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Ultrasound-Guided Infraclavicular Axillary Vein Cannulation  [PDF]
Miguel A. García-Díaz, Manuel Ruiz-Castro
International Journal of Clinical Medicine (IJCM) , 2017, DOI: 10.4236/ijcm.2017.84022
Abstract: Background and Objective: Percutaneous central venous cannulation is a common invasive procedure. In comparison with an external landmark technique, the advantages of ultrasound-guided venous access include direct visualization of the anatomy and in vivo visualization of venous cannulation. Methods: We evaluated an ultrasound-guided technique for infraclavicular axillary vein cannulation, focusing on its ease of use, success rate and complications rate. One hundred and twenty patients who submitted to central venous catheter placement were punctured using our technique. The patients were positioned so that their ipsilateral upper limb was abducted at 90° to the longitudinal axis, which makes it possible to visualize the infraclavicular vessels due to the elevation of the clavicle, thereby improving accessibility. Results: Cannulation was successful in all patients. The median time from the start of the first puncture (of the skin) until the aspiration of blood was 15 s (range 7 - 135 s). Both infraclavicular axillary veins were cannulated, and the vein was punctured successfully at the first attempt in 95% of the patients, without complications during the procedure. Conclusion: We propose an ultrasound-guided infraclavicular approach of the axillary vein, with a high success rate and no complications in the present cohort.
Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block: A Comparative Study with Nerve Stimulator-Guided Method  [PDF]
Fu-Chao Liu,Jiin-Tarng Liou,Yung-Fong Tsai,Allen H. Li
Chang Gung Medical Journal , 2005,
Abstract: Background: The aim of this study was to compare the efficacy of axillary brachial plexusblock using an ultrasound-guided method with the nerve stimulator-guidedmethod. We also compared the efficacy of ultrasound-guided single-injectionwith those of double-injection for the quality of the block.Methods: Ninety patients scheduled for surgery of the forearm or hand were randomlyallocated into three groups (n = 30 per group), i.e., nerve stimulator-guidedand double-injection (ND) group, ultrasound-guided and double-injection(UD) group, and ultrasound-guided and single-injection (US) group. Eachpatient received 0.5 ml kg-1 of 1.5% lidocaine with 5 μg kg-1 epinephrine.Patients in the ND group received half the volume of lidocaine injected nearthe median and radial nerves after identification using a nerve stimulator.Patients in the UD group received half the volume of lidocaine injectedaround the lateral and medial aspects of the axillary artery, while those in theUS group were given the entire volume near the lateral aspect of the axillaryartery. The extent of the sensory blockade of the seven nerves and motorblockades of the four nerves were assessed 40 min after the performance ofaxillary brachial plexus block.Results: Seventy percent of the patients in the ND and US groups as well as 73% ofthe patients in the UD group obtained satisfactory sensory and motor blockades.The success rate of performing the block was 90% in patients in theND and UD groups and 70% in the US group. The incidence of adverseevents was significantly higher in the ND group (20%) compared with that inthe US group and the UD group (0%; p = 0.03).Conclusions: Ultrasound-guided axillary brachial plexus block, using either single- or double-injection technique, provided excellent sensory and motor blockadeswith fewer adverse events.
Ultrasound Guided Core Biopsy versus Fine Needle Aspiration for Evaluation of Axillary Lymphadenopathy in Patients with Breast Cancer  [PDF]
Marie A. Ganott,Margarita L. Zuley,Gordon S. Abrams,Amy H. Lu,Amy E. Kelly,Jules H. Sumkin,Mamatha Chivukula,Gloria Carter,R. Marshall Austin,Andriy I. Bandos
ISRN Oncology , 2014, DOI: 10.1155/2014/703160
Abstract: Rationale and Objectives. To compare the sensitivities of ultrasound guided core biopsy and fine needle aspiration (FNA) for detection of axillary lymph node metastases in patients with a current diagnosis of ipsilateral breast cancer. Materials and Methods. From December 2008 to December 2010, 105 patients with breast cancer and abnormal appearing lymph nodes in the ipsilateral axilla consented to undergo FNA of an axillary node immediately followed by core biopsy of the same node, both with ultrasound guidance. Experienced pathologists evaluated the aspirate cytology without knowledge of the core histology. Cytology and core biopsy results were compared to sentinel node excision or axillary dissection pathology. Sensitivities were compared using McNemar’s test. Results. Of 70 patients with axillary node metastases, FNA was positive in 55/70 (78.6%) and core was positive in 61/70 (87.1%) ( ). The FNA and core results were discordant in 14/70 (20%) patients. Ten cases were FNA negative/core positive. Four cases were FNA positive/core negative. Conclusion. Core biopsy detected six (8.6%) more cases of metastatic lymphadenopathy than FNA but the difference in sensitivities was not statistically significant. Core biopsy should be considered if the node is clearly imaged and readily accessible. FNA is a good alternative when a smaller needle is desired due to node location or other patient factors. This trial is registered with NCT01920139. 