay S

    2014-03-01

    Right ventricular septal pacing has been long touted as a more physiologic alternative to right ventricular apical pacing. This article reviews the physiologic and clinical evidence for right ventricular septal versus apical pacing, and presents a novel angiographic technique for efficient attainment of the optimal septal pacing site. The reasons for equivocal clinical findings in septal versus apical pacing studies are discussed, and a new strategy for non-apical pacing clinical trial design utilizing comparative anatomic assessment of septal pacing site versus clinical outcome is proposed.

  17. Design and implementation of Pharyngeal electrical Stimulation for early de-cannulation in TRACheotomized (PHAST-TRAC) stroke patients with neurogenic dysphagia: a prospective randomized single-blinded interventional study.

    PubMed

    Dziewas, Rainer; Mistry, Satish; Hamdy, Shaheen; Minnerup, Jens; Van Der Tweel, Ingeborg; Schäbitz, Wolf; Bath, Philip M

    2017-06-01

    Rationale Ongoing dysphagia in stroke patients weaned from mechanical ventilation often requires long-term tracheotomy to protect the airway from aspiration. In a recently reported single-centre pilot study, a significantly larger proportion (75%) of tracheotomized dysphagic stroke patients regained sufficient control of airway management allowing tracheotomy tube removal (decannulation) 24-72 h after pharyngeal electrical stimulation (PES) compared to controls who received standard therapy over the same time period (20%). Aim To assess the safety and efficacy of PES in accelerating dysphagia rehabilitation and enabling decannulation of tracheotomized stroke patients. Design International multi-centre prospective randomized controlled single-blind trial in approximately 126 ICU patients (the 90th percentile of the calculated maximum sample size). Study outcomes Primary outcome: proportion of stroke patients considered safe for decannulation 24-72 h after PES compared to control patients who do not receive PES. Key secondary outcomes focus on: dysphagia severity, decannulation rates, decannulation rate after a repeat PES treatment in patients persistently dysphagic after an initial PES treatment, stroke severity, duration of ICU-stay, occurrence of adverse events including pneumonia and need for recannulation over 30 days or until hospital discharge (if earlier). Discussion Dysphagia and related airway complications are reported as one of the main reasons for stroke patients remaining tracheotomized once successfully weaned from ventilation. This study will evaluate if PES can improve airway safety sufficiently enough to allow earlier tracheotomy tube removal.

  18. 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.

  19. ENTRY POINT FOR THE ANTEGRADE FEMORAL INTRAMEDULLARY NAIL: A CADAVER STUDY

    PubMed Central

    Labronici, Pedro José; Galeno, Luiz; Teixeira, Thiago Martins; Franco, José Sergio; Hoffmann, Rolix; de Toledo Lourenço, Paulo Roberto Barbosa; Giordano, Vincenzo; Pallottino, Alexandre; do Amaral, Ney Pecegueiro

    2015-01-01

    Objective: To analyze the natural exit of the wire guides in major trochanter through retrograde femoral approach, in cadaver specimens. Material and Method: 100 femurs had been perforated between the femoral condyles, at 1.2 cm of the intercondylar region. A 3-mm straight wire guide was introduced, through retrograde approach, until the proximal extremity of femur was reached. Femurs were assessed for posterosuperior and anterosuperior portions of major trochanter, pear-shaped cavity, and upper median line between the head-neck and the major trochanter. Results: in 62%, the straight wire guides exited at the anterior surface of major trochanter. In the pear-shaped cavity, the median distance found was 1.0 cm and the interquartile range was 0.5 cm, initially expressing, in relation to pear-shaped cavity, better accuracy. Conclusion: the central axis of the medullar canal, at coronal plane, projected better accuracy in the region of the pear-shaped cavity. PMID:27077057

  20. Counter-Chemical, Biological, Radiological, and Nuclear Operations

    DTIC Science & Technology

    2007-01-26

    operating under the auspices of the PSI intercepted a marine vessel in the Mediterranean Sea on its way from Malaysia to Libya. The ship was...missile (not including short-range, non-nuclear, direct fire missiles, bombs, or rockets such as Maverick or wire-guided missiles), whose target is

  1. 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

  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. The Light Armored Cavalry Regiment -- Reconnaissance Force of the Future

    DTIC Science & Technology

    1992-12-01

    appli- que armor made this possible. The Bradely Scout Vehicle, armed with a 25 mm cannon and a wire guided missile system, could now engage and destroy...University Press. 1986 Palmer, David Richard, Summons of the Trumpet. Novato. CA. Presidio Press. 1978. Palmer, Bruce Jr., The 25 Year War. America’s Military

  4. Manual tube-to-tubesheet welding torch

    DOEpatents

    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.

  5. 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.

  6. 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.

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

    ClinicalTrials.gov

    2016-10-24

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

  8. 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.

  9. Radio-guided localization of clinically occult breast lesions: current modalities and future directions.

    PubMed

    Aydogan, Fatih; Velidedeoglu, Mehmet; Kilic, Fahrettin; Yilmaz, Halit

    2014-01-01

    The extensive availability of breast cancer screening programs and improvement in diagnostic imaging have led to more frequent detection of suspicious and clinically occult breast lesions. Early detection of tumor is important for breast-conserving treatment. Incomplete excision is a major risk factor for local recurrence. Following precise localization and removing the entire lesion while achieving adequate clear margins is the key factor for successful management of non-palpable breast lesions. For this purpose, several techniques such as wire-guided localization, intra-operative ultrasound guided resection, radio-guided occult lesion localization and radioactive seed localization have been described and applied. In this article, we overview the two commonly used localization techniques, radio-guided occult lesion localization and wire-guided localization, particularly describing their advantages and drawbacks.

  10. Electromagnetic navigation versus fluoroscopy in aortic endovascular procedures: a phantom study.

    PubMed

    Tystad Lund, Kjetil; Tangen, Geir Arne; Manstad-Hulaas, Frode

    2017-01-01

    To explore the possible benefits of electromagnetic (EM) navigation versus conventional fluoroscopy during abdominal aortic endovascular procedures. The study was performed on a phantom representing the abdominal aorta. Intraoperative cone beam computed tomography (CBCT) of the phantom was acquired and merged with a preoperative multidetector CT (MDCT). The CBCT was performed with a reference plate fixed to the phantom that, after merging the CBCT with the MDCT, facilitated registration of the MDCT volume with the EM space. An EM field generator was stationed near the phantom. Navigation software was used to display EM-tracked instruments within the 3D image volume. Fluoroscopy was performed using a C-arm system. Five operators performed a series of renal artery cannulations using modified instruments, alternatingly using fluoroscopy or EM navigation as the sole guidance method. Cannulation durations and associated radiation dosages were noted along with the number of cannulations complicated by loss of guidewire insertion. A total of 120 cannulations were performed. The median cannulation durations were 41.5 and 34.5 s for the fluoroscopy- and EM-guided cannulations, respectively. No significant difference in cannulation duration was found between the two modalities (p = 0.736). Only EM navigation showed a significant reduction in cannulation duration in the latter half of its cannulation series compared with the first half (p = 0.004). The median dose area product for fluoroscopy was 0.0836 [Formula: see text]. EM-guided cannulations required a one-time CBCT dosage of 3.0278 [Formula: see text]. Three EM-guided and zero fluoroscopy-guided cannulations experienced loss of guidewire insertion. Our findings indicate that EM navigation is not inferior to fluoroscopy in terms of the ability to guide endovascular interventions. Its utilization may be of particular interest in complex interventions where adequate visualization or minimal use of contrast agents is

  11. Counterobstacle Vehicle (COV) Utility Study. Volume 1.

    DTIC Science & Technology

    1986-05-01

    depending on the mine potency and density. Mines achieve their lethality by attacking the relatively * lightly armored underside of the attacking...to 60 minutes per 100 meters 4. Neutralize Standard Threat Anti-Tank Ditch (Priority 3) a. Past capability: The CEV with its armored protection and...Battalion (+) Task Force consisting of M113 armored personnel carriers mounted with TOW wire guided missiles and M60A3 main battle tanks attacking a

  12. Verification and Validation Plan for Three-Dimensional Probability of Incapacitation Methodology for Masonry Structures (3DPIMMS)

    DTIC Science & Technology

    2011-01-01

    Hellfire (FA, K2, K2A, K2B, M, N, P2A), Javelin, Tube-Launched Optically-Tracked Wire-Guided (TOW) Bunker Buster , Precision Guided Mortar Munition...Perforation locations are collected and input similarly as before, but now a warhead detonation point is also needed for the creation of direction...file. It is a statistical representation of warhead fragmentation as described by the Joint Munitions Effectiveness Manual (JMEM) and is derived

  13. Air Mobility and the Development of Attack Aviation During the Vietnam War from 1965-1967

    DTIC Science & Technology

    2014-06-13

    armed helicopter roles. These included escort, reconnaissance, security, screens, deception, suppressive fires, raids, patrol actions, and anti- tank ...gunships was the M22 anti- tank guided missile system. The wire-guided systems fired AGM-22B missiles capable of destroying tanks , armored vehicles...helicopters pylons to carry weapon systems. Installation of pylons allowed the Cobra to carry rocket pods, 7.62mm mini-guns, and anti- tank missiles. The

  14. Percutaneous transcatheter closure of patent ductus arteriosus with an amplatzer duct occluder using retrograde guidewire-established femoral arteriovenous loop.

    PubMed

    Zhang, Jian-Fa; Huang, Ding; Yang, Yi-Ning; Gao, Xiao-Ming; Ma, Yi-Tong

    2008-05-01

    1. The traditional antegrade wire-guided percutaneous transcatheter approach is not ideal in closing some types of patent ductus arteriosus (PDA) with abnormal morphology. The aim of the present study was to evaluate the efficacy of a retrograde wire-guided transcatheter approach for closure of some types of PDA using the Amplatzer duct occluder (ADO). 2. Nineteen patients with abnormal PDA morphology, including a smaller ostium of the side of the pulmonary artery compared with the side of the descending aorta, severe calcification or tortuosity, were included in the present study. In these patients, after the antegrade approach failed to cross a wire from the pulmonary artery via the PDA to the descending aorta, a retrograde guidewire was passed through the PDA in the opposite direction, from the descending aorta to the pulmonary artery, to establish a femoral arteriovenous loop that assisted the deployment of the ADO in all 19 patients. The size of the PDA, as determined by angiography, was 3.1 +/- 1.1 mm and the diameter of the ADO selected was 6.5 +/- 1.5 mm. 3. In 16 cases, systolic murmur disappeared after the procedure. Systolic murmur (less than Grade II) and angiographic residual shunt remained in three cases immediately after the procedure, but disappeared 1 month later. Mean pulmonary arterial pressure decreased from 33 +/- 8 to 22 +/- 4 mmHg in all 19 patients (P < 0.01). There were no complications during or after the procedure. 4. The retrograde wire-guided technique offers an alternative approach to facilitate closure of a PDA that cannot be achieved by traditional antegrade wire-guided methods due to morphological abnormalities in the PDA.

  15. A comparison of amethocaine and liposomal lidocaine cream as a pain reliever before venipuncture in children: a randomized control trial.

    PubMed

    Poonai, Naveen; Alawi, Khalid; Rieder, Michael; Lynch, Tim; Lim, Rodrick

    2012-02-01

    Although the use of anesthetic creams before intravenous (IV) insertion has been shown to be both safe and effective in decreasing pain during IV cannulation, the use of any single agent based on efficacy is not yet considered the standard of care in children. We sought to compare a commonly used preparation, 4% liposomal lidocaine (Maxilene), with 4% amethocaine (Ametop), a newer agent with reportedly good efficacy and an intrinsic vasodilatory effect. A total of 60 children aged 5 to 12 years were randomized to receive topically either 4% amethocaine or 4% liposomal lidocaine before IV cannulation. The primary outcome variable was the child's rating of pain using the Faces Pain Scale - Revised. Secondary outcomes included success rate on first IV cannulation attempt, cannulation difficulty ratings by the nurses, and adverse skin reactions. We found no statistically significant differences in self-reported scores in the Faces Pain Scale-Revised with the use of 4% amethocaine versus 4% lidocaine before IV cannulation. There was a trend toward fewer IV cannulation attempts in the 4% amethocaine group. Adverse skin reactions were uncommon, and there were no statistically significant differences between groups. This study demonstrates that there is no difference between 4% amethocaine and 4% liposomal lidocaine in reducing pain associated with IV cannulation in children. Amethocaine confers no advantage in improving IV cannulation success rate over lidocaine. Both agents are associated with few local adverse skin reactions.

  16. Arthroscopic bony bankart repair using double-threaded headless screw: a case report.

    PubMed

    Kokubu, Takeshi; Nagura, Issei; Mifune, Yutaka; Kurosaka, Masahiro

    2012-01-01

    We present a case of arthroscopic fixation for bony Bankart lesion using a double-threaded cannulated screw. A 39-year-old man sustained a left shoulder injury from a motorcycle accident. Radiographs showed bony Bankart lesion and CT revealed 40% defect of glenoid articular surface. Arthroscopic fixation was performed using double-threaded cannulated screw after the bony fragment was reduced by suturing the labrum at the edge with a suture anchor. Arthroscopic bony Bankart repair using double-threaded cannulated screw fixation is effective because compression force could be applied between bony fragments and the screw head is not exposed in the glenohumeral joint.

  17. Prolonged bile duct obstruction: a new experimental model for cirrhosis in the rat.

    PubMed Central

    Kountouras, J.; Billing, B. H.; Scheuer, P. J.

    1984-01-01

    Hepatic morphological abnormalities were examined in rats whose bile ducts had been either cannulated and then obstructed or irreversibly ligated for 5, 10, 15 and 28 days or longer. Throughout the experiment most of the morphological changes observed in the cannulated group were comparable to those in the ligated group. Portal inflammation and marginal bile duct proliferation were noted with the same frequency in both groups. Biliary obstruction for 15 days or more led to cirrhosis. After 28 days obstruction, five out of six cannulated rats and four out of six ligated animals respectively developed cirrhosis. The development of cirrhosis was progressive and associated with ascites. It is concluded that in the rat the morphological sequelae of long term cholestasis induced by either cannulation and obstruction or ligation of bile ducts are similar and are accompanied by cirrhosis. The advantages of this experimental model for the study of human cirrhosis are discussed. Images Fig. 1 Fig. 2 PMID:6743531

  18. Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy

    PubMed Central

    Lee, Tae Hoon; Park, Sang-Heum

    2016-01-01

    Various endoscopic techniques have been developed to overcome the difficulties in biliary or pancreatic access during endoscopic retrograde cholangiopancreatography, according to the preference of the endoscopist or the aim of the procedures. In terms of endoscopic methods, guidewire-assisted cannulation is a commonly used and well-known initial cannulation technique, or an alternative in cases of difficult cannulation. In addition, precut sphincterotomy encompasses a range of available rescue techniques, including conventional precut, precut fistulotomy, transpancreatic septotomy, and precut after insertion of pancreatic stent or pancreatic duct guidewire-guided septal precut. We present a literature review of guidewire-assisted cannulation as a primary endoscopic method and the precut technique for the facilitation of selective biliary access. PMID:27642848

  19. How to insert a peripheral cannula.

    PubMed

    Shaw, Sally Jane

    2016-11-16

    Rationale and key points This article aims to assist practitioners to undertake the safe and effective insertion of a peripheral cannula. It provides information on best practice related to peripheral cannulation with an open-ported safety cannula. The same principles for practice apply to non-ported open safety cannulae. » Peripheral cannulation enables venous access, the administration of intravenous medication, infusion therapy and total parenteral nutrition. It also enables blood samples to be obtained. » Peripheral cannulation is a common procedure that requires high standards of care and management to optimise patient outcomes. Reflective activity 'How to' articles can help update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: » How you think this article has changed your practice when performing peripheral cannulation. » How you could use this resource to assist with supporting colleagues.

  20. False aneurysm of aorta secondary to partial occlusion clamp injury: diagnosis by nuclear flow study

    SciTech Connect

    Becker, R.M.; Wexler, J.; Frater, R.W.

    1981-09-01

    A 72-year-old woman presented 12 months postaortic valve replacement with a false aneurysm near the aortic cannulation site. The diagnosis was suspected from clinical findings and confirmed by a nuclear flow study. The patient refused surgery and died shortly afterward. At autopsy, a smooth-walled 1 cm defect adjacent to the cannulation site (presumably related to injury from a partial occlusion clamp) was found; this would have been easily reparable with surgery.

  1. An alternative cardiopulmonary bypass strategy for intracaval baffle repair of scimitar syndrome.

    PubMed

    Federici, Duccio; Montesi, Gianfranco; Ghitti, Davide; Galletti, Lorenzo

    2017-06-01

    Intracaval buffle repair of scimitar syndrome is classically performed under deep hypothermic circulatory arrest or using low-flow modalities of cardiopulmonary bypass with peripheral cannulation. We propose an alternative perfusion approach to the procedure using total intrapericardial cannulation under full-flow normothermic cardiopulmonary bypass. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  2. Development and Resuscitation of a Sedated, Mature Male Miniature Swine Severe Hemorrhage Model

    DTIC Science & Technology

    2011-07-01

    with midazolam , and hemorrhaged 60% of estimated blood volume (39 mL/kg) exponentially for 1 hour with no resuscitation (control; n 16). An...an approximate end-tidal CO2 of 40 mm Hg. An ear vein was cannulated with an 18- to 22-gauge intracath for subsequent midazolam administration. The...external jugular vein was cannulated with a silastic catheter (0.062 inch inside diameter 0.125 inch outside diameter) for midazolam administration

  3. Comparison of Iontophoretic Lidocaine to EMLA Cream for Pain Reduction Prior to Intravenous Fannulation in Adults

    DTIC Science & Technology

    2000-10-01

    i COMPARISON OF IONTOPHORETIC LIDOCAINE TO EMLA CREAM FOR PAIN REDUCTIONPRIOR TO INTRAVENOUS CANNULATION IN ADULTS Kenneth Lee Spence LT, NC, USN...COMPARISON OF IONTOPHORETIC LIDOCAINE TO EMLA CREAM FOR PAIN REDUCTION PRIOR TO INTRAVENOUS CANNULATION IN ADULTS 5a. CONTRACT NUMBER 5b. GRANT...most operative anesthesia, can be a source of pain and anxiety. Lidocaine , a local anesthetic, is frequently injected intradermally to decrease pain

  4. 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.

  5. Ultrasound-Guided Vascular Access Simulator for Medical Training: Proposal of a Simple, Economic and Effective Model.

    PubMed

    Fürst, Rafael Vilhena de Carvalho; Polimanti, Afonso César; Galego, Sidnei José; Bicudo, Maria Claudia; Montagna, Erik; Corrêa, João Antônio

    2017-03-01

    To present a simple and affordable model able to properly simulate an ultrasound-guided venous access. The simulation was made using a latex balloon tube filled with water and dye solution implanted in a thawed chicken breast with bones. The presented model allows the simulation of all implant stages of a central catheter. The obtained echogenicity is similar to that observed in human tissue, and the ultrasound identification of the tissues, balloon, needle, wire guide and catheter is feasible and reproducible. The proposed model is simple, economical, easy to manufacture and capable of realistically and effectively simulating an ultrasound-guided venous access.

  6. Knuckle technique guided by intravascular ultrasound for in-stent restenosis occlusion treatment

    PubMed Central

    Tasic, Mladen; Jagic, Nikola; Miloradovic, Vladimir; Nikolic, Dusan

    2015-01-01

    One of the rarest lesions is in-stent restenosis chronic total occlusion (CTO). Limited data suggest that the treatment success rate is dependent on the possibility to cross into the lumen of an occluded stent, and the decision about what technique to use varies by operator preference. The knuckle technique is used to create a deliberate dissection plane in various CTO techniques. A guide wire is pushed until a complex loop is formed and advanced through the lesion. In this report we present a case where a knuckle wire guided by intravascular ultrasound control is used to penetrate the distal cap in an in-stent restenosis CTO lesion. PMID:25848374

  7. Small Structures, Big Droplets: The Role of Nanoscience in Fog Harvesting.

    PubMed

    Pinchasik, Bat-El; Kappl, Michael; Butt, Hans-Jürgen

    2016-12-27

    Designing materials for water harvesting has gained much attention in recent years as water scarcity continues to be one of the biggest problems facing mankind. In this issue of ACS Nano, Xu et al. propose a new device for harvesting water from fog. They use conically shaped copper wires with periodic roughness to enhance condensation and transport of water drops. While the periodic roughness enhances drop coalescence and motion, the conical shape of the wires guides the drops in a specific direction. Together, a self-sustained water-harvesting system is described which does not require additional external stimulus but makes use of a smart design and economic production.

  8. Resternotomy, a single-center experience.

    PubMed

    Salehi, Mehrdad; Bakhshandeh, Ali Reza; Saberi, Kianoush; Alemohammad, Mahmood; Sobhanian, Keivan; Karamnezhad, Maziar; Rigi, Farangis Sarouneh

    2017-01-01

    Background Reoperations are technically more difficult because of the risks associated with reentry in a heart with more advanced pathology, little reserve, and more frequent comorbidities. Routine peripheral cannulation before resternotomy is inadvisable, time-consuming, and has no noticeable role in decreasing the risks of reentry. We present our experience of resternotomy without routine peripheral cannulation. Methods This was a retrospective study on 237 consecutive patients who underwent resternotomy between June 2011 and July 2013. Their mean age was 47.7 ± 18.2 years. We chose the best approach individually, according to lateral radiograph findings, patient risk factors, and previous surgery. Our goal was to observe events intraoperatively and their outcomes postoperatively. Results Mean intensive care unit stay was 3.1 ± 0.9 days. Twenty-one (8.8%) patients died during their hospital stay. The most common cause of death was renal failure in 15 (71.4%) patients, coagulopathy in 4 (19%), and cardiac failure in 2 (9.5%). We had 3 right ventricular, one right atrial, one pulmonary artery, and 2 inferior vena caval tears during resternotomy and dissection; bleeding was controlled easily without peripheral cannulation. Femoral cannulation before resternotomy was performed in one patient who needed an emergency pulmonary embolectomy. Conclusions Based on our experience, resternotomy with central cannulation is a safe strategy, and peripheral cannulation before resternotomy should be reserved for highly selected patients.

  9. A rapid and non-surgical procedure for jugular catheterization of pigs.

    PubMed

    Matte, J J

    1999-07-01

    A rapid and non-surgical method for jugular catheterization in pigs was set up in 30 piglets of 6.2 kg, 23 pigs of 46 kg and 84 kg and two lactating multiparous sows. The animal was restrained on a V-shaped table (piglets) or with a rope around the mandible (slaughter pigs and sows). The vein was located with the Vacutainer system and a wire guide was inserted into the Vacutainer needle up to the vein lumen. When the needle was removed, the catheter was inserted over the wire guide and advanced until it penetrated the skin and thereafter, the vein wall. The catheter was fixed outside by a large tape and coiled inside a patch just behind the ears. The technique utilizes readily available material and is no more risky for the animal than a single blood sampling. Moreover, it can be performed within 15 to 20 min (including animal restraint) within pens. This new approach might have important implications not only for research purposes by facilitating repeated blood samplings but also for projects which require a rapid and easy method for testing of any kind of pharmaceutical or other type of products under husbandry conditions.

