Vascular access cannulation in hemodialysis patients: technical approach / Canulação do acesso vascular em pacientes em hemodiálise: abordagem técnica

ABSTRACT Introduction: The vascular access cannulation technique varies among clinics, and guidelines on vascular access give little importance to cannulation techniques. The objective of this study was to evaluate the cannulation technique and to determine which factors are associated with each detail of the technique. Material and methods: The vascular access cannulation was evaluated in 260 patients undergoing hemodialysis. The type and anatomical location of the vascular access, the cannulation technique, direction, gauge, and distance between needles, besides bevel direction and needle rotation were registered. Results: The arteriovenous fistula was the most frequent vascular access (88%), the most used cannulation technique was area (100%), the needle direction was anterograde in most cases (79.5%), and the mean distance between the tips of needles was 7.57±4.43 cm. For arteriovenous grafts, the proximal anatomical location (brachial artery) and cannulation with 16G needles in anterograde position were more predominant. For arteriovenous fistulas, the distal anatomical location (radial artery) and cannulation through 15G needles were more common. Cannulation of vascular access in retrograde direction was associated with a greater distance between needles (13.2 ± 4.4 vs 6.1 ± 3 cm, p < 0.001). Kt/V was higher when the distance between needles was higher than 5 cm (1.61 ± 0.3 vs. 1.47 ± 0.28, p < 0.01). Conclusions: The vascular access cannulation technique depends on the vascular access characteristics and expertise of cannulators. Clinical trials are required for the formulation of guidelines for vascular access cannulation.

RESUMO Introdução: A técnica de canulação do acesso vascular varia entre instituições de saúde, e as diretrizes sobre o acesso vascular dão pouca importância às técnicas de canulação. O objetivo deste estudo foi avaliar a técnica de canulação e determinar quais fatores estão associados a cada detalhe da técnica. Material e métodos: A canulação do acesso vascular foi avaliada em 260 pacientes em hemodiálise. Foram registrados o tipo e localização anatômica do acesso vascular, a técnica de canulação, a direção, a bitola e a distância entre as agulhas, além da direção do bisel e da rotação da agulha. Resultados: A fístula arteriovenosa foi o acesso vascular mais frequente (88%), a técnica de canulação mais utilizada foi a área (100%), a direção da agulha foi anterógrada na maioria dos casos (79,5%) e a distância média entre as pontas das agulhas foi de 7,57 ± 4,43 cm. Para enxertos arteriovenosos, a localização anatômica proximal (artéria braquial) e a canulação com agulhas 16G em posição anterógrada foram mais predominantes. Para as fístulas arteriovenosas, a localização anatômica distal (artéria radial) e a canulação através de agulhas 15G foram mais comuns. A canulação do acesso vascular na direção retrógrada foi associada a uma maior distância entre as agulhas (13,2 ± 4,4 v.s. 6,1 ± 3 cm, p < 0,001). O Kt / V foi maior quando a distância entre as agulhas foi superior a 5 cm (1,61 ± 0,3 vs. 1,47 ± 0,28, p < 0,01). Conclusões: A técnica de canulação do acesso vascular depende das características do acesso vascular e da experiência dos "canuladores". Ensaios clínicos são necessários para a formulação de diretrizes para a canulação do acesso vascular.

Hydrodynamic evaluations of four mock femoral venous cannulas

Abstract Objective: To report the results of four mock femoral venous cannulas and the hydrodynamical superiority of one of them, which is the completely punched (CP) model, upon the other three. Methods: Four simulated femoral venous cannulas (single-stage, two-stage, multi-stage, and CP model) were designed from a 1/4" x 1/16" x 68 cm polyvinyl chloride (PVC) tubing line for testing. Holes on the PVC tubes were opened by a 5 mm aortic punch. In order to evaluate the cannulas' drainage performance, gelofusine was used as fluid. The fluid was drained for 60 seconds by gravitation and then measured for each model separately. Results: Mean drained volumes of single-stage, two-stage, and multi-stage cannulas were 2.483, 2.561, and 2.603 mL, respectively. However, the CP cannula provided us a mean drained volume of 2.988 mL. There were significant differences among the variables of the CP cannula and the other three mock cannulas concerning the drained fluid flow (P<0.01). Conclusion: In our study, the measured mean volumes showed us that more drainage surface area provides better fluid drainage.