1. Introduction The prognosis of the newly diagnosed breast cancer patient depends on a number of factors, among the most important of which is the extent of spread of disease to the axillary lymph nodes [1, 2]. Because treatment is influenced by the presence and number of axillary lymph nodes involved, evaluation of the axillary nodes has been performed in every patient that could tolerate it after a diagnosis of invasive carcinoma [3]. In the past, a complete surgical dissection of the axilla was performed, resulting in significant morbidity, including a 30% incidence of lymphedema [4]. The development of sentinel node mapping resulted in a notable reduction in morbidity; however, if a sentinel node was positive, often not discovered until final pathologic processing done postoperatively, complete axillary dissection would be performed at a later date to assess the total number of lymph nodes involved, thus requiring a second surgical procedure and anesthesia [5–7]. A preoperative diagnosis of axillary metastasis by ultrasound guided node biopsy would streamline patient care and reduce operating room time and expense
Intracranial depth electrodes implantation in the era of image-guided surgery
Centeno, Ricardo Silva;Yacubian, Elza Márcia Targas;Caboclo, Luis Otávio Sales Ferreira;Carrete Júnior, Henrique;Cavalheiro, Sérgio;
Arquivos de Neuro-Psiquiatria , 2011, DOI: 10.1590/S0004-282X2011000500022
Abstract: the advent of modern image-guided surgery has revolutionized depth electrode implantation techniques. stereoelectroencephalography (seeg), introduced by talairach in the 1950s, is an invasive method for three-dimensional analysis on the epileptogenic zone based on the technique of intracranial implantation of depth electrodes. the aim of this article is to discuss the principles of seeg and their evolution from the talairach era to the image-guided surgery of today, along with future prospects. although the general principles of seeg have remained intact over the years, the implantation of depth electrodes, i.e. the surgical technique that enables this method, has undergone tremendous evolution over the last three decades, due the advent of modern imaging techniques, computer systems and new stereotactic techniques. the use of robotic systems, the constant evolution of imaging and computing techniques and the use of depth electrodes together with microdialysis probes will open up enormous prospects for applying depth electrodes and seeg both for investigative use and for therapeutic use. brain stimulation of deep targets and the construction of "smart" electrodes may, in the near future, increase the need to use this method.
Ultrasound Guided Port-A-Cath Implantation  [PDF]
Hossein Hemmati, Mohammad Sadegh Esmaeli Delshad, Mohammad Reza Barzegar, Ali Babaei Jandaghi, Behruz Najafi, Mohammad Reza Asgary, Acieh Es-Haghi
Surgical Science (SS) , 2014, DOI: 10.4236/ss.2014.54028

Purpose: The use of port catheters is well accepted in the management of patients with malignancy. In this study, we compare the technical success and the complication rates of ultrasound guided Port-A-Cath implantation with doing this procedure by using the anatomical landmark method. Methods: In a retrospective study, from 2006 to 2009, medical files of 104 patients who had undergone Port-A-Cath implantation were reviewed. The indication for port catheter implantation was malignancy in all cases. Among our patients, Port-A-Cath implantation was done in 63 patients by using landmark method and in 41 patients by guidance of ultrasound. All patients had been observed for complications including pain, port infection, and port thrombus, thrombus of central veins, skin necrosis, and success in using of Port-A-Cath for at least one month following the procedure, in the vascular clinic. Results: in landmark method group, 2 catheters were non-functional just after placement (3.2%) while all Port-A-Caths in ultrasound-guided group were functional. Ten patients (15.9%) in land mark group and 1 patient (2.4%) in ultrasound-guided group were complicated. The difference between complication rate in anatomic landmarks method and ultrasound-guided method was statistically significant (p < 0.04). There was no significant difference in two groups in duration of port placement (p < 0.345), age (p < 0.444), site of port placement (p < 0.244) or type of malignancy (p < 0.18). Conclusion: Considering high rate of success and low complications in placement of Port-A-Cath with ultrasound guidance, this method is superior to the land mark method in patients with malignancy.

Ultrasound-Guided Axillary Brachial Plexus Block in Patients with Chronic Renal Failure: Report of Sixteen Cases  [PDF]
Fu-Chao Liu,Lung-I Lee,Jiin-Tarng Liou,Yu-Ling Hui
Chang Gung Medical Journal , 2005,
Abstract: In this report, 16 patients with end-stage renal disease undergoing forearm arteriovenousshunt surgery were subjected to an ultrasound-guided axillary approach for brachialplexus nerve block. Two doses of 15 ml lidocaine 1.5% were injected using a double-shottechnique The spread of the solution within the plexus sheath could be visualized using ahigh-resolution 12-MHz imaging probe. Most patients (94%) experienced an excellent analgesiain the regions innervated by median, ulnar and radial nerves with a lower percentageof complete analgesia (63%) in the areas innervated by musculocutaneous nerve. Threepatients, who complained of pain during the surgery required further supplements of narcotics.There were no complications such as, nerve injury, puncture of the axillary vessels orother systemic reactions. This technique provides adequate analgesia - without complicationsand without difficulty - for extremity surgery in patients with end-stage renal diseases.
