Effect of different puncture needle models on the risk of bleeding after renal puncture / 重庆医学

Objective To study the effect of different types of renal puncture needles on the risk of bleeding after renal puncture.Methods A retrospective analysis was performed on 428 patients who under-went renal biopsy in the Third Affiliated Hospital of Chongqing Medical University and Jiulongpo District People's Hospital of Chongqing from January 2020 to December 2022.Different types of puncture needles were used to compare the occurrence of postoperative bleeding complications(hematoma,hematuria).Results The incidence of bleeding complications after renal puncture in 428 patients was 21.0％(90/428),of which the incidence of hematoma was 18.9％(81/428),the incidence of hematuria was 2.1％(9/428),the median decrease in hemoglobin(Hb)was 5 g/L,and the incidence of serious complications such as blood transfusion and interventional therapy was 0.7％(4/428).The patients with different types of renal puncture needles were grouped(16G group,18G group).There was no significant difference in baseline data and distri-bution of renal pathological types between the two groups(P＞0.05).The incidence of postoperative bleeding in 16G group and 18G group was 22.4％(52/232)and 19.4％(38/196),respectively.The incidence of hema-toma was 20.6％(48/232)and 16.8％(33/196),respectively.The incidence of hematuria was 1.7％(4/232)and 2.6％(5/196),respectively.The decrease of Hb was 6(0,16)g/L and 4(0,17)g/L,respectively.There was no significant difference(P＞0.05).There was no significant difference in the incidence of serious compli-cations such as blood transfusion,interventional therapy and Hb decrease＞10 g/L between the two groups(P＞0.05).Conclusion Ultrasound-guided renal biopsy is safe and has a low incidence of serious complica-tions.There was no significant relationship between different puncture needle types and postoperative bleeding risk.

Effects of ultrasound guided pericapsular nerve group combined with lateral femoral cutaneous nerve block on analgesia,stress response and postoperative cognitive function in patients undergoing hip replacement / 临床外科杂志

Objective To investigate the effect of ultrasound guided block of pericapsular nerve(PENG)combined with lateral femoral cutaneous nerve(LFCN)on analgesia,stress response and postoperative cognitive function in patients undergoing hip replacement.Methods 102 patients who underwent hip Joint replacement in our hospital from September 2020 to September 2022 were selected and randomly divided into control group(51 cases)and study group(51 cases).The control group was given ultrasound guided iliac fascia space block(FICB),and the study group was given ultrasound guided PENG combined with LFCN block.The perioperative related indicators,postoperative analgesia effect,stress response indicators and postoperative cognitive function of the two groups were compared.Results There was no statistically significant difference in the comparison of surgical time between the two groups(P＞0.05).The amount of sufentanil used and the number of analgesic pump used within 48 hours after surgery in the study group were significantly lower than those in the control group(P＜0.05).The first postoperative time of getting out of bed and hospitalization in the study group were significantly shorter than those in the control group(P＜0.05).There was no statistically significant difference in VAS scores between the two groups at 6 h,12 h,24 h,and 48 h after surgery(P＞0.05).The VAS scores of the study group were significantly lower than those of the control group at 6 h,12 h,and 24 h after surgery(P＜0.05).The heart rate(HR)and Mean arterial pressure(MAP)of the control group were higher at the time of block(T1),30 min of block(T1)(T2),and the end of block(T3)than at the time of entry(T0)(P＜0.05).HR and MAP of the study group were significantly lower than those of the control group(P＜0.05).The MMSE scores of the two groups at 6 h,12 h,24 h,and 48 h after surgery were lower than those before surgery(P＜0.05),but the MMSE scores of the study group were significantly higher than those of the control group(P＜0.05).Conclusion Using ultrasound guided PENG combined with LFCN block for patients undergoing hip Joint replacement can more effectively reduce the amount of opioids and the number of use of analgesia pump,reduce postoperative pain in the exercise state,reduce stress reaction,and have less impact on cognitive function,so as to promote faster recovery of patients.

Application research of ultrasound oblique axis plane guidance technique in PICC puncture / 中华护理杂志

Objective To explore the application efficacy and safety of oblique ultrasound-guided techniques in PICC puncture,in order to provide guidance and references for clinical application.Methods Through convenient sampling,654 patients from a tertiary A hospital in Zhejiang Province from March to December 2022 were selected as the study subjects.The random numbers were generated through Excel table functions and they were randomly grouped into 3 groups:A,B,and C.The ultrasound short axis method,long axis method,and oblique axis method were employed to guide PICC puncture catheterization,respectively.The success rate of PICC puncture,the number of subcutaneous adjustments of the puncture needle,puncture time,and the occurrence of puncture complications(such as hematoma,puncture of the posterior wall of blood vessels,accidental injury to arteries,and accidental injury to nerves)were recorded during the catheterization process in 3 groups.Results A total of 654 patients completed the study,including 215 in group A,219 in group B,and 220 in group C.The success rate of first-time puncture in the group C(86.36％)was higher than that in group A(73.95％)and group B(63.93％),and there was a statistically significant difference among 3 groups(P＜0.001).The subcutaneous adjustment frequency of the puncture needle was 1(1,1)in group C,1(1,2)in group A,and 1(1,2)in group B.The difference between 3 groups was statistically significant(P＜0.001);the puncture time of group C was shorter than that of group A and group B,and the difference was statistically significant(P＜0.001).There was a statistically significant difference in the puncture time between 3 groups(P＜0.017);the pairwise comparison of the number of subcutaneous needle adjustments and the success rate of a puncture between 3 groups showed that there was a statistical difference between group C and group A,and between group C and group B(P＜0.017),while there was no statistical difference between group A and group B(P＞0.017).There was statistical significance(P＜0.05)among 3 groups in terms of complications such as accidental nerve injury and puncture of the contralateral vascular wall by puncture needle,but there was no statistical significance in terms of accidental arterial injury and hematoma occurrence among 3 groups.Conclusion Compared with the short axis approach and the long axis approach,the ultrasound oblique axis approach guided PICC puncture has statistical differences in the success rate of a puncture and the incidence of puncture complications,etc.It is recommended to use the ultrasound oblique axis approach during PICC puncture.