  10. 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.

  11. Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome.

    PubMed

    Dietl, Charles A; Wernly, Jorge A; Pett, Stuart B; Yassin, Said F; Sterling, José P; Dragan, Robert; Milligan, Karen; Crowley, Mark R

    2008-03-01

    The purposes of this study are to evaluate the outcome of extracorporeal membrane oxygenation support in a subgroup of patients with Hantavirus cardiopulmonary syndrome who had a predicted mortality of 100% and to assess the complications associated with this treatment modality and with different cannulation techniques. Thirty-eight patients with severe Hantavirus cardiopulmonary syndrome were supported with extracorporeal membrane oxygenation between April 1994 and June 2006. Cannulation of the femoral vessels was performed on an emergency basis by a percutaneous approach in 15 (39.5%) and by an open technique in 23 (60.5%) patients. Duration of extracorporeal membrane oxygenation averaged 132 hours (range: 5-276 hours). Complications from percutaneous cannulation occurred in 4 (26.6%) of 15 patients: retroperitoneal hematoma in 2 (13.3%) and lower extremity ischemia in 2 (13.3%) patients, which resolved after insertion of a distal perfusion cannula. Complications from open femoral cannulation occurred in 8 (34.8%) of 23 patients: severe bleeding in 7 (30.4%) patients and lower extremity ischemia in 1 (4.3%) patient who required a leg amputation. The overall survival was 60.5% (23/38 patients). Six (40%) of the 15 patients cannulated percutaneously and 9 (39.1%) of 23 patients who had open cannulation died. All survivors recovered completely and were discharged from the hospital after a mean hospital stay of 20.8 days (range: 10-39 days). Almost two thirds of the patients with severe Hantavirus cardiopulmonary syndrome who were supported with extracorporeal circulation survived and recovered completely. The complications associated with both types of femoral cannulation may be attributed to the fact that all patients were in shock or in full cardiac arrest, and the procedure had to be done expeditiously. Earlier institution of extracorporeal membrane oxygenation may decrease the complication rates and improve the overall survival.

  12. Release of experimental retinal vein occlusions by direct intraluminal injection of ocriplasmin

    PubMed Central

    Stassen, Jean Marie; Meenink, Thijs C M; Janssens, Tom; Vanheukelom, Valérie; Naus, Gerrit J L; Beelen, Maarten J; Jonckx, Bart

    2016-01-01

    Purpose Retinal vein occlusions (RVO) are a major cause of vision loss in people aged 50 years and older. Current therapeutic options limit the consequences of RVO but do not eliminate the cause. Cannulation of the involved vessel and removal of the clot may provide a more permanent solution with a less demanding follow-up. However, cannulation of smaller retinal veins remains challenging. This paper explores the use of ocriplasmin (recombinant plasmin without its kringles) to clear RVO, using a robotic micromanipulator. Methods Branch RVO were induced in a porcine model with rose bengal followed by 532 nm endolaser to the superior venous branch of the optic nerve. The vein was cannulated proximal to the occlusion or beyond the first branching vessel from the obstruction. The vein was infused with a physiologic citric acid buffer solution (CAM) or CAM/ocriplasmin. The time of cannulation, number of attempts, and the ability to release the thrombus were recorded. Results Cannulation and infusion was possible in all the cases. The use of a micromanipulator allowed for a consistent cannulation of the retinal vein and positional stability allowed the vein to remain cannulated for up to 20 min. In none of the attempts (5/5) with CAM did the thrombus dissolve, despite repeat infusion/relaxation cycles. In 7/7 injections of CAM/ocriplasmin near to the point of obstruction, the clot started to dissolve within a few minutes of injection. An infusion, attempted beyond the first venous branch point proximal to the clot, was unsuccessful in 2/3 attempts. Conclusions Ocriplasmin is effective in resolving RVO if injected close to the site of occlusion with the use of a micromanipulator. PMID:27688592

  13. Training and evaluating spinal surgeons: the development of novel performance measures.

    PubMed

    Woodrow, Sarah I; Dubrowski, Adam; Khokhotva, Mykola; Backstein, David; Rampersaud, Y Raja; Massicotte, Eric M

    2007-12-01

    Cohort study. The purpose of this study was to develop and validate a series of novel assessment measures for use during a lumbar pedicle cannulation task. There is increasing pressure being placed on the surgical community to develop appropriate assessment measures of technical skills as an indicator of surgical competence. To date, little research has been performed in this area in spinal surgery. Twelve novice and 7 expert spine surgeons cannulated a complete set of lumbar pedicles on a synthetic model. Electromagnetic markers were traced to record their dominant hand and arm movements while the forces applied to the model were measured using a small force plate. The amount of wrist motion, mean forces, peak forces, and task time were evaluated. Following task completion, angles of pedicle cannulation and the number and location of all breaches in the models were recorded. Novice surgeons used less mean force (91 N vs. 115 N, P = 0.001) but required more time to perform each cannulation task (12.4 seconds vs. 8.2 seconds, P < 0.001). Cannulation by novices demonstrated a greater mean number of frank (far lateral) pedicle breaches (1.5 vs. 0 per individual, P = 0.002), but no differences in the angles of cannulation were seen (P = 0.988). Four variables, 3 involving process measures and 1 an outcome measure, can be used to distinguish between novice and expert spine surgeons using a simple lumbar spine pedicle cannulation task, providing evidence of their construct validity. Knowledge of these differences may be useful in objective evaluation of surgical competence and providing precise feedback during the training of this skill, thereby enhancing learning.

  14. Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: a randomized controlled trial

    PubMed Central

    Taddio, Anna; Soin, Herpreet Kaur; Schuh, Suzanne; Koren, Gideon; Scolnik, Dennis

    2005-01-01

    Background Historically, children have been undertreated for their pain, and they continue to undergo painful cutaneous procedures without analgesics. A new topical anesthetic, liposomal lidocaine 4% cream (Maxilene, RGR Pharma, Windsor, Ont.), has become available. It has pharmacologic properties that are superior to other topical anesthetics, including an onset of action of only 30 minutes. We sought to determine the success rate of cannulation, analgesic effectiveness, procedure duration and rate of adverse skin reactions when liposomal lidocaine is used before intravenous cannulation of children. Methods In this double-blind randomized controlled trial, children aged 1 month to 17 years received liposomal lidocaine or placebo before cannulation. Success on first cannulation attempt was recorded, and, among children 5 years and older, pain was evaluated before and after the attempt by the child, parents and research assistant using a validated measure (Faces Pain Scale-Revised). For children younger than 5 years, pain was evaluated by the parents and research assistant only. The total duration of the procedure and adverse skin reactions were also recorded. Results Baseline characteristics did not differ (p > 0.05) between children who received liposomal lidocaine (n = 69) and those who received placebo (n = 73). Cannulation on the first attempt was achieved in 74% of children who received liposomal lidocaine compared with 55% of those who received placebo (p = 0.03). Among children 5 years of age and older (n = 67), lower mean pain scores during cannulation were reported by those receiving liposomal lidocaine (p = 0.01). Similarly, lower mean pain scores during cannulation were reported by the parents and research assistant for all children who received liposomal lidocaine than for all those who received placebo (p < 0.001). The mean total procedure duration was shorter with liposomal lidocaine (6.7 v. 8.5 minutes; p = 0.04). The incidence of transient dermal

  15. Current state in tracking and robotic navigation systems for application in endovascular aortic aneurysm repair.

    PubMed

    de Ruiter, Quirina M B; Moll, Frans L; van Herwaarden, Joost A

    2015-01-01

    This study reviewed the current developments in manual tracking and robotic navigation technologies for application in endovascular aortic aneurysm repair (EVAR). EMBASE and MEDLINE databases were searched for studies reporting manual tracking or robotic navigation systems that are able to manipulate endovascular surgical tools during abdominal or thoracic aortic aneurysm repair. Reports were grouped by the navigation systems and categorized into phantom, animal, and clinical studies. First, the general characteristics of each system were compared. Second, target registration error and deployment error were used to compare the accuracy of the tracking systems. Third, all systems were reviewed for fluoroscopy time (FT), radiation dose, and contrast volumes, if reported, in rigid and nonrigid studies. Fourth, vascular cannulation performance of the systems was compared, studying cannulation time, Imperial College Complex Cannulation Scoring Tool score, and the number of wall hits and catheter movements within rigid studies. Of 721 articles and references found, 18 studies of four different navigation systems were included: the Aurora (Northern Digital, Waterloo, Ontario, Canada) tracking system, the StealthStation (Medtronic Inc, Minneapolis, Minn) tracking system, an ultrasound localization tracking system, and the Sensei (Hansen Medical, Mountain View, Calif) steerable remote-controlled robotic navigation system. The mean tracking accuracy averaged 1 mm for the three manual tracking systems measured in a rigid environment. An increase of target registration error reaching >3 mm was reported when measured in a nonrigid experimental environment or due to external distortion factors. Except within small-animal studies or case studies, no evidence was found on reduction of clinical outcome parameters, such as FT, radiation dose, and contrast volumes, within clinical EVAR. A comparison of vascular cannulation performance in rigid studies revealed that the Sensei robotic

  16. Value of C-Arm Cone Beam Computed Tomography Image Fusion in Maximizing the Versatility of Endovascular Robotics.

    PubMed

    Chinnadurai, Ponraj; Duran, Cassidy; Al-Jabbari, Odeaa; Abu Saleh, Walid K; Lumsden, Alan; Bismuth, Jean

    2016-01-01

    To report our initial experience and highlight the value of using intraoperative C-arm cone beam computed tomography (CT; DynaCT(®)) image fusion guidance along with steerable robotic endovascular catheter navigation to optimize vessel cannulation. Between May 2013 and January 2015, all patients who underwent endovascular procedures using DynaCT image fusion technique along with Hansen Magellan vascular robotic catheter were included in this study. As a part of preoperative planning, relevant vessel landmarks were electronically marked in contrast-enhanced multi-slice computed tomography images and stored. At the beginning of procedure, an intraoperative noncontrast C-arm cone beam CT (syngo DynaCT(®), Siemens Medical Solutions USA Inc.) was acquired in the hybrid suite. Preoperative images were then coregistered to intraoperative DynaCT images using aortic wall calcifications and bone landmarks. Stored landmarks were then overlaid on 2-dimensional (2D) live fluoroscopic images as virtual markers that are updated in real-time with C-arm, table movements and image zoom. Vascular access and robotic catheter (Magellan(®), Hansen Medical) was setup per standard. Vessel cannulation was performed based on electronic virtual markers on live fluoroscopy using robotic catheter. The impact of 3-dimensional (3D) image fusion guidance on robotic vessel cannulation was evaluated retrospectively, by assessing quantitative parameters like number of angiograms acquired before vessel cannulation and qualitative parameters like accuracy of vessel ostium and centerline markers. All 17 vessels were cannulated successfully in 14 patients' attempted using robotic catheter and image fusion guidance. Median vessel diameter at origin was 5.4 mm (range, 2.3-13 mm), whereas 12 of 17 (70.6%) vessels had either calcified and/or stenosed origin from parent vessel. Nine of 17 vessels (52.9 %) were cannulated without any contrast injection. Median number of angiograms required before

  17. 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

  18. Effects of fatty acid supplements on milk yield and energy balance of lactating dairy cows.

    PubMed

    Harvatine, K J; Allen, M S

    2006-03-01

    Saturated and unsaturated fatty acid supplements (FS) were evaluated for effects on yield of milk and milk components, concentration of milk components including milk fatty acid profile, and energy balance. Eight ruminally and duodenally cannulated cows and 8 noncannulated cows were used in a replicated 4 x 4 Latin square design experiment with 21-d periods. Treatments were control and a linear substitution of 2.5% fatty acids from saturated FS (SAT; prilled, hydrogenated free fatty acids) for partially unsaturated FS (UNS; calcium soaps of long-chain fatty acids). The SAT treatment did not change milk fat concentration, but UNS linearly decreased milk fat in cannulated cows and tended to decrease milk fat in noncannulated cows compared with control. Milk fat depression with UNS corresponded to increased concentrations of trans-10, cis-12 conjugated linoleic acid and trans C18:1 fatty acids in milk. Milk fat profile was similar for SAT and control, but UNS decreased concentration of short- and medium-chain FA. Digestible energy intake tended to decrease linearly with increasing unsaturated FS in cannulated and noncannulated cows. Increasing unsaturated FS linearly increased empty body weight and net energy gain in cannulated cows, whereas increasing saturated FS linearly increased plasma insulin. Efficiency of conversion of digestible energy to milk tended to decrease linearly with increasing unsaturated FS for cannulated cows only. Addition of SAT provided little benefit to production and energy balance, whereas UNS decreased energy intake and milk energy yield.

  19. A comparison of performance between Teflon and polyurethane safety cannulae at extremes of operating temperatures.

    PubMed

    Jeyanathan, J; Webster, B B; Hawksley, O J; Mellor, A J

    2012-06-01

    In the United Kingdom, approximately eight million peripheral cannulations are performed each year. Intravenous cannulae are made from either polytetrafluoroethylene (Teflon) or polyurethane. Polyurethane has a lower incidence of thrombophlebitis, however the physical characteristics of polyurethane may make the cannulae difficult to use at higher ambient temperatures. This effect maybe of importance to those involved in cannulation in extreme environments and especially for military doctors deployed in current theatres of operations. In a randomised single blinded study we investigated the different characteristics of Teflon and polyurethane cannulae (Vasofix Safety Cannulae, B Braun) at three different temperatures (-10 degrees C, 21 degrees C and 40 degrees C). There is no statistically significant difference in the ease or speed of cannulation of either polyurethane or Teflon safety cannulae in extremes of temperature. This study provides evidence that performance of polyurethane safety cannulae are not impaired by temperature extremes.

  20. Diagnosing segmental wedge fracture of the tibia before performing intramedullary nailing.

    PubMed

    Gutowski, Christina; Abrams, Jeffrey S; Gutowski, W T

    2013-08-01

    Tibial shaft fractures with a wedge butterfly segment are often repaired with intramedullary fixation. At the time of presentation, the fragment may appear benign on radiographs as a portion of the cortical bone in an acceptable position. However, a segment that includes the entire circumference of the tibial cortex can be a problem during surgical stabilization. This ring effect will demand cannulation of the butterfly segment with the guide wire before rod insertion. Since computed tomography is not always necessary for minimally displaced fractures, this issue may not be discovered until surgery. Lack of cannulation may lead to painful nonunion. Preoperative recognition of this fracture pattern and intraoperative butterfly cannulation will improve the postoperative stability of this fracture.

  1. Accidental carotid artery catheterization during attempted central venous catheter placement: a case report.

    PubMed

    Maietta, Pauline Marie

    2012-08-01

    More than 2.1 million central venous catheters are placed annually. While carotid artery cannulation is rare, its effects can be devastating. Anesthesia providers frequently work with central venous catheters in the perioperative setting. Therefore, it is imperative that they be able to identify and react appropriately to carotid artery injury both in preexisting central lines and those that they have placed. This case report details a case of accidental carotid artery catheterization during attempted right internal jugular vein catheterization and the steps taken to treat the patient following its recognition. A discussion of technique for central venous catheterization, indications for suspicion of arterial puncture, methods for confirming venous or arterial placement, appropriate methods for management of carotid artery cannulation, and the benefit of ultrasound in central venous cannulation follow. Through the appropriate use of equipment, early detection and management of carotid artery injury, and proper training, patient outcomes may be improved.

  2. 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

  3. 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

  4. 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

  5. Comparison of cortical bone drilling induced heat production among common drilling tools.

    PubMed

    Palmisano, Andrew C; Tai, Bruce L; Belmont, Barry; Irwin, Todd A; Shih, Albert; Holmes, James R

    2015-05-01

    Significant data exist regarding heat production of twist drills; however, there are little data regarding cannulated drills or Kirschner (K) wires. This study compared the heat produced during bone drilling with twist drills, K wires, and a cannulated drill. It was hypothesized that drilling temperature would increase with tool sizes used in orthopaedic surgery; with twist drills producing the least amount of heat followed by cannulated drills and K wires. Twist drills (2.0, 2.5, and 3.5 mm), K wires (1.25, 1.6, and 2.0 mm), and a cannulated drill (2.7 mm) were driven into warmed human cadaveric tibia by a battery-powered hand drill. The drill was secured on a servo-controlled linear actuator to provide a constant advancing speed (1 mm/s) during drilling. Two thermocouples were embedded 2 mm from the surface at 0.5 and 1.5 mm from the drill hole margin. Eight tests were performed for each tool. Twist drills exhibited a positive trend between size and heat production. The size effect was less significant with K wires. K wires resulted in significantly (P = 0.008 at 0.5 mm) higher peak temperatures than twist drills of the same size. A 2.7-mm cannulated drill produced more than double the temperature rise of a 2.5-mm twist drill. Twist drills produced the smallest temperature rise among all bit types. Thermal effects should not be a reason for choosing K-wire size. The cannulated drill showed significantly higher temperatures when compared with standard drills, reaching maximal temperatures comparable with K wires.

  6. Virtual ventriculostomy with 'shifted ventricle': neurosurgery resident surgical skill assessment using a high-fidelity haptic/graphic virtual reality simulator.

    PubMed

    Lemole, Michael; Banerjee, P Pat; Luciano, Cristian; Charbel, Fady; Oh, Michael

    2009-05-01

    Based on a study of 48 neurological residents using a high fidelity haptic/graphic virtual reality simulator to perform ventricular cannulation, we recorded absolute Euclidean distance from the catheter tip to the foramen of Monroe within the ventricle. The data suggest that as expected, successful first attempts to cannulate the virtual 'shifted ventricle' are much less frequent than previous assessments with normal virtual ventricular anatomy. Furthermore, the significant improvement observed by the second attempt implies that the learning curve has been affected and the process 'jump started'.

  7. Clinical review: Complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine

    PubMed Central

    Scheer, Bernd Volker; Perel, Azriel; Pfeiffer, Ulrich J

    2002-01-01

    In order to evaluate the complications and risk factors associated with peripheral arterial catheters used for haemodynamic monitoring, we reviewed the literature published from 1978 to 2001. We closely examined the three most commonly used arterial cannulation sites. The reviewed papers included a total of 19,617 radial, 3899 femoral and 1989 axillary artery catheterizations. Factors that contribute to higher complication rates were investigated. Major complications occurred in fewer than 1% of the cases, and rates were similar for the radial, femoral and axillary arteries. We conclude that arterial cannulation is a safe procedure. PMID:12133178

  8. Clip migration after vacuum-assisted stereotactic breast biopsy: a pitfall in preoperative wire localization.

    PubMed

    Bernaerts, A; De Schepper, A; Van Dam, P; Pouillon, M

    2007-01-01

    Vacuum-assisted stereotactic breast biopsy has become an irreplaceable instrument in the management of suspicious mammographic lesions. If the initial mammographic lesion becomes obscured or absent following the biopsy, a clip is commonly placed by interventional breast radiologists at the biopsy site. This enables future wire localization if atypical or malignant histology warrants excision. Currently, clip malposition or migration has become increasingly recognized in the literature as a possible complication of stereotactic breast biopsy. As in this case, recognition of migration of the clip was crucial in the planning of the patient's subsequent wire localization procedure. This article aims to increase the awareness of radiologists and surgeons of this potential pitfall to prevent false-negative biopsies and minimize positive surgical margins after wire-guided breast conservation surgery. Routine evaluation of pre- and postbiopsy mammograms and prospective identification of inaccurate clip placement before stereotactic wire localization and excision should be performed.

  9. Mitomycin-C: 'a ray of hope' in refractory corrosive esophageal strictures.

    PubMed

    Nagaich, N; Nijhawan, S; Katiyar, P; Sharma, R; Rathore, M

    2014-04-01

    Increasingly frequent dilation may become a self-defeating cycle in refractory stricture as recurrent trauma enhance, scar formation, and ultimately recurrence and potential worsening of the stricture. In 12 patients of caustic induced esophageal stricture, who failed to respond despite rigorous dilatation regimen for more than one year, a trial of topical mitomycin-C application to improve dilatation results was undertaken, considering the recently reported efficacy and safety of this agent. Mitomycin-C was applied for 2-3 minutes at the strictured esophageal segment after dilation with wire-guided Savary-Gilliard dilator. Patient was kept nil by mouth for 2-3 hours. After 4-6 sessions of mitomycin-C treatment, resolution of symptoms and significant improvement in dysphagia score and periodic dilatation index was seen in all 12 patients. Mitomycin-C topical application may be a useful strategy in refractory corrosive esophageal strictures and salvage patients from surgery.

  10. 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

  11. 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.

  12. Extramedullary haematopoiesis in axillary lymph nodes following neoadjuvant chemotherapy for locally advanced breast cancer.

    PubMed

    Takhar, Arunjit Singh; Ney, Alex; Patel, Meera; Sharma, Anup

    2013-05-22

    We report the case of a 53-year-old lady who presented with a lump in her left breast. Her initial investigations demonstrated a grade III invasive ductal carcinoma of the breast that was tethered to the pectoralis major; imaging and cytology also revealed metastatic nodes in the left axilla. After undergoing neoadjuvant chemotherapy with evidence of clinical and radiological tumour response, a wire-guided wide local excision and axillary node clearance was performed. When a histological analysis of the specimen was performed, there was no evidence of a viable metastatic tumour in the axillary lymph nodes, but there were several areas of extramedullary haematopoiesis. There are only two other reports in the literature of this finding. This could represent a potential source of false-positive diagnosis of axillary metastasis from breast cancer. It would be prudent to consider biopsy prior to clearance if there are megakaryocytes in axillary node cytology.

  13. 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.

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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    USDA-ARS?s Scientific Manuscript database

    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,...

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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    PubMed

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

    2014-01-01

    To assess the technical challenges in percutaneous coronary intervention of Anomalous right coronary artery arising from the left sinus of valsalva. 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. 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. 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. Copyright © 2014. Published by Elsevier B.V.

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

    USDA-ARS?s Scientific Manuscript database

    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...

  19. UPTAKE AND ELIMINATION OF DICHLOROACETIC ACID BY RAINBOW TROUT

    EPA Science Inventory

    Dichloroacetic acid (DCA) is a by-product of drinking water chlorination and is a hepatocarcinogen in rodents. Preliminary results of a chronic testing effort with Japanese medaka suggest the possibility of similar effects is fish. Adult rainbow trout were cannulated from the dor...