Eficacia y complicaciones de la técnica de doble guía durante la canulación de la vía biliar principal / Efficacy and complications of double guidewire technique in biliary tract cannulation

RESUMEN Objetivo: Determinar la eficacia y seguridad de la técnica de doble guía en pacientes con canulación difícil durante una CPRE. Materiales y métodos: El presente estudio se realizó, entre el mes de enero del 2015 y julio del 2016. Se procedió a sintetizar la data, de éxito y complicaciones de la TDG en pacientes con canulación difícil y cuando la inserción de la guía en el conducto pancreático fue hecha involuntariamente después de una técnica estándar. Resultados: 24 pacientes sometidos a una CPRE con TDG; 17 fueron mujeres (70,8%) y 7 varones (29,2%). La edad promedio fue 65,21±16,49 años. La indicación más frecuente fue coledocolitiasis en 62,5 %, luego colangiocarcinoma, 12,5 %. El diagnóstico final post CPRE, fue coledocolitiasis en 45,8%, seguido por fibrosis de papila, 29,2%. El éxito de la técnica de la doble guía fue de 87,5%. Hubo 3 casos de canulación frustra con la TDG, dos pacientes presentaron pancreatitis post CPRE (8,3%), no hubo casos de perforaciones. Conclusiones: La TDG es una alternativa eficaz a la CPRE catalogada como de canulación difícil por técnica convencional, sea cual fuere la etiología, con un alto porcentaje de éxito técnico y con una tasa baja de pancreatitis post CPRE, semejante a la reportada en otros países.

ABSTRACT Objective: To determine the efficacy and safety of double guidewire technique in patients with difficult biliary cannulation during ERCP. Materials and methods: We conducted a retrospective cohort study of all ERCPs performed between January 2015 and July 2016. DGT was performed in patients for whom biliary cannulation was difficult and guidewire insertion into the pancreatic duct (PD) was inadvertently achieved while attempting the standard WGC technique. Results: 24 patients were enrolled with ERCP and DGT; 17 were female (70.8%) and 7 male (29.2%). The average age was 65.21±16.49 years. The most frequent indication was choledocholithiasis (62.5%), then cholangiocarcinoma (12.5%). Post ERCP diagnosis was choledocholithiasis (45.8%), and papillary fibrosis (29.2%). The success of DGT was 87.5%. Three cases of failure cannulation with the DGT were reported, two patients had pancreatitis post ERCP (8.3%), there were no cases of perforations. Conclusions: TDG, is an effective alternative to difficult biliary cannulation during ERCP with conventional methods; with a high success rate and low rate of post ERCP pancreatitis, similarly to reported in other countries.

Cervical cannulation for surgical repair of congenital cardiac defects in infants and small children

Abstract INTRODUCTION: The biggest challenge faced in minimally invasive pediatric cardiac surgery is cannulation for cardiopulmonary bypass. Our technique and experience of cervical cannulation in infants and small children for repair of congenital cardiac defects is reported in this study. METHODS: From January 2013 to June 2015, 37 children (22 males) with mean age of 17.97±8.63 months and weight of 8.06±1.59 kg were operated on for congenital cardiac defects through right lateral thoracotomy. The most common diagnosis was ventricular septal defect (18 patients). In all patients, right common carotid artery, right internal jugular vein and inferior vena cava were cannulated for institution of cardiopulmonary bypass and aorta was cross clamped through right 2nd intercostal space. RESULTS: There were no deaths or any major complications related to cervical cannulation. Common carotid artery cannulation provided adequate arterial inflow while internal jugular vein with inferior vena cava provided adequate venous return in all patients. No patient required conversion to sternotomy or developed vascular, neurological or wound related complications. Three patients had residual lesions (small leak across ventricular septal defect patch-2, Grade II left atrio-ventricular valve regurgitation-1) and one patient had mild left ventricular dysfunction. At discharge, both common carotid artery and internal jugular vein were patent on color Doppler ultrasonography in all patients. In a mean follow-up period of 11.4±2.85 months, all patients were doing well. No patient had any wound related, neurological or vascular complication. No patient had residual leak across ventricular septal defect patch. CONCLUSION: Cervical cannulation of common carotid artery and internal jugular vein is a safe, reliable, efficient and quick method for institution of cardiopulmonary bypass in minimally invasive pediatric cardiac surgery.