Application and research progress of ultrasound in acupuncture treatment / 中国针灸

The operation standardization, quantitative standard and safety of acupuncture treatment are important links in the development of acupuncture modernization. In recent years, with the continuous development of ultrasonic imaging technology, ultrasonic medicine has the characteristics of visualization, quantitative analysis and real-time dynamics, which could play a unique role in acupuncture treatment. In this paper, the research progress of the combined application of ultrasonic medicine and acupuncture treatment is described from three aspects: ultrasound guidance helping to standardize acupuncture operation, ultrasound guidance helping to improve and evaluate the clinical efficacy of acupuncture, and ultrasound guidance helping to improve the safety of acupuncture, aiming to providing new ideas for the application of modern medicine in traditional medicine.

Efficacy of ultrasound-guided sclerotherapy combined with radiofrequency ablation on the treatment of complex lymphatic malformations in children / 中华实用儿科临床杂志

Objective:To investigate the safety and efficacy of ultrasound-guided sclerotherapy combined with radiofrequency ablation on the complex lymphatic malformations (LM) in children.Methods:The clinical data of 21 children with complex LM treated with ultrasound-guided sclerotherapy combined with radiofrequency ablation in the First Affiliated Hospital of Zhengzhou University from June 2018 to October 2021 were retrospectively analyzed.Intraoperative and postoperative complications were recorded.Imaging examinations were performed at 1, 3, 6, 9, 12, 18, 24 months postoperatively to observe the recurrence, the volume of the lesions and their reduction rate were calculated, and the efficacy was analyzed. Friedman test was used to compare the lesion volume at different time points before and after surgery, and the reduction rate of lesion volume at 1 month postoperatively and other time points after surgery. Results:A total of 21 children were included in this study, among them, there were 12 males and 9 females, age range from 1 month to 5 years and 6 months, with a median age of 23 months.A total of 26 LM in 21 children were successfully treated, and no serious complications like organ damage occurred during and after surgery.One patient with abdominal LM had a postoperative infection, which was controlled by 3 weeks of catheter drainage.Four LM in 3 children recurred at 3 or 6 months after surgery, while all lesions were significantly narrowed down than those before surgery and they were cured after 1-3 sessions of continued sclerotherapy.There were significant differences in the lesion volumes before surgery and 1, 3, 6, 9, 12, 18 and 24 months postoperatively [222.26(159.57, 316.40) cm 3vs.43.06(22.74, 62.53) cm 3, 31.56(15.49, 45.94) cm 3, 25.21(9.63, 36.22) cm 3, 19.80(6.79, 28.81) cm 3, 12.80(3.93, 20.38) cm 3, 7.13(0, 11.34) cm 3, and 2.79(0, 4.93) cm 3; all P<0.05]. There were significant differences between the volume reduction rates at 1 month postoperatively and 3, 6, 9, 12, 18, and 24 months postoperatively [79.36(73.30, 87.81)% vs.85.40(81.09, 91.61)%, 88.85(84.70, 93.61)%, 91.67(87.87, 95.05)%, 94.15(94.47, 97.35)%, 97.11(95.02, 100.00)%, and 99.04(97.93, 100.00)%; all P<0.05]. Patients were followed up for 24 months, and all of them were cured. Conclusions:Ultrasound-guided sclerotherapy combined with radiofrequency ablation is a minimally invasive, safe and effective therapeutic strategy for children with complex LM.

The feasibility and safety of ultrasound-guided needle-perc assisted retrograde intrarenal surgery in the treatment of small but complex renal calculi / 中华泌尿外科杂志

Objective:To analyze the safety and efficacy of ultrasound-guided needle-perc assisted retrograde intrarenal surgery (RIRS) in the treatment of small but complex renal calculi, and summarize our clinical experience.Methods:The clinical data of 36 patients with small but complicated renal stones treated by ultrasound-guided needle-perc assisted RIRS in Beijing Tsinghua Changgung Hospital from January 2020 to April 2022, were retrospectively analyzed. There were 25 males and 11 females. The average age was (54.7±6.1) years, and the body mass index (BMI) was (26.3±3.1) kg/m 2. The maximum diameter of the calculi was (1.8±0.7) cm. There were 28 patients without renal hydronephrosis before operation, 8 patients with mild to moderate renal hydronephrosis, 4 patients with caliceal diverticular stones, 32 patients with lower pole stones, 10 patients with ureteral stones, 6 patients with previous surgical history of ipsilateral kidney stones, and 3 patients with stones in the solitary kidneys. Patients were placed in oblique supine lithotomy position or prone split leg position (female). For lower pole stones or diverticular stones that were difficult to be handled by flexible ureteroscope, the needle-perc was used to puncture the stones in target calyx under ultrasound guidance. Holmium laser was then used to pulverize or fragment the calculi, and the flexible ureteroscope was used to remove or further pulverize the stone fragments. Perioperative indexes and postoperative complications were recorded, and stone-free rate was analyzed. Results:All 36 cases were successfully operated. The median operation time was 61.5(59.0, 66.8)min, with a median decrease in hemoglobin on the first postoperative day of 1.6(0.8, 2.0)g/ L, a median postoperative hospital stay of 1.5(1.0, 2.0)days, and a median needle-perc tract of 1(1, 2). The complications were recorded in 4 patients (11.1%), all of which were Clavien-Dindo grade I, including postoperative fever in 2 patients and analgesic use in 2 patients. The primary stone-free rate was 83.3% (30/36). The 6 patients with residual stones were treated by external physical vibration lithecbole on the 3rd to 7th day after surgery. After 1 month follow-up, residual stone expulsion were seen in 3 patients. Three patients with residual stones were followed up regularly. The final stone-free rate was 91.7% (33/36).Conclusions:Ultrasound-guided needle-per assisted RIRS is safe and effective in the treatment of small but complex renal calculi, with high postoperative stone free rate and low complication rate.