  20. Effect of feeding cows genetically modified maize on the bacterial community in the bovine rumen.

    PubMed

    Wiedemann, S; Gürtler, P; Albrecht, C

    2007-12-01

    Rumen-cannulated cows (n = 4) were fed successively silage made from either conventional or genetically modified (GM) maize. Results revealed no effects of GM maize on the dynamics of six ruminal bacterial strains (investigated by real-time PCR) compared to the conventional maize silage.

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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    USDA-ARS?s Scientific Manuscript database

    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 ± ...

  3. 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.

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

    USDA-ARS?s Scientific Manuscript database

    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...

  5. Effects of short-term oilseed supplementation on plasma fatty acid composition in lactating beef cows

    USDA-ARS?s Scientific Manuscript database

    Twenty-four three-year old Angus cows (512.2 ± 21.6 kg) and six ruminally cannulated beef heifers (523.1 ± 16.9 kg) were used to determine the impact of feeding oilseeds starting at the beginning of estrus synchronization until maternal recognition of pregnancy on plasma fatty acid composition. Star...

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

    USDA-ARS?s Scientific Manuscript database

    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...

  7. Orchardgrass forage effects on bacterial communities and long-chain fatty acid profiles in the rumen of Holstein heifers

    USDA-ARS?s Scientific Manuscript database

    The aim of this study was to determine if ruminal bacterial community composition (BCC) and long-chain fatty acid (FA) profiles differed in heifers grazing in orchardgrass pasture (OP) versus those fed hay (OH) harvested from the same field at the same stage of maturity. Five ruminally cannulated Ho...

  8. Accidental subclavian artery catheterization during attempted internal jugular central venous catheter placement: a case report.

    PubMed

    Paliwal, Bharat; Kamal, Manoj; Purohit, Anamika; Rana, Kirti; Chouhan, Dilip Singh

    2015-01-01

    Central venous catheter placement has been routinely employed for anesthetic and intensive care management. Despite proper technique used and expertise complications do occur; some of which are related to catheter misplacements. We report a case in which subclavian artery was accidently catheterized during attempted internal jugular venous cannulation.

  9. Non-cuffed dual lumen catheters in the external jugular veins versus other central veins for hemodialysis patients.

    PubMed

    Moini, Majid; Rasouli, Mohammad R; Kenari, Mohammad Mahmoodzadeh; Mahmoodi, Hamid Reza

    2009-01-01

    To compare prospective between insertion of non-cuffed dual lumen catheter in the external jugular vein and other central veins for hemodialysis (HD), we studied 68 chronic dialysis patients randomly allocated into two groups: one with external jugular vein catheterization as access for HD and another with other central venous catheterization, internal jugular or subclavian vein. Our results showed there were no significant differences regarding successful cannulation, com-plications, total numbers of dialysis, development of pain and infection at the site of cannulation, patency rate of the catheters, and efficacy of hemodialysis between both groups. In addition, the patency of the catheter in the external jugular vein was not affected by previous cannulation of other central veins. In contrast, there was a significant correlation between numbers of attempts for cannulation in both groups and development of hematoma and infection, (p< 0.05). In conclusion, our results showed that the external jugular vein may be an alternative for other central veins for insertion of temporary non-cuffed hemodialysis catheter.

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

    USDA-ARS?s Scientific Manuscript database

    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)...

  11. Effect of ruminal fill on foraging behavior, intake rate, and plasma ghrelin, serum insulin and glucose levels of cattle grazing a vegetative micro-sward

    USDA-ARS?s Scientific Manuscript database

    The impact of ruminal fill (RF) on foraging behavior, intake rate and 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), 0....

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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    USDA-ARS?s Scientific Manuscript database

    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...

  16. Total left main coronary artery occlusion after aortic aneurysm repair and valve replacement.

    PubMed

    DePace, N L; Lemole, G M; Wolf, N W; Dowinsky, S; Untereker, W; Spagna, P M

    1991-02-01

    A 38-year-old woman with complete occlusion of the left main coronary artery secondary to cannulation during aortic valve replacement is presented. The clinical course was characterized by progressive left ventricular dysfunction and congestive heart failure. Recognition of this potential problem when it occurs is important as to institute therapeutic measures which may interrupt a patient's progressive clinical deterioration.

  17. 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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    USDA-ARS?s Scientific Manuscript database

    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...

  20. S-Nitrosylation and the Development of Pulmonary Hypertension

    DTIC Science & Technology

    2011-02-01

    plies blood to spinotrapezius muscle (supplemental Figure I), were isolated for cannulation.29 Immunolabeling on TEM Sections TD arteries and cremaster ...as the mean ±SE (n=6). Scale bar equals 0.5 µm. (B) eNOS localization at the MEJ. Isolated cremaster , coronary, mesentery vessels were immuno

  1. Mechanical Comparison of Headless Screw Fixation and Locking Plate Fixation for Talar Neck Fractures.

    PubMed

    Karakasli, Ahmet; Hapa, Onur; Erduran, Mehmet; Dincer, Cemal; Cecen, Berivan; Havitcioglu, Hasan

    2015-01-01

    For talar neck fractures, open reduction and internal fixation have been thought to facilitate revascularization and prevent osteonecrosis. Newer screw systems allow for placement of cannulated headless screws, which provide compression by virtue of a variable pitch thread. The present study compared the biomechanical fixation strength of cannulated headless variable-pitch screw fixation and locking plate fixation. A reproducible talar neck fracture was created in 14 fresh cadaver talar necks. Talar head fixation was then performed using 2 cannulated headless variable-pitch 4-mm/5-mm diameter (4/5) screws (Acutrak; Acumed, Hillsboro, OR) and locking plate fixation. Headless variable-pitch screw fixation had lower failure displacement than did locking plate fixation. No statistically significant differences were found in failure stiffness, yield stiffness (p = .655), yield load (p = .142), or ultimate load between the 2 fixation techniques. Cannulated headless variable-pitch screw fixation resulted in better failure displacement than locking plate fixation in a cadaveric talus model and could be considered a viable option for talus fracture fixation. Headless, fully threaded, variable-pitch screw fixation has inherent advantages compared with locking plate fixation, because it might cause less damage to the articular surface and can compress the fracture for improved reduction. Additionally, plate fixation can increase the risk of avascular necrosis owing to the wider incision and dissection of soft tissues.

  2. Minimally Invasive Mitral Valve Surgery I

    PubMed Central

    Ailawadi, Gorav; Agnihotri, Arvind K.; Mehall, John R.; Wolfe, J. Alan; Hummel, Brian W.; Fayers, Trevor M.; Farivar, R. Saeid; Grossi, Eugene A.; Guy, T. Sloane; Hargrove, W. Clark; Khan, Junaid H.; Lehr, Eric J.; Malaisrie, S. Chris; Murphy, Douglas A.; Rodriguez, Evelio; Ryan, William H.; Salemi, Arash; Segurola, Romualdo J.; Shemin, Richard J.; Smith, J. Michael; Smith, Robert L.; Weldner, Paul W.; Goldman, Scott M.; Lewis, Clifton T. P.; Barnhart, Glenn R.

    2016-01-01

    Abstract Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection. PMID:27654407

  3. Non-radiation endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis during pregnancy.

    PubMed

    Wu, Wenming; Faigel, Douglas O; Sun, Gang; Yang, Yunsheng

    2014-11-01

    Gallstone diseases are common during pregnancy. In most cases, patients are asymptomatic and do not require any treatment. However, choledocholithiasis, cholangitis, and gallstone pancreatitis may potentially become life-threatening for both mother and fetus and often require urgent intervention. Although endoscopic retrograde cholangiopancreatography (ERCP) has become the standard technique for removing common bile duct stones, it is associated with ionizing radiation that could carry teratogenic risk. Non-radiation ERCP (NR-ERCP) is reported to be effective without incurring this risk. Two techniques have been described to confirm bile duct cannulation: bile aspiration and image guidance. With bile aspiration, biliary cannulation is confirmed by applying suction to the cannula to yield bile, thus confirming an intrabiliary position. Image guidance involves using ultrasound or direct visualization (choledochoscopy) to confirm selective biliary cannulation or duct clearance. Once cannulation is achieved, the stones are removed using standard ERCP techniques and tools. Case series and retrospective studies have reported success rates of up to 90% for NR-ERCP with complication rates similar to standard ERCP. Pregnancy outcomes are not adversely affected by NR-ERCP, but whether the avoidance of radiation carries benefit for the baby is unknown. Prospective comparative trials are lacking. NR-ERCP is technically demanding and should be attempted only by skilled biliary endoscopists in properly equipped and staffed health-care institutions, in a multidisciplinary setting. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

  4. Functional Cardiorespiratory Toxicity Screening of Candidate Antiparasitic Drugs and Antidotes for Chemical Poisons. Study of the Effects of Drugs Upon the Cardiovascular and Respiratory Systems

    DTIC Science & Technology

    1988-06-01

    Statham P23AC pressure transducer for measurement of arterial blood pressure. The left Scarotid artery was cannulated with a Millare Mikro -tip* catheter...infused simultaneously. A Miliar* Mikro -tipO pressure transducer catheter will t. introduced through the left cdrotid artery; the tip will be positioned

  5. A home-made low-cost hydraulic swivel and catheter assembly for blood pressure recording and drug infusion in freely moving mice.

    PubMed

    Tsai, Meng-Li; Huang, Jian-Jia; Chou, Li-Min; Chen, Chien-Chang

    2008-06-01

    We constructed a chassis that tightly fixes catheters for cannulation to the muscle. It can buffer pulling forces to avoid a mechanical tearing of the skin of mice as a result of movement. A simple hydraulic swivel was also made for blood pressure recording and drug infusion in freely moving mice.

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

    USDA-ARS?s Scientific Manuscript database

    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...

  7. 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.…

  8. 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)

  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. UPTAKE AND ELIMINATION OF DICHLOROACETIC ACID BY RAINBOW TROUT

    EPA Science Inventory

    Dichloroacetic acid (DCA) is a by-product of drinking water chlorination and is a hepatocarcinogen in rodents. Preliminary results of a chronic testing effort with Japanese medaka suggest the possibility of similar effects is fish. Adult rainbow trout were cannulated from the dor...

  11. The real effectiveness of ultrasound guidance in subclavian venous access.

    PubMed

    Milone, Marco; Di Minno, Giovanni; Di Minno, Matteo Nicola Dario; Salvatore, Giuseppe; Iacovazzo, Carmine; Policastro, Carmela; Milone, Francesco

    2010-01-01

    The technique of ultrasound-guided subclavian cannulation was evaluated in our experience assessing the real effectiveness of such procedure. We have evaluated 297 subclavian cannulation, performed for the placement of central venous catheter both with landmark method (176 patients) and ultrasound guided technique (121 patients) to assess the real effectiveness of the ultrasound-guided technique to reduce the mechanical complication of the subclavian vein puncture. A total of 23 mechanical complications were identified. Of these, 8 were pneumothorax and 15 arterial puncture. Such cases were identified from the pool of patients who had undergone subclavian venous cannulation with landmark method. However these complications occurred only in difficult venous access and teaching procedure performed with landmark method. An ultrasound-guided recent technique for the placement of central venous access should be adopted since such technique seems to reduce the incidence of failure and mechanical complications. However it is worth notice that the clinical effect of using ultrasound guidance technique seems to be more significant when the internal jugular vein rather than the subclavian vein is cannulated. Our experience demonstrate that, both in no difficult cases and in no teaching procedures, central venous catheterization using landmark technique seems to be acceptable on both clinical and medico-legal grounds. However the ultrasound guided technique is necessarily required to achieve the reduction of complications in difficult venous access.

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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    USDA-ARS?s Scientific Manuscript database

    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...

  16. Influence of protein type and level on nitrogen and forage utilization in cows consuming low-quality forage

    USDA-ARS?s Scientific Manuscript database

    Minimal quantities of ruminally degradable protein from supplements may improve supplement utilization efficiency of ruminants grazing dormant forages. In Exp. 1, N retention, ruminal NH3, serum urea N, and NDF digestibility was evaluated for 12 ruminally cannulated cows in an incomplete Latin Squa...

  17. Evaluation of an electromagnetic 3D navigation system to facilitate endovascular tasks: a feasibility study.

    PubMed

    Sidhu, R; Weir-McCall, J; Cochennec, F; Riga, C; DiMarco, A; Bicknell, C D

    2012-01-01

    We describe a novel approach to arterial cannulation using the StealthStation(®) Guidance System (Medtronic, USA). This uses electromagnetic technology to track the guidewire, displaying a 3D image of the vessel and guidewire. The study was performed on a 'bench top' simulation model called the Cannulation Suite comprising of a silicone aortic arch model and simulated fluoroscopy. The accuracy of the StealthStation(®) was assessed. 16 participants of varying experience in performing endovascular procedures (novices: 6 participants, ≤5 procedures performed; intermediate: 5 participants, 6-50 procedures performed; experts: 5 participants, >50 procedures performed) underwent a standardised training session in cannulating the left subclavian artery on the model with the conventional method (i.e. with fluoroscopy) and with the StealthStation(®). Each participant was then assessed on cannulating the left subclavian artery using the conventional method and with the StealthStation(®). Performance was video-recorded. The subjects then completed a structured questionnaire assessing the StealthStation(®). The StealthStation(®) was accurate to less than 1 mm [mean (SD) target registration error 0.56 mm (0.91)]. Every participant was able to complete the cannulation task with a significantly lower use of fluoroscopy with the navigation system compared with the conventional method [median 0 s (IQR 0-2) vs median 14 s (IQR 10-19), respectively; p = <0.001]. There was no significant difference between the StealthStation(®) and conventional method for: total procedure time [median 17 s (IQR 9-53) vs median 21 s (IQR 11-32), respectively; p=0.53]; total guidewire hits to the vessel wall [median 0 (IQR 0-1) vs median 0 (IQR 0-1), respectively; p=0.86]; catheter hits to the vessel wall [median 0.5 (IQR 0-2) vs median 0.5 (IQR 0-1), respectively; p=0.13]; and cannulation performance on the global rating scale [median score, 39/40 (IQR 28-39) vs 38/40 (IQR 33-40), respectively

  18. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients

    PubMed Central

    Karakitsos, Dimitrios; Labropoulos, Nicolaos; De Groot, Eric; Patrianakos, Alexandros P; Kouraklis, Gregorios; Poularas, John; Samonis, George; Tsoutsos, Dimosthenis A; Konstadoulakis, Manousos M; Karabinis, Andreas

    2006-01-01

    Introduction Central venous cannulation is crucial in the management of the critical care patient. This study was designed to evaluate whether real-time ultrasound-guided cannulation of the internal jugular vein is superior to the standard landmark method. Methods In this randomised study, 450 critical care patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 critical care patients in whom the landmark technique was used. Randomisation was performed by means of a computer-generated random-numbers table, and patients were stratified with regard to age, gender, and body mass index. Results There were no significant differences in gender, age, body mass index, or side of cannulation (left or right) or in the presence of risk factors for difficult venous cannulation such as prior catheterisation, limited sites for access attempts, previous difficulties during catheterisation, previous mechanical complication, known vascular abnormality, untreated coagulopathy, skeletal deformity, and cannulation during cardiac arrest between the two groups of patients. Furthermore, the physicians who performed the procedures had comparable experience in the placement of central venous catheters (p = non-significant). Cannulation of the internal jugular vein was achieved in all patients by using ultrasound and in 425 of the patients (94.4%) by using the landmark technique (p < 0.001). Average access time (skin to vein) and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < 0.001). In the landmark group, puncture of the carotid artery occurred in 10.6% of patients, haematoma in 8.4%, haemothorax in 1.7%, pneumothorax in 2.4%, and central venous catheter-associated blood stream infection in 16%, which were all significantly increased compared with the ultrasound group (p < 0.001). Conclusion The present data suggest that ultrasound

  19. Arteriovenous fistula combined with brachial artery superficialization is effective in patients with a high risk of maturation failure.

    PubMed

    Murakami, Masaaki; Sakaguchi, Genichi; Mori, Noriko

    2017-02-01

    In patients with a high risk of fistula immaturity, we created arteriovenous fistulas (AVFs) combined with brachial artery superficialization. With this procedure, the superficialized arteries are used as drawing routes and the AVFs as returning routes. This is a technical report about AVFs combined with brachial artery superficialization. Twenty-four consecutive patients with a high risk of fistula immaturity who underwent AVFs with brachial artery superficialization were included in this single-center retrospective study. High risk for maturation failure was defined with a combination of the vessel size measured by ultrasound and the length of the straight segment for cannulation. The indications were as follows: (1) a vein diameter of <2 mm or an artery diameter at the point of anastomosis of <2 mm (n = 9); and (2) a vein cannulation site of <10 cm long, which is too short for two cannulations (n = 15). Initially, after careful examination of the vessels by duplex ultrasound imaging, we created an AVF at an appropriate site. Subsequently, the brachial artery was exposed and the side branches were ligated. The brachial artery was mobilized to the ventral aspect of the upper arm, and the subcutaneous tissue under the brachial artery was sutured. A skin flap was then placed over the transposed brachial artery. One patient died of sepsis due to central venous catheter infection before the initial cannulation. All other patients underwent successful two-needle cannulation with a prescribed blood flow. The median age of the patients was 78 years. The first successful cannulation was achieved at a median of 17 days (range, 12-547) after AVF creation. Two patients underwent cannulation >30 days after surgery (58 and 547 days) because their vascular accesses were created before initiation of hemodialysis treatment. Median postoperative follow-up duration was 524 days (range, 15-1394 days). Nine patients (38%) died during follow-up of unrelated causes. At 12

  20. Flexible robotics with electromagnetic tracking improves safety and efficiency during in vitro endovascular navigation.

    PubMed

    Schwein, Adeline; Kramer, Ben; Chinnadurai, Ponraj; Walker, Sean; O'Malley, Marcia; Lumsden, Alan; Bismuth, Jean

    2017-02-01

    One limitation of the use of robotic catheters is the lack of real-time three-dimensional (3D) localization and position updating: they are still navigated based on two-dimensional (2D) X-ray fluoroscopic projection images. Our goal was to evaluate whether incorporating an electromagnetic (EM) sensor on a robotic catheter tip could improve endovascular navigation. Six users were tasked to navigate using a robotic catheter with incorporated EM sensors in an aortic aneurysm phantom. All users cannulated two anatomic targets (left renal artery and posterior "gate") using four visualization modes: (1) standard fluoroscopy mode (control), (2) 2D fluoroscopy mode showing real-time virtual catheter orientation from EM tracking, (3) 3D model of the phantom with anteroposterior and endoluminal view, and (4) 3D model with anteroposterior and lateral view. Standard X-ray fluoroscopy was always available. Cannulation and fluoroscopy times were noted for every mode. 3D positions of the EM tip sensor were recorded at 4 Hz to establish kinematic metrics. The EM sensor-incorporated catheter navigated as expected according to all users. The success rate for cannulation was 100%. For the posterior gate target, mean cannulation times in minutes:seconds were 8:12, 4:19, 4:29, and 3:09, respectively, for modes 1, 2, 3 and 4 (P = .013), and mean fluoroscopy times were 274, 20, 29, and 2 seconds, respectively (P = .001). 3D path lengths, spectral arc length, root mean dimensionless jerk, and number of submovements were significantly improved when EM tracking was used (P < .05), showing higher quality of catheter movement with EM navigation. The EM tracked robotic catheter allowed better real-time 3D orientation, facilitating navigation, with a reduction in cannulation and fluoroscopy times and improvement of motion consistency and efficiency. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  1. The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients.

    PubMed

    Pikwer, A; Bååth, L; Davidson, B; Perstoft, I; Akeson, J

    2008-01-01

    Central venous catheters are used in various hospital wards. An anterior-posterior chest X-ray is usually obtained soon after cannulation to assess the location of the catheter tip. This prospective clinical study was designed to determine the radiographic catheter tip position after central venous cannulation by various routes, to identify clinical problems possibly associated with the use of malpositioned catheters and to make a cost-benefit analysis of routine chest X-ray with respect to catheter malposition. A total 1619 central venous cannulations were recorded during a three-year period with respect to patient data, information about the cannulation procedures, the radiographic catheter positions and complications during clinical use. The total incidence of radiographic catheter tip malposition, defined as extrathoracic or ventricular positioning, was 3.3% (confidence interval 25 to 4.3%). Cannulation by the right subclavian vein was associated with the highest risk of malposition, 9.1%, compared with 1.4% by the right internal jugular vein. Six of the 53 malpositioned catheters were removed or adjusted. No case of malposition was associated with vascular perforation, local venous thrombosis or cerebral symptoms. We conclude that the radiographic incidence of central venous catheter malpositioning is low and that clinical use of malpositioned catheters is associated with few complications. However, determination of the catheter position by chest X-ray should be considered when mechanical complications cannot be excluded, aspiration of venous blood is not possible, or the catheter is intended for central venous pressure monitoring, high flow use or infusion of local irritant drugs.

  2. Routine Use of Distal Arterial Perfusion in Pediatric Femoral Venoarterial Extracorporeal Membrane Oxygenation.

    PubMed

    Schad, Christine A; Fallon, Brian P; Monteagudo, Julie; Okochi, Shunpei; Cheung, Eva W; Morrissey, Nicholas J; Kadenhe-Chiweshe, Angela V; Aspelund, Gudrun; Stylianos, Steven; Middlesworth, William

    2017-01-01

    Lower-extremity ischemia is a significant complication in children on femoral venoarterial extracorporeal membrane oxygenation (VA ECMO). Our institution currently routinely uses distal perfusion catheters (DPCs) in all femoral arterial cannulations in attempts to reduce ischemia. We performed a single-center, retrospective review of pediatric patients supported with femoral VA ECMO from January 2005 to November 2015. The outcomes of patients with prophylactic DPC placement at cannulation (prophylactic DPC) were compared to a historical group with DPCs placed in response only to clinically evident ischemic changes (reactive DPC). Ischemic complication requiring invasive intervention (fasciotomy or amputation) was the primary outcome. Twenty-nine patients underwent a total of 31 femoral arterial cannulations, 17 with prophylactic DPC and 14 with reactive DPC. Ischemic complications requiring invasive intervention developed in 2 of 17 (12%) prophylactic DPC patients versus 4 of 14 (29%) reactive DPC. In the reactive DPC group, 7 of 14 (50%) had ischemic changes postcannulation, six underwent DPC placement, and three out of six of these patients still required invasive intervention. One of the seven patients had ischemic changes, did not undergo DPC, and required amputation. While a greater percentage of patients in the prophylactic group was cannulated during extracorporeal cardiopulmonary resuscitation (ECPR), statistical significance was not otherwise demonstrated. We demonstrate feasibility of superficial femoral artery (SFA) access in pediatric patients. We note fewer ischemic complications with prophylactic DPC placement, and observe that salvaging a limb with a reactive DPC was only successful 50% of the time. Although there was no statistical difference in the primary outcome between the two groups, limitations and confounding factors include small sample size and a greater percentage of patients in the prophylactic DPC group cannulated with ECPR in progress.

