Fractura intravascular de un catéter arterial: una complicación poco común pero real / Intravascular fracture of an arterial catheter: an uncommon nevertheless real complication

Arterial catheterization is a common procedure performed for invasive blood pressure as well as cardiac output monitoring and blood sampling for analysis. The fracture or embolization of arterial catheters are rare but serious complications, and may cause vascular thrombosis or occlusion. Ultrasound can be used to identify the intravascular fragment, however their removal may be complex. The authors report a case of intra-arterial catheter fracture in the radial artery, confirmed by ultrasound and surgically removed. This case may alert to be aware of this complication when using this invasive method, helping to prevent future complications for patients.

La introducción de un catéter arterial es un procedimiento realizado regularmente para evaluar la presión arterial invasiva, el gasto cardíaco y tomar muestras de sangre para su análisis. La fractura y la embolización de los catéteres arteriales son complicaciones poco frecuentes pero graves y pueden causar trombosis u oclusión de la arteria. La ecografía puede usarse para identificar el fragmento intravascular, pero la extracción puede ser compleja. Presentamos un caso de fractura intravascular del catéter de la arteria radial confirmada por ecografía y extirpada quirúrgicamente. Este caso señala la necesidad de prestar atención a esta complicación cuando se usa el monitoreo invasivo, para evitar complicaciones futuras para los enfermos.

Ultrasound-guided central venous catheterization - "Syringe-Free" approach / Cateterização venosa central guiada por ultrassom - abordagem "Syringe-Free"

Abstract Background and objectives: Central venous catheterization of the internal jugular vein is a commonly performed invasive procedure associated with a significant morbidity and even mortality. Ultrasound-guided methods have shown to improve significantly the success of the technique and are recommended by various scientific societies, including the American Society of Anesthesiologists. The aim of this report is to describe an innovative ultrasound-guided central line placement of the internal jugular vein. Technique: The authors describe an innovative ultrasound-guided central line placement of the internal jugular vein based on an oblique approach - the "Syringe-Free" approach. This technique allows immediate progression of the guide wire in the venous lumen, while maintaining a real-time continuous ultrasound image. Conclusions: The described method adds to the traditional oblique technique the possibility of achieving a continuous real-time ultrasound-guided venipuncture and a guide wire insertion that does not need removing the probe from the puncture field, while having a single operator performing the whole procedure.

Resumo Justificativa e objetivos: A cateterização venosa central da veia jugular interna é um procedimento invasivo feito frequentemente e associado a morbilidade significativa e até mesmo mortalidade. Os métodos guiados por ultrassonografia têm demonstrado uma melhoria do sucesso desse procedimento e são recomendados por várias sociedades científicas, incluindo a American Society of Anesthesiologists. O objetivo deste artigo é descrever uma abordagem inovadora de cateterização venosa central guiada por ultrassonografia no nível da veia jugular interna. Técnica: Os autores descrevem técnica ecoguiada inovadora de cateterização venosa central da veia jugular interna, baseada numa abordagem oblíqua - a abordagem Syringe-Free. Essa técnica permite uma progressão imediata do fio-guia ao longo do lúmen venoso e manter uma visualização ecográfica em tempo real e contínua. Conclusões: A técnica descrita acrescenta à técnica oblíqua tradicional a possibilidade de, com um único operador, conseguir uma punção venosa central com visualização ecográfica contínua e em tempo real associada à inserção do fio-guia sem necessidade de afastamento do transdutor de ultrassonografia do campo de punção.

Effect of nitric oxide inhibitor and donor substances on the infammatory process caused by endodontic irrigants

Nitric oxide (NO) has been considered a key molecule in infammation. OBJECTIVE: The aim of this study was to evaluate the effect of treatment with L-NAME and sodium nitroprussiate, substances that inhibit and release NO, respectively, on tissue tolerance to endodontic irrigants. MATERIAL AND METHODS: The vital dye exudation method was used in a rat subcutaneous tissue model. Injections of 2 percent Evans blue were administered intravenously into the dorsal penial vein of 14 male rats (200-300 g). The NO inhibitor and donor substances were injected into the subcutaneous tissue in the dorsal region, forming two groups of animals: G1 was inoculated with L-NAME and G2 with sodium nitroprussiate. Both groups received injections of the test endodontic irrigants: acetic acid, 15 percent citric acid, 17 percent EDTA-T and saline (control). After 30 min, analysis of the extravasated dye was performed by light absorption spectrophotometry (620 nm). RESULTS: There was statistically signifcant difference (p<0.05) between groups 1 and 2 for all irrigants. L-NAME produced a less intense infammatory reaction and nitroprussiate intensifed this process. CONCLUSIONS: Independently of the administration of NO inhibitors and donors, EDTA-T produced the highest irritating potential in vital tissue among the tested irrigating solutions.