Comparison of the anesthetic effect of remazolam and dexmedetomidine in ultrasound-guided brachial plexus block for replantation of severed finger / 实用医学杂志

Objective To compare the anesthetic effects of remazolam and dexmedetomidine assisted sedation in the operation of finger replantation under ultrasound guided brachial plexus block.Methods 60 patients undergoing severed finger replantation were randomly divided into remazolam group(group R)and a dexmedetomidine group(group D)by random number table method,with 30 cases in each group.Both groups received a single brachial plexus block under ultrasound guidance.Group R was injected with remazolam 0.1 mg/kg,followed by 1 mg/(kg·h)pump until 10 min before the end of the operation.In group D,a load dose of 0.5 μg/kg of dexmedetomidine was injected,followed by continuous infusion at a rate of 0.5 μg/(kg·h)until 10 min before the end of surgery.The MAP,HR and SpO2 values of the two groups were compared when the patients entered the room(T0),the wound was cleaned and disinfected(T1);the tourniquet was upper(T2);the operation began(T3);the tourniquet was relaxed(T4);and the operation ended(T5).MOAA/S scores and BIS values were compared between the two groups at different time.The time from the beginning of medication to the absence of consciousness and the time of consciousness recovery after drug withdrawal were compared between the two groups.Blood lactic acid(Lac)before applying tourniquet and 15 min after relaxing tourniquet were compared between the two groups.The occurrence of intraoperative adverse reactions was recorded in the two groups.Results The MAP of patients in group R had little fluctuation at each time during the operation,and the MAP of patients in group D was significantly increased at T1,T2,T3 and T0 moments and at the same time as that in group R(P<0.05);HR in group R was stable at all times,and HR in group D significantly slowed down at T1,T2 and at the same time with group R(P<0.05).Patients in both groups achieved ideal sedation during the operation(MOAA/S score≤3 points),and the MOAA/S score of patients in group R at T5 minutes after drug withdrawal was higher than that at other moments of the same group and group D(P<0.05);the BIS value of group R was higher than that of group D(P<0.05).The loss time and recovery time of consciousness in group R were shorter than those in group D(P<0.05).The incidence of intraoperative hypertension and bradycardia in group D was significantly higher than that in group R,and the incidence of respiratory depression in group R was higher than that in group D(P<0.05).There was no significant change in lactate value between the two groups(P>0.05).Conclusion Remazolam and dexmedetomidine can satisfy sedation in brachial plexus nerve block for replantation of severed finger under ultrasound guidanc.Compared with dexmedetomidine,remazolam has better sedation control,stable hemodynamics,low incidence of circulatory adverse events.

Application efficacy of ultrasound-guided dorsal scapular nerve block in treating postoperative pain after shoulder arthroscopic surgery / 中国医学装备

Objective:To explore the application efficacy of ultrasound-guided dorsal scapular nerve block in treating postoperative pain after shoulder arthroscopic surgery.Methods:A total of 60 patients underwent shoulder arthroscopic surgery who admitted to hospital were selected,and all patients were divided into dorsal scapular nerve block group,intermuscular groove brachial plexus block group and oral analgesic therapy group according to the treatment methods for postoperative pain,with 20 cases in each group.The visual analogue score(VAS)of pain,the number of effective compressing analgesic pump within 24 hours after surgery and the number of cases of using pethidine to remedy analgesia,the degree of numbness in the affected limb at the time of leaving the anesthesia recovery room and 6 hours after surgery,adverse reactions after anesthesia resuscitation,and satisfaction of patient were compared among the three groups.Results:The differences of VAS scores of three groups at the time of extubation,the 3rd h,6th h,12th h and 24th h after surgery between resting state and action state were not significant(tat the time of extubation=1.04,t=1.11,t3rd h=0.97,t=1.03,t6th h=0.86,t=0.93,t12th h=1.01,t=0.81,t24th h=1.17,t=1.01,P>0.05),respectively.Within postoperative 24h,there were not significant differences between the number of effective compressing analgesic pump and the rate of remedy analgesia in dorsal scapular nerve block group(x2=1.347,x2=1.556,P>0.05),respectively.The degree of numbness in the affected limb at the time of leaving the anesthesia recovery room and the 6th hours after surgery in dorsal scapular nerve block group was significantly better than that in intermuscular groove brachial plexus block group and oral analgesic therapy group(x2=5.316,x2=5.452,P<0.05),respectively.The rate of upper limb numbness and weakness and the rate of difficulty breathing at 1st d after surgery in dorsal scapular nerve block group was significantly better than that in intermuscular groove brachial plexus block group and oral analgesic therapy group(x2=7.631,x2=6.973,P<0.05),respectively.The probability of the satisfaction of patients for postoperative analgesic effect in dorsal scapular nerve block group was significantly better than that in intermuscular groove brachial plexus block group and oral analgesic therapy group(x2=6.592,x2=6.638,P<0.05),respectively.Conclusion:Ultrasound-guided dorsal scapular nerve block has favorable analgesic effect after surgery,which can improve the degree of the numbness of the affected limb and the adverse reactions after anesthesia resuscitation for patients.It is a safe and effective treatment method for pain.