Hemoptysis After Subclavian Vein Puncture for Pacemaker Implantation: Importance of Wire-Guided Venous Puncture
Antoine Kossaify, Nayla Nicolas and Pierre Edde
Clinical Medicine Insights: Case Reports , 2012, DOI: 10.4137/CCRep.S10006
Abstract: We report a case of hemoptysis occurring after subclavian vein puncture for pacemaker implantation. Hemoptysis related to injury of lung parenchyma is a rare complication of subclavian vein access and is usually self limited, but can affect prognosis in critically ill patients. Venogram-guided or even better wire-guided venous puncture allow safe access to the subclavian vein in difficult cases. A review of the pertinent literature is also presented.
Colonoscopic polypectomy in anticoagulated patients  [cached]
Shai Friedland, Daniel Sedehi, Roy Soetikno
World Journal of Gastroenterology , 2009,
Abstract: AIM: To review our experience performing polypectomy in anticoagulated patients without interruption of anticoagulation.METHODS: Retrospective chart review at the Veterans Affairs Palo Alto Health Care System. Two hundred and twenty five polypectomies were performed in 123 patients. Patients followed a standardized protocol that included stopping warfarin for 36 h to avoid supratherapeutic anticoagulation from the bowel preparation. Patients with lesions larger than 1 cm were generally rescheduled for polypectomy off warfarin. Endoscopic clips were routinely applied prophylactically.RESULTS: One patient (0.8%, 95% CI: 0.1%-4.5%) developed major post-polypectomy bleeding that required transfusion. Two others (1.6%, 95% CI: 0.5%-5.7%) had self-limited hematochezia at home and did not seek medical attention. The average polyp size was 5.1 ± 2.2 mm.CONCLUSION: Polypectomy can be performed in therapeutically anticoagulated patients with lesions up to 1 cm in size with an acceptable bleeding rate.
Intramedullary fixation of proximal humerus fractures: do locking bolts endanger the axillary nerve or the ascending branch of the anterior circumflex artery? A cadaveric study
Stefaan Nijs, An Sermon, Paul Broos
Patient Safety in Surgery , 2008, DOI: 10.1186/1754-9493-2-33
Abstract: Six different commercially available proximal humeral nails were implanted in 30 shoulders of 18 cadavers. After fluoroscopically guided implantation the shoulders were carefully dissected and the distance between the locking screws, the axillary nerve and the ascending branch of the anterior circumflex artery was measured.The course of the axillary nerve varies. A mean distance of 55.8 mm (SD = 5.3) between the lateral edge of the acromions and the axillary nerve at the middle of the humerus in a neutrally rotated position was observed. The minimum distance was 43.4 mm, the maximum 63.9 mm.Bent nails with oblique head interlocking bolts appeared to be the most dangerous in relation to the axillary nerve. The two designs featuring such a bend and oblique bolt showed a mean distance of the locking screw to the axillary nerve of 1 mm and 2.7 mm respectively Sirus (Zimmer?) and (Stryker?) T2 PHN (Proximal Humeral Nail)).Regarding the ascending branch of the anterior circumflex artery, there was no difference between the nails which have an anteroposterior locking option.It is of great importance for surgeons treating proximal humerus fractures to understand the relative risk of any procedure they perform. Since the designs of different nailing systems risk damaging the axillary nerve and ascending branch, blunt dissection, the use of protection sleeves during drilling and screw insertion, and individual risk evaluation prior to the use of a proximal humeral nail are advocated.As proximal humerus fractures are amongst the most common fractures (third most common fracture) [1], there are many implants indicated for their treatment. Intramedullary implants are frequently used to treat A- and B-type fractures of the proximal humerus minimally invasively (even percutaneously). Due to the proximity of the axillary nerve, there is a potential risk of iatrogenic injury. The risk of these injuries was demonstrated in a previous publication from our group [2].As the axillary ner
Skills and the Clinical Application of CT Guided Radioactive Seed 125I Implantation in Treating Multiple Lung Metastatic Masses  [PDF]
Wei LI,Gang DAN,Jianqing JIANG,Lie YANG
Chinese Journal of Lung Cancer , 2010,
Abstract: Background and objective 125I seed implantation treatment of pulmonary metastases, often because of complicated structure of the chest, was considered as restricted areas. The aim of this study is to evaluate the effectiveness of CT guided radioactive 125I seed implantation in treating lung metastatic tumors. Methods Totally 115 metastatic masses were found in 30 patients with CT guiding. 125I seeds were implanted into lung metastatic masses. The approach of implantation was determined according to the location of the lesions (hilar masses, peripheral masses and masses covered by skeletal thorax). The therapeutic effects were evaluated by CT. Results Uniform distribution were achieved by single puncture in 84.3% of patients. The rest patients (15.7%) were received replanting. The follow-up period was 6-24 months (mean 14.6). Among 115 lesions in 30 cases, complete response (CR) was achieved in 80 nodes, partial response (PR) in 20 nodes, No change (NC) in 8 nodes and progressive disease (PD) in 7 nodes. The total response rate was 86.9%. The one-year local control rate were 93.9% (108/115). No severe perioperative complications occurred. Conclusion CT guided radioactive seed 125I implantation is a safe and effective procedure in treating multiple lung metastatic tumor with minimal invasion.
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