Guide wire-assisted cannulation versus conventional contrast to prevent pancreatitis: A systematic review and meta-analysis based on randomized control trials / Canulación asistida por alambre guía versus contraste convencional para prevenir la pancreatitis: Una revisión sistemática y meta-análisis basados en ensayos aleatorios controlados

Objective: Through this systematic review and meta-analysis, we aim to clarify the differences between these two techniques, thus improving primary success cannulation and reducing complications during endoscopic retrograde cholangiopancreatography, primarily pancreatitis. Methods: A comprehensive search was conducted to search for data available up until June2015from the most important databases available in the health field: EMBASE, MEDLINE (via PubMed), Cochrane, LILACS and CENTRAL (via BVS), SCOPUS, the CAPES database (Brazil), and gray literature. Results: Nine randomized clinical trialsincluding2583 people were selected from20,198 studies for meta-analysis. Choledocholithiasis had been diagnosed in mostly (63.8%) of the patients, who were aged an average of 63.15 years. In those patients treated using the guide wire-assisted cannulation technique, provided a significantly lower instance of pancreatitis (RD=0.03; 95% CI: 0.01-0.05; I2= 45%) and greater primary success cannulation (RD=0.07; 95% CI: 0.03-0.12; I2=12%) than conventional contrast cannulation. Conclusions: The guide wire-assisted technique, when compared to the conventional contrast technique, reduces the risk of pancreatitis and increases primary success cannulation rate. Thus, guide wire-assisted cannulation appears to be the most appropriate first-line cannulation technique

Objetivo: A través de esta revisión sistemática y meta-análisis, nuestro objetivo es aclarar las diferencias entre estas dos técnicas, mejorando así la canulación de éxito primario y reducir las complicaciones durante la colangiopancreatografía retrógrada endoscópica, principalmente la pancreatitis. Métodos: Una búsqueda exhaustiva se realizó para buscar datos disponibles hasta junio de 2015, desde las bases de datos más importantes disponibles en el campo de la salud: EMBASE, MEDLINE (vía PubMed), Cochrane, LILACS y CENTRAL (a través de la BVS), SCOPUS, la base de datos CAPES (Brasil), y la literatura gris. Resultados: Nueve ensayos clínicos aleatorios incluyendo 2583 personas fueron seleccionados de 20198 estudios de meta- análisis. Coledocolitiasis había sido diagnosticada en su mayoría (63,8%) de los pacientes, que tenían entre un promedio de 63,15 años. En los pacientes tratados con la técnica de canulación guiada, proporcionado una instancia significativamente menor de pancreatitis (RD=0,03; IC del 95%: 0,01-0,05; I2=45%) y una mayor canalización de éxito primario (RD=0,07; IC del 95%: 0,03-0.12; I2=12%) que la canulación por contraste. Conclusiones: La técnica canulación con alambre guía, en comparación a la técnica de contraste convencional, reduce el riesgo de pancreatitis y aumenta la tasa de canulación con éxito primario. Por lo tanto, canulación con alambre guía parece ser la técnica de canulación de primera línea y la más adecuada

Robot-assisted needle insertion for venous catheterization / Injeção-robô para cateterismo venoso

Vein access can be challenging for a variety of patients. The development of robots-assisted central or peripheral veins puncture would facilitate life of health professionals and patients. New robots are under development for this purpose and probably they will become available for practical use in the near future. These techniques may decrease significantly the cost of medicine, which currently uses less informatics resources than other industries.