Comparative study on the curative effect of ultrasound-guided radiofrequency ablation and surgical excision in the treatment of salivary gland mixed tumor / 中华超声影像学杂志

Objective:To compare the therapeutic effects of ultrasound-guided radiofrequency ablation (RFA) and surgical resection on salivary gland mixed tumor with diameter ≤3 cm, and to analyze the feasibility and clinical value of RFA in the treatment of salivary gland mixed tumor.Methods:A retrospective study was conducted on 43 patients with salivary gland mixed tumor whose diameter ≤3 cm were treated in the First Affiliated Hospital of Zhengzhou University from March 2020 to March 2022.According to the treatment method, they were divided into an ablation group of 20 cases and a resection group of 23 cases. The complete ablation rate of the ablation group was evaluated, the postoperative absorption of ablation foci in the ablation group was recorded, and the perioperative indexes and the incidence of postoperative complications of the two groups were compared. The long-term prognosis of the two groups was followed up, and the incidence of recurrence, malignant metastasis and appearance recovery were evaluated.Results:In the ablation group, the complete ablation rate was 100.00% (20/20). The lesion volume reduction rates at 1, 3, 6 and 12 months after operation were -(39.60±16.18)%, (8.61±8.10)%, (31.87±14.68)% and (58.64±14.82)%, respectively. The operation time, recovery feeding time, postoperative hospital stay and intraoperative bleeding in the ablation group were less than those in the resection group, and the differences were statistically significant (all P<0.001). Postoperative complications occurred in 2 cases in the ablation group and 9 cases in the resection group. There was significant difference in the total incidence of postoperative complications between the two groups(χ 2=4.768, P=0.029). There was 1 case of recurrence in the ablation group, and no facial depression or protuberance occurred 1 year after operation. There was no recurrence in the resection group, one year after operation, the incidence of facial depression and facial protuberance was 13.04%(3/23) and 0, respectively.There was no malignant metastasis in both groups. Conclusions:Ultrasound-guided RFA is safe and effective in the treatment of mixed tumors of salivary gland with diameter ≤3 cm, and the therapeutic effect is not significantly different from that of surgery. With minimal trauma and good cosmetic effect, it has a great application prospect.

Application of ultrasound-guided central venous catheterization at various sites in infants with shock / 中国当代儿科杂志

OBJECTIVES@#To study the clinical characteristics of ultrasound-guided central venous catheterization at various sites in infants with shock, and to explore how to quickly select the site for central venous puncture in infants with shock.@*METHODS@#The medical data of 112 infants who were diagnosed with shock and underwent central venous catheterization in the Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, from January 2016 to December 2020 were reviewed retrospectively. The patients were divided into an ultrasound group (n=70) and a body surface location group (n=42) according to whether the catheterization was carried out under ultrasound guidance. The application of ultrasound-guided catheterization at various sites in infants was summarized and analyzed, and the success rate of one-time puncture, overall success rate, catheterization time, and complications were compared between these sites.@*RESULTS@#Compared with the body surface location group, the ultrasound group had a significantly higher success rate of one-time puncture, a significantly shorter catheterization time, and a significantly reduced incidence rate of complications in internal jugular vein and femoral vein catheterizations (P<0.05). In the ultrasound group, the proportion of internal jugular vein catheterization was the highest (51%, 36/70), followed by femoral vein catheterization (33%, 23/70), and subclavian vein catheterization (16%, 11/70). For the comparison between different puncture sites under ultrasound guidance, internal jugular vein catheterization showed the shortest time of a successful catheterization [5.5 (5.0, 6.5) minutes] (P<0.05). There was no significant difference in the incidence rate of complications among the different puncture sites groups (P>0.05).@*CONCLUSIONS@#In infants with shock, ultrasound-guided internal jugular vein catheterization can be used as the preferred catheterization method for clinicians.

Efficacy analysis of ultrasound-guided percutaneous radiofrequency ablation in the treatment of nonmetastatic pheochromocytoma / 中华超声影像学杂志

Objective:To investigate the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation in the treatment of nonmetastatic pheochromocytoma.Methods:A retrospective analysis was performed on 7 patients with nonmetastatic pheochromocytoma admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2020, all of whom underwent ultrasound-guided percutaneous radiofrequency ablation. The changes of postoperative blood pressure, improvement of symptoms, intraoperative and postoperative complications were observed.Plasma free methoxypinephrine (MN) and normetanephrine (NMN) levels were recorded before and 2 weeks after operation. The reduction rate of ablation lesion volume at 1, 3 and 6 months after operation was calculated.Results:Postoperative blood pressure of all 7 patients was reduced to the normal range within 3 days, and symptoms such as headache were significantly relieved immediately after operation.No serious complications occurred during or after operation. Plasma free MN and NMN levels decreased to normal levels 2 weeks after operation. The mean reduction rates of the ablation lesions at 1, 3 and 6 months after operation were (46.61±13.42)%, (67.21±10.54)% and (85.73±4.15)%, respectively. Postoperative follow-up of 12-30 months showed that the blood pressure, plasma free MN and NMN levels of the patients were all in the normal range, and no symptoms such as headache and palpitation occurred again. All the tumors were completely ablated, and no recurrence was observed.Conclusions:Ultrasound-guided percutaneous radiofrequency ablation in the treatment of nonmetastatic pheochromocytoma is minimally invasive, safe and effective, and can retain adrenal cortex function, which is worthy of clinical promotion.

