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Medicine Jul 2021Thoracentesis is performed to both diagnose and/or treat pleural effusion, and several important complications of thoracentesis are occasionally observed. To assess...
INTRODUCTION
Thoracentesis is performed to both diagnose and/or treat pleural effusion, and several important complications of thoracentesis are occasionally observed. To assess precise thoracentesis procedures, we evaluated the position of the needle tip during thoracentesis by using a thoracentesis unit, comparing experienced and inexperienced groups.
METHODS
Twenty eight physicians (19 board-certified pulmonologists as an experienced group and the remaining 9 as an inexperienced group) participated at Fukujuji Hospital in January 2021. All participants performed 2 punctures with a handmade thoracentesis unit and measured the needle's angle to the midline.
RESULTS
The median distance from the needle tip to the midline when the needle was inserted 5 cm (D5) was 0.47 cm (range 0.06-1.05), and the median difference between D5 on the 1st puncture (D51st) and D5 on the 2nd puncture (D52nd) was 0.22 cm (range 0.00-0.69). D5 was shorter in the experienced group than in the inexperienced group (median 0.40 cm (range 0.06-0.66) vs 0.58 cm (range 0.44-1.05), P < .001). There were no significant differences in the D51st and D52nd distances between the experienced and inexperienced groups (median 0.22 cm (range 0.00-0.40) vs 0.41 cm (range 0.04-0.69), P = .094). When 4 areas were divided by the x-axis and y-axis, 32 punctures (55.2%) deviated to the right-upper quadrant, and 25 (86.2%) of participants made the 1st puncture and 2nd puncture in the same direction.
CONCLUSIONS
All doctors should know that the needle direction might shift by approximately 1 cm, and more than half of the practitioners punctured towards the upper right.
Topics: Clinical Competence; Humans; Thoracentesis
PubMed: 34260543
DOI: 10.1097/MD.0000000000026600 -
BMC Surgery Nov 2023We sought to evaluate the effect of early short-term abdominal paracentesis drainage (APD) in moderately severe and severe acute pancreatitis (MSAP/SAP) with pelvic...
BACKGROUND
We sought to evaluate the effect of early short-term abdominal paracentesis drainage (APD) in moderately severe and severe acute pancreatitis (MSAP/SAP) with pelvic ascites.
METHODS
A total of 135 MSAP/SAP patients with early pelvic ascites were divided into the Short-term APD group (57 patients) and the Non-APD group (78 patients). The effects, complications, and prognosis of short-term APD patients were evaluated.
RESULTS
The baseline characteristics in the two groups were similar. The target days of intra-abdominal hypertension relief, half-dose enteral nutrition, duration of mechanical ventilation, length of intensive care unit stay (in days) and total hospitalization (also in days) were all lower in the Short-term APD group than in the Non-APD group (P = 0.002, 0.009, 0.004, 0.006 and 0.019), while the white blood cell count and serum C-reaction protein level decreased significantly more quickly (P < 0.01 and P < 0.05), and the prevalence of intra-abdominal infection was also significantly lower (P = 0.014) in the former than the latter. No complications occurred in early APD patients, and the microbial cultures of pelvic ascites were all negative. In addition, patients with early APD presented fewer cases of residual wall-off necrosis or fluid collection (P = 0.008) at discharge and had a lower incidence of rehospitalization and percutaneous catheter drainage and/or necrosectomy (P = 0.017 and 0.009).
CONCLUSIONS
For MSAP/SAP patients with pelvic ascites, the early short-term APD is feasible and safe to perform, and it can decrease clinical symptoms, reduce intra-abdominal infection and shorten the hospital stay. It may also reduce the incidence of rehospitalization and surgical intervention.
Topics: Humans; Pancreatitis; Paracentesis; Ascites; Acute Disease; Drainage; Intraabdominal Infections
PubMed: 38012699
DOI: 10.1186/s12893-023-02269-z -
Medicina (Kaunas, Lithuania) Oct 2022Sophisticated screening protocols for genetic abnormalities constitute an important component of current prenatal care, aiming to identify high-risk pregnancies and... (Review)
Review
Sophisticated screening protocols for genetic abnormalities constitute an important component of current prenatal care, aiming to identify high-risk pregnancies and offer appropriate counseling to parents regarding their options. Definite prenatal diagnosis is only possible by invasive prenatal diagnostic testing (IPDT), mainly including amniocentesis and chorionic villous sampling (CVS). The aim of this comparative review was to summarize and compare the existing recommendations on IPDT from the most influential guidelines. All the reviewed guidelines highlight that IPDT is indicated based on a positive screening test rather than maternal age alone. Other indications arise from medical history and sonography, with significant variations identified between the guidelines. The earlier time for amniocentesis is unequivocally set at ≥15 gestational weeks, whereas for CVS, the earlier limit varies from ≥10 to ≥11 weeks. Certain technical aspects and the overall approach demonstrate significant differences. Periprocedural management regarding Rhesus alloimmunization, virologic status and use of anesthesia or antibiotics are either inconsistent or insufficiently addressed. The synthesis of an evidence-based algorithm for IPDT is of crucial importance to healthcare professionals implicated in prenatal care to avoid unnecessary interventions without compromising optimal prenatal care.