Avaliação in vitro do controle microbiano e da neutralização de endotoxinas presentes nos canais radiculares por nanopartículas de prata / Effectiveness of silver nanoparticles on microorganisms and endotoxins in root canals

O objetivo deste trabalho foi avaliar a capacidade da solução de nanopartículas de prata, utilizada como irrigante e medicação intracanal, em controlar os microrganismos e neutralizar endotoxinas no canal radicular. Para isso, foram utilizadas 48 raízes de dentes humanos padronizadas em 16 mm e com diâmetro apical correspondente a uma lima tipo Kerr no. 30. Os canais foram contaminados por 28 dias com E. coli e por 21 dias com E. faecalis e C. albicans. Os espécimes foram divididos em quatro grupos (n=12), de acordo com a substância utilizada(solução irrigadora e medicação intracanal): G1) solução salina e solução salina(grupo controle); G2) hipoclorito de sódio 1% associado ao creme Endo-PTC ehidróxido de cálcio - protocolo tradicional da FOUSP; G3) solução de nanopartículasde prata 50 ppm e hidróxido de cálcio associado à solução de nanopartículas de prata; e G4) solução de nanopartículas de prata 50 ppm e solução de nanopartículasde prata 50 ppm. Foram realizadas cinco coletas do conteúdo do canal radicularpara avaliar a atividade antimicrobiana: coleta de confirmação, imediatamente após a instrumentação (1ª. coleta) e outra após sete dias (2ª. coleta); imediatamente após a remoção da medicação (3ª. coleta) e outra após sete dias (4ª. coleta). A neutralização da endotoxina foi avaliada apenas nas quatro últimas coletas. Os resultados obtidos foram submetidos a análise estatística (Kruskall-Wallis e Dunn).Todas as soluções irrigadoras promoveram redução significativa dos microrganismos após a instrumentação (1ª. coleta) (p<0,05)...

The objective of this study was to evaluate the antimicrobial effect and endotoxin detoxified of solution of silver nanoparticles used as irrigating and dressing in root canals. Forty-eigth single-root human teeth were used. All root canals sized 16 mmand were enlarged to a Kerr file number .30. Root canals were infected for 28 days with E. coli and for 21 days with E. faecalis and C. albicans. The specimens were divided into four groups (n=12), according to the substance used (irrigating solutionand dressing): G1) saline and saline (control), G2) sodium hypochlorite 1% withEndo-PTC cream and calcium hydroxide; G3) solution of Ag-NP 50 ppm and calcium hydroxide with Ag-NP; and G4) solution of Ag-NP 50 ppm and solution of Ag-NP 50ppm. Five samplings of root canal were accomplished to evaluate the antimicrobial activity: confirmation sample, immediately after instrumentation (1st. Sample), and other after 7 days (2 nd. Sample), immediately after dressing removed (3 rd. Sample) and other after 7 days (4 th. Sample). The endotoxina detoxified was evaluated on lyin the last four samples by Limulus assay. Results were analysed by Kruskal-Wallisand Dunn. All irrigation solutions caused significant reduction of microorganisms after instrumentation (1 st. Collection) (p <0.05). After 7 days there was increase of the number of bacteria in all groups, returning to the initial number of microorganisms in the groups prepared with saline and sodium hypochlorite, however, the recolonization of microorganisms in root canals of groups of solution silver nanoparticles was smaller than the number of confirmation sample (p <0.05),showing residual effect...

Antimicrobial effect of intracanal substances

In some situations, endodontic infections do not respond to therapeutic protocol. In these cases, it is suggested the administration of an alternative intracanal medication that presents a wide spectrum of action and has an in-depth effect on the root canal system. The purpose of this study was to assess the antimicrobial action of ciprofloxacin, metronidazole and polyethylene glycol and natrosol vehicles with different associations and concentrations. The minimum inhibitory concentration (MIC) was determined by using the agar dilution method. The culture media (Müller-Hinton agar) were prepared containing antimicrobial agents at multiple two-fold dilutions of 0.25 to 16 µg/mL, and with the vehicles at the concentrations of 50, 45, 40, 35, 30 and 25 percent. Twenty-three microbial strains were selected for the study. Metronidazole was not capable of eliminating any of the tested microorganisms. The association of ciprofloxacin with metronidazole resulted in a reduction of the MIC. The vehicle polyethylene glycol inhibited the growth of 100 percent of the tested strains, while natrosol inhibited 18 percent of the strains. Ciprofloxacin formulations with polyethylene glycol presented better effects than those of formulations to which metronidazole was added. It was possible to conclude that ciprofloxacin presented antimicrobial action against all tested bacterial strains, and its association with metronidazole was synergic. The vehicle polyethylene glycol showed antimicrobial effect and the ciprofloxacin/polyethylene glycol association was the most effective combination for reducing the tested bacteria and yeasts.