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British Journal of Neurosurgery Jun 2024A brain abscess is a neurosurgical emergency and frequently requires drainage to relieve intracranial pressure and identify the offending organism. Surgical adjuncts... (Review)
Review
A brain abscess is a neurosurgical emergency and frequently requires drainage to relieve intracranial pressure and identify the offending organism. Surgical adjuncts including neuronavigation and intra-operative CT and MRI facilitate surgery, but have limitations, including cost and not offering real time intracranial views. Intra-operative ultrasound is a fast and relatively cheap tool which offers live, real time imaging and visualisation of an abscess being aspirated, but is less frequently used. We describe our technique of ultrasound guidance as an adjunct with neuronavigation for brain abscess aspiration, review the literature on surgical adjuncts and remind the neurosurgical community of its value in this and other cranial procedures. We summarise our recent experience in its use in six patients with a brain abscess. There is a learning curve to using intra-operative ultrasound, but we recommend its routine use in abscess drainage surgery.
Topics: Humans; Brain Abscess; Drainage; Male; Ultrasonography, Interventional; Neuronavigation; Female; Middle Aged; Adult; Suction; Aged; Neurosurgical Procedures
PubMed: 34402710
DOI: 10.1080/02688697.2021.1961683 -
Nature Communications May 2024Snails can stably slide across a surface with only a single high-payload sucker, offering an efficient adhesive locomotion mechanism for next-generation climbing robots....
Snails can stably slide across a surface with only a single high-payload sucker, offering an efficient adhesive locomotion mechanism for next-generation climbing robots. The critical factor for snails' sliding suction behaviour is mucus secretion, which reduces friction and enhances suction. Inspired by this, we proposed an artificial sliding suction mechanism. The sliding suction utilizes water as an artificial mucus, which is widely available and evaporates with no residue. The sliding suction allows a lightweight robot (96 g) to slide vertically and upside down, achieving high speeds (rotation of 53°/s and translation of 19 mm/s) and high payload (1 kg as tested and 5.03 kg in theory), and does not require energy during adhesion. Here, we show that the sliding suction is a low-cost, energy-efficient, high-payload and clean adhesive locomotion strategy, which has high potential for use in climbing robots, outdoor inspection robots and robotic transportation.
PubMed: 38740752
DOI: 10.1038/s41467-024-48293-2 -
European Urology Focus Jan 2024Controversy exists regarding the therapeutic benefit of suction use during percutaneous nephrolithotripsy (PCNL). (Review)
Review
CONTEXT
Controversy exists regarding the therapeutic benefit of suction use during percutaneous nephrolithotripsy (PCNL).
OBJECTIVE
To review and highlight the options available in the use of suction for PCNL, and to discuss their strengths and limitations.
EVIDENCE ACQUISITION
A systematic literature search was performed using Scopus, EMBASE, and PubMed. Thirty four studies were included. There was one ex vivo study. Among clinical studies, 24 used a vacuum/suctioning sheath and nine a handpiece suction device/direct-in-scope suction. The suction technique was employed in standard, mini-PCNL, supermini-PCNL, and enhanced supermini‑PCNL techniques.
EVIDENCE SYNTHESIS
Handpiece suction devices demonstrated better safety and efficiency in treating large stones than nonsuction PCNL and in a much shorter time. Trilogy and ShockPulse-SE were equally effective, safe, and versatile for standard PCNL and mini-PCNL. The heavier handpiece makes Trilogy less ergonomically friendly. Laser suction handpiece devices can potentiate laser lithotripsy by allowing for better laser control with simultaneous suction of small fragments and dust. Integrated suction-based sheaths are available in reusable and disposable forms for mini-PCNL only. Mini-PCNL with suction reported superior outcomes for operative time and stone-free rate to mini-PCNL. This also helped minimize infectious complications by a combination of intrarenal pressure reduction and faster aspiration of irrigation fluid reducing the risk of sepsis, enhance intraoperative vision, and improve lithotripsy efficiency, which makes it a very attractive evolution for PCNL.