  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. Facile mechanical shaking method is an improved isolation approach for islet preparation and transplantation

    PubMed Central

    Yin, Nina; Chen, Tao; Yu, Yuling; Han, Yongming; Yan, Fei; Zheng, Zhou; Chen, Zebin

    2016-01-01

    Successful islet isolation is crucial for islet transplantation and cell treatment for type 1 diabetes. Current isolation methods are able to obtain 500–1,000 islets per rat, which results in a waste of ≥50% of total islets. In the present study, a facile mechanical shaking method for improving islet yield (up to 1,500 per rat) was developed and summarized, which was demonstrated to be more effective than the existing well-established stationary method. The present results showed that isolated islets have a maximum yield of 1,326±152 when shaking for 15 min for the fully-cannulated pancreas. For both fully-cannulated and half-cannulated pancreas in the presence of rat DNAse inhibitor, the optimal shaking time was amended to 20 min with a further increased yield of 1,344±134 and 1,286±124 islets, respectively. Furthermore, the majority of the isolated islets were morphologically intact with a well-defined surface and almost no central necrotic zone, which suggested that the condition of islets obtained via the mechanical shaking method was consistent with the stationary method. Islet size distribution was also calculated and it was demonstrated that islets from the stationary method exhibited the same size distribution as the non-cannulated group, which had more larger islets than the fully-cannulated and half-cannulated groups isolated via the shaking method. In addition, the results of glucose challenge showed that the refraction index of each group was >2.5, which indicated the well-preserved function of isolated islets. Furthermore, the transplanted islets exhibited a therapeutic effect after 1 day of transplantation; however, they failed to control blood glucose levels after ~7 days of transplantation. In conclusion, these results demonstrated that the facile mechanical shaking method may markedly improve the yield of rat islet isolation, and in vitro and in vivo investigation demonstrated the well-preserved function of isolated islets in the control of

  5. The role of robotic endovascular catheters in fenestrated stent grafting.

    PubMed

    Riga, Celia V; Cheshire, Nicholas J W; Hamady, Mohamad S; Bicknell, Colin D

    2010-04-01

    Fenestrated stent grafting has allowed the treatment of complex thoraco-abdominal aneurysm disease via a totally endovascular approach, but the procedure can be technically challenging and time consuming. We investigated whether this procedure may be enhanced by remotely steerable robotic endovascular catheters. A four-vessel fenestrated stent graft partially deployed within a computed tomography (CT)-reconstructed pulsatile thoraco-abdominal aneurysm silicon model was used. Fifteen operators were recruited to participate in the study and divided into three groups, based on their endovascular experience: group A (n = 4, 100-200 endovascular procedures, group B (n = 5, 200-300), and group C (n = 6, >300). All operators were asked to cannulate the renal and visceral vessels under fluoroscopic guidance, using conventional and robotic techniques. Quantitative (catheterization times and wire/catheter tip movements) and qualitative metrics (procedure-specific-rating scale [IC3ST]), which grades operators on catheter use, instrumentation, successful cannulation/catheterization, and overall performance were compared. Median procedure time for cannulation of all four vessels was reduced using the robotic system (2.87 min, interquartile range [IQR; 2.20-3.90] versus 17.24 min [11.90-19.80]; P < .001) for each individual operator, regardless of the level of endovascular experience. The total number of wire/catheter movements taken to complete the task was also significantly reduced (38, IQR [29-57] versus 454 [283-687]; P < .001). There were significant differences in time and movement for cannulation of each individual vessel in the phantom. Robotic catheter operator radiation exposure was negligible as the robotic workstation is remote and away from the radiation source. Overall performance scores significantly improved using the robotic system, despite minimal operator exposure to this technology (IC3ST score 29/35, IQR [22.8-30.7] versus 19/35 [13-24.3]; P = .002). Each

  6. Eliminating a Major Cause of Wire Drawing Breakage in A-15 High-Field Superconductors

    SciTech Connect

    Austen, Alfred R.

    2003-05-20

    Eliminating a Major Cause of Wire Drawing Breakage in A-15 High-Field Superconductors Phase 1 Summary Purpose of the research: The Phase 1 goal was to make a significant improvement in the wire drawing technology used for difficult to draw superconductor precursor composites. Many ductile Nb-Al and Nb-Sn precursor wire composites have experienced the onset of wire drawing breakage at about 1.5 mm diameter. Phase 1 focused on evaluating the role that precision rigid guidance of the wire into the drawing die and the hydrostatic stress state at the die entrance played in preventing wire breakage. Research carried out: The research performed depended upon the construction of both a mechanical wire guide and a hydrostatic pressure stiffened wire guidance system. Innovare constructed the two wire guidance systems and tested them for their ability to reduce wire drawing breakage. One set of hardware provided rigid alignment of the wires to their wire drawing die axes within 0.35 degrees using ''hydrostatic pressure stiffening'' to enable the precision guidance strategy to be implemented for these highly flexible small diameter wires. This apparatus was compared to a guide arrangement that used short span mechanical guide alignment with a misalignment limit of about 0.75 degrees. Four A-15 composite wires with breakage histories were drawn to evaluate the use of these wire guiding systems to reduce and/or eliminate wire breakage. Research findings and results: In Phase 1, a breakthrough in wire drawing technology for A-15 superconductor composites was achieved by dramatically limiting or eliminating breakage in four different A-15 composite precursor wire designs during the drawing of these very desirable composites that previously could not be drawn to near final size. Research results showed that the proposed Phase 1 mechanical wire guides were sufficiently effective and successful in eliminating breakage when used along with other advanced wire drawing technology to

  7. Eustachian Tube Dilation via a Transtympanic Approach in 6 Cadaver Heads: A Feasibility Study.

    PubMed

    Dean, Marc; Chao, Wei-Chieh; Poe, Dennis

    2016-10-01

    The goal of this study was to evaluate the feasibility of endoscopic transtympanic balloon dilation of the cartilaginous eustachian tube. To accomplish this, transtympanic balloon dilation of the cartilaginous eustachian tube was performed on 11 eustachian tubes (6 cadaver heads). The balloon catheter was introduced and passed through the protympanic orifice of the eustachian tube transtympanically under endoscopic view and cannulated without incident in all cadavers. Computed tomography was then performed postprocedure to evaluate for inadvertent dilation of the bony eustachian tube, adverse placement of the balloon, or any bony fractures. The balloon was seen to be successfully inflated in the cartilaginous portion without damage to surrounding structures in all cases. This demonstrates that under endoscopic guidance, the protympanic orifice of the eustachian tube can be feasibly cannulated and reliably traversed, allowing for targeted dilation of the cartilaginous eustachian tube from a transtympanic approach.

  8. Endoscopy and papillotomy in diseases of the biliary tract and pancreas

    SciTech Connect

    Siegel, J.H.

    1980-12-01

    Endoscopic retrograde cholangiography (ERCP), the most advanced of the gastrointestinal endoscopic procedures, provides both specific diagnostic information pertaining to diseases of the biliary tract and pancreas and definitive therapy available only with this modality. ERCP is safe and accurate, establishing a primary diagnosis in 80% of cases and, in experienced hands, cannulation is successful in 98%. In addition to cholangiography, pancreatography has been a significant achievement providing accurate diagnostic yield through direct cannulation and opacification of the pancreatic duct while permitting collection of secretions for cytological evaluation and chemical analyses. The therapeutic extension of ERCP, endoscopic papillotomy (EPT), is successful in 94% of cases in the treatment of common bile duct stones and papillary stenosis, providing comparable results to surgical procedures while reducing morbidity, mortality and convalescence. Because of the accuracy and safety of these procedures, they should be considered early in suspected diseases of the biliary tract and pancreas so that the clinician can establish a specific diagnosis and provide definitive therapy.

  9. Long-axis view for ultrasound-guided central venous catheter placement via the internal jugular vein

    PubMed Central

    Mahan, Angel F.; McEvoy, Matthew D.; Gravenstein, Nikolaus

    2016-01-01

    Background In modern practice, real-time ultrasound guidance is commonly employed for the placement of internal jugular vein catheters. With a new tool, such as ultrasound, comes the opportunity to refine and further optimize the ultrasound view during jugular vein catheterization. We describe jugular vein access techniques and use the long-axis view as an alternative to the commonly employed short-axis cross-section view for internal jugular vein access and cannulation. Conclusion The long-axis ultrasound-guided internal jugular vein approach for internal jugular vein cannulation is a useful alternative technique that can provide better needle tip and guidewire visualization than the more traditional short-axis ultrasound view. PMID:28913474

  10. Open aortic arch repair: state-of-the-art and future perspectives.

    PubMed

    Ouzounian, Maral; LeMaire, Scott A; Coselli, Joseph S

    2013-01-01

    Surgical procedures for the treatment of complex aortic arch pathology remain among the most challenging cardiovascular operations, incurring considerable risk for death and stroke. The purpose of this article is to describe the evolution of our approach to open repair of the aortic arch. Our arterial cannulation strategy has shifted from femoral and direct aortic to right axillary and more recently innominate artery cannulation. This transition has facilitated the administration of continuous antegrade cerebral perfusion and more moderate levels of hypothermia during complex repairs. Modifications in surgical technique, including arch reconstruction with the trifurcated graft, and the classical and frozen elephant trunk techniques have simplified the conduct of the operation. Experimental and clinical research supporting the evolution of our approach is discussed in this paper. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Three new techniques for creation of a steerable sheath, a 4F snare, and bidirectional sheath inversion using existing endovascular materials.

    PubMed

    Mallios, Alexandros; Yankovic, Willy; Boura, Benoit; Combes, Myriam

    2012-09-01

    We present three novel techniques for creation of (1) a steerable sheath, (2) a 4F snare device, and (3) dual anterograde and retrograde double-wire percutaneous transluminal angioplasty access technique using a single femoral puncture. These techniques were conceived and bench-tested in our institution, allowing the utilization of inexpensive equipment for complicated endovascular procedures. They offer (1) controlled navigation, no-touch vessel cannulation and cannulation of angulated vessels, contralateral limb of stent grafts, fenestrations, and branches; (2) a low-profile (4F external diameter) modifiable snare with the ability to expand to the size of an entire aneurysm and the ability to undo the snare in case of blockage with other endovascular material; and (3) in situ sheath inversion for concomitant anterograde and retrograde percutaneous angioplasty with a single femoral puncture.

  12. [Giant pseudoaneurysm of the ascending aorta following the aortic valve replacement;report of a case].

    PubMed

    Kawahara, Yu; Inage, Yuichi; Masaki, Naoki; Toyama, Shuji; Fukasawa, Manabu

    2013-08-01

    56-year-old male, who had undergone re-aortic valve replacement (AVR) 33 years ago, received preoperative study for pancreatic surgery. Computed tomography (CT) revealed a giant pseudoaneurysm (7 cm diameter) of the ascending aorta. The ascending aorta was not dilated. A midline skin incision was performed, followed by full sternotomy. A tight pericardial adhesion was carefully dissected. Cardiopulmonary bypass was established by femoral arterial and bicaval venous cannulation. The pseudoaneurysm was incised under the retrograde cardioplegic protection. A communication between ascending aorta and aneurysm was found 1 cm distal to the previous aortic suture line. This communication coincided with the cardioplegic root cannulation site. The aortic prosthetic valve was intact. The ascending aorta was replaced with 26 mm prosthetic graft. Postoperative course was uneventful. In this case, CT was useful to select the approach to the complicated postoperative surgical site.

  13. Plastic Biliary Stent Migration During Multiple Stents Placement and Successful Endoscopic Removal Using Intra-Stent Balloon Inflation Technique: A Case Report and Literature Review.

    PubMed

    Calcara, Calcedonio; Broglia, Laura; Comi, Giovanni; Balzarini, Marco

    2016-02-05

    Late migration of a plastic biliary stent after endoscopic placement is a well known complication, but there is little information regarding migration of a plastic stent during multiple stents placement. A white man was hospitalized for severe jaundice due to neoplastic hilar stenosis. Surgical eligibility appeared unclear on admission and endoscopy was carried out, but the first stent migrated proximally at the time of second stent insertion. After failed attempts with various devices, the migrated stent was removed successfully through cannulation with a dilation balloon. The migration of a plastic biliary stent during multiple stents placement is a possible complication. In this context, extraction can be very complicated. In our patient, cannulation of a stent with a dilation balloon was the only effective method.

  14. Interpretation of duplex ultrasound dialysis access testing.

    PubMed

    Bandyk, Dennis F

    2013-01-01

    Conditions producing dialysis access dysfunction include failure of access maturation, cannulation injury to the conduit wall, thrombosis, low-volume flow, and aneurysmal degeneration. Duplex ultrasound is an accurate diagnostic technique to assess dialysis access anatomy and function, including the obligatory criteria for maturation, eg, volume flow >800 mL/min, conduit depth 0.6 cm from skin surface, and adequate (>5 mm) conduit diameter for cannulation. Measurement of access volume flow from the brachial artery or access conduit is prognostic for effective dialysis and conduit patency; including the determination of whether access maturation has occurred or when to intervene for a duplex-identified access stenosis. The application of duplex surveillance after autogenous vein or prosthetic bridge dialysis access construction has the potential to improve patency and function in the patient whose life is dependent on effective hemodialysis. © 2013 Elsevier Inc. All rights reserved.

  15. Septic arthritis of the hip after percutaneous femoral artery catheterization.

    PubMed

    Backstein, David; Hutchison, Carol; Gross, Allan

    2002-12-01

    Infection of the hip joint can cause severe articular damage. Standard treatment of septic arthritis includes surgical débridement and intravenous antibiotics. Options for definitive management in the presence of joint destruction include excision arthroplasty, arthrodesis, and total hip arthroplasty. Two cases of septic arthritis of the hip as a complication of femoral artery cannulation are presented. These cases highlight a potential complication that may not be readily appreciated by clinicians who routinely perform femoral vascular cannulation. After all evidence of ongoing infection had disappeared, both cases ultimately were treated with total hip arthroplasty. Both patients have improved function and pain at 2.5 and 5 years of follow-up. Given the frequency with which femoral intravascular catheters are used in numerous procedures, methods of avoiding infection of the hip joint must be implemented. These 2 cases emphasize the potential risks of these procedures and show management with total hip arthroplasty. Copyright 2002, Elsevier Science (USA). All rights reserved.

  16. Use of the Amplatzer Type 2 Plug for Flow Redirection in Failing Autogenous Hemodialysis Fistulae

    SciTech Connect

    Bozkurt, Alper Kırbaş, İsmail; Kasapoglu, Benan; Teber, Mehmet Akif

    2015-08-15

    PurposeTo present our experience with redirecting the outflow of mature arteriovenous fistulae (AVFs) in patients with cannulation and/or suboptimal flow problems by percutaneous intervention using the Amplatzer Vascular Plug II (AVP II).MethodsWe retrospectively reviewed patients who presented with difficulty in cannulation and/or suboptimal flow in the puncture zone of the AVF and who underwent intervention using the AVP II to redirect the outflow through a better cannulation zone from March 2009 to November 2012. The mean survival rate of all AVFs was estimated, and the effects of patient age, sex, and AVF age on the AVF survival time were determined.ResultsIn total, 31 patients (17 male and 14 female) with a mean age of 57.8 years (range, 20–79 years) were included. In 2 patients, the AVF failed within the first 15 days because of rapid thrombosis. In 9 patients, the new AVF route was working effectively until unsalvageable thrombosis developed. One of the 31 patients died 9 months before the last radiologic evaluation. The new AVF route was still being used for dialysis in the remaining 19 patients. The mean AVF survival rate was 1,061.4 ± 139.4 days (range, 788–1,334 days). Patient age, sex, and AVF age did not affect the survival time.ConclusionWe suggest that the AVP II is useful for redirecting the outflow of AVFs with cannulation problems and suboptimal flow. Patency of existing AVFs may be extended, thereby extending surgery-free or catheter intervention-free survival period.

  17. Pullout performance comparison of novel expandable pedicle screw with expandable poly-ether-ether-ketone shells and cement-augmented pedicle screws.

    PubMed

    Aycan, Mehmet Fatih; Tolunay, Tolga; Demir, Teyfik; Yaman, Mesut Emre; Usta, Yusuf

    2017-02-01

    Aim of this study is to assess the pullout performance of various pedicle screws in different test materials. Polyurethane foams (Grade 10 and Grade 40) produced in laboratory and bovine vertebrae were instrumented with normal, cannulated (cemented), novel expandable and normal (cemented) pedicle screws. Test samples were prepared according to the ASTM F543 standard testing protocols and surgical guidelines. To examine the screw placement and cement distribution, anteriosuperior and oblique radiographs were taken from each sample after insertion process was completed. Pullout tests were performed in an Instron 3369 testing device. Load versus displacement graphs were recorded and the ultimate pullout force was defined as the maximum load (pullout strength) sustained before failure of screw. Student's t-test was performed on each group whether the differences between pullout strength of pedicle screws were significant or not. While normal pedicle screws have the lowest pullout strength in all test materials, normal pedicle screws cemented with polymethylmethacrylate exhibit significantly higher pullout performance than others. For all test materials, there is a significant improvement in pullout strength of normal screws by augmentation. While novel expandable pedicle screws with expandable poly-ether-ether-ketone shells exhibited lower pullout performance than normal screws cemented with polymethylmethacrylate, their pullout performances in all groups were higher than the ones of normal and cannulated pedicle screws. For all test materials, although cannulated pedicle screws exhibit higher pullout strength than normal pedicle screws, there are no significant differences between the two groups. The novel expandable pedicle screws with expandable poly-ether-ether-ketone shells may be used instead of normal and cannulated pedicle screws cemented with polymethylmethacrylate due to their good performances.

  18. Metabolic and Hemodynamic Effects of CO2 Pneumoperitoneum in a Controlled Hemorrhage Model

    DTIC Science & Technology

    2001-06-01

    carotid artery was exposed and cannulated with polyethylene tubing (PE-50). This line was prefilled with heparinized saline and attached to a pressure...the abdomen. A 60-mL syringe filled with CO2 was attached to one of the catheters and used for the abdominal insufflation and the other one was...was drawn. The pressure was then released as the syringe and manometer were disconnected from the catheters. The abdo- men was also gently compressed

  19. The use of EMLA cream to decrease venipuncture pain in children.

    PubMed

    Rogers, Tanya L; Ostrow, C Lynne

    2004-02-01

    Venipuncture is one of the most painful medical procedures for a child, and it is one of the most frequently performed. This literature synthesis reviews evidence for the use of eutectic mixture of local anesthetics (EMLA) cream to reduce the pain children experience during venipuncture. EMLA cream was compared with placebo, iontophoresis, and amethocaine cream and was found to be an effective local anesthetic for pediatric venipuncture pain during both intravenous cannulation and phlebotomy.

  20. Minimal contribution of the gastrointestinal tract to splanchnic uptake of intravenously infused ethanol

    SciTech Connect

    Huang, Mingta )

    1992-02-26

    The uptake of iv infused ethanol in the liver and the GI tract were determined by the portal-hepatic and arterial-portal gradients of ethanol in this report. Male Wistar rats were cannulated either in the portal vein (P), the hepatic vein (H) and the inferior vena cava (V) or in the common carotid artery (A), the portal vein (P) and the inferior vena cava (V). The experiments were performed in the fed state only on those animals whose daily food consumption has returned to pre-cannulation level. Ethanol was infused into V at a rate of 15.2 umol/min/rat for 90 min. Five sets of P and H blood or A and P blood were simultaneously taken from PHV and APV cannulated rats between 60 and 90 min of infusion when plasma ethanol concentrations in A,P and H were found to reach plateau. Ethanol concentration P was 3.10 {plus minus} 1.17 mM (SD), H was 2.64 {plus minus} 1.19 mM(SD). The difference between the two was highly significant. P-H gradient was 0.46 {plus minus} 0.06 mM(SD). A-P gradients of ethanol in APV cannulated were 0.03 {approximately} 0.04 mM, 12 {approximately} 15 times lower than hepatic gradient. It was concluded that the role of alcohol dehydrogenase activity recently found in the GI tract in metabolizing blood ethanol is insignificant in comparison to that of the liver.

  1. Comparison of oral midazolam with intranasal dexmedetomidine premedication for children undergoing CT imaging: a randomized, double-blind, and controlled study.

    PubMed

    Ghai, Babita; Jain, Kajal; Saxena, Akshay Kumar; Bhatia, Nidhi; Sodhi, Kushaljit Singh

    2017-01-01

    Children undergoing computerized tomography (CT) frequently require sedation to allay their anxiety, and prevent motion artifacts and stress of intravenous (IV) cannulation. The aim of this trial was to compare the effectiveness of oral midazolam and intranasal dexmedetomidine as sole premedicants in children for carrying out both IV cannulation as well as CT scanning, without the need for additional IV sedatives. Fifty-nine children, aged 1-6 years, scheduled to undergo CT imaging under sedation were randomized to receive either 0.5 mg·kg(-1) oral midazolam (group M) or 2.5 mcg·kg(-1) intranasal dexmedetomidine (group D). After 20-30 min, intravenous cannulation was performed and response to its placement was graded using the Groningen Distress Rating Scale (GDRS). After cannulation, children were transferred on the CT table, and assessed using the Ramsay sedation score (RSS). CT imaging was performed without any further sedative if the RSS was ≥4. If there was movement or decrease in sedation depth (RSS ≤ 3), ketamine 1 mg·kg(-1) IV was given as an initial dose, followed by subsequent doses of 0.5 mg·kg(-1) IV if required. A Significantly higher proportion of children in group D (67%) achieved RSS ≥ 4 as compared to group M (24%) (P-0.002). The risk ratio (95% CI) was 2.76 (1.38-5.52). Significantly lower GDRS scores were noted in group D (1(1-2)) as compared to group M (2(1-2)) at the time of venipuncture (P = 0.04). In the doses and time intervals used in our study, intranasal dexmedetomidine (2.5 μg·kg(-1) ) was found to be superior to oral midazolam (0.5 mg·kg(-1) ) for producing satisfactory sedation for CT imaging. © 2016 John Wiley & Sons Ltd.

  2. Acute compartment syndrome of the hand in Henoch-Schonlein Purpura

    PubMed Central

    Luis, Guntur E; Ng, Eng-Seng

    2007-01-01

    An eight year old boy with Henoch-Schonlein Purpura (HSP) presented with acute compartment syndrome (ACS) of his left hand following arterial cannulation of his radial artery in intensive care unit. Emergency decompression and fasciotomy were performed. The authors report this first case in literature and discuss how HSP can be complicated by ACS and ways to prevent the latter from happening. PMID:17411454

  3. Coronary air embolism in off-pump surgery caused by blower-mister device.

    PubMed

    Korkmaz, Askin Ali; Guden, Mustafa; Korkmaz, Feride; Yuce, Murat

    2008-01-01

    Gaseous emboli caused by the blower-mister result in air locks within coronary vessels. We describe the case of a coronary air embolism caused by a blower-mister device on off-pump surgery. The tip of the device unexpectedly entered the coronary artery through arteriotomy and caused the air emboli. Air locks in the coronary circulation led to hemodynamic deterioration, and cardiopulmonary bypass was started following the emergency cannulation.