Topics: Pregnancy; Humans; Female; Chorionic Villi Sampling; Amniocentesis; Aneuploidy; Prenatal Diagnosis; Maternal Age
PubMed: 36295632
DOI: 10.3390/medicina58101472 -
Liver International : Official Journal... Oct 2022Patients with cirrhotic refractory ascites ineligible for transjugular intrahepatic shunt (TIPSS) have limited treatment options apart from repeated large volume... (Observational Study)
Observational Study
BACKGROUND AND AIMS
Patients with cirrhotic refractory ascites ineligible for transjugular intrahepatic shunt (TIPSS) have limited treatment options apart from repeated large volume paracentesis. The alfapump® is an implantable device mobilizing ascites from the peritoneal cavity to the bladder, from where it can be excreted. The aim of this observational cohort study was to prospectively investigate safety and efficacy of the device in a real-world cohort with cirrhotic refractory ascites and contraindications for TIPSS.
METHODS
A total of 106 patients received an implant at 12 European centres and were followed up for up to 24 months. Complications, device deficiencies, frequency of paracentesis, clinical status and survival were recorded prospectively.
RESULTS
Approximately half of the patients died on-study, about a quarter was withdrawn because of serious adverse events leading to explant, a sixth were withdrawn because of liver transplant or recovery, and nine completed follow-up. The most frequent causes of on-study death and complication-related explant were progression of liver disease and infection. The device reduced the requirement for large-volume paracentesis significantly, with more than half of patients not having required any post-implant. Survival benefits were not observed. Device-related reinterventions were predominantly caused by device deficiencies. A post-hoc comparison of the first 50 versus the last 50 patients enrolled revealed a decreased reintervention rate in the latter, mainly related to peritoneal catheter modifications.
CONCLUSIONS
The device reduced paracentesis frequency in a real-world setting. Technical complications were successfully decreased by optimization of management and device modification (NCT01532427).
Topics: Ascites; Humans; Liver Cirrhosis; Liver Transplantation; Paracentesis; Portasystemic Shunt, Transjugular Intrahepatic; Registries
PubMed: 35686702
DOI: 10.1111/liv.15337 -
Journal of General Internal Medicine Jun 2021
Topics: Humans; Paracentesis
PubMed: 33821412
DOI: 10.1007/s11606-021-06723-7 -
The Journal of Invasive Cardiology Nov 2020Iatrogenic pneumopericardium after pericardiocentesis due to accidental leakage from the side port of the sheath has been reported in the literature. In the present...
Iatrogenic pneumopericardium after pericardiocentesis due to accidental leakage from the side port of the sheath has been reported in the literature. In the present case, it occurred during passage of the guidewire. Every step needs to be done meticulously. The patient should be advised not to take a deep breath during the puncture.
Topics: Humans; Iatrogenic Disease; Pericardiocentesis; Pneumopericardium
PubMed: 33130598
DOI: No ID Found -
Canadian Journal of Rural Medicine :... 2020
Topics: Humans; Male; Nerve Block; Paracentesis; Penis; Priapism; Pudendal Nerve; Young Adult
PubMed: 33004701
DOI: 10.4103/CJRM.CJRM_97_19 -
The American Journal of Case Reports Feb 2020BACKGROUND Acute bacterial pericarditis is rare, and the incidence numbers have been declining in the modern antibiotic era. Purulent bacterial pericarditis is a fatal...
BACKGROUND Acute bacterial pericarditis is rare, and the incidence numbers have been declining in the modern antibiotic era. Purulent bacterial pericarditis is a fatal disease in which mortality rates can reach 100% if left untreated. CASE REPORT We present a case of primary purulent bacterial pericarditis with polymicrobial growth including Micromonas micro, Prevotella intermedia and Fusobacterium species, all of which are anaerobic flora of the oral cavity. Constant re-accumulation of the purulent pericardial effusion led the patient to have recurrent echocardiographic and clinical cardiac tamponade requiring recurrent pericardiocentesis' and eventually a pericardial window. CONCLUSIONS Although rare, bacterial pericarditis has been noted to lead to clinical and echocardiographic tamponade. Early diagnosis and treatment are necessary for improving clinical outcomes. It is important to have a suspicion for purulent pericarditis, due to its high level of mortality, in patients who present with non-specific symptoms and pleuritic chest pain.