CONCLUSIONS
Suction devices in PCNL are reforming the way PCNL is being done. Adding suction to mini-PCNL reduces infectious complications and improves the stone-free rate. Our review shows that despite the limited evidence, suction techniques appear to improve PCNL outcomes.
PATIENT SUMMARY
In this review, we looked at the intra- and perioperative outcomes of percutaneous nephrolithotripsy (PCNL) with the addition of suction. With better stone fragmentation and fewer postoperative infections, this technology is very useful particularly for mini-PCNL.
Topics: Humans; Kidney Calculi; Suction; Lithotripsy; Lithotripsy, Laser; Postoperative Complications
PubMed: 37442721
DOI: 10.1016/j.euf.2023.06.010 -
Journal of Medical Radiation Sciences Sep 2023Breast abscesses are still a common cause of morbidity among lactational females. Over the years, there has been an increase in the incidence of non-lactational breast... (Review)
Review
Breast abscesses are still a common cause of morbidity among lactational females. Over the years, there has been an increase in the incidence of non-lactational breast abscesses and a decrease in lactational breast abscesses. The management could be the use of the conventional method of surgical incision and drainage or the newer techniques of needle aspiration or suction drain or catheter in addition to the administration of antibiotics. The use of needle aspiration as the minimal-invasive conservative technique is generally recommended for abscesses less than 3-5 cm in diameter. However, recent studies have compared the two methods for abscesses larger than 3 cm and among patients with risk factors for breast abscesses. We aim to present the clinical evidence showing the comparison between needle aspiration and incision and drainage for breast abscesses irrespective of the size of the abscesses. There is a lack of comparative information on the two treatment modalities for breast abscesses larger than 3 cm in diameter; however, needle aspiration is being tried because of its advantages like cosmetic preference, short hospital stay and healing time, and no stoppage of breastfeeding.
Topics: Female; Humans; Abscess; Mastitis; Breast; Breast Diseases; Ultrasonography, Interventional
PubMed: 37118650
DOI: 10.1002/jmrs.682 -
Diagnostics (Basel, Switzerland) May 2024The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions... (Review)
Review
The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing retrograde intrarenal surgery (RIRS) as a standard of care in the endourological management of renal stones. With the ever-changing landscape of RIRS over the decades shaped by technological advancements in lasers and flexible scopes, the UAS has also continuously evolved. The utility of suction in endourology has recently changed the way RIRS is performed and is a game changer for FURS outcomes. With strong clinical and experimental evidence to support its use, the UAS has undergone a transformative change in the recent past, with its ability to monitor intrarenal pressure and provide a superior vacuum-cleaner effect that improves the trifecta of RIRS, namely an improved single-stage stone-free rate (SFR), minimise complications, and reduce reinterventions. Our comprehensive review outlines the key clinical and experimental evidence and traces the developments that were key to modifying the traditional UAS into a flexible and navigable suction ureteric access sheath (FANS) and highlights how the design and modifications, in turn, influence the ability to push the boundaries of RIRS.
PubMed: 38786332
DOI: 10.3390/diagnostics14101034 -
Advanced Science (Weinheim,... Jun 2024The emergence of the field of soft robotics has led to an interest in suction cups as auxiliary structures on soft continuum arms to support the execution of... (Review)
Review
The emergence of the field of soft robotics has led to an interest in suction cups as auxiliary structures on soft continuum arms to support the execution of manipulation tasks. This application poses demanding requirements on suction cups with respect to sensorization, adhesion under non-ideal contact conditions, and integration into fully soft systems. The octopus can serve as an important source of inspiration for addressing these challenges. This review aims to accelerate research in octopus-inspired suction cups by providing a detailed analysis of the octopus sucker, determining meaningful performance metrics for suction cups on the basis of this analysis, and evaluating the state-of-the-art in suction cups according to these performance metrics. In total, 47 records describing suction cups are found, classified according to the deployed actuation method, and evaluated on performance metrics reflecting the level of sensorization, adhesion, and integration. Despite significant advances in recent years, the octopus sucker outperforms all suction cups on all performance metrics. The realization of high resolution tactile sensing in suction cups and the integration of such sensorized suction cups in soft continuum structures are identified as two major hurdles toward the realization of octopus-inspired manipulation strategies in soft continuum robot arms.