  4. Ultrasonic Quantification of Blood Volume Redistribution under Hypergravity

    DTIC Science & Technology

    1986-01-15

    into the legs, reducing venous return to the heart. This shift produces an increased pressure in the arteries and veins of the legs and a decreased...rely upon invasive measurement of venous and arterial pressures by cannulation * of vessels and upon various indirect noninvasive indicetori of...determination by esophageal catheter, and, more recently, flow determination by Doppler flowmeter. Loss of eye level arterial pressure has been correlated

  5. Brachial Arterial Pressure Monitoring during Cardiac Surgery Rarely Causes Complications.

    PubMed

    Singh, Asha; Bahadorani, Bobby; Wakefield, Brett J; Makarova, Natalya; Kumar, Priya A; Tong, Michael Zhen-Yu; Sessler, Daniel I; Duncan, Andra E

    2017-06-01

    Brachial arterial catheters better estimate aortic pressure than radial arterial catheters but are used infrequently because complications in a major artery without collateral flow are potentially serious. However, the extent to which brachial artery cannulation promotes complications remains unknown. The authors thus evaluated a large cohort of cardiac surgical patients to estimate the incidence of related serious complications. The institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database and Perioperative Health Documentation System Registry of the Cleveland Clinic were used to identify patients who had brachial artery cannulation between 2007 and 2015. Complications within 6 months after surgery were identified by International Classification of Diseases, Ninth Revision diagnostic and procedural codes, Current Procedural Terminology procedure codes, and Society of Thoracic Surgeons variables. The authors reviewed electronic medical records to confirm that putative complications were related plausibly to brachial arterial catheterization. Complications were categorized as (1) vascular, (2) peripheral nerve injury, or (3) infection. The authors evaluated associations between brachial arterial complications and patient comorbidities and between complications and in-hospital mortality and duration of hospitalization. Among 21,597 qualifying patients, 777 had vascular or nerve injuries or local infections, but only 41 (incidence 0.19% [95% CI, 0.14 to 0.26%]) were potentially consequent to brachial arterial cannulation. Vascular complications occurred in 33 patients (0.15% [0.10 to 0.23%]). Definitely or possibly related infection occurred in 8 (0.04% [0.02 to 0.08%]) patients. There were no plausibly related neurologic complications. Peripheral arterial disease was associated with increased risk of complications. Brachial catheter complications were associated with prolonged hospitalization and in-hospital mortality. Brachial artery cannulation for

  6. No Stone Left Unturned: Using Choledocholithiasis to Open a Papillary Stenosis via a Choledochodudenal Fistula

    PubMed Central

    Shellenberger, M. Joshua

    2016-01-01

    In a patient found to have cholelithiasis and choledocholithiasis, a choledochoduodenal fistula was used to gain access to the bile duct. Due to severe stenosis and atrophy of the major papilla, cannulation was not possible. Stones were purposely impacted in the native ampulla to cause bulging and stretching of the stenosis. Once the stenosis was stretched, the bile and pancreatic duct were accessed via the native ampulla, allowing for stone removal. PMID:26958565

  7. No Stone Left Unturned: Using Choledocholithiasis to Open a Papillary Stenosis via a Choledochodudenal Fistula.

    PubMed

    West, Sara; Shellenberger, M Joshua

    2016-01-01

    In a patient found to have cholelithiasis and choledocholithiasis, a choledochoduodenal fistula was used to gain access to the bile duct. Due to severe stenosis and atrophy of the major papilla, cannulation was not possible. Stones were purposely impacted in the native ampulla to cause bulging and stretching of the stenosis. Once the stenosis was stretched, the bile and pancreatic duct were accessed via the native ampulla, allowing for stone removal.

  8. Dialysis access in a patient with multiple central venous stenoses.

    PubMed

    Cui, Tianlei; Zhao, Yuliang; Li, Xiao; Zhou, Li; Liu, Fang; Fu, Ping

    2014-01-01

    We report a female patient, with obstructed right femoral and right brachiocephalic vein, narrowed left femoral vein, left brachiocephalic vein and superior vena cava, due to long-term catheterization for dialysis. Angioplasty and synthesized graft transplant were successfully performed. The new access withstood early cannulation only 3 days after the procedure. Angioplasty can ameliorate existing stenosis and enable permanent access creation, while an artificial graft may provide faster maturation than documented.

  9. Intrapelvic Protrusion of a Broken Guide Wire Fragment during Fixation of a Femoral Neck Fracture

    PubMed Central

    Afshar, Ahmadreza

    2017-01-01

    During fixation of a femoral neck fracture in a 23-year-old male patient with cannulated screws, a broken guide wire fragment inadvertently advanced through the hip joint and protruded into the pelvis. A second surgical approach was needed to remove the broken fragment from the pelvis. Awareness of such a potentially devastating complication will make surgeons more cautious during implementation of orthopedic instruments and increases patient’s safety during surgery.

  10. Additional Studies on Metabolism of WR-158,122 in Rats and Monkeys.

    DTIC Science & Technology

    1981-03-10

    activity of 69 uCi/mg or 24 mCi/mmole. The radiochemical purity in a number of TLC systems was > 98%. Treatment Suspension. A typical treatment...in Table 3. Biliary 14 excretion (as C) varied rather widely from 2.5 to 23.6%. This variation may reflect the adequacy of biliary excretory ...that the livers of these bile duct ligated and bile duct cannulated animals may not be functioning as well as in unoperated animals suggests that

  11. Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

    PubMed Central

    Wang, Fei; Xu, Boming; Li, Quanpeng; Zhang, Xiuhua; Jiang, Guobing; Ge, Xianxiu; Nie, Junjie; Zhang, Xiuyun; Wu, Ping; Ji, Jie; Miao, Lin

    2016-01-01

    Abstract Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is challenging. Results of ERCP in those patients varied. The aim of our study was to evaluate the safety and effectiveness of various endoscopes-assisted ERCP in patients with surgically altered anatomy. Fifty-two patients with Billroth II reconstruction (group A), 20 patients with subtotal or total gastrectomy with Roux-en-Y anastomosis (group B), 25 patients with pancreatoduodenectomy or Roux-en-Y hepaticojejunostomy reconstruction (group C) were included. Gastroscope, duodenoscope, colonoscope, and double-balloon enteroscope were used. The endoscope insertion success rate of groups A, B, C was 96.2% (50/52), 85.0% (17/20), 80% (20/25), respectively. χ2 test showed that there was no significant difference between the 3 groups (P = 0.068). The mean insertion time was 36.7, 68.4, and 84.0 minutes, respectively. One-way ANOVA showed that the insertion time of group C was significantly longer than that of groups B and C (both P <0.001). The endoscopic cannulation success rates of groups A, B, C were 90%, 82.4%, and 100%, respectively. χ2 test showed that there was no significant difference between the 3 groups (P = 0.144). The mean cannulation time was 19.4, 28.1, and 20.4 minutes, respectively. One-way ANOVA showed that the cannulation time of group B was longer than that of groups A and C (P <0.001, P = 0.001, respectively). In total, 74 patients with successful biliary cannulation achieved the therapeutic goal; thus, the clinical success rate was 76.3% (74/97). Our study showed that ERCP in patients with surgically altered anatomy was safe and feasible. PMID:28033284

  12. The metabolism and excretion of curcumin (1,7-bis-(4-hydroxy-3-methoxyphenyl)-1,6-heptadiene-3,5-dione) in the rat.

    PubMed

    Holder, G M; Plummer, J L; Ryan, A J

    1978-12-01

    Curcumin labelled with deuterium and tritium was prepared. Oral and intraperitoneal doses of [3H]curcumin led to the faecal excretion of most of the radioactivity. 2. Intravenous and intraperitoneal doses of [3H]curcumin were well excreted in the bile of cannulated rats. 3. The major biliary metabolites were glucuronides of tetrahydrocurcumin and hexahydrocurcumin. A minor biliary metabolite was dihydroferulic acid together with traces of ferulic acid. Metabolites were identified using chemical ionization mass spectrometry.

  13. Successful staged operation for acute type A aortic dissection with paraplegia.

    PubMed

    Ando, Takashi; Abe, Hiroyuki; Nagata, Tokuichiro; Makuuchi, Haruo

    2013-06-01

    A 75-year-old man presented with both paraplegia and acute occlusion of the abdominal aorta at onset. Extraanatomical bypass was performed following spinal drainage. After 3 days, the ascending aorta replaced under cardiopulmonary bypass using the extraanatomical bypass graft for arterial cannulation. The abdominal aorta was replaced after 6 months. A staged operation is one of the options for acute aortic dissection with paraplegia and acute occlusion of the abdominal aorta.

  14. Bilateral axillary artery inflow in the treatment of a rare case of pseudocoarctation of the aortic arch.

    PubMed

    Mazzola, Alessandro; Gregorini, Renato; DeCurtis, Guglielmo; Ciocca, Marco

    2007-10-01

    The axillary artery is the preferred site for arterial cannulation in operations for ascending aorta and aortic arch replacement in order to reduce perfusion-related morbidity in acute dissection and to prevent cerebral embolism in atherosclerotic aneurysm. We present the case of a patient with a chronic dissection presenting as pseudocoarctation of the aortic arch in which bilateral axillary artery inflow was necessary to perfuse both ascending and descending aorta.

  15. Suture-induced right coronary artery stenosis.

    PubMed

    Seltmann, Martin; Achenbach, Stephan; Muschiol, Gerd; Feyrer, Richard

    2010-01-01

    An 82-year-old patient developed right heart failure in the days after surgical aortic valve replacement. Coronary CT angiography showed a high-grade stenosis of the mid-right coronary artery. Adjacent suture material seen on noncontrast CT suggested that the lesion was related to surgical closure of the right atrial cannulation site. Invasive angiography confirmed the stenosis, and percutaneous intervention was successfully performed.

  16. Prospective Durability Testing of a Vascular Access Phantom

    DTIC Science & Technology

    2010-09-01

    ultrasound guidance when obtaining central venous access.19,20 The increasing use of ultrasound guidance for vascular access has created an educational...with difficult intravenous access. Ann Emerg Med. 2005;46:456-61. 7. Gallieni M, Cozzolino M. Uncomplicated central vein catheterization of high risk...al. Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: The third sonography

  17. ERCP in patients with periampullary diverticulum.

    PubMed

    Rajnakova, Andrea; Goh, Peter M; Ngoi, Sing Shang; Lim, Seng Gee

    2003-01-01

    Duodenal diverticula, discovered incidentally in patients during endoscopic retrograde cholangiopancreatography, are usually asymptomatic, but can be the source of significant morbidity. The aim of this study was to evaluate the indications for endoscopic retrograde cholangiopancreatography, the course of this procedure and complications after this procedure in patients with periampullary diverticulum. Clinical, laboratory, ultrasonographic, and endoscopic retrograde cholangiopancreatography data of 626 patients from a single endoscopy center were retrospectively analyzed. The periampullary diverticulum was identified in 72 patients (11.5%). The difficulty in cannulation of papilla of Vater was encountered in 57 patients (79.2%) with diverticulum compared to 54 patients (9.7%) without diverticulum (P < 0.001). Cannulation of common bile duct was successful in 592 patients (94.6%). Cannulation of common bile duct failed in 8 patients (11.1%) with diverticulum compared to 26 patients (4.7%) without diverticulum (P = 0.046). Patients without diverticulum (n = 168, 31.9%) had two-times more often dilated common bile duct > or = 6 mm without stone on ultrasound compared to patients with diverticulum (n = 12, 17.6%) (P = 0.017). Patients with diverticulum presented 1.8-times more often with retained stone in the common bile duct than patients without diverticulum (16.7% vs. 9.7%). 17.3% of patients developed post-endoscopic retrograde cholangiopancreatography complications, which did not significantly differ in both groups. However, the patients who presented with retained common bile duct stones had higher post-endoscopic retrograde cholangiopancreatography complications (P = 0.011). Cannulation of the common bile duct is more difficult in patients with periampullary diverticulum and requires more skills. Periampullary diverticulum is also associated with higher risk of retained stones in the common bile duct which may lead to higher post-endoscopic retrograde

  18. Ultrasound guidance for central vascular access in the neonatal and pediatric intensive care unit.

    PubMed

    Al Sofyani, Khouloud; Khouloud, Al Sofyani; Julia, Guilbert; Abdulaziz, Boker; Yves, Chevalier Jean; Sylvain, Renolleau

    2012-04-01

    Percutaneous central venous cannulation (CVC) in infants and children is a challenging procedure, and it is usually achieved with a blinded, external landmark-guided technique. Recent guidelines from the National Institute for Clinical Excellence (NICE) recommend the use of ultrasound guidance for central venous catheterization in children. The purpose of this study was to evaluate this method in a pediatric and neonatal intensive care unit, assessing the number of attempts, access time (skin to vein), incidence of complication, and the ease of use for central venous access in the neonatal age group. After approval by the local departmental ethical committee, we evaluated an ultrasound-guided method over a period of 6 months in 20 critically ill patients requiring central venous access in a pediatric intensive care unit and a neonatal intensive care unit (median age 9 (0-204) months and weight 9.3 (1.9-60) kg). Cannulation was performed after locating the puncture site with the aid of an ultrasound device (8 MHz transducer, Vividi General Electrics(®) Burroughs, USA) covered by a sterile sheath. Outcome measures included successful insertion rate, number of attempts, access time, and incidence of complications. Cannulation of the central vein was 100% successful in all patients. The right femoral vein was preferred in 60% of the cases. The vein was entered on the first attempt in 75% of all patients, and the median number of attempts was 1. The median access time (skin to vein) for all patients was 64.5 s. No arterial punctures or hematomas occurred using the ultrasound technique. In a sample of critically ill patients from a pediatric and neonatal intensive care unit, ultrasound-guided CVC compared with published reports on traditional technique required fewer attempts and less time. It improved the overall success rate, minimized the occurrence of complications during vein cannulation and was easy to apply in neonatal and pediatric patients.

  19. Ultrasound guidance for central vascular access in the neonatal and pediatric intensive care unit

    PubMed Central

    Khouloud, Al Sofyani; Julia, Guilbert; Abdulaziz, Boker; Yves, Chevalier Jean; Sylvain, Renolleau

    2012-01-01

    Background: Percutaneous central venous cannulation (CVC) in infants and children is a challenging procedure, and it is usually achieved with a blinded, external landmark-guided technique. Recent guidelines from the National Institute for Clinical Excellence (NICE) recommend the use of ultrasound guidance for central venous catheterization in children. The purpose of this study was to evaluate this method in a pediatric and neonatal intensive care unit, assessing the number of attempts, access time (skin to vein), incidence of complication, and the ease of use for central venous access in the neonatal age group. Methods: After approval by the local departmental ethical committee, we evaluated an ultrasound-guided method over a period of 6 months in 20 critically ill patients requiring central venous access in a pediatric intensive care unit and a neonatal intensive care unit (median age 9 (0–204) months and weight 9.3 (1.9–60) kg). Cannulation was performed after locating the puncture site with the aid of an ultrasound device (8 MHz transducer, Vividi General Electrics® Burroughs, USA) covered by a sterile sheath. Outcome measures included successful insertion rate, number of attempts, access time, and incidence of complications. Results: Cannulation of the central vein was 100% successful in all patients. The right femoral vein was preferred in 60% of the cases. The vein was entered on the first attempt in 75% of all patients, and the median number of attempts was 1. The median access time (skin to vein) for all patients was 64.5 s. No arterial punctures or hematomas occurred using the ultrasound technique. Conclusions: In a sample of critically ill patients from a pediatric and neonatal intensive care unit, ultrasound-guided CVC compared with published reports on traditional technique required fewer attempts and less time. It improved the overall success rate, minimized the occurrence of complications during vein cannulation and was easy to apply in neonatal

  20. Radial access - be prepared!

    PubMed

    Stathopoulos, Ioannis

    2008-10-01

    We present the case of a 46-year-old female patient that experienced recurrent stent thrombosis and underwent attempted primary PCI via the radial artery. Although radial artery cannulation with a 6 Fr sheath and the diagnostic angiography were successfully performed, the PCI could not be achieved because of failure to advance the 6 Fr guide through the radial artery, due to severe angulation of a high take-off radial artery, combined with a proximal radial artery stenosis.

  1. Traumatic Brain Injury Creates Biphasic Systemic Hemodynamic and Organ Blood Flow Responses in Rats

    DTIC Science & Technology

    1990-01-01

    injury. Fluid percussion brain injury produced an immediate systemic hypertension followed by a hypotension and low cardiac output. Organ blood flows...37.5°C using a heating pad. The right femoral artery was cannulated for blood pressure monitoring using a quartz transducer (Hewlett Packard) and an...Since the hypertensive responses were usually maximal at 30 sec after injury, the mean arterial pressure and heart rate at 30 sec after sham injury

  2. Transradial approach for coronary angiography and interventions in patients with coronary bypass grafts: tips and tricks.

    PubMed

    Burzotta, Francesco; Trani, Carlo; Hamon, Martial; Amoroso, Giovanni; Kiemeneij, Ferdinand

    2008-08-01

    Among patients undergoing coronary procedures, patients with coronary artery bypass grafts represent an important, high risk subgroup. Routine transradial approach may be successfully adopted in these patients to reduce access-site complications. However, transradial cannulation of the grafts may result technically demanding. In this article we discuss the specific technical issues and we present a series of tips and tricks which may facilitate angiography and interventions on both internal mammary and aorto-coronary grafts.

  3. Role of No in the Regulation of Systemic and Renal Hemodynamics Following Hemorrhagic Shock in the Rate

    DTIC Science & Technology

    2007-11-02

    suprapubic incision for urine sampling. The right internal jugular vein was cannulated with two PE-50 catheters. Inulin , PAH and pentobarbital sodium...aortic arch (10). Glomerular filtration rate (GFR) and effective renal plasma flow were determined by the renal clearance of inulin -carboxyl...Carboxyl-14C] and aminohippuric acid P-[glycyl-2-3H] respectively (New England Nuclear, Boston, MA). The 14C- inulin was infused at a rate of 0.06uCi/min

  4. Arthroscopic stabilization procedures for recurrent anterior shoulder instability.

    PubMed

    Yahiro, M A; Matthews, L S

    1989-11-01

    Anterior shoulder instability is a common and functionally disabling problem in young athletes. The goal in treatment of this condition is a stable, yet mobile, joint. Current methods now being utilized in the arthroscopic stabilization of the anterior shoulder include staple capsulorrhaphy, removable rivet capsulorrhaphy, cannulated screw fixation, and the transglenoid suture technique. These techniques and the clinical experience with each are reviewed, with an emphasis on providing stability, improving function, and allowing earlier rehabilitation in the unstable shoulder of the athlete.

  5. Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis.

    PubMed

    Wani, Sachin; Hall, Matthew; Wang, Andrew Y; DiMaio, Christopher J; Muthusamy, V Raman; Keswani, Rajesh N; Brauer, Brian C; Easler, Jeffrey J; Yen, Roy D; El Hajj, Ihab; Fukami, Norio; Ghassemi, Kourosh F; Gonzalez, Susana; Hosford, Lindsay; Hollander, Thomas G; Wilson, Robert; Kushnir, Vladimir M; Ahmad, Jawad; Murad, Faris; Prabhu, Anoop; Watson, Rabindra R; Strand, Daniel S; Amateau, Stuart K; Attwell, Augustin; Shah, Raj J; Early, Dayna; Edmundowicz, Steven A; Mullady, Daniel

    2016-04-01

    There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis. AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10% and 20%, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed. Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80%). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence. This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  6. Effects of Unmodified and Cross-Linked Stroma Free Hemoglobin Solutions on Blood Pressure and Renal Function in the Hypotensive Rat

    DTIC Science & Technology

    1993-09-09

    polyethylene (PE-240) tubing and the femoral artery was cannulated with PE-50 tubing for blood pressure monitoring as well as blood sampling . The...of 30 minutes, two 20 minute control clearance periods were obtained during which blood pressure was measured continuously and urine collected for...Figure 3). The concentrations of total hemoglobin measured in blood samples obtained at the end of the experiment were no different between rats

  7. Enhancing screw stability in osteosynthesis with hydroxyapatite granules.

    PubMed

    Hasegawa, K; Yamamura, S; Dohmae, Y

    1998-01-01

    We employed hydroxyapatite (HA) granules to enhance screw fixation in revision surgery of failed osteosynthesis with a compression hip screw system in an 83-year-old woman. After reduction of the fracture, the fracture site with a large bone defect was filled with HA granules, and osteosynthesis was accomplished with a double cannulated lag screw and plate system. We feel that this HA granule augmentation method may also be suitable for osteosynthesis in other osteoporotic fractures.

  8. Safety and efficacy of polyurethane vascular grafts for early hemodialysis access.

    PubMed

    Kakisis, John D; Antonopoulos, Constantine; Mantas, George; Alexiou, Evaggelos; Katseni, Konstantina; Sfyroeras, George; Moulakakis, Konstantinos; Geroulakos, George

    2017-08-30

    Arteriovenous grafts made of polyurethane (PU) have the advantage of early cannulation obviating the placement of a central vein catheter in patients with an acute need for long-term hemodialysis. The aim of the present study was to evaluate the safety, efficacy and complication rate of PU vascular grafts for dialysis access in patients in whom early cannulation was performed. Between January 2007 and December 2015, 125 straight brachial-axillary grafts were placed in patients with an acute thrombosis of a previous arteriovenous access. Sixty-four were PU and 61 were polytetrafluoroethylene (PTFE) grafts. Patency and complications rates were compared between the two groups. The median interval from implantation to cannulation was 1 day in the PU group vs 28 days in the PTFE group. Cumulative infection rate at 5 years was 13% and 8% in the PU and the PTFE groups, respectively (P = .6). None of the patients in the PU group developed a pseudoaneurysm necessitating intervention, compared with one patient in the PTFE group. Primary and secondary patency rates did not differ significantly between the two groups. The cumulative median primary patency was 23 months in the PU group vs 26 months in the PTFE group. Median secondary patency was 42 vs 33 months, respectively. Diabetes mellitus was the only factor adversely affecting graft patency in both groups. PU grafts offer the advantage of early cannulation with infection, pseudoaneurysm formation and patency rates similar to those of the PTFE grafts. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  9. Transapical perfusion for peri-arrest salvage during transcutaneous aortic valve implantation.