O acesso venoso pode ser difícil em muitos pacientes. O desenvolvimento de robôs com capacidade de puncionar veias centrais ou periféricas pode facilitar a vida dos profissionais de saúde e dos pacientes. Novos robôs estão sendo desenvolvidos para essa finalidade e, provavelmente, entrarão em uso na prática clínica em um futuro próximo. Técnicas como estas poderão baixar progressivamente o custo em medicina, que, atualmente, tem usado menos recursos de informática que outras áreas.

Role of Balloon-Sheathed Intraductal Ultrasonography for Patients with Extensive Pneumobilia

Intraductal ultrasonography (IDUS) is one of the most useful diagnostic tools for various extrahepatic biliary diseases. However, conventional IDUS has some limitations in providing accurate cross-sectional imaging of the bile duct in patients with extensive pneumobilia. Using a balloon-sheathed catheter, the US system (balloon-sheathed IDUS) can overcome these limitations. Sixteen patients underwent balloon-sheathed IDUS during endoscopic retrograde cholangiography. The balloon-sheathed IDUS was inserted via a transpapillary route when visualization of the bile duct with conventional IDUS was distorted by extensive pneumobilia. The patient group had a mean age of 65.5 years, and 56.3% (9/16) were male. The balloon-sheathed IDUS permitted successful visualization of the bile duct in all patients, regardless of the extent of pneumobilia. Using this system, remnant common bile duct stones were detected in five patients (31.3%), and cholangiocarcinoma was detected in one patient (6.3%). The balloon-sheath IDUS aided in stone sweeping. No significant complications, including bleeding, perforation, or pancreatitis, occurred in any of the patients. The balloon-sheathed catheter US system was useful and safe for biliary IDUS in patients with extensive pneumobilia.

Easily Removable Ureteral Catheters for Internal Drainage in Children: A Preliminary Report

PURPOSE: We review our experience using a new and easily removable ureteral catheter in patients who underwent complicated ureteral reimplantation. Our goal was to shorten hospital stay and lower anxiety during catheter removal without fear of postoperative ureteral obstruction. MATERIALS AND METHODS: Between April 2009 and September 2010, nine patients who underwent our new method of catheter removal after ureteral reimplantation were enrolled. Patients who underwent simple ureteral reimplantation were excluded from the study. Following ureteral reimplantation, a combined drainage system consisting of a suprapubic cystostomy catheter and a ureteral catheter was installed. Proximal external tubing was clamped with a Hem-o-lok clamp and the rest of the external tubing was eliminated. Data concerning the age and sex of each patient, reason for operation, method of ureteral reimplantation, and postoperative parameters such as length of hospital stay and complications were recorded. RESULTS: Of the nine patients, four had refluxing megaureter, four had a solitary or non-functional contralateral kidney and one had ureteral stricture due to a previous anti-reflux operation. The catheter was removed at postoperative week one. The mean postoperative hospital stay was 2.4 days (range 1-4 days), and the mean follow-up was 9.8 months. None of the patients had postoperative ureteral obstructions, and there were no cases of migration or dislodgement of the catheter. CONCLUSION: Our new method for removing the ureteral catheter would shorten hospital stays and lower levels of anxiety when removing ureteral catheters in patients with a high risk of postoperative ureteral obstruction.

Nelaton catheter assisted versus standard nasogastric tube insertion: a randomized, clinical trial

It is sometimes difficult to insert a nasogastric tube in an anaesthetized patient. We evaluated the benefit of reinforcing the distal portion of the nasogastric tube with a Nelaton catheter: 8 and 10 French Nelaton catheters were inserted into 16 and 18 French nasogastric tubes respectively through the first proximal holes of tubes up to their tips. The patients anaesthetized were randomly allocated into either the control or the Nelaton groups, and nasogastric tube was inserted as deeply as the catheter length, then the catheter was withdrawn and the tube was inserted farther to reach the stomach. Eighty patients [40 in each group] were included in this study. The success rate of nasogastric tube insertion was 90% in the Nelaton group and 57% in the control group [P = 0.001]. The mean insertion time was 80 [SD 43] and 92 [SD 35] seconds in the Nelaton and the control groups respectively

Supra-Cath : A Life Saving Catheter.