PubMed: 38874316
DOI: 10.1002/advs.202400806 -
European Heart Journal. Acute... Dec 2023Short-term percutaneous mechanical circulatory support by a micro-axial flow pump is increasingly used to support the left ventricle in cardiogenic shock. After a... (Review)
Review
Short-term percutaneous mechanical circulatory support by a micro-axial flow pump is increasingly used to support the left ventricle in cardiogenic shock. After a correct indication and placement, appropriate device management in the cardiac intensive care unit is vital to ensure optimal pump function and adequate haemodynamic support. A key element hereby is a correct percutaneous ventricular assist device (pVAD) position. This review explains how an optimal left-sided pVAD position can be achieved and maintained, focusing on the correct insertion depth and rotational angle. Useful imaging techniques, placement and replacement manoeuvres, and monitoring options through the console are discussed. The frequently encountered problem of mal-rotation towards the mitral valve, which may cause suction alarms, haemolysis, aortic regurgitation, and inadequate haemodynamic support, is explained. Finally, a practical bedside approach to assess pVAD position and discern suction alarms due to mal-positioning from haemodynamic problems is proposed.
Topics: Humans; Treatment Outcome; Shock, Cardiogenic; Hemodynamics; Intra-Aortic Balloon Pumping; Heart-Assist Devices
PubMed: 37607271
DOI: 10.1093/ehjacc/zuad097 -
BMC Oral Health Sep 2023Dental procedures involving drilling and grinding can produce a significant amount of suspended aerosol particles (PM) and bioaerosols. This study aims to analyze the...
BACKGROUNDS
Dental procedures involving drilling and grinding can produce a significant amount of suspended aerosol particles (PM) and bioaerosols. This study aims to analyze the size and concentration of aerosol particles generated during drilling and to investigate the effectiveness of two air exchange systems, namely forceful suction (FS) and air disinfection machines (DM), in removing PM.
METHODS
For this study, 100 extracted permanent teeth were collected and divided into three groups: without suction (n = 50), suction with forceful suction (n = 25), and suction with air disinfection machines (n = 25). The removal rate of suspended aerosol particles was analyzed using particle counters and air data multimeter.
RESULTS
When drilling and grinding were performed without vacuum, 0.75% of the aerosol particles generated were PM2.5-10, 78.25% of total suspended aerosol particles (TSP) were PM2.5, and 98.68% of TSP were PM1. The nanoanalyzer measurements revealed that the aerodynamic diameter of most aerosol particles was below 60 nm, with an average particle diameter of 52.61 nm and an average concentration of 2.6*10 ultrafine aerosol particles. The air change per hour (ACH) was significantly lower in the air disinfection machines group compared to the forceful suction group. Additionally, the number of aerosol particles and mass concentration was significantly lower in the air disinfection machines group compared to the forceful suction group in terms of PM2.5 levels. However, the forceful suction group also reduced the mass concentration in PM10 level than the air disinfection machines group.
CONCLUSION
In conclusion, the air exchange system can reduce the aerosol particles generated during drilling and grinding. Comparing the two air exchange systems, it was found that the air disinfection machines group reduces the number of aerosol particles and mass concentration in PM2.5 levels, while the forceful suction group reduces the mass concentration in PM10 level.