Ultrasound-guided transgluteal puncture and catheter drainage in the treatment of deep pelvic abscess with pelvic adhesion / 中华超声影像学杂志

Objective:To investigate the safety and efficacy of transgluteal ultrasound-guided puncture and drainage in prone position in the treatment of deep pelvic abscess with pelvic adhesion.Methods:A total of 24 cases of deep pelvic abscess with pelvic adhesion treated in the ultrasound intervention room of the First Affiliated Hospital of Zhengzhou University from October 2018 to May 2021 were selected.Ultrasound-guided puncture and drainage were performed through the buttocks. The operation time, blood loss and distal limb pain during the operation were recorded. The decreasing trend of body temperature, the white blood cell, C-reactive protein and abscess size were observed. The incidence of complications such as bleeding, pain, infection and intestinal injury were counted.Results:There were 28 abscesses in 24 patients were successfully intubated through the buttocks, the abscesses disappeared after drainage, and there were no serious complications after operation. During the follow-up of 3-22 months, there was no abscess recurrence and no long-term complications.Conclusions:Ultrasound-guided transgluteal puncture and drainage is safe and effective in the treatment of deep pelvic abscess with pelvic adhesion.

Preferred display size and visual distance for ultrasound-guided radial artery cannulation / Tamaño preferido de la imagen en pantalla y distancia visual para la canalización de la arteria radial guiada por ecografía

Abstract Introduction: In-line positioning of an ultrasound image provides higher success rates and less time to completion for radial arterial cannulation. But preferable size and distance of ultrasound display has not been previously discussed. Objective: To assess the ideal visual distance and display size when using a smart phone or tablet as the ultrasound image display. Methods: Four smart phones or tablets were used as ultrasound displays in six different configurations in a simulated radial artery puncture. In a questionnaire, 116 anaesthesiologists working in Ibaraki Prefecture, Japan, were asked which of the six configurations was preferable for radial artery cannulation. Results: Sixty anaesthesiologists answered the questionnaire. About half (53%) preferred the smaller display (4- or 5.5-inch) fixed at a distance of 30 to 40 cm, and most of the rest (44%) preferred the larger display (7.9- or 9.7-inch) placed posterior to the probe with a visual distance of 45 to 60 cm. Conclusions: Among the anaesthesiologists, the preferable size and visual distance for ultrasound-guided radial artery cannulation varied using a smart phone or tablet for in-line display.

Resumen Introducción: El posicionamiento en línea con una imagen ecográfica permite mayores tasas de éxito y reduce el tiempo para realizar la canalización de la arteria radial. Sin embargo, no se ha hablado sobre cuál es el tamaño y la distancia preferibles para la imagen en pantalla. Objetivo: Evaluar la distancia visual y el tamaño de la imagen en pantalla cuando se utiliza un teléfono inteligente o una tableta para visualizar la imagen ecográfica. Métodos: Se utilizaron cuatro teléfonos inteligentes o tabletas como pantalla para visualizar las imágenes ecográficas en seis configuraciones distintas, en una simulación de la canalización de la arteria radial. Mediante un cuestionario se preguntó a 116 anestesiólogos que trabajan para la Prefectura de Ibaraki, Japón, cuál de las seis configuraciones era preferible para la canalización de la arteria radial. Resultados: Sesenta anestesiólogos respondieron el cuestionario. Aproximadamente la mitad (53%) prefirieron la imagen más pequeña (4 o 5,5 pulgadas), fija a una distancia de 30 a 40 cm, y la mayoría de los otros (44%) prefirieron la imagen más grande (7,9- o 9,7 pulgadas), colocada en la parte posterior al transductor, con una distancia visual de 45 a 60 cm. Conclusiones: Entre los anestesiólogos, el tamaño preferido y la distancia visual para la canalización de la arteria radial guiada por ecografía, varió utilizando un teléfono inteligente o una tableta para su visualización en línea.

Hidrodisección guiada por ultrasonido para el tratamiento de pacientes con sindrome del tunel carpiano / Ultrasound-Guided hydrodissection for treatment of Patients with Carpal Tunnel Syndrome