Amebic liver abscesses are more likely to be solitary and more commonly located in the right hepatic lobe. Though uncommon, erosion usually from left lobe into the pericardium is the most dangerous complication of amebic liver abscess. We encountered an interesting case of an elderly male, who presented with features suggestive of cardiac temponade. We could demonstrate the left lobe abscess, pericardial effusion and also pericardial fistula on ultrasonography. Patient was successfully managed by percutaneous drainage of left lobe hepatic abscess by Supra- Cath, which also drained pericardial effusion with immediate symptomatic relief.

Uso de la Sonda de Foley para el Control del Sangrado de la Pared Abdominal por los Orificios de los Trócares durante la Cirugía Laparoscópica / Use of Foley’s catheter to control abdominal wall bleeding in the trocar insertion place during laparoscopic surgery

INTRODUCCIÓN: Las hemorragias en los puntos de entrada de los trócares son en ocasiones difíciles de cohibir y se asocian con una morbilidad que oscila desde el dolor parietal y el hematoma, hasta el hemoperitoneo masivo. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo de nuestra experiencia en el control de las hemorragias en los puntos de entrada de los trócares de laparoscopia mediante compresión con balón de sonda de Foley, en los que la hemostasia mediante electrocoagulación no fue efectiva. RESULTADOS: La técnica fue empleada en 35 pacientes (27 mujeres y 8 varones) con una edad media de 45,37 años (intervalo 24 - 82 años). La mediana de tiempo hasta la retirada de la sonda fue 36 horas (intervalo 24 - 48 horas), sin evidenciarse ningún tipo de complicación hemorrágica, prolongación de la estancia ni reingreso hospitalario. CONCLUSIONES: La compresión con balón de sonda de Foley es un método sencillo y eficaz para el control de las hemorragias a través de los orificios de los trócares de laparoscopia.

BACKGROUND: Abdominal wall bleeding in the port-site insertion place during laparoscopic surgery is sometimes difficult to control and can be associated with morbidity ranging from parietal pain up to haematoma and massive haemoperitoneum. PATIENTS AND METHODS: We perform a retrospective study of our experience in the management of the abdominal wall bleeding port-site using a Foley’s catheter (24F), in those cases when haemostasis with electrocautery was not achieved. RESULTS: This technique was used in 35 patients (27 women and 8 men) with a mean age of 45,37 years (range 24-82 years). The median of time up to the removal of the catheter was 36 hours (range 24-48 hours), without observing bleeding or prolongation of the hospital stay or readmission. CONCLUSIONS: The use of Foley’s catheter is a simple and efficient method for the control of the port-site bleeding during laparoscopic surgery.

Cystic craniopharyngioma: intratumoral chemotherapy with alpha interferon / Craniofaringioma cístico: quimioterapia intratumoral com interferon alfa

OBJECTIVE: To assess whether the cystic craniopharyngiomas can be controlled with the use of intratumoral applications of interferon alpha. METHOD: Nineteen patients with the diagnosis of cystic craniopharyngioma were treated with intratumoral chemotherapy with interferon alpha from January 2002 to April 2006. All patients underwent placement of an intracystic catheter connected to an Ommaya reservoir. Through this reservoir were made applications during chemotherapy cycles. Each cycle corresponded to application of 3,000,000 units of interferon alpha three times per week on alternate days totalizing 36,000,000 units. Response to treatment was evaluated by calculating the tumor volume on MRI control after one, three and six months after the end of each cycle. Patients who developed worsening of symptoms or who had insignificant reduction in tumor volume during follow-up underwent repeat cycle chemotherapy. RESULTS: Four patients received four cycles of chemotherapy, three patients received three cycles, six patients received two cycles and six patients received one. The lower percentage of reduction in tumor volume was 60 percent and the bigger reduction was 98.37 percent. Eleven patients had a reduction greater than 90 percent. Five patients had a tumor reduction between 75 and 90 percent and in three patients the tumors were reduced by less than 75 percent. No deaths occurred during treatment and side effects of interferon alpha were well tolerated. No treatment was discontinued. Follow-up after the last application ranged from one year and five months to three years and nine months. CONCLUSION: The intratumoral chemotherapy with interferon alpha decreases the volume of cystic craniopharyngiomas and so far can be considered a new therapeutic alternative.

