Single needle versus double needle celiac trunk neurolysis in abdominal malignancy pain management: a randomized controlled trial / Neurólise do tronco celíaco com o uso de agulha única versus agulha dupla no manejo da dor abdominal maligna: estudo randômico controlado

Abstract Background: Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients' position and the double needle technique using posterior anterocrural approach. Methods: In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. Results: The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0%; 13.8 ± 1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards Visual Analog Scale: double needles celiac neurolysis = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) and single needle celiac neurolysis = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) after 1 day, 1 week, 1 and 3 months respectively. However, Visual Analog Scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). Conclusion: Single needle celiac neurolysis with changing patients' position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.

Resumo Introdução: A neurólise do plexo celíaco guiada por tomografia computadorizada tornou-se uma técnica quase segura para aliviar a dor abdominal maligna. Comparamos a técnica de agulha única mudando o posicionamento do paciente e a técnica de agulha dupla usando a abordagem anterocrural posterior. Métodos: No grupo designado para neurólise celíaca com agulha dupla (n = 17), a técnica de abordagem anterocrural posterior foi utilizada com duas agulhas para injetar 12,5 mL de fenol a 10% de cada lado em decúbito ventral. No grupo designado para neurólise celíaca com agulha única (n = 17), a abordagem anterocrural posterior foi utilizada com uma única agulha para injetar 25 mL de fenol a 10% do lado esquerdo com o paciente em decúbito lateral esquerdo e posteriormente virado para o lado direito. Os parâmetros de monitorização foram a taxa de falha dos bloqueios e a duração do posicionamento dos pacientes, o tempo da técnica, os escores da escala visual analógica, as complicações (hipotensão, diarreia, vômitos, hemorragia, dano neurológico e infecção) e a analgesia de resgate. Resultados: A taxa de falha dos bloqueios e a duração do posicionamento dos pacientes aumentaram significativamente na neurólise celíaca com o uso de agulha dupla vs. agulha única (30,8% vs. 0%,13,8 ± 1,2 vs. 8,9 ± 1; p = 0,046, p ≤ 0,001, respectivamente). Além disso, o tempo da técnica foi significativamente maior na neurólise celíaca com agulha dupla que na neurólise celíaca com agulha única (24,5 ± 5,1 vs. 15,4 ± 1,8; p ≤ 0,001). Não houve diferença significativa em relação aos escores da escala visual analógica: neurólise celíaca com agulha dupla = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) e neurolise celíaca com agulha única = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) após um dia,uma semana, um e três meses, respectivamente. No entanto, os escores da escala visual analógica para cada grupo foram significativamente menores comparados aos valores basais (p ≤ 0,001). Não houve diferença estatisticamente significativa quanto à analgesia de resgate e complicações (p > 0,05). Conclusão: A neurólise celíaca com o uso de agulha única e a alteração do posicionamento do paciente apresenta uma taxa menor de falha do bloqueio, menos tempo de procedimento e menor duração do posicionamento do paciente que o uso de duas agulhas para neurólise celíaca em malignidade abdominal.

Our Experience with CT Guided Lung FNAC/ Biopsy

Introduction: CT guided lung FNAC/Biopsy is beingincreasingly used for the tissue diagnosis of lung lesions. CTis the safest and most accurate method of biopsying centrallesions and lesions adjacent to or involving the hila andmediastinal structures. This study was aimed at evaluatingthe frequency of complications following CT – guided lungBiopsy/FNACMaterial and methods: This was a retrospective study. 53CT guided procedures performed during the year 2016 wereincluded in the study. All the patients had a CT examination ofthe chest (plain and contrast) done before the guided procedurewhich was used as a road map. CT examination was doneon a Siemens somatom 148 slice scanner. In some patientstable dose oral contrast was also given done to delineate theoesophagus.Results: The incidence of pneumothorax was 1.06% i.e. only1 patient out of 53 had minimal pneumothorax which wastreated conservatively.Conclusion: CT guided lung FNAC/Biopsy is a safeprocedure if done in expert hands with a multi-disciplinaryteam approach. Complications can be minimised by carefulselection of the patient... considering the site and size oflesion; associated lung conditions etc