    PubMed

    Göbölös, L; Tsang, G M; Curzen, N; Calver, A L; Ohri, S K

    2015-11-01

    An 80-year-old man developed severe haemodynamic instability during a transapical aortic valve implantation. He was not suitable for a conventional surgical approach due to comorbidities and patent aortocoronary bypass grafts also limited further stabilizing actions. As a bail-out procedure, we demonstrate the feasibility of transapical arterial cannulation by crossing a newly implanted TAVI valve in order to establish an emergency bypass circuit. © The Author(s) 2015.

  10. Plating of patella fractures: techniques and outcomes.

    PubMed

    Taylor, Benjamin C; Mehta, Sanjay; Castaneda, Joaquin; French, Bruce G; Blanchard, Chris

    2014-09-01

    Operative treatment of displaced patella fractures with tension band fixation remains the gold standard, but is associated with a significant rate of complications and symptomatic implants. Despite the evolution of tension band fixation to include cannulated screws, surprisingly little other development has been made to improve overall patient outcomes. In this article, we present the techniques and outcomes of patella plating for displaced patella fractures and patella nonunions.

  11. Comparison Between Human and Porcine Thromboelastograph Parameters in Response to Ex-Vivo Changes to Platelets, Plasma, and Red Blood Cells

    DTIC Science & Technology

    2013-01-01

    the effect of isolated changes in platelet count on the rotational thromboelastometry (ROTEM) parameters using platelet-rich plasma and platelet-poor...ongoing therapeutic anticoagulation therapy, use of over-the-counter drugs such as aspirin, ibuprofen , herbal products, or nonsteroidal anti-inflammatory...Inc., Bothell, Washington, USA) to guide access to the femoral vein. The vein was cannulated (SI-09700, 7 Fr. Side -port/ Percutaneous Sheath Catheter

  12. Cortical Plasticity as Revealed by Ocular Dominance Shift: Effects of Limited Visual Environments.

    DTIC Science & Technology

    1986-11-03

    recording from visual cortex began with a tracheotomy and femoral vein cannulation performed under ketamine-promazine anesthesia (25 mg/kg and 3 mg/kg, i.m...can be explained, to an extent, by differences between rods and cones and their central actions. In cats, rods outnumber cones 10:1 in the area...if "alternating occlusion " (1lubel & Viesel, 1965) were used to control which eye viewed the world when optic flow were permitted. Such an

  13. Non-adrenergic, non-cholinergic reflex secretion of parotid saliva in rats elicited by mastication and acid applied on the tongue.

    PubMed

    Ekström, J

    1998-09-01

    Chewing and acid on the tongue evoked a flow of saliva from the duct-cannulated parotid gland of the conscious rat despite pretreatment with atropine and adrenoceptor antagonists. This non-adrenergic, non-cholinergic (NANC) response depended on an intact parasympathetic innervation and was abolished by a tachykinin antagonist. The present findings are consistent with a physiological role for the secretory NANC mechanisms of the salivary glands.

  14. Incidence of cannula associated deep vein thrombosis after veno-venous ECMO.

    PubMed

    Menaker, Jay; Tabatabai, Ali; Rector, Raymond; Dolly, Katelyn; Kufera, Joseph; Lee, Eugenia; Kon, Zachary; Sanchez, Pablo; Pham, Si; Herr, Daniel L; Mazzeffi, Michael; Rabinowitz, Ronald P; OʼConnor, James V; Stein, Deborah M; Scalea, Thomas M

    2017-02-13

    Limited literature regarding the incidence of cannula associated deep vein thrombosis (CaDVT) following veno-venous extracorporeal membrane oxygenation (VV ECMO) exists. The purpose of this study was to identify the incidence of post decannulation CaDVT and identify any associated risk factors. Forty eight patients were admitted between August 2014 and January 2016 to the Lung Rescue Unit were included in the study. Protocolized anticoagulation levels (partial thromboplastin time 45-55 second) and routine post decannulation DVT screening were in place during the study period. Forty-one (85.4%) patients had CaDVT. Of those with CaDVT, 31 (76%) patients were treated with full anti-coagulation therapy. 34 (76%) patients with right internal jugular cannulation had CaDVT at cannula site. Twenty-five (61%) patients had CaDVT in the lower extremity. (18 associated right femoral vein cannulation; 7 left femoral vein cannulation) 18 (44%) patients had both upper and lower extremity CaDVT. Overall, patients with CaDVT tended to be older, have a higher body mass index (BMI) and on ECMO longer (p=NS). Mean PTT during time on ECMO between patients that did and did not have CaDVT did not differ. No clinical evidence of pulmonary embolism was seen.

  15. Verification of Embolic Channel Causing Blindness Following Filler Injection.

    PubMed

    Tansatit, Tanvaa; Moon, Hyoung Jin; Apinuntrum, Prawit; Phetudom, Thavorn

    2015-02-01

    Ocular complications following cosmetic filler injections are serious situations. This study provided scientific evidence that filler in the facial and the superficial temporal arteries could enter into the orbits and the globes on both sides. We demonstrated the existence of an embolic channel connecting the arterial system of the face to the ophthalmic artery. After the removal of the ocular contents from both eyes, liquid dye was injected into the cannulated channel of the superficial temporal artery in six soft embalmed cadavers and different color dye was injected into the facial artery on both sides successively. The interior sclera was monitored for dye oozing from retrograde ophthalmic perfusion. Among all 12 globes, dye injections from the 12 superficial temporal arteries entered ipsilateral globes in three and the contralateral globe in two arteries. Dye from the facial artery was infused into five ipsilateral globes and in three contralateral globes. Dye injections of two facial arteries in the same cadaver resulted in bilateral globe staining but those of the superficial temporal arteries did not. Direct communications between the same and different arteries of the four cannulated arteries were evidenced by dye dripping from the cannulating needle hubs in 14 of 24 injected arteries. Compression of the orbital rim at the superior nasal corner retarded ocular infusion in 11 of 14 arterial injections. Under some specific conditions favoring embolism, persistent interarterial anastomoses between the face and the eye allowed filler emboli to flow into the globe causing ocular complications.

  16. Circularity, Solidity, Axes of a Best Fit Ellipse, Aspect Ratio, and Roundness of the Foramen Ovale: A Morphometric Analysis With Neurosurgical Considerations.

    PubMed

    Zdilla, Matthew J; Hatfield, Scott A; McLean, Kennedy A; Cyrus, Leah M; Laslo, Jillian M; Lambert, H Wayne

    2016-01-01

    The structure of the foramen ovale of the sphenoid bone is clinically important, particularly with regard to surgical procedures that cannulate the foramen such as percutaneous trigeminal rhizotomy for the treatment of trigeminal neuralgia, percutaneous biopsy of parasellar lesions, and electroencephalographic analysis of the temporal lobe among patients undergoing selective amygdalohippocampectomy. Differences in the morphology of the foramen ovale (FO) have been reported to contribute to difficulties in the cannulation of the FO. Reports regarding the structure of the FO, however, use subjective and ambiguous descriptions of morphology, including "oval," "truly oval," "elongated oval," "elongated," "semicircular," "almond," "round," "rounded," "slit," "irregular," "D shape," and "pear." Therefore, it is necessary to describe the structure of the FO with reproducible objective morphometric data. This study analyzed 169 foramina to determine normative morphometric shape descriptions of the following: area, perimeter, circularity, solidity, axes of a best fit ellipse, aspect ratio, and roundness. The shape descriptors reported herein may aid in identification and description of structural variation in FO including bony projections encroaching upon the foramina and may improve surgical approaches to transovale cannulation.

  17. Making the invisible visible: near-infrared spectroscopy and phlebotomy in children.

    PubMed

    Strehle, Eugen-Matthias

    2010-10-01

    Phlebotomy and venous cannulation are the most frequently performed and the most distressing invasive procedures in pediatrics. The aim of this pilot study was to assess whether a novel vein imaging system was advantageous for the identification of superficial veins, thus reducing the number of skin punctures. The Vein Viewer was trialled in 50 children <16 years of age who required venous blood sampling or peripheral venous catheterization as part of their standard clinical care. A questionnaire with 10 questions about their experience of using this equipment was distributed to the pediatric doctors and nurses performing the procedures. During a 9-month period, 38 venipunctures and 12 cannulations were performed in 50 children (mean age 6.67 years). On average, 1.7 puncture attempts per child were necessary. Fifty questionnaires were completed by 11 consultants, 16 registrars, 20 senior house officers, and 3 nurses. Seventy-two percent rated the imaging device as useful, 8% as not useful, and 20% remained neutral. Visibility of the peripheral veins was improved in 76% of children, and the same as with room light in 24%. Near-infrared technology facilitated venipuncture and venous cannulation in a pediatric cohort. Further, controlled trials are required including children of specific age groups and those from ethnic minorities.

  18. Effect of naloxone on regional cerebral blood flow during endotoxin shock in conscious rats

    SciTech Connect

    Law, W.R.; Ferguson, J.L. )

    1987-09-01

    Maintenance of cerebral blood flow (CBF) is vital during cardiovascular shock. Since opioids have been implicated in the pathophysiology of endotoxin shock and have been shown to alter cerebral perfusion patterns, the authors determined whether opioids were responsible for any of the changes in regional CBF observed during endotoxin shock and whether the use of naloxone might impair or aid in the maintenance of CBF. When blood flow (BF) is studied with radioactively-labeled microspheres in rats, the left ventricle of the heart is often cannulated via the right carotid artery. Questions have arisen concerning the potential adverse effects of this method on CBF in the hemisphere ipsilateral to the ligated artery. They measured right and left regional CBF by use of this route of cannulation. Twenty-four hours after cannulations were performed, flow measurements were made using radiolabeled microspheres in conscious unrestrained male Sprague-Dawley rats (300-400 g) before and 10, 30, and 60 min after challenging with 10 mg/kg Escherichia coli endotoxin (etx) or saline. Naloxone (2 mg/kg) or saline was given as a treatment 25 min post-etx. They found no significant differences between right and left cortical, midbrain, or cerebellar BF at any time in any treatment group. Therefore naloxone treatment of endotoxin shock may be beneficial in preventing decreases in regional CBF.

  19. Complications of internal jugular vein retrograde catheterization.

    PubMed

    Gemma, M; Beretta, L; De Vitis, A; Mattioli, C; Calvi, M R; Antonino, A; Rizzi, B; Crippa, L; D'Angelo, A

    1998-01-01

    We report on the incidence of complications of 172 internal jugular vein retrograde catheterizations (IJVRCs) performed on 126 patients. Standard cannulation and X-ray control of the catheter tip placement were performed. Difficulties encountered during the manouvre were registered. Patients with a jugular catheter in place for more than one day had neck echography on catheter removal and one week later. Carotid artery puncture occurred in 20 (12%) cases and lymphatic vessel puncture in one. In 13 (8%) cases IJVRC failed due to difficulties in advancing the guide. X-ray films documented catheter misplacement in 39 (23%) cases: loop into the internal jugular vein in 11 (6%); paravertebral venous plexus cannulated in one; other extracranial jugular afferent cannulated in 4 (2%); catheter tip into the jugular lumen in 10 (6%); catheter tip beyond the jugular bulb in 13 (8%). First neck echography documented: one perivascular hematoma (absent one week later); 3 (4%) jugular vein thrombosis (2 asymptomatic and absent one week later; one symptomatic and still evident one week later). Positive neck echography was not associated with difficulties, length of catheterization, diameter of the catheter. IJVRC is a simple and safe procedure with a low incidence of serious complications.

  20. New technical approaches in stereotaxic catheterization of cerebral ventriculi: implications for the L-arginine/NO synthase/nitric oxide cascade.

    PubMed

    Manolidis, G; Neamţu, C; Vasincu, D; Jaba, Irina-Maria; Rădăşanu, Oana; Mungiu, O C

    2004-01-01

    In order to study the actions of certain substances at cerebral level, a stereotactic device for ensuring a precise catheterization of points in certain cerebral areas was used. For the operation technique was used a stereotaxic atlas specifically designed for rat brain (G. Paxinos, C. Watson, 1998), which offers all the necessary information for the identification of the trepanation. Stereotaxic implantation of cannules in the brain is useful for microinjecting solutions containing various substances (in amounts of microl), directly and targeted in the anatomical structures of the brain. The technique described can use either metalic or silastic cannules, that have variable lumen (usually for adapting a Hamilton syringe). The cannules can be implanted at cerebroventricular level, having the possibility to target all the cerebral ventricles. The intracerebroventricular (icv) administration of L-arginine induces a significant increase of response latency for mechano-algesic test. The most obvious changes are induced following the administration of the association of L-NAME with L-arginine, situation when is manifested an important increase of the response latency, starting with 5 minutes post-administration and continuing up to 45 minutes determination. The increase is significantly higher compared with the results obtained with L-arginine alone. A similar evolution is registered in the case of the plantar test.

  1. A Novel Round Insulated Tip Papillotome as an Alternative to the Classic Needle-Knife for Precut Sphincterotomy in Endoscopic Retrograde Cholangiopancreatography

    PubMed Central

    Baysal, Birol; Akin, Hakan; Masri, Omar; İnce, Ali Tüzün; Senturk, Hakan

    2015-01-01

    Objective. The purpose of this study was to investigate the efficacy and safety of a new round insulated tip papillotome (r-ITP) as compared to that of the classic needle-knife sphincterotome (NKS) in difficult-to-cannulate endoscopic retrograde cholangiopancreatography (ERCP) patients. Materials and Methods. Patients with no exclusion criteria and an intact papilla referred for ERCP were invited to participate in the study. “Difficult-to-cannulate” patients, defined as failure to achieve deep biliary cannulation within five minutes from the first touch of papilla, with no more than ten attempts permitted, were randomly assigned for precut sphincterotomy using either the classic NKS or r-ITP. Results. Seventy and 69 patients were randomly assigned to the NKS and r-ITP groups, respectively. The groups were comparable regarding age, sex, indications, and associated conditions. There was no statistically significant difference in terms of successful cannulation or post-ERCP complications between the two groups. Only five patients (3.6%) developed mild to moderate post-ERCP pancreatitis and two had mild bleeding. No perforations or deaths were encountered. Conclusions. Although the round insulated tip papillotome was not shown to be superior to the classic NKS concerning efficacy and safety when used by an experienced endoscopist, it remains a simple, safe, and efficacious alternative. PMID:26347424

  2. Innovative Procedure for Inferior Mesenteric Artery Embolization Using the Amplatzer Vascular Plug 4 during Endovascular Aneurysm Repair.

    PubMed

    Morikage, Noriyasu; Samura, Makoto; Takeuchi, Yuriko; Tanaka, Yuya; Ueda, Koshiro; Harada, Takasuke; Yamashita, Osamu; Suehiro, Kotaro; Hamano, Kimikazu

    2017-05-10

    The aim of this study is to present an easy and quick technique for embolization of the inferior mesenteric artery (IMA) during endovascular aneurysm repair (EVAR). We performed IMA embolization using a conventional EVAR device alone with the femoral artery approach during EVAR, which has not been reported previously. First, a 16F or 18F DrySeal Sheath is inserted from the femoral artery into the site around the IMA. Second, cannulation is performed in the IMA with an angiography catheter having a 0.038-inch inner lumen that is used for gate cannulation during EVAR. Third, IMA embolization is performed using the Amplatzer Vascular Plug 4 (AVP4). The use of the DrySeal Sheath facilitates cannulation of the IMA, and its combination with a stent-graft balloon allows the AVP4 to be placed at the root of the IMA without deviation of the catheter. The success rate of the procedure was 90.9% (30/33 cases). The median procedure time was 11.6 min. No complications due to IMA embolization were noted. This procedure enables safe and quick placement of the AVP4 in the IMA using the catheter insertion approach from the femoral artery, which has been conventionally regarded as difficult. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  3. High-definition fiber tracking guidance for intraparenchymal endoscopic port surgery.

    PubMed

    Fernandez-Miranda, Juan C; Engh, Johnathan A; Pathak, Sudhir K; Madhok, Ricky; Boada, Fernando E; Schneider, Walter; Kassam, Amin B

    2010-11-01

    The authors have applied high-definition fiber tracking (HDFT) to the resection of an intraparenchymal dermoid cyst by using a minimally invasive endoscopic port. The lesion was located within the mesial frontal lobe, septal area, hypothalamus, and suprasellar recess. Using high-dimensional (256 directions) diffusion imaging, more than 250,000 fiber tracts were imaged before and after surgery. Trajectory planning using HDFT in a computer model was used to facilitate cannulation of the cyst with the endoscopic port. Analysis of the proposed initial surgical route was overlaid onto the fiber tracts and was predicted to produce substantial disruption to prefrontal projection fibers (anterior limb of the internal capsule) and the cingulum. Adjustment of the cannulation entry point 1 cm medially was predicted to cross the corpus callosum instead of the anterior limb of the internal capsule or the cingulum. Following cyst resection performed using endoscopic port surgery, postoperative imaging demonstrated accurate cannulation of the lesion, with improved quantitative signal from both the anterior limb of the internal capsule and the cingulum. The observed fiber preservation from the cingulum and the anterior limb of the internal capsule, with minor injury to the corpus callosum, was in close agreement with preoperative trajectory modeling. Comparison of pre- and postoperative HDFT data facilitated quantification of the benefits and costs of the surgical trajectory. Future studies will help to determine whether HDFT combined with endoscopic port surgery facilitates anatomical and functional preservation in such challenging cases.

  4. Endophthalmitis: a rare complication of arteriovenous fistula infection.

    PubMed

    Desai, Madhav; Rapoor, Ram; Gudithi, Swarna Latha; Kumar, Ravi; Prasad, Neela; Dakshinamurty, Kaligotla Venkata

    2008-04-01

    Vascular access infection is a frequent problem in patients undergoing maintenance hemodialysis. Infection of arteriovenous fistula (AVF) is less common than dialysis catheter-associated infection. Previous case reports described endophthalmitis secondary to hemodialysis catheter-related infection, but not secondary to native AVF infection. We report a rare patient of endophthalmitis as a metastatic infection of AVF cannulation site abscess. A 19-year-old girl on maintenance hemodialysis for the past 2 years has presented with a history of fever, chills, and rigor of 3-days duration and painful dimness of vision in the left eye of 1-night duration. It was followed by redness of the eye, photophobia, and ocular discharge. On examination, the patient was febrile with an abscess near cannulation site of AVF. There was no perception of light in the left eye, conjunctiva was congested, cornea was clear, hypopyon present, and pupil was mid-dilated, not reacting to light. Lens was clear. Vitreitis and exudative retinal detachment was present. Methicillin sensitive Staphylococcus aureus was isolated from blood, pus from AVF abscess and vitreous fluid. Diagnosis of endophthalmitis was confirmed by B-scan ultrasound. She was treated with both intravenous and intraocular antibiotics and drainage of pus from AVF abscess and therapeutic vitrectomy. Though arteriovenous abscess responded to sensitive antibiotics and drainage, vision has not improved much. Strict aseptic precautions during regular AVF cannulation are required. Lapses may lead to loss of vision apart from described complications like access closure, endocarditis, and osteomyelitis.

  5. Photic and circadian regulation of melatonin production in the Mozambique tilapia Oreochromis mossambicus.

    PubMed

    Nikaido, Yoshiaki; Ueda, Satomi; Takemura, Akihiro

    2009-01-01

    Diverse circadian systems related to phylogeny and ecological adaptive strategies are proposed in teleosts. Recently, retinal photoreception was reported to be important for the circadian pacemaking activities of the Nile tilapia Oreochromis niloticus. We aimed to confirm the photic and circadian responsiveness of its close relative-the Mozambique tilapia O. mossambicus. Melatonin production in cannulated or ophthalmectomized fish and its secretion from cultured pineal glands were examined under several light regimes. Melatonin production in the cannulated tilapias was measured at 3-h intervals; it fluctuated daily, with a nocturnal increase and a diurnal decrease. Exposing the cannulated fish to several light intensities (1500-0.1 lx) and to natural light (0.1 and 0.3 lx) suppressed melatonin levels within 30 min. Static pineal gland culture under light-dark and reverse light-dark cycles revealed that melatonin synthesis increased during the dark periods. Rhythmic melatonin synthesis disappeared on pineal gland culture under constant dark and light conditions. After ophthalmectomy, plasma melatonin levels did not vary with light-dark cycles. These results suggest that (1) Mozambique tilapias possess strong photic responsiveness, (2) their pineal glands are sensitive to light but lack circadian pacemaker activity, and (3) they require lateral eyes for rhythmic melatonin secretion from the pineal gland.

  6. Effect of Periradial Administration of Papaverine on Radial Artery Diameter

    PubMed Central

    Nagaraja, P. S.; Singh, Naveen G.; Manjunatha, N.; Desai, Rushikesh Chintamanrao

    2017-01-01

    Background: Radial artery cannulation is a skillful procedure. An experienced anesthesiologist might also face difficulty in cannulating a feeble radial pulse. Aim: The purpose of the study was to determine whether periradial subcutaneous administration of papaverine results in effective vasodilation and improvement in the palpability score of radial artery. Settings and Design: Prospective, double-blinded trial. Methodology: Thirty patients undergoing elective cardiac surgery were enrolled in the study. 30 mg of papaverine with 1 ml of 2% lignocaine and 3 ml of normal saline were injected subcutaneously 1–2 cm proximal to styloid process of the radius. Radial artery diameter before and after 20 min of injection papaverine was measured using ultrasonography. The palpability of the radial pulse was also determined before the injection of papaverine and 20 min later. Patients were monitored for hemodynamics and any complications were noted. Statistical Analysis Used: Student's t-test for paired data. Results: Radial artery diameter increased significantly (P < 0.0001), and the pulse palpability score also showed statistically significant improvement (P < 0.0001) after periradial subcutaneous administration of papaverine. There was no statistically significant difference in heart rate, mean arterial blood pressure before and after papaverine injection. No complications were noted in 24 h of follow-up. Conclusion: Periradial subcutaneous administration of papaverine significantly increased the radial artery diameter and pulse palpability score, which had an impact on ease of radial artery cannulation essential for hemodynamic monitoring in cardiac surgical patients. PMID:28298790

  7. Helical computed tomographic dacryocystography and its role in the diagnosis and management of lacrimal drainage system blocks and medial canthal masses

    PubMed Central

    Udhay, Priti; Noronha, Olma Veena

    2008-01-01

    Aim: To study the indications, technique and diagnostic utility of helical computed tomographic dacryocystography (CTDCG). Materials and Methods: Retrospective analysis of 13 patients who underwent CTDCG with subsequent surgical intervention, during the period January 2003 to December 2005, was done. Axial plain computed tomography (CT) scan was performed, followed by administration of water-soluble contrast in the conjunctival cul de sac or by cannulation of the lacrimal passages. Thin-slice helical CT with two-dimensional (2D) and three-dimensional (3D) coronal and sagittal reformation was done. Results: Four patients were males and 9 were females. Age range was 5 to 62 years. Seven patients presented with watering and 6 patients with a medial canthal mass. Three patients had history of trauma. CTDCG was performed by instillation technique in 10 patients and by cannulation in 3 patients. CTDCG showed mass lesion displacing the sac in 5 cases, nasolacrimal duct obstruction in 6 cases and mucocele in 2 cases. Based on the findings on CTDCG, 5 patients underwent mass excision, 7 underwent dacryocystorhinostomy and 1 patient underwent primary silicone tube intubation. Conclusion: Helical CTDCG is a safe and useful diagnostic tool for the lacrimal surgeon. Instillation technique is a physiological and convenient method, and cannulation is needed only in cases where adequate visualization is not achieved. PMID:18158401

  8. Long-Term Follow-Up Results of Delayed Fixation of Femoral Neck Fractures in Adults

    PubMed Central

    Elmi, Asghar; Tabrizi, Ali; Rouhani, Alireza; Mirzatolouei, Fardin

    2013-01-01

    Background Femoral neck fractures are urgent injuries that require precise reduction and stable fixation. In some cases, however, early treatment is not possible. Objectives The present study aimed to evaluate long-term results of delayed fixation of femoral neck fractures using cannulated screws. Patients and Methods This retrospective descriptive-analytical study was conducted on 26 patients with femoral neck fractures. The patients were treated through a closed reduction and fixation method using cannulated screws. Patients were followed up for at least five years and the rate of complications was determined. Results In this study, 26 patients with mean age of 34.3 years were assessed. Average time interval from injury to surgery was 46.4 ± 12.2 hours; 18 patients (69%) were operated on with more than 36 hours of delay. Incidence of AVN and nonunion was reported in 10 (38.4%) and 3 (11.5%) patients, respectively. Conclusions Time plays an important role in treatment results of femoral neck fractures. To treat the fractures, closed reduction and fixation using cannulated screws may still be the best option. PMID:24350142

  9. Anesthetic considerations in robotic mitral valve surgery

    PubMed Central

    Andre, J. Valery; Ritter, Matthew J.