El estudio tuvo como objetivo comparar el grupo de hidrodisección de solución salina normal guiada por ultrasonido más esteroides y el grupo de hidrodisección de solución salina normal guiada por ultrasonido sola en pacientes con síndrome del túnel carpiano (STC), y determinar su relevancia clínica en relación con los resultados del tratamiento. Realizamos 60 hidrodisecciones guiadas por ecografía con solución salina normal con y sin inyecciones de corticosteroides en 51 pacientes con STC y evaluamos los resultados de la ecografía antes y después 21. Evers S, Thoreson AR, Smith J, Zhao C, Geske JR, Amadio PC. Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel. Muscle Nerve 2017 June 16. doi: 10.1002/mus.25723. 22. Smith J, Wisniewski S, J, Finnoff JT, Payne JM. Sonographically Guided Carpal Tunnel Injections. J Ultrasound Med 2008;27:1485-1490. 23. Trescott AME. Peripheral Nerve Entrapments: Clinical Diagnosis and Management. 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Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR, Jr., et al. The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: Ameta-analysis of evidence level 1 studies. The American journal of sports medicine 2017;45:2647-2653. 30. Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology. 2001;56(11):1459­ 66 31. Ortiz-Corredor F, Enriquez F, Diaz-Ruiz J, Calambas N. Natural evolution of carpal tunnel syndrome in untreated patients. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 2008;119:1373-1378 32. Gordon T, Brushart TM, Chan KM. Augmenting nerve regeneration with electrical stimulation. Neurol Res 2008; 30:1012- 1022. 33. Aulisa L, Tamburrelli F, Padua R, Romanini E, Lo Monaco M, Padua L. Carpal tunnel syndrome: Indication for surgical treatment based on electrophysiologic study. J Hand Surg Am 1998; 23:687-691. 34. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom- de Jong B. Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC Fam Pract. 2010;11:54. 35. Girlanda P, Dattola R, Venuto C, Mangiapane R, Nicolosi C, Messina C. Local steroid treatment in idiopathic carpal tunnel syndrome: short- and longterm efficacy. J Neurol. 1993; 240(3):187- 190. 36. Karadas¸ Ö, Tok F, Ulas¸ UH, Odabas¸i Z. The effectiveness of triamcinolone acetonide vs. procaine hydrochloride injection in the management of carpal tunnel syndrome: a double blind randomized clinical trial. Am J Phys Med Rehabil. 2011; 90(4):287-292. 128 LA PRENSA MÉDICA ARGENTINA Ultrasound-Guided hydrodissection for treatment of Patients with Carpal Tunnel Syndrome V.107/Nº 2 de la inyección. Clasificamos estas inyecciones en dos grupos según la solución salina normal más corticosteroide (grupo de esteroides). solución salina normal (grupo de control) y también registramos datos clínicos que incluyen el sexo, la edad, el lado de la inyección, el peso corporal y la duración de las molestias relacionadas con el STC antes de la inyección. Los resultados se midieron mediante la escala analógica visual que se asignó para evaluar el resultado primario. Los resultados secundarios se evaluaron mediante el cuestionario del síndrome del túnel carpiano de Boston, el área transversal del nervio mediano y estudios electrofisiológicos. La evaluación se realizó antes de la inyección y 1, 3 y 6 meses después de la inyección, y se comparó el alivio de los síntomas de los pacientes que recibieron la inyección de solución salina normal y de esteroides. Comparamos las hidrodisecciones con la solución salina normal y las inyecciones de corticosteroides; los datos clínicos, la preinyección de CSA-MN en la entrada del túnel carpiano y las puntuaciones de BCTQ antes de la inyección no mostraron diferencias significativas entre los grupos (p> 0,05). Todos los pacientes (datos de 30 muñecas en cada grupo) completaron el estudio. En comparación con el grupo de control, en todos los momentos posteriores a la inyección, ambos grupos tuvieron una reducción significativa del dolor y la discapacidad, una mejoría en las medidas de respuesta electrofisiológica y una disminución del área transversal del nervio mediano. Nuestro estudio revela que la solución salina normal guiada por ecografía con y sin hidrodisección de corticosteroides tiene un efecto terapéutico en los pacientes con STC. Se demostró que la hidrodisección nerviosa es potencialmente beneficiosa para los pacientes con STC antes de la cirugía. La hidrodisección es un procedimiento simple y mínimamente invasivo que se puede realizar utilizando únicamente NS. Además, en comparación con la inyección a ciegas, la hidrodisección bajo guía ecográfica puede reducir las posibilidades de lesión nerviosa.

The study aimed to compare Ultrasound-Guided Normal saline plus steroid hydrodissection group and Ultrasound-Guided normal saline alone hydrodissection group in patients with carpal tunnel syndrome (CTS), and to determine their clinical relevance in relation to treatment outcomes. We performed 60 US-guided hydrodissections Normal saline with and without corticosteroid injections in 51 patients with CTS and evaluated their pre- and post-injection US findings. We categorized these injections into two groups based on the normal saline plus corticosteroid (steroid group). normal saline (control group) and we also recorded clinical data including gender, age, side of injection, BW, and the duration of pre-injection CTS related discomfort. The outcomes were measured using the visual analog scale was assigned to assess the primary outcome. The secondary outcomes were assessed using the Boston Carpal Tunnel Syndrome Questionnaire, cross-sectional area of the median nerve, and electrophysiological studies. The assessment was performed prior to injection, and 1, 3, and 6 months' post-injection, and the symptom relief for the patients receiving normal saline and steroid injection were compared. We compared hydrodissections with normal saline and corticosteroid injections the clinical data, pre injection CSA-MN at the inlet of the carpal tunnel, and pre-injection BCTQ scores showed no significant intergroup differences (p > 0.05). All patients (data from 30 wrists in each group) completed the study. Compared both the control group, at all post-injection time points, both groups had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve. Our study reveals that ultrasound-guided Normal saline with and without corticosteroid hydrodissection has therapeutic effect in patients CTS. Nerve hydrodissection was shown to be potentially beneficial for CTS patients' pre-surgery. Hydrodissection is a simple, minimally invasive procedure that can be performed using only NS. In addition, compared to blind injection, hydrodissection under ultrasound guidance can lower the chances of nerve injury.

Ultrasound-guided two-point block of transverse abdominal muscle plane in high-risk elderly patients undergoing inguinal hernia repair / 中华普通外科杂志