Topics: Humans; Disinfection; Suction; Aerosols; Particulate Matter
PubMed: 37684672
DOI: 10.1186/s12903-023-03369-1 -
Gynecologic and Obstetric Investigation 2024Gestational trophoblastic disease (GTD) is a rare pregnancy-related condition consisting of premalignant and malignant forms arising from proliferation of trophoblastic... (Review)
Review
BACKGROUND
Gestational trophoblastic disease (GTD) is a rare pregnancy-related condition consisting of premalignant and malignant forms arising from proliferation of trophoblastic cells. The malignant forms are collectively referred to as gestational trophoblastic neoplasia (GTN) and are highly sensitive to chemotherapy. However, surgical procedures remain indispensable in the diagnosis and treatment of GTD.
OBJECTIVES
The aim of this review was to summarize surgical interventions in the treatment of GTD and GTN. We reviewed indications, efficacy, possible complications, and oncological outcomes of surgery.
METHODS
Three searches were performed in the databases of PubMed, Embase, and the Cochrane Library to create an up-to-date overview of existing literature on the following subjects: (1) the role of primary hysterectomy in GTD and GTN; (2) the role of second curettage in GTD and GTN; (3) fertility sparing surgery in GTN; (4) surgical management of metastases. Included articles originated from the time period 1952-2022. Articles written in English, Spanish, and French were included.
OUTCOMES
Thirty-eight articles were found and selected. Surgical evacuation through suction curettage is most used and advised in the treatment of GTD. A second curettage could be beneficial in patients with low hCG levels and low FIGO scores. In women who have completed their families, primary hysterectomy might be considered as the risk of subsequent GTN is lower than after suction curettage. In case of the rare forms of GTN (epithelioid trophoblastic tumor or placental site trophoblastic tumor) surgical tumor resection remains the most important step in treatment. Data on fertility sparing surgery in GTN are scarce and this treatment should be considered experimental.
CONCLUSION AND OUTLOOK
Surgery remains an important part of treatment of GTD and is sometimes indispensable to achieve curation. Further collection of evidence is needed to determine treatment steps.
Topics: Humans; Female; Gestational Trophoblastic Disease; Pregnancy; Hysterectomy; Fertility Preservation; Uterine Neoplasms; Curettage
PubMed: 37788661
DOI: 10.1159/000534065 -
Nursing Research and Practice 2023To generate a landscape of the current knowledge in the interventional management and outcomes of purulent skin and soft tissue infections. (Review)
Review
AIM
To generate a landscape of the current knowledge in the interventional management and outcomes of purulent skin and soft tissue infections.
DESIGN
This study is a scoping review.
METHODS
Electronic searches were undertaken using CINAHL, Medline, Cochrane Library, British Nursing Index, Science Direct, the National Health Service knowledge and library hub, ClinicalTrials.gov, and MedNar. The population, concept, context framework, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews were utilised, supporting a rigorous appraisal and synthesis of literature. . The initial search and synthesis of literature were completed in January 2022 with repeat searches completed in March 2022 and July 2023. There were no imposed chronological parameters placed on the returned literature.
RESULTS
Nineteen papers were reviewed. Incision and drainage with primary closure, needle aspiration, loop drainage, catheter drainage, and suction drainage are viable adjuncts or alternatives to the traditional surgical management of skin and soft tissue abscesses.
CONCLUSION
Despite the empirically favourable alternatives to the incision and drainage technique demonstrated, this does not appear to be driving a change in clinical practice. Future research must now look to mixed and qualitative evidence to understand the causative mechanisms of incision and drainage and its ritualistic practice. . Ritual surgical practices must be challenged if nurses are to improve the treatment and management of this patient group. This will lead to further practice innovation. : This study explored the challenges posed to patients, clinicians, nurses, and stakeholders, resulting from the ritualistic practice of the incision and drainage technique in purulent skin or soft tissue abscesses. Empirically and holistically viable alternatives were identified, impacting all identified entities and recommending a wider holistic study. . Adherence to EQUATOR guidance was achieved through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
PubMed: 37841078
DOI: 10.1155/2023/5849141