    2017-01-01

    The robotic approach to cardiac surgery offers patients numerous potential advantages compared with a traditional sternotomy approach including shorter hospital length of stay, reduced pain, fewer blood transfusions, and a quicker return to normal daily activities. At the same time, robotic cardiac surgery requires that the anesthesiologist employs several subspecialty skillsets in order to provide optimal care for these patients. Multiple different regional anesthesia techniques may be used to improve analgesia, reduce opioid dosages, and facilitate rapid extubation at the conclusion of the case. Several peripheral cannulation strategies for cardiopulmonary bypass (CPB) exist and the anesthesia team may assist with percutaneous cannulation of the superior vena cava (SVC) or positioning of an endo-pulmonary vent. Similarly the anesthesiologist may be asked to percutaneously cannulate the coronary sinus for retrograde cardioplegia delivery. The need for one-lung ventilation (OLV) and heavy reliance on transesophageal echocardiography (TEE) occupy much of the anesthesiologist’s attention during these cases. Variations in institutional practice exist. Reviews of current practice and future studies may help refine the anesthetic approach to robot-assisted cardiac surgery. PMID:28203541

  10. “Open” approach to aortic arch aneurysm repair☆

    PubMed Central

    Al Kindi, Adil H.; Al Kimyani, Nasser; Alameddine, Tarek; Al Abri, Qasim; Balan, Baskaran; Al Sabti, Hilal

    2014-01-01

    Aortic arch aneurysm is a relatively rare entity in cardiac surgery. Repair of such aneurysms, either in isolation or combined with other cardiac procedures, remains a challenging task. The need to produce a relatively bloodless surgical field with circulatory arrest, while at the same time protecting the brain, is the hallmark of this challenge. However, a clear understanding of the topic allows a better and less morbid approach to such a complex surgery. Literature has shown the advantage of selective cerebral perfusion techniques in comparison with only circulatory arrest. Ability to perfuse the brain has allowed circulatory arrest temperatures at moderate hypothermia without the need for deep hypothermia. Even though cannulation site selection appears to be a minor issue, literature has shown that the subclavian/axillary route has the best outcomes and that femoral cannulation should only be reserved for no access patients. Although different techniques for arch anastomosis have been described, we routinely perform the distal first technique as we find it to be less cumbersome and easiest to reproduce. In this review our aim is to outline a systematic approach to aortic arch surgery. Starting with indications for intervention and proceeding with approaches on site of cannulation, approaches to brain protection with hypothermia and selective cerebral perfusion and finally surgical steps in performing the distal and arch vessels anastomosis. PMID:24954988

  11. "Open" approach to aortic arch aneurysm repair.

    PubMed

    Al Kindi, Adil H; Al Kimyani, Nasser; Alameddine, Tarek; Al Abri, Qasim; Balan, Baskaran; Al Sabti, Hilal

    2014-07-01

    Aortic arch aneurysm is a relatively rare entity in cardiac surgery. Repair of such aneurysms, either in isolation or combined with other cardiac procedures, remains a challenging task. The need to produce a relatively bloodless surgical field with circulatory arrest, while at the same time protecting the brain, is the hallmark of this challenge. However, a clear understanding of the topic allows a better and less morbid approach to such a complex surgery. Literature has shown the advantage of selective cerebral perfusion techniques in comparison with only circulatory arrest. Ability to perfuse the brain has allowed circulatory arrest temperatures at moderate hypothermia without the need for deep hypothermia. Even though cannulation site selection appears to be a minor issue, literature has shown that the subclavian/axillary route has the best outcomes and that femoral cannulation should only be reserved for no access patients. Although different techniques for arch anastomosis have been described, we routinely perform the distal first technique as we find it to be less cumbersome and easiest to reproduce. In this review our aim is to outline a systematic approach to aortic arch surgery. Starting with indications for intervention and proceeding with approaches on site of cannulation, approaches to brain protection with hypothermia and selective cerebral perfusion and finally surgical steps in performing the distal and arch vessels anastomosis.

  12. Biliary excretion of amphetamine and methamphetamine in the rat

    PubMed Central

    Caldwell, J.; Dring, L. G.; Williams, R. T.

    1972-01-01

    1. 14C-labelled amphetamine and methamphetamine were injected into rats cannulated at the bile duct under thiopentone anaesthesia and the output of their metabolites in urine and bile was determined. 2. With amphetamine, 69% of the 14C was excreted in the urine and 16% in the bile in 24h. The main metabolite in bile was the glucuronide of 4-hydroxyamphetamine. The output of unchanged amphetamine was much greater in cannulated rats than in intact rats. 3. With methamphetamine, 54% of the 14C appeared in the urine and 18% in the bile. The main metabolite in the bile was the glucuronide of 4-hydroxynorephedrine. The output of amphetamine, a metabolite of methamphetamine, was much greater in cannulated rats than in intact rats. 4. Evidence has been obtained for the enterohepatic circulation of certain amphetamine and methamphetamine metabolites in the rat. 5. Thiopentone anaesthesia appeared to inhibit the ring hydroxylation of amphetamine administered as such or formed as a metabolite of methamphetamine. PMID:4646778

  13. Consecutive pathological and immunological alterations during experimentally induced swine dysentery - a study performed by repeated endoscopy and biopsy samplings through an intestinal cannula.

    PubMed

    Jacobson, M; Lindberg, R; Jonasson, R; Fellström, C; Waern, M Jensen

    2007-06-01

    The development of intestinal lesions after inoculation with Brachyspira hyodysenteriae was followed by repeated endoscopy and biopsy sampling through a caecal cannula. Seven eight-week-old pigs were cannulated and inoculated, two were cannulated but not inoculated, and two pigs were inoculated but not cannulated. Endoscopy, biopsy, and blood sampling to determine SAA (serum amyloid A), haptoglobin, cortisol, and WBC counts were performed at scheduled time-points. At the third day of disease, endoscopy showed a hyperaemic, perturbed mucosa and excessive amount of mucus. Histologically, crypt hyperplasia, depletion of goblet cell mucus, and erosions were noted. Simultaneously, elevated acute phase proteins and circulating monocytes, and decreased number of intraepithelial CD3(+) cells were observed. After five days the pigs recovered. Intestinal lesions were demarcated and interspersed among apparently normal mucosa and blood parameters returned to initial values. Endoscopy through an intestinal cannula made it possible to follow the development of intestinal alterations in vivo and describe the sequential events during the course of swine dysentery. The number of animals used in a study could thus be minimised and the precision of the experiment increased.

  14. Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995-2007.

    PubMed

    Cook, T M; Bland, L; Mihai, R; Scott, S

    2009-07-01

    The distribution of medico-legal claims in English anaesthetic practice is unreported. We studied National Health Service Litigation Authority claims related to anaesthesia since 1995. All claims were reviewed by three clinicians and variously categorised, including by type of incident, claimed outcome and cost. Anaesthesia-related claims account for 2.5% of all claims and 2.4% of the value of all claims. Of 841 relevant claims 366 (44%) were related to regional anaesthesia, 245 (29%) obstetric anaesthesia, 164 (20%) inadequate anaesthesia, 95 (11%) dental damage, 71 (8%) airway (excluding dental damage), 63 (7%) drug related (excluding allergy), 31 (4%) drug allergy related, 31 (4%) positioning, 29 (3%) respiratory, 26 (3%) consent, 21 (2%) central venous cannulation and 18 (2%) peripheral venous cannulation. Defining which cases are, from a medico-legal viewpoint, 'high risk' is uncertain, but the clinical categories with the largest number of claims were regional anaesthesia, obstetric anaesthesia, inadequate anaesthesia, dental damage and airway, those with the highest overall cost were regional anaesthesia, obstetric anaesthesia, and airway and those with the highest mean cost per closed claim were respiratory, central venous cannulation and drug error excluding allergy. The data currently available have limitations but offer useful information. A closed claims analysis similar to that in the USA would improve the clinical usefulness of analysis.

  15. Comparative toxicokinetics and metabolism of rebaudioside A, stevioside, and steviol in rats.

    PubMed

    Roberts, A; Renwick, A G

    2008-07-01

    The toxicokinetics and metabolism of rebaudioside A, stevioside, and steviol were examined in rats for comparative purposes to determine whether toxicological studies conducted previously with stevioside would be applicable to the structurally-related glycoside, rebaudioside A. Single, oral doses of the radiolabelled compounds were extensively and rapidly absorbed with plasma concentration-time profiles following similar patterns for stevioside and rebaudioside A. Elimination of radioactivity from plasma was essentially complete within 72h. All plasma samples had similar metabolite profiles; the predominant radioactive component in all samples was steviol, with lower amounts of steviol glucuronide(s) and low levels of one or two other metabolites. Rebaudioside A, stevioside, and steviol were metabolized and excreted rapidly, with the majority of the radioactivity eliminated in the feces within 48h. Urinary excretion accounted for less than 2% of the administered dose for all compounds in both intact and bile duct-cannulated rats, and the majority of the absorbed dose was excreted via the bile. After administration of the compounds to intact and bile duct-cannulated rats, radioactivity in the feces was present primarily as steviol. The predominant radioactive compound detected in the bile of all cannulated rats was steviol glucuronide(s), indicating de-conjugation in the lower intestine. Overall, the data on toxicokinetics and metabolism indicate that rebaudioside A and stevioside are handled in an almost identical manner. These studies support the use of toxicological safety studies conducted with stevioside for the safety assessment of rebaudioside A.

  16. Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws.

    PubMed

    Klingler, Jan-Helge; Scholz, Christoph; Kogias, Evangelos; Sircar, Ronen; Krüger, Marie T; Volz, Florian; Scheiwe, Christian; Hubbe, Ulrich

    2015-01-01

    To describe the minimally invasive technique for cement augmentation of cannulated and fenestrated screws using an injection cannula as well as to report its safety and efficacy. A total of 157 cannulated and fenestrated pedicle screws had been cement-augmented during minimally invasive posterior screw-rod spondylodesis in 35 patients from January to December 2012. Retrospective evaluation of cement extravasation and screw loosening was carried out in postoperative plain radiographs and thin-sliced triplanar computed tomography scans. Twenty-seven, largely prevertebral cement extravasations were detected in 157 screws (17.2%). None of the cement extravasations was causing a clinical sequela like a new neurological deficit. One screw loosening was noted (0.6%) after a mean follow-up of 12.8 months. We observed no cementation-associated complication like pulmonary embolism or hemodynamic insufficiency. The presented minimally invasive cement augmentation technique using an injection cannula facilitates convenient and safe cement delivery through polyaxial cannulated and fenestrated screws during minimally invasive screw-rod spondylodesis. Nevertheless, the optimal injection technique and design of fenestrated screws have yet to be identified. This trial is registered with German Clinical Trials DRKS00006726.

  17. Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws

    PubMed Central

    Kogias, Evangelos; Sircar, Ronen; Krüger, Marie T.; Volz, Florian; Scheiwe, Christian; Hubbe, Ulrich

    2015-01-01

    Purpose. To describe the minimally invasive technique for cement augmentation of cannulated and fenestrated screws using an injection cannula as well as to report its safety and efficacy. Methods. A total of 157 cannulated and fenestrated pedicle screws had been cement-augmented during minimally invasive posterior screw-rod spondylodesis in 35 patients from January to December 2012. Retrospective evaluation of cement extravasation and screw loosening was carried out in postoperative plain radiographs and thin-sliced triplanar computed tomography scans. Results. Twenty-seven, largely prevertebral cement extravasations were detected in 157 screws (17.2%). None of the cement extravasations was causing a clinical sequela like a new neurological deficit. One screw loosening was noted (0.6%) after a mean follow-up of 12.8 months. We observed no cementation-associated complication like pulmonary embolism or hemodynamic insufficiency. Conclusions. The presented minimally invasive cement augmentation technique using an injection cannula facilitates convenient and safe cement delivery through polyaxial cannulated and fenestrated screws during minimally invasive screw-rod spondylodesis. Nevertheless, the optimal injection technique and design of fenestrated screws have yet to be identified. This trial is registered with German Clinical Trials DRKS00006726. PMID:26075297

  18. Authentication of Radial Versus Femoral Arterial Pressure Waveform-Derived Cardiac Output With Transesophageal Echocardiography-Derived Cardiac Output Measurements in Patients Undergoing On-Pump Coronary Bypass Surgery.

    PubMed

    Maddali, Madan Mohan; Waje, Niranjan Dilip; Sathiya, Panchatcharam Murthi

    2017-08-01

    The aim of this study was to ascertain if arterial waveform-derived cardiac output measurements from radial and femoral cannulation sites were reliable as compared with transesophageal echocardiography (TEE)-derived cardiac output (CO) values, and which of the CO measurements derived from radial and the femoral arterial pressure waveforms closely tracked simultaneously measured TEE-derived CO values. This study also aimed to ascertain if cardiopulmonary bypass (CPB) would impact the accuracy of arterial pressure-derived CO values from either of the 2 sites. A prospective observational study. Tertiary care cardiac center. Cardiac surgical patients undergoing on-pump primary coronary artery bypass surgery. Waveform-derived CO monitoring through radial and femoral artery cannulation using a FloTrac/Vigileo system. Twenty-seven consecutive cardiac surgical patients undergoing on-pump primary coronary artery bypass surgery were included in the study. Cardiac output was measured sequentially by the arterial pressure waveform analysis method from radial and femoral arterial sites and compared with simultaneously measured TEE-derived CO. Cardiac output data were obtained in triplicate at 6 predefined time intervals: before and after sternotomy, 5, 15, and 30 minutes after separation from CPB and prior to shifting the patient out of the operating room. The overall bias of the study was 0.11 and 0.27, the percentage error was 19.31 and 18.45, respectively, for radial and femoral arterial waveform-derived CO values as compared with TEE-derived CO measurements. The overall precision as compared with the TEE-derived CO values was 16.94 and 15.95 for the radial and femoral cannulation sites, respectively. The bias calculated by the Bland-Altman method suggested that CO measurements from the radial arterial site were in closer agreement with TEE-derived CO values at all time periods, and the relation was not affected by CPB. However, percentage error and precision calculations

  19. Biomechanical Comparison of Inter-fragmentary Compression Pressures: Lag Screw versus Herbert Screw for Anterior Odontoid Screw Fixation.

    PubMed

    Park, Jin-Woo; Kim, Kyoung-Tae; Sung, Joo-Kyung; Park, Seong-Hyun; Seong, Ki-Woong; Cho, Dae-Chul

    2017-09-01

    The purpose of the present study was to compare inter-fragmentary compression pressures after fixation of a simulated type II odontoid fracture with the headless compression Herbert screw and a half threaded cannulated lag screw. We compared inter-fragmentary compression pressures between 40- and 45-mm long 4.5-mm Herbert screws (n=8 and n=9, respectively) and 40- and 45-mm long 4.0-mm cannulated lag screws (n=7 and n=10, respectively) after insertion into rigid polyurethane foam test blocks (Sawbones, Vashon, WA, USA). A washer load cell was placed between the two segments of test blocks to measure the compression force. Because the total length of each foam block was 42 mm, the 40-mm screws were embedded in the cancellous foam, while the 45-mm screws penetrated the denser cortical foam at the bottom. This enabled us to compare inter-fragmentary compression pressures as they are affected by the penetration of the apical dens tip by the screws. The mean compression pressures of the 40- and 45-mm long cannulated lag screws were 50.48±1.20 N and 53.88±1.02 N, respectively, which was not statistically significant (p=0.0551). The mean compression pressures of the 40-mm long Herbert screw was 52.82±2.17 N, and was not statistically significant compared with the 40-mm long cannulated lag screw (p=0.3679). However, 45-mm Herbert screw had significantly higher mean compression pressure (60.68±2.03 N) than both the 45-mm cannulated lag screw and the 40-mm Herbert screw (p=0.0049 and p=0.0246, respectively). Our results showed that inter-fragmentary compression pressures of the Herbert screw were significantly increased when the screw tip penetrated the opposite dens cortical foam. This can support the generally recommended surgical technique that, in order to facilitate maximal reduction of the fracture gap using anterior odontoid screws, it is essential to penetrate the apical dens tip with the screw.

  20. Septicemia

    PubMed Central

    Austin, T. W.; Holliday, R. L.

    1976-01-01

    Certain factors which are major determinants in the survival of the septic patient - age, underlying disease, infecting organism - are beyond the physician's control. Others, however, we can have some impact on. These include initial vigorous supportive treatment, early and appropriate antibiotic administration and timely surgical intervention. In the following discussion current understanding of the pathophysiology of sepsis is outlined, together with a practical approach to the problem of patient management. PMID:21308028

  1. How to value a buy-in/buy-out.

    PubMed

    Peltz, Steven

    2006-01-01

    Buy-ins and buy-outs provide an opportunity for both existing owners of medical practices and prospective new physicians. For physicians, buy-ins represent the chance to have a financial stake in the practice, under the physician control and direction. This article explores helpful guidelines for valuing the practice and provides perspective in viewing the situations of buy-in and buy-out.

  2. On the development of radiation tolerant surveillance camera from consumer-grade components

    NASA Astrophysics Data System (ADS)

    Klemen, Ambrožič; Luka, Snoj; Lars, Öhlin; Jan, Gunnarsson; Niklas, Barringer

    2017-09-01

    In this paper an overview on the process of designing a radiation tolerant surveillance camera from consumer grade components and commercially available particle shielding materials is given. This involves utilization of Monte-Carlo particle transport code MCNP6 and ENDF/B-VII.0 nuclear data libraries, as well as testing the physical electrical systems against γ radiation, utilizing JSI TRIGA mk. II fuel elements as a γ-ray sources. A new, aluminum, 20 cm × 20 cm × 30 cm irradiation facility with electrical power and signal wire guide-tube to the reactor platform, was designed and constructed and used for irradiation of large electronic and optical components assemblies with activated fuel elements. Electronic components to be used in the camera were tested against γ-radiation in an independent manner, to determine their radiation tolerance. Several camera designs were proposed and simulated using MCNP, to determine incident particle and dose attenuation factors. Data obtained from the measurements and MCNP simulations will be used to finalize the design of 3 surveillance camera models, with different radiation tolerances.

  3. Elucidating low-frequency vibrational dynamics in calcite and water with time-resolved third-harmonic generation spectroscopy.

    PubMed

    Wang, Liang; Liu, Weimin; Fang, Chong

    2015-07-14

    Low-frequency vibrations are foundational for material properties including thermal conductivity and chemical reactivity. To resolve the intrinsic molecular conformational dynamics in condensed phase, we implement time-resolved third-harmonic generation (TRTHG) spectroscopy to unravel collective skeletal motions in calcite, water, and aqueous salt solution in situ. The lifetime of three Raman-active modes in polycrystalline calcite at 155, 282 and 703 cm(-1) is found to be ca. 1.6 ps, 1.3 ps and 250 fs, respectively. The lifetime difference is due to crystallographic defects and anharmonic effects. By incorporating a home-built wire-guided liquid jet, we apply TRTHG to investigate pure water and ZnCl2 aqueous solution, revealing ultrafast dynamics of water intermolecular stretching and librational bands below 500 cm(-1) and a characteristic 280 cm(-1) vibrational mode in the ZnCl4(H2O)2(2-) complex. TRTHG proves to be a compact and versatile technique that directly uses the 800 nm fundamental laser pulse output to capture ultrafast low-frequency vibrational motion snapshots in condensed-phase materials including the omnipresent water, which provides the important time dimension to spectral characterization of molecular structure-function relationships.

  4. Reliability testing of the Hughes temperature controlled 1/4 watt split cycle cryogenic cooler (HD-1045 (V)/UA)

    NASA Astrophysics Data System (ADS)

    Shaffer, James; Dunmire, Howard; Samuels, Raemon; Trively, Martin

    1989-12-01

    The U.S. Army CECOM Center for Night Vision and Electro-Optics (C2NVEO) is responsible for developing cryogenic coolers for all infrared imaging systems for the Army. C2NVEO also maintains configuration management control of the forward-looking infrared (FLIR) Common Module coolers used in thermal imagers in fielded Army weapon systems such as: M60A3 and M1 Tanks, Bradley Fighting Vehicle (BFV) System, tube-launched, optically tracked, wire-guided (TOW) Missile System, and Army Attack Helicopters. Currently, there are over 30,000 coolers in fielded systems and several thousand more are added each year. C2NVEO conducts development programs and monitors contractor internal research and development efforts to improve cooler performance such as reliability, audio noise, power consumption, and output vibration. The HD-1045 1/4-Watt Split Stirling Cooler was originally designed and developed by the C2NVEO in the early 1970s as a replacement for the gas bottle/cryostat used on the Manportable Common Thermal Night Sights. To date, however, the HD-1045 cooler has been used in the field in the Integrated Sight Unit (ISU) of the BFV System and is currently being used in the Driver Thermal Viewer (DTV) full scale development program. This document describes and reports the results of reliability testing done on Hughes Temperature Controlled 1/4 Watt split Cycle Cryogenic Coolers (HD-1045 (V)/UA), referred to herein as the coolers.