Objective:To investigate the effect of ultrasound-guided transversus abdominis plane (TAP) block combined with iliohypogastric/ilioinguinal TAP block in high-risk elderly patients undergoing inguinal hernia repair.Methods:Sixty male patients undergoing elective inguinal hernia repair, aged ≥70 years, BMI 18-23 kg/m 2, ASAⅢ-Ⅳ grade, were randomly divided into two groups: ultrasound-guided lateral TAP block combined with iliohypogastric/ilioinguinal TAP block group (combined group) and lateral TAP block group (lateral group), with 30 cases in each group. In the combined group, the injection concentration of 0.375% ropivacaine 20 ml was at the iliohypogastric/ilioinguinal TAP puncture site and the lateral TAP puncture site was also 20 ml, and the lateral group only injected 0.375% 20 ml at the lateral TAP puncture site. The Visual Analogue Scale (VAS) of the two groups were compared at surgical skin incision (T 1), opening of external oblique aponeurosis (T 2), free hernia sac (T 3), separation of preperitoneal space and patch placement (T 4), suture of transverse abdominal fascia (T 5), suture of external oblique abdominal aponeurosis (T 6) and skin incision are closed (T 7); The VAS were compared during rest and activity at 2, 4, 6, 8, 12 and 24 hours after surgery. The cumulative consumption of relief analgesics was compared. Results:Compared with the lateral group, the VAS of the combined group during T 3-T 5 was significantly lower ( P<0.05). The VAS score at 4, 6 and 8 hours after operation in the combined group was also significantly lower ( P<0.05). There was no statistical significance in VAS score at rest between the two groups 24 h after operation ( P>0.05). The cumulative consumption of relief analgesics in the combined group was lower ( P<0.05). The difference of adverse events between the two groups was not statistically significant ( P>0.05). Conclusion:In high-risk elderly patients, ultrasound-guided transverse abdominal muscle plane two-point block can be used as a safe alternative method of intraoperative analgesia.

Recent advance in ultrasound-guided fascial space block in analgesia in patients after cesarean section / 中华神经医学杂志

With the development of ultrasound technology, the needle position and local anesthetic diffusion can be observed in real time, and therefore, the accuracy and success rate of nerve block have been significantly improved. Ultrasound-guided fascial space block, such as transversus abdominis plane block and quadratus psoas block, has been widely used in postoperative analgesia in delivery woman. This paper reviews the application of ultrasound-guided fascial space block in postoperative analgesia of cesarean section in recent years, in order to provide reference for further clinical application.

Clinical application of percutaneous ultrasonography-guided gallbladder polyp biopsy and radiofrequency ablation: a primary study / 中华超声影像学杂志

Objective:To analyze the feasibility and efficacy of ultrasound-guided percutaneous biopsy and radiofrequency ablation of gallbladder polyps.Methods:From April 2019 to January 2021, 25 patients with gallbladder polyps underwent ultrasound-guided biopsy and radiofrequency ablation in the ultrasound department of the First Affiliated Hospital of Zhengzhou University were collected, the maximum diameter of the lesion was 11.00(10.00, 12.50)mm. Under general anesthesia, ultrasound-guided injection of water into the gallbladder serosa layer was performed to make the gallbladder edema thicker than or equal to 10 mm. Percutaneous biopsy and radiofrequency ablation of gallbladder polyps were performed to ablate the gallbladder mucosa layer of polyps and polyp attachment.Intraoperative contrast-enhanced ultrasound was used to evaluate the need for supplementary ablation.The operation time, intraoperative and postoperative conditions were recorded. The complete ablation rate of gallbladder polyps, the reduction rate of lesion volume after ablation, the incidence of complications and the effect of operation on gallbladder wall thickness and gallbladder contraction rate were evaluated.Results:Biopsy and radiofrequency ablation of gallbladder polyps were successfully performed in 25 patients.There were 14 cases of cholesterol polyp, 5 cases of adenoma, 5 cases of inflammatory polyp and 1 case of gallbladder adenomyosis. Twenty-nine gallbladder polyps showed changes after ablation, and the lesion volume was reduced to varying degrees. In the first, third and sixth months, the volume reduction rates of ablation focus were 70.74%(58.55%, 77.56%), 89.47%(85.04%, 96.87%) and 100%(95.68%, 100%) respectively, and the differences were statistically significant ( P<0.05). There were no significant differences in gallbladder wall thickness and gallbladder contraction rate before and 1 month after operation ( P>0.05). The operation time was 14-39(23.32±6.68)min. During the operation, 3 patients(12.0%) had a decrease in heart rate, 2 patients(8.0%) had mild abdominal pain and 1 patient(4.0%) had obvious abdominal pain, which was relieved after treatment. No bleeding, gallbladder perforation, abdominal infection and other complications occurred. All patients were followed up for 1 to 22 months, with a median of 6 (3, 7) months. No patients were lost or follow-up, polyp recurrence, or new polyps, or secondary gallstone. Conclusions:Ultrasound-guided biopsy and radiofrequency ablation of gallbladder polyps is a feasible choice for gallbladder preserving treatment of gallbladder polyps with low complication rate.

The safety and efficacy of ultrasound guided combined needle-perc and standard percutaneous nephrolithotomy in the treatment of staghorn stone / 中华泌尿外科杂志