OBJETIVO: Avaliar se os craniofaringiomas císticos podem ser controlados com aplicações intratumorais de interferon alfa. MÉTODO: De janeiro de 2002 a abril de 2006, 19 pacientes foram submetidos à colocação de um cateter intracístico conectado a reservatório de Ommaya para aplicações intratumorais de ciclos de 36.000.000 de unidades de interferon alfa. A resposta ao tratamento foi avaliada pelo cálculo do volume tumoral na ressonância magnética de controle ao término de cada ciclo. RESULTADOS: Os pacientes receberam de um a quatro ciclos de quimioterapia. Onze pacientes apresentaram uma redução do volume tumoral maior que 90 por cento; cinco pacientes apresentaram uma redução entre 75 por cento e 90 por cento e três pacientes uma redução menor de 75 por cento. Não houve óbitos durante o tratamento e os efeitos colaterais do inferferon alfa foram bem tolerados. Nenhum tratamento foi interrompido. CONCLUSÃO: A quimioterapia intratumoral com interferon alfa diminui o volume dos craniofaringeomas císticos e pode ser considerada uma nova alternativa terapêutica.

Utilidade da cultura da ponta de cateter no diagnóstico de infecção neonatal / Usefulness of catheter tip culture in the diagnosis of neonatal infections

OBJETIVO: Determinar o número de unidades formadoras de colônias que melhor correlaciona com a infecção relacionada a cateter em recém-nascidos. MÉTODOS: Este foi um estudo prospectivo de culturas semiquantitativas de pontas de cateteres de recém-nascidos da unidade neonatal da Faculdade de Medicina de Botucatu. Os microrganismos isolados de cateteres e hemoculturas periféricas foram identificados e submetidos ao teste de sensibilidade a drogas. O ponto de corte ótimo foi determinado pela curva receiver operating characteristic (ROC). RESULTADOS: Foram estudados 85 cateteres de 63 recém-nascidos. A espécie Staphylococcus epidermidis foi prevalente (75 por cento) nos cateteres. Dos 11 episódios de infecção diagnosticados, oito (72,7 por cento) foram associados aos estafilococos coagulase-negativa, dos quais seis pertenciam à espécie S. epidermidis. Pela curva ROC, o ponto de corte ótimo para o diagnóstico de infecção relacionada a cateter foi 122 unidades formadoras de colônias. CONCLUSÃO: O ponto de corte 122 unidades formadoras de colônias melhor se correlacionou com o diagnóstico de infecção relacionada a cateter em recém-nascidos.

OBJECTIVE: To determine the number of colony-forming units (CFU) that best correlates with catheter-related infections (CRI) in newborns. METHODS: This was a prospective study of semiquantitative cultures of catheter tips obtained from newborns in the neonatal unit at Faculdade de Medicina de Botucatu, state of São Paulo, Brazil. The microorganisms isolated from catheter and peripheral blood cultures were identified and submitted to a drug susceptibility test. The optimal cutoff point was determined by the receiver operating characteristic (ROC) curve. RESULTS: A total of 85 catheters obtained from 63 newborns were studied. Staphylococcus epidermidis was the predominant species in the catheters (75 percent). Eight of 11 (72.7 percent) CRI episodes were associated with coagulase-negative staphylococci, six of which were of the S. epidermidis type. ROC curve analysis indicated that the optimal cutoff point for the diagnosis of CRI was 122 CFU. CONCLUSION: The cutoff point of 122 CFU correlated best with the diagnosis of CRI in newborns.