Topics: Adult; Anti-Bacterial Agents; Bacteria, Anaerobic; Cardiac Tamponade; Fusobacterium; Humans; Male; Pericardiocentesis; Pericarditis; Prevotella intermedia; Rare Diseases
PubMed: 32107365
DOI: 10.12659/AJCR.921633 -
The American Journal of Case Reports Jan 2023BACKGROUND Small pericardial effusions are common with chronic hypothyroidism, but large pericardial effusion with tamponade or pre-tamponade physiology is a rare...
BACKGROUND Small pericardial effusions are common with chronic hypothyroidism, but large pericardial effusion with tamponade or pre-tamponade physiology is a rare complication of severe uncontrolled hypothyroidism. Presentation of pericardial effusion of any etiology can range from being asymptomatic to hemodynamic instability with cardiac tamponade, depending on the amount and speed of accumulation of pericardial fluid, but pericardial effusion associated with hypothyroidism are usually small. Protracted medication non-adherence was a key factor in our patient's presentation. CASE REPORT We present a case of a woman in her 40s with a known history of autoimmune hypothyroidism with medication non-adherence for longer than 9 months who presented with fatigue, weight gain, limited physical activity, and exertional dyspnea with bilateral swelling of the upper and lower extremities. Examination revealed muffled heart sounds, positive JVD, and positive pulsus paradoxus. She had an elevated TSH, low free T4, and a high anti-thyroid peroxidase antibody level. Echocardiography revealed a large pericardial effusion with impending tamponade. Pericardiocentesis with pericardial drain was done and the patient's symptoms resolved quickly. The patient was restarted on a prior dose of levothyroxine 175 mcg. She had improved by the 3rd day of hospitalization; the pericardial drain was removed, and she was discharged with access to medication. Follow-up revealed complete resolution of her symptoms. CONCLUSIONS This case emphasizes the importance of recognition of hypothyroidism as the etiology of life-threatening large pericardial effusions, as it is treatable and recurrences are preventable. To prevent recurrence, it is important to achieve euthyroidism after treating an episode of pericardial effusion.
Topics: Adult; Female; Humans; Cardiac Tamponade; Hypothyroidism; Pericardial Effusion; Pericardiocentesis; Thyroxine; Echocardiography
PubMed: 36654486
DOI: 10.12659/AJCR.938520 -
Medicina (Kaunas, Lithuania) Oct 2023: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular diseases involving the temporomandibular joint complex and the...
The Effect of Arthrocentesis Treatment for Maximum Mouth Opening and Pain in Temporomandibular Joint Diseases and the Effect of Splint, Drug, and Physical Therapy on This Treatment.
: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular diseases involving the temporomandibular joint complex and the surrounding muscle and osseous structure. TMD can be classified as intra-articular or extra-articular. The aim of this study was to evaluate the effect of arthrocentesis in terms of maximum mouth opening (MMO) and pain in patients with TMD of intra-articular origin. In addition to this treatment, the effects of factors such as splints, medication, and physical therapy on arthrocentesis were examined. : This retrospectively designed study was conducted with 79 patients who had previously undergone arthrocentesis. These patients were divided into three groups according to the Research Diagnostic Criteria for temporomandibular disorder: disc displacement (DD) with locking (Group 1), DD without locking (Group 2), and degenerative joint diseases (Group 3) groups. The maximum mouth opening (MMO) and visual analog score (VAS) values of the groups were recorded before arthrocentesis (Baseline: T0), on the third day after arthrocentesis (T1), and at the sixth month (T2) after arthrocentesis. Information about whether the patients received concurrent medical treatment, splint treatment, and physical therapy was also recorded. These data were compared between groups. : It was observed that the VAS scores in all three groups decreased from T1 compared to T0 ( < 0.05). Likewise, the MMO value increased in all groups at T1 compared to T0. ( < 0.05). It was observed that splint treatment, pain killer and muscle relaxant treatment, and physical therapy made no additional contribution to arthrocentesis in terms of reducing pain or increasing MMO value ( > 0.05). : Arthrocentesis was observed to be effective in terms of pain and function in TMJ patients in this study. It was observed that splint therapy, physical therapy, and medical therapy made no additional contribution to arthrocentesis in terms of MMO or pain.
Topics: Humans; Arthrocentesis; Splints; Retrospective Studies; Treatment Outcome; Range of Motion, Articular; Temporomandibular Joint Disorders; Pain; Physical Therapy Modalities; Mouth
PubMed: 37893485
DOI: 10.3390/medicina59101767