Objective To summarize our preliminary clinical experience of ultrasound-guided needle-perc combined with standard percutaneous nephrolithotomy (PCNL) in the treatment of staghorn stones,and to analyze its safety and efficacy.Methods The clinical data of 65 patients with staghom stones treated by ultrasound-guided needle-perc combined with standard PCNL under general anesthesia with the patient in prone position from December 2017 to June 2019 were retrospectively reviewed.A total of 41 males and 24 females were included.The mean age was (53.5 + 8.9) years.The mean body mass index (BMI) was (25.1 ± 2.9) kg/m2,and the mean stone diameter was (10.9 ± 3.1) cm.Among them,there were 3 cases with bilateral staghorn stones,38 cases with complete staghorn calculi,36 cases with non-or mild preoperative hydronephrosis,12 cases with previous ipsilateral renal surgery,and 9 cases with solitary kidneys.Ultrasound-guided renal access and tract dilation were used to establish F24 standard channel.Pneumatic combined with ultrasonic lithotripsy with suction system was used to treat staghorn stones under nephroscope.Needle-perc consists of F4.2 needle-like metal sheath connected with a three-way tube.A 0.6 mm diameter video fiber,200 um holmium laser fiber and liquid perfusion device can be connected through the three-way tube respectively.The residual stone in the parallel calyx after standard PCNL were punctured by needle-perc under ultrasound guidance,and then the holmium laser fiber was used for lithotripsy.Results In this study,a total of 68 renal units were included.The median operative time was 79.8 minutes,ranging 45-129 minutes.The median decrease of hemoglobin on postoperative day 1 was 10.6 g/L,ranging 0-25.9 g/L.The median length of postoperative hospital stay was 5.5 days,ranging 4-7 days and the median time of tract establishment was 4.8 minutes,ranging 2.5-9.6 minutes.The median number of standard tract established was 1.5,ranging 1-3 and the median number of needle-perc punctured was 1.0,ranging 1-3.The total complication rate was 10.3％ (7 cases),including 5 cases of Clavien grade I,2 cases of postoperative fever,3 cases of analgesic use.There were 2 cases of Clavien grade II.All of them were blood transfusion.The initial stone free rate was 79.4％ (54/68).Of the 14 patients with residual stones,9 patients underwent second-stage operation,7 patients were stone free,and the final stone free rate was 89.7％ (61/68).Conclusions Ultrasound-guided needle-perc combined with standard PCNL is safe and effective in the treatment of staghorn stone.

The safety and efficacy of ultrasound guided combined needle-perc and standard percutaneous nephrolithotomy in the treatment of staghorn stone / 中华泌尿外科杂志

Objective@#To summarize our preliminary clinical experience of ultrasound-guided needle-perc combined with standard percutaneous nephrolithotomy (PCNL) in the treatment of staghorn stones, and to analyze its safety and efficacy.@*Methods@#The clinical data of 65 patients with staghorn stones treated by ultrasound-guided needle-perc combined with standard PCNL under general anesthesia with the patient in prone position from December 2017 to June 2019 were retrospectively reviewed. A total of 41 males and 24 females were included. The mean age was (53.5+ 8.9) years. The mean body mass index (BMI) was (25.1±2.9) kg/m2, and the mean stone diameter was (10.9±3.1) cm. Among them, there were 3 cases with bilateral staghorn stones, 38 cases with complete staghorn calculi, 36 cases with non- or mild preoperative hydronephrosis, 12 cases with previous ipsilateral renal surgery, and 9 cases with solitary kidneys. Ultrasound-guided renal access and tract dilation were used to establish F24 standard channel. Pneumatic combined with ultrasonic lithotripsy with suction system was used to treat staghorn stones under nephroscope. Needle-perc consists of F4.2 needle-like metal sheath connected with a three-way tube. A 0.6 mm diameter video fiber, 200 um holmium laser fiber and liquid perfusion device can be connected through the three-way tube respectively. The residual stone in the parallel calyx after standard PCNL were punctured by needle-perc under ultrasound guidance, and then the holmium laser fiber was used for lithotripsy.@*Results@#In this study, a total of 68 renal units were included. The median operative time was 79.8 minutes, ranging 45-129 minutes. The median decrease of hemoglobin on postoperative day 1 was 10.6 g/L, ranging 0-25.9 g/L. The median length of postoperative hospital stay was 5.5 days, ranging 4-7 days and the median time of tract establishment was 4.8 minutes, ranging 2.5-9.6 minutes. The median number of standard tract established was 1.5, ranging 1-3 and the median number of needle-perc punctured was 1.0, ranging 1-3. The total complication rate was 10.3% (7 cases), including 5 cases of Clavien grade Ⅰ, 2 cases of postoperative fever, 3 cases of analgesic use. There were 2 cases of Clavien grade Ⅱ. All of them were blood transfusion. The initial stone free rate was 79.4%(54/68). Of the 14 patients with residual stones, 9 patients underwent second-stage operation, 7 patients were stone free, and the final stone free rate was 89.7%(61/68).@*Conclusions@#Ultrasound-guided needle-perc combined with standard PCNL is safe and effective in the treatment of staghorn stone.

Comparison of postoperative pain between ultrasound-guided quadratus lumborum block versus ultrasound-guided caudal epidural block in children 1-6 years old undergoing unilateral lower abdominal and urological surgeries in Philippine Children's Medical Center: A randomized controlled trial

@#<p><strong>BACKGROUND:</strong> Ultrasound?guided quadratus lumborum block (QLB) is a regional anesthetic technique which can provide post-op pain control for pediatric patients undergoing abdominal surgery. We hypothesized that the quadratus lumborum block would be as efficacious as a caudal block in providing pain control.</p><p><strong>OBJECTIVE:</strong> To compare the postoperative analgesic effect of ultrasound-guided QLB versus ultrasound-guided caudal block among 1-6 years old children undergoing lower abdominal and urological surgeries in Philippine Children's Medical Center.</p><p><strong>METHODS:</strong> This is a single-blinded randomized control trial. 50 patients enrolled aged between 1 and 6 years. The patients were randomly classified into the caudal block group and quadratus lumborum block group. The primary outcome is the need for analgesia during the first 24 hours.</p><p><strong>RESULTS:</strong> A significant difference in the proportion of patients who requested for rescue analgesia was observed with caudal block having more patients in need of analgesic (100% CB vs 48% QLB, p<0.001). No postoperative complication was observed.</p><p><strong>CONCLUSIONS AND RECOMMENDATIONS:</strong> The quadratus lumborum block was more effective in reducing the postoperative pain management during the initial 48 hours. Quadratus lumborum block is recommended for future pediatric procedures requiring postoperative pain control, safety, practicality and economy.</p>