Efficacy observation of modified herringbone-Trendelenburg position in the laparoscopic anterior resection for rectal cancer / 中国实用护理杂志

Objective To explore the effects of modified herringbone-Trendelenburg position in the laparoscopic anterior resection for rectal cancer patients. Methods A total of 108 patients undergoing laparoscopic anterior resection were recruited and randomly assigned to observation group(54 cases) and control group (54 cases). Patients in the observation group were positioned in modified herringbone-Trendelenburg position, while the patients in the control group were placed in conventional Trendelenburg position. The data of heart rate (HR), mean arterial pressure (MAP) were recorded at 3minutes before body position change and 3 minutes after body position change, 3 minutes before recover horizontal position and 3 minutes after recover horizontal position. Intraocular pressure (IOP) were measured at 3 minutes after general anesthesia in supine position (T0), and 3 minutes after pneumoperitoneum while in the operation position (T1), every 1 hour (T2 to T3), 3 minutes before recover horizontal position at the end of pneumoperitoneum (T4), 3 minutes after recover horizontal position (T5) and 30 minutes after recover horizontal position(T6). Investigate the satisfaction of the surgeons regarding the surgical position of the patients.Followed up investigation at 24h and 48h after surgery were enforced to record the situation of the pain in the shoulder and postoperative complications of the lower limbs. Results The heart rate pre-and post the change of body position in observation group were (2.11±0.92), (-2.78±1.01) beats/min respectively, while the control group were (5.98±2.98), (-6.03±1.98) beats/min, the differences were statically significant (t=9.111,9.851, P<0.01).The mean arterial pressure pre-and post the change of body position in observation group were (1.67 ± 1.23), (2.21 ± 0.89) mmHg(1mmHg=0.133kPa) respectively, while the control group were (7.20±2.30), (6.41±1.87)mmHg, the differences were statically significant(t=15.512, 14.811, P<0.01).The differences of intra-ocular pressure between 2 groups had no statistical significance at T0 and T6 (P>0.05). The intra-ocular pressure were (13.64±1.66), (16.56±1.82),(19.78±1.70),(21.00±1.71),(18.53±1.77)mmHg respectively from T1 to T5, lower than that of control group (15.59±2.03),(19.40±1.89), (23.22±2.15), (25.38±2.09), (22.35±1.76)mmHg, the differences were statically significant (t=5.442-11.907, P<0.01).The incidence of shoulder pain and low leg pain in observation group were 9.26％(5/54), 7.41％(4/54) respectively, lower than that of control group 46.29％(25/54),31.48％(17/54), the differences were statically significant (t=17.778,9.755,P<0.01). The scores of shoulder pain and low leg pain in observation group were (1.38±0.38), (2.02±0.34) points, lower than that of control group (4.44 ± 0.48), (3.85 ± 0.57) points, the differences were statically significant (t=36.761, 20.162, P<0.01). The satisfaction rate of surgeons was 87.04％(47/54) in the observation group, higher than that in the control group 55.56％ (30/54), the difference was statically significant (χ2=5.119, P=0.024). Conclusion Modified herringbone-Trendelenburg position can maintain the circulatory system stability better without affecting the operation, reduce the elevation of IOP, effectively improve the comfort of the operation position of the patients,reduce the postoperative complications of the lower limbs and the incidence rate of the shoulder pain in the laparoscopic anterior resection for rectal cancer patients.

Assessment of the influence of the hammock on neuromotor development in nursing full-term infants

OBJECTIVE: to evaluate the influence of the hammock on neuromotor development in full-term infants. METHOD: the study included 26 infants born at normal gestational age, of single-births and birth weight > 2500g, 19 of them constituting the group of hammock-users and seven the group of non-hammock-users. All the 26 infants had their neuromotor development assessed using the Alberta Infant Neuromotor Scale, at six months of age. The assessments, undertaken in the infants' homes at times convenient to both mothers and children, were recorded on video and two other observers evaluated the infants' performance. RESULTS: the neuromotor development of the hammock-using infants obtained a lower score than did that of the non-hammock-using infants (p 0.03). Among the four postures evaluated by AIMS, the upright position was the only one that showed a statistically significant difference between the two groups (p 0; 01). In the correlation analysis, maternal age showed a negative relationship ((r = -0.42; p 0.03;) and the value of the Apgar score at 1 minute a positive relationship with neuromotor development (r = 0.49; p 0.05;). CONCLUSION: hammock-using infants present slower neuromotor development than the non-hammock-users of the same age...