  5. PORTAL VEIN EMBOLIZATION USING AN ADAPTED HYSTEROSALPINGOGRAPHY CATHETER

    PubMed Central

    STEINBRÜCK, Klaus; ALVES, Jefferson; FERNANDES, Reinaldo; ENNE, Marcelo; PACHECO-MOREIRA, Lúcio Filgueiras

    2014-01-01

    Background Portal vein embolization is an accepted procedure that provides hypertrophy of the future remnant liver in order to reduce post-hepatectomy complications. Aim To present a series submitted to portal vein embolization using an adapted hysterosalpingography catheter via transileocolic route. Methods Were performed right portal branch embolization in 19 patients using hysterosalpingography catheter. For embolizing the vessel, was used Gelfoam® powder with absolute alcohol solution. Indications for hepatectomy were colorectal liver metastases in all cases. Results An adequate growth of the future remnant liver was achieved in 15 patients (78.9%) and second time hepatectomy could be done in 14 (73.7%). In one patient (5.2%), tumor progression prevented surgery. One patient presented acute renal failure after portal embolization. Conclusions The hysterosalpingography catheter is easy to handle and can be introduced into the portal vein with a wire guide. There were no major post-embolization complication. Its use is safe, cheap and effective. PMID:25184773

  6. Percutaneous angioscopy after excimer laser angioplasty

    NASA Astrophysics Data System (ADS)

    Nakamura, Fumitaka; Kvasnicka, Jan; Geschwind, Herbert J.; Uchida, Yasumi

    1992-08-01

    Angioscopy has proved to provide more detailed information on lesion morphology before and after interventional procedures than angiography. Therefore, to evaluate the effects of laser angioplasty, angioscopy was performed in five patients with peripheral or coronary vascular disease who underwent excimer laser angioplasty. The excimer laser was operated at 308 nm, 135 nsec, 25 Hz, and 40 - 60 mJ/mm2 and was coupled into multifiber wire-guided catheters of 1.4 to 2.0 mm diameter for coronary lesions and 2.2 mm for peripheral lesions. There were three coronary (one left anterior descending, one circumflex, one right coronary artery) and two peripheral (one common iliac artery, one superficial femoral artery) lesions. Angioscopy was successfully performed before and after laser ablation without any complications in all five lesions. The characteristics of angioscopic findings after excimer laser angioplasty consisted of flaps, fractures of plaques, and abundant tissue remnants. There was no apparent thermal injury. Recanalized channels were small and irregular. These results indicate that (1) angioscopy is effective and safe for evaluation of lesion morphology after laser angioplasty, (2) laser ablation does not result in thermal injury, and (3) irregular channels after recanalization and abundant tissue remnants may explain the suboptimal results after laser angioplasty.

  7. High-performance, extrusion-cast explosives with low sensitivity: Interim report No. 2

    SciTech Connect

    Scribner, K.J.; von Holtz, E.; Simpson, R.L.

    1989-01-10

    Lawrence Livermore National Laboratory (LLNL) has developed a class of explosives having both high performance for modern precision munitions and greater safety for reduced vulnerability of launch platforms (ships, planes, ammunition storage sites) to enemy fire or accidents. Known as extrusion-cast explosives (ECXs), they have demonstrated performance levels equivalent to the most powerful now available, but test results indicate they are far less sensitive than the conventional high-energy explosives. Specifically, in a sympathetic-detonation test, ECX that was immediately adjacent to a deliberately-detonated donor charge did not detonate in two of three tests, whereas Comp B did detonate sympathetically in this test. Also, this ECX provided performance equivalent to that of the high-performance explosive LX-14, when tested in the TOW (tube-launched, optically-sighted, wire-guided) missile. This report describes the performance, vulnerability, and processing (at this stage of development) of this class of explosives. 9 refs., 18 figs., 11 tabs.

  8. [Endoscopic sclerosis with pneumatic distension for pyriform sinus fistula treatment].

    PubMed

    Sanchís Blanco, G; Gutiérrez San Román, C; Bordallo Vázquez, M; Cortés Sáez, J; Barrios Fontoba, J E; Lluna González, J; Esteban Ricós, M J; Vila Carbó, J J

    2014-01-01

    Classic treatment for pyriform sinus fistula (PSF) has been surgical excision; however, less invasive therapeutic alternatives whose aim is the obliteration of the sinus have been described subsequently. The authors present a technical modification of endoscopic sclerosis with diathermy (ESD): continuous infusion of air flow through the flexible endoscope was used to distend the pyriform sinus and facilitate recognition of the fistula opening. The sinus obliteration was performed with a wire guide and diathermy. In the last 15 years, 9 patients were diagnosed of suffering from PSF in our institution. Initial treatment was antibiotics therapy associated in some cases to cervical abscess drainage. Fistulectomy was performed in 4 cases and ESD in 4. The ninth patient received both treatments, performing electrocauterization after a surgical recurrence. Three of the patients who underwent surgery relapsed; none treated by ESD did, or had any complications. In our experience, endoscopic sclerosis with pneumatic distension is a simple technique, reproducible, not invasive and very effective; hence we consider it might become a first line therapy for PSF.

  9. Flight experiments and evolutionary development of a laser-propelled transatmospheric vehicle

    NASA Astrophysics Data System (ADS)

    Mead, Franklin B., Jr.; Myrabo, Leik N.; Messitt, Donald G.

    1998-09-01

    In a series of spectacular experiments conducted at the High Energy Laser Systems Test Facility (HELSTF), White Sands Missile Range (WSMR), NM, using 13- to 15-cm diameter, 40- to 60-g vehicles designed to fly on the 10 kW PLVTS pulsed carbon dioxide laser (1 kJ pulses for 30 microsecond duration at 10 Hz), Prof. Leik Myrabo of Rensselaer Polytechnic Institute (RPI) and Dr. Franklin Mead of the Air Force Research Laboratory's (AFRL) Propulsion Directorate, have been successfully flying laser propelled Lightcraft under a joint Air Force/NASA flight demonstration program. The axisymmetric Lightcraft vehicles are propelled by airbreathing, pulsed- detonation engines with an infinite fuel specific impulse. Impulse coupling coefficients have been measured with ballistic pendulums as well as a piezoelectric load cell and fall in the range of 100 to 200 N/MW. Horizontal wire-guided flights up to 400 ft, using a unique laser beam pointing and tracking guidance system, have demonstrated up to 2.0 G's acceleration measured by a photo-optic array. Spin-stabilized free-flights with active tracking/beam control have been accomplished to altitudes of 15.25 meters. This paper will summarize the progress made to date on the Lightcraft Technology Demonstration flight test program, since the first 12 - 14 July 1996, experiments at HELSTF.

  10. TOW Target Collimator Design Review And Performance Tests

    NASA Astrophysics Data System (ADS)

    Wolk, Martin; Coddington, Gerald R.; Armstrong, Edward P.

    1990-02-01

    The target collimator test set for the tube-launched, optically tracked, wire-guided (TOW) missile launch system is reviewed and tested to facilitate calibration with emphasis on system alignment. Test set objective lens dispersion data and Gaussian analysis for visible and infrared (IR) wavelengths are included; associated optical point spread and modulation transfer curves obtained from observations at 0.6328 um with a Wyko model 6000 interferometer are also exhibited. In addition, test set bandpass filter transmittance spectra in the visible and near IR, obtained with a Bomem model DA3.02 Fourier-transform interferometer spectrometer, are displayed as well as mean transmittance values weighted with standard photopic data over indicated spectral intervals. Evaluation of the data presented indicates the need for more stringent requirements for test set bandpass filter specifications in order to reduce the recently emerged visual alignment problem essentially caused by chromatic aberration correlated with use of new stock filters. Primarily due to this result, a new design version of the test set employing a reflective collimator would be more appropriate to cover the required visible, 575 nm, and near IR, 0.94 um and 1.25 um peak nominal wavelengths, provided it is sufficiently cost-effective to implement. This investigation should be of interest and useful for those engaged in related optical alignment work especially for those involved with electro-optic calibration support of TOW.

  11. A clever technique for placement of a urinary catheter over a wire

    PubMed Central

    Abbott, Joel E.; Heinemann, Adam; Badalament, Robert; Davalos, Julio G.

    2015-01-01

    Objective: The objective was to present a straightforward, step-by-step reproducible technique for placement of a guide-wire into any type of urethral catheter, thereby offering a means of access similar to that of a council-tip in a situation that may require a different type of catheter guided over a wire. Materials and Methods: Using a shielded intravenous catheter inserted into the eyelet of a urinary catheter and through the distal tip, a “counsel-tip” can be created in any size or type of catheter. Once transurethral bladder access has been achieved with a hydrophilic guide-wire, this technique will allow unrestricted use of catheters placed over a wire facilitating guided catheterization. Results: Urethral catheters of different types and sizes are easily advanced into the bladder with wire-guidance; catheterization is improved in the setting of difficult urethral catheterization (DUC). Cost analysis demonstrates benefit overuse of traditional council-tip catheter. Conclusion: Placing urinary catheters over a wire is standard practice for urologists, however, use of this technique gives the freedom of performing wire-guided catheterization in more situations than a council-tip allows. This technique facilitates successful transurethral catheterization over wire in the setting of DUC for all catheter types and styles aiding in urologic management of patients at a cost benefit to the health care system. PMID:26229328

  12. Radioguided localisation of impalpable breast lesions using 99m-Technetium macroaggregated albumin: Lessons learnt during introduction of a new technique to guide preoperative localisation

    SciTech Connect

    Landman, Joanne; Kulawansa, Sagarika; McCarthy, Michael; Troedson, Russell; Phillips, Michael; Tinning, Jill; Taylor, Donna

    2015-03-15

    Preoperative wire-guided localisation (WGL) of impalpable breast lesions is widely used but can be technically difficult. Risks include wire migration, inaccurate placement, and inadequate surgical margins. Research shows that radioguided occult lesion localisation (ROLL) is quicker, easier, and can improve surgical and cosmetic outcomes. An audited introduction of ROLL was conducted to validate the technique as a feasible alternative to WGL. Fifty patients with single impalpable lesions and biopsy proven malignancy or indeterminate histology underwent WGL followed by intralesional radiopharmaceutical injection of 99m-Technetium macroaggregated albumin. Postprocedural mammography was performed to demonstrate wire position, and scintigraphy to evaluate radiopharmaceutical migration. Lymphoscintigraphy and intraoperative sentinel node biopsy were performed if indicated, followed by lesion localisation and excision using a gamma probe. Specimen imaging was performed, with immediate reexcision for visibly inadequate margins. Accurate localisation was achieved in 86% of patients with ROLL compared to 72% with WGL. All lesions were successfully removed, with clear margins in 71.8% of malignant lesions. Reexcision and intraoperative sentinel node localisation rates were equivalent to preaudit figures for WGL. ROLL was easy to perform and problems were infrequent. Inaccurate radiopharmaceutical placement necessitating WGL occurred in four patients. Minor radiopharmaceutical migration was common, but precluded using ROLL in only two cases. ROLL is effective, simple, inexpensive, and easily learnt; however, preoperative confirmation of correct radiopharmaceutical placement using mammography and the gamma probe is important to help ensure successful lesion removal. Insertion of a backup hookwire is recommended during the initial introduction of ROLL.

  13. A Portable, Shock-Proof, Surface-Heated Droplet PCR System for Escherichia coli Detection

    PubMed Central

    Angus, Scott V.; Cho, Soohee; Harshman, Dustin K.; Song, Jae-Young; Yoon, Jeong-Yeol

    2015-01-01

    A novel polymerase chain reaction (PCR) device was developed that uses wire-guided droplet manipulation (WDM) to guide a droplet over three different heating chambers. After PCR amplification, end-point detection is achieved using a smartphone-based fluorescence microscope. The device was tested for identification of the 16S rRNA gene V3 hypervariable region from Escherichia coli genomic DNA. The lower limit of detection was 103 genome copies per sample. The device is portable with smartphone-based end-point detection and provides the assay results quickly (15 min for a 30-cycle amplification) and accurately. The system is also shock and vibration resistant, due to the multiple points of contact between the droplet and the thermocouple and the Teflon film on the heater surfaces. The thermocouple also provides realtime droplet temperature feedback to ensure it reaches the set temperature before moving to the next chamber/step in PCR. The device is equipped to use either silicone oil or coconut oil. Coconut oil provides additional portability and ease of transportation by eliminating spilling because its high melting temperature means it is solid at room temperature. PMID:26164008

  14. Diverticulum With Papillae: Does Position of Papilla Affect Technical Success?

    PubMed

    Parlak, Erkan; Suna, Nuretdin; Kuzu, Ufuk B; Taşkiran, İsmail; Yildiz, Hakan; Torun, Serkan; Yüksel, Mahmut; Çiçek, Bahattin; Dişibeyaz, Selçuk; Şahin, Burhan

    2015-10-01

    The presence of peripapillary diverticulum (PPD) can cause some biliary diseases, especially common bile duct stones, and also, literally, can change the technique of endoscopic retrograde cholangiopancreatography (ERCP) and affect the complication ratio of this procedure. In this study, we investigate the effect of localization and position of the papilla according to the diverticulum on the success of therapeutic ERCP procedures. The study was conducted prospectively in the patients with naive papillae, who underwent ERCP for a period of 16 months. In all patients, the position of papillae according to the diverticulum (the periphery of the diverticulum is thought as the clock circumference, and the position of papillae is defined as the dials of clock), the success rate of biliary cannulation, total procedure time, overall treatment success rate of ERCP, and the complications are investigated. During this period, 222 (18.5%) of the 1205 enrolled patients who underwent ERCP had PPD. Of the patients with PPD, 123 (55.4%) were female and 99 (44.6%) were male, and the median age was 68.9±10.1 years. According to the position of the papilla by the diverticulum, 90 (40.5%) patients have it on 7 o'clock position, 64 (28.8%) patients have on 6 o'clock position, 63 (28.3%) patients have on 5 o'clock position, and 5 (2.3%) patients have on 1 o'clock position. In the cases of the papilla on 1 o'clock position according to the diverticulum, cannulation procedures were found to be more difficult than other patients (P<0.05). The presence of the diverticulum did not affect the success of therapeutic procedures and did not increase the ratio of complications. In the presence of PPD, additional cannulation techniques may be required for the procedure. Particularly, the aid of percutaneous techniques may be needed for the papilla on 1 o'clock position.

  15. Defining and comparing learning actions in two simulation modalities: students training on a latex arm and each other's arms.

    PubMed

    Ravik, Monika; Havnes, Anton; Bjørk, Ida Torunn

    2017-02-02

    To explore, describe and compare learning actions that nursing students used during peripheral vein cannulation training on a latex arm or each other's arms in a clinical skills centre. Simulation-based training is thought to enhance learning and transfer of learning from simulation to the clinical setting and is commonly recommended in nursing education. What students actually are doing during simulation-based training is, however, less explored. The analysis of learning actions used during simulation-based training could contribute to development and improvement of simulation as a learning strategy in nursing education. A qualitative explorative and descriptive research design, involving content analysis of video recordings, was used. Video-supported observation of nine nursing students practicing vein cannulation was conducted in a clinical skills centre in late 2012. The students engaged in various learning actions. Students training on a latex arm used a considerably higher number of learning actions relative to those training on each other's arms. In both groups, students' learning actions consisted mainly of seeking and giving support. The teacher provided students training on each other's arms with detailed feedback regarding insertion of the cannula into the vein, while those training on a latex arm received sparse feedback from the teacher and fellow students. The teacher played an important role in facilitating nursing students' practical skill learning during simulation. The provision of support from both teachers and students should be emphasised to ensure that nursing students' learning needs are met. This study suggest that student nurses may be differently and inadequately prepared in peripheral vein cannulation in two simulation modalities used in the academic setting; training on a latex arm and on each other's arms. © 2017 John Wiley & Sons Ltd.

  16. Efficacy and safety of ultrasound-guided internal jugular vein catheterization in low birth weight newborn.

    PubMed

    Montes-Tapia, Fernando; Rodríguez-Taméz, Antonio; Cura-Esquivel, Idalia; Barreto-Arroyo, Itzel; Hernández-Garduño, Adolfo; Rodríguez-Balderrama, Isaías; Quero, José; de la O-Cavazos, Manuel

    2016-10-01

    Central venous catheterization is not the first choice of vascular access in neonates. Success depends on the size of the vessel and the skill of the health professional performing the procedure. The internal jugular vein provides a predictable path for central venous cannulation, although it is more difficult to cannulate infants than adults and even more difficult in smaller newborns. We conducted a prospective study in 100 newborns, in which a 4 Fr ultrasound-guided central venous catheter was placed in the right internal jugular vein (RIJV). The study population was low birth weight (LBW) newborns <2500g, very low birth weight (VLBW) newborns <1500g and extremely low birth weight (ELBW) newborns <1000g. There were 53% female patients, mean gestational age was 31weeks, mean weight 1352g and the CVC was placed at a mean of 12days of extrauterine life. Birth weight distribution was 39% LBW; 33% VLBW and 28% ELBW. A mean of two (1-8) attempts were necessary with a procedure duration of 16.8 (10-40) minutes. Success of RIJV catheterization was 94%. One attempt was necessary in 50% and up to 5 attempts in 95.7%. Success by weight was VLBW, 97.2%; ELBW, 92.9%; LBW, 91.7%. A venous hematoma occurred in 5% of cases. Ultrasound-guided RIJV cannulation with real-time visualization to gain access to the central venous circulation in low birth weight newborns is effective and safe. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx.

    PubMed

    Chalouhi, Nohra; Dumont, Aaron S; Tjoumakaris, Stavropoula; Gonzalez, L Fernando; Bilyk, Jurij R; Randazzo, Ciro; Hasan, David; Dalyai, Richard T; Rosenwasser, Robert; Jabbour, Pascal

    2012-05-01

    Endovascular therapy is the primary treatment option for carotid-cavernous fistulas (CCFs). Operative cannulation of the superior ophthalmic vein (SOV) provides a reasonable alternative route to the cavernous sinus when all transvenous and transarterial approaches have been unsuccessful. The role of the liquid embolic agent Onyx in the management of CCFs has not been well documented, especially when using an SOV approach. The purpose of this study is to assess the safety and efficacy of Onyx embolization of CCFs through a surgical cannulation of the SOV. The authors retrospectively reviewed all patients with CCFs who were treated with Onyx through an SOV approach between April 2009 and April 2011. Traditional endovascular approaches had failed in all patients. A total of 10 patients were identified, 1 with a Type A CCF, 5 with a Type B CCF, and 4 with a Type D CCF. All fistulas were embolized in 1 session. Onyx was the sole embolic agent used in 7 cases and was combined with coils in 3 other cases. Complete obliteration was achieved in 8 patients and a significant reduction in fistulous flow was achieved in 2 patients, which later progressed to near-complete occlusion on angiographic follow-up. All patients experienced a complete clinical recovery with excellent cosmetic results and were free from recurrence at their latest clinical follow-up evaluations. Onyx embolization is an excellent therapy for CCFs in general, and through an SOV approach in particular. Direct operative cannulation of the SOV followed by Onyx embolization may be the best treatment option in patients with CCFs when all other endovascular approaches have been exhausted.

  18. Rodent Working Heart Model for the Study of Myocardial Performance and Oxygen Consumption

    PubMed Central

    Kheir, John N.

    2016-01-01

    Isolated working heart models have been used to understand the effects of loading conditions, heart rate and medications on myocardial performance in ways that cannot be accomplished in vivo. For example, inotropic medications commonly also affect preload and afterload, precluding load-independent assessments of their myocardial effects in vivo. Additionally, this model allows for sampling of coronary sinus effluent without contamination from systemic venous return, permitting assessment of myocardial oxygen consumption. Further, the advent of miniaturized pressure-volume catheters has allowed for the precise quantification of markers of both systolic and diastolic performance. We describe a model in which the left ventricle can be studied while performing both volume and pressure work under controlled conditions. In this technique, the heart and lungs of a Sprague-Dawley rat (weight 300-500 g) are removed en bloc under general anesthesia. The aorta is dissected free and cannulated for retrograde perfusion with oxygenated Krebs buffer. The pulmonary arteries and veins are ligated and the lungs removed from the preparation. The left atrium is then incised and cannulated using a separate venous cannula, attached to a preload block. Once this is determined to be leak-free, the left heart is loaded and retrograde perfusion stopped, creating the working heart model. The pulmonary artery is incised and cannulated for collection of coronary effluent and determination of myocardial oxygen consumption. A pressure-volume catheter is placed into the left ventricle either retrograde or through apical puncture. If desired, atrial pacing wires can be placed for more precise control of heart rate. This model allows for precise control of preload (using a left atrial pressure block), afterload (using an afterload block), heart rate (using pacing wires) and oxygen tension (using oxygen mixtures within the perfusate). PMID:27584550

  19. Latarjet Fixation

    PubMed Central

    Alvi, Hasham M.; Monroe, Emily J.; Muriuki, Muturi; Verma, Rajat N.; Marra, Guido; Saltzman, Matthew D.

    2016-01-01

    Background: Attritional bone loss in patients with recurrent anterior instability has successfully been treated with a bone block procedure such as the Latarjet. It has not been previously demonstrated whether cortical or cancellous screws are superior when used for this procedure. Purpose: To assess the strength of stainless steel cortical screws versus stainless steel cannulated cancellous screws in the Latarjet procedure. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen matched-pair shoulder specimens were randomized into 2 separate fixation groups: (1) 3.5-mm stainless steel cortical screws and (2) 4.0-mm stainless steel partially threaded cannulated cancellous screws. Shoulder specimens were dissected free of all soft tissue and a 25% glenoid defect was created. The coracoid process was osteomized, placed at the site of the glenoid defect, and fixed in place with 2 parallel screws. Results: All 10 specimens failed by screw cutout. Nine of 10 specimens failed by progressive displacement with an increased number of cycles. One specimen in the 4.0-mm screw group failed by catastrophic failure on initiation of the testing protocol. The 3.5-mm screws had a mean of 274 cycles (SD, ±171 cycles; range, 10-443 cycles) to failure. The 4.0-mm screws had a mean of 135 cycles (SD, ±141 cycles; range, 0-284 cycles) to failure. There was no statistically significant difference between the 2 types of screws for cycles required to cause failure (P = .144). Conclusion: There was no statistically significant difference in energy or cycles to failure when comparing the stainless steel cortical screws versus partially threaded cannulated cancellous screws. Clinical Relevance: Latarjet may be performed using cortical or cancellous screws without a clear advantage of either option. PMID:27158630

  20. Conscious Sedation Procedures Using Intravenous Midazolam for Dental Care in Patients with Different Cognitive Profiles: A Prospective Study of Effectiveness and Safety

    PubMed Central

    Collado, Valérie; Faulks, Denise; Nicolas, Emmanuel; Hennequin, Martine

    2013-01-01

    The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N2O/O2 was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N2O/O2), were shown to be safe and effective in patients with intellectual disability when administered by dentists. PMID:23940729