Retrieval of dislodged central venous pressure catheters: early experience with three case presentations

Central venous catheters [CVP] are frequently used in clinical practice. Occasionally, catheters may become dislodged. If percutaneous retrieval fails, then cardiothoracic surgery is necessary to retrieve the fractured catheter and avoid potential complications. This report describes early experiences of three different modes of broken catheter retrieval: the first by use of a snare catheter; the second by surgery and the third during bypass surgery. We conclude that broken fragments of catheters that lodge in the right side of the heart or pulmonary circulation can be retrieved most of the time percutaneously by snare catheters

Tratamento de lesões calcificadas com uso do dispositivo Tornus: relato de dois casos / Treatment of calcified lesions with the tornus device: report of two cases

Apresenta-se neste relato o tratamento bem-sucedido de dois pacientes com lesões coronárias complexas, calcificadas, sendo uma delas uma oclusão total crônica, na qual foi utilizado um novo dispositivo para facilitar o procedimento percutâneo.

We describe two complex cases of calcified lesions, one of which a total chronic occlusion, that were successfully treated with a new device that facilitates the percutaneous procedure.

Resistência à flambagem de instrumentos endodônticos empregados no cateterismo de canais radiculares atresiados / Resistence to buckling of the endodontic instruments used in the catherism of the partially calcified root canals

Este estudo analisa a forma de trabalho, as dimensões e a resistência à flambagem de instrumentos endodônticos empregados no caterismo de canais radiculares etresiados. Foram analisados instrumentos C+File, Colorinox e Nitiflex da Dentisply-Maillefer, CC Cord da Antaeos e HI da Miltex. As dimensões foram determinadas no projetor de perfil. As formas foram obtidas no MEV. A resistência à flambagem foi quantificada pela aplicação de uma força na direção axial dos instrumentos. Concluiu-se que os instrumentos C+File apresentaram formas e dimensões diferentes. Os instrumentos C-File apresentam maior resistência à flambagem seguidos pelo CC Cord.

Comparison of the TINTARA uterine manipulator with the Cohen cannula in gynecologic laparoscopy.

OBJECTIVE: To assess the efficacy of the TINTARA uterine manipulator and the Cohen cannula for gynecologic laparoscopy. MATERIAL AND METHOD: Sixty women scheduled for laparoscopy were randomized for use of TINTARA (n = 30) or Cohen (n = 30) as a uterine manipulator. The degree of anterior and lateral deviation of the uterus, operative time, surgical complications and ease of use were recorded and compared between the two groups. RESULTS: The mean ranges of anterior and lateral deviation of the uterus in TINTARA and Cohen groups were 61.17 +/- 19.37 vs. 49.33 +/- 22.58 degrees (p = 0.033) and 107.03 +/- 39.68 vs. 85.5 +/- 37.52 degrees (p = 0.035) respectively. The percentage of patients having dye leakage from the cervix in the Cohen group was greater than in the TINTARA group, but the difference was not statistically significant. Both instruments provided similar ease of use. Complications were not found in either group. CONCLUSION: TINTARA was found to have more advantages than the Cohen in moving the uterus in both anterior and lateral directions.

Abordagem da valva do tronco pulmonar por desvio direito e uso de cânula bicaval: estudo experimental / Approach of the pulmonary valve using right heart bypass and bicaval cannula: experimental study

OBJETIVO: O objetivo deste estudo foi reproduzir a cirurgia de abordagem da valva do tronco pulmonar por desvio direito, avaliando-se uma nova cânula venosa bicaval com balonetes insufláveis para uso por miniacesso. MÉTODOS: Utilizaram-se 15 suínos da raça Large-White, sendo cinco para a padronização técnica das vias de acesso e monitorização hemodinâmica, nove submetidos ao experimento por meio de esternotomia, e um animal excluído da amostra, operado por mínimo acesso ao tórax. O desvio direito foi estabelecido pela drenagem bicaval, sendo a cânula introduzida pela veia jugular interna direita e locada nas veias cavas cranial e caudal. Os parâmetros medidos foram: Pressão Arterial Média (PAM); Freqüência Cardíaca (FC); Saturação O2 (SAT O2); Capnografia (PetCO2) e Temperatura (T). A análise estatística foi feita comparando-se os valores