OBJETIVO: Avaliar a influência do uso da rede de descanso sobre o desenvolvimento neuromotor de lactentes nascido a termo aos seis meses de idade. MÉTODO: Foram incluídos 26 lactentes, nascidos a termo, de parto único e com peso > 2500g, 19 foram inseridos no grupo que faziam uso da rede de descanso e sete foram incluídos no grupo que não faziam uso da rede de descanso. Os 26 lactentes estavam com seis meses de idade quando tiveram seu desenvolvimento neuromotor avaliado por meio da Alberta Infant Neuromotor Scale. Todas as avaliações foram registradas em vídeo-gravações e as performances neuromotoras foram reavaliadas e pontuadas por dois avaliadores capacitados e cegos ao estudo. RESULTADOS: O desenvolvimento neuromotor dos lactentes que fazem uso da rede apresentou pior escore quando comparado ao desenvolvimento neuromotor dos lactentes que não fazem uso da rede (p 0,03). Dentre as quatro posturas avaliadas na AIMS a postura em pé foi à única que apresentou diferença estatisticamente significativa entre os dois grupos (p 0,01). Na análise de correlação, a idade da mãe apresentou relação negativa (r = -0,42; p 0,03;) e o valor de Apgar no 1º minuto relação positiva com o desenvolvimento neuromotor (r = 0,49; p 0,05;). CONCLUSÃO: Os lactentes que fazem uso da rede de descanso apresentam um desenvolvimento neuromotor mais lento quando comparado ao desenvolvimento de lactentes de mesma idade que não fizeram uso da rede de descanso...

How to measure Blood Pressure

Correct measurement of blood pressure is essential in the diagnosis and management of hypertension. Having a blood pressure machine with the proper-sized cuff is crucial, as are the correct procedural steps in taking the reading. This article outlines the steps in measuring blood pressure, to ensure that accurate readings are taken.

Study of Patient's Position to Reduce Late Complications in High Dose Rate Intracavitary Radiation of the Uterine Cervix Cancer / 대한방사선종양학회지

PURPOSE: Radiation proctitis and radiation cystitis are frequent and problematic late complications in patients treated with radiation for the uterine cervix cancer. Authors tried to find out the better patient's position in high dose rate intracavitary radiation to reduce the radiation dose of bladder and rectum. MATERIALS AND METHODS: In 13 patients, Foley catheters were inserted to patients' bladder and rectum and were ballooned with radioopaque dye. After insertion of a tandem and two ovoids, semi-orthogonal anteroposterior and lateral films were taken in both lithotomy and supine position. The rectal point and bladder point were defined according to the criteria recommended in the ICRU Report 38 with modification. Using these films, all patients' bladder and rectal dose were calculated in both positions (the radiation dose of A point was set to 400 cGy). And also, the distance of bladder and rectum from uterine cervical os was calculated in both positions. RESULTS: The average radiation dose of rectum was 240.7 cGy in lithotomy position and 278.3 cGy in supine position, and the average radiation dose of bladder was 303.5 cGy in lithotomy position and 255.8 cGy in supine position. After the paired t-test, the radiation dose of rectum in lithotomy position was marginally significantly lower than that in supine position, while the radiation dose of bladder in lithotomy position was significantly higher than that in supine position. On the other hand, the average distance between rectum and cervical os was 35.2 mm in lithotomy position and 32.3 mm in supine position. and the average distance between bladder and cervical os was 30.4 mm in lithotomy position and 34.0 mm in supine posi-tion. After the paired t-test, the distance between rectum and cervical os in lithotomy position was significantly longer than that in supine position, while the distance between bladder and cervical os in lithotomy position was significantly shorter than that in supine position. CONCLUSION: The radiation dose of bladder can be reduced in supine position and the radiation dose of rectum can be reduced in lithotomy position, so we can choose appropriate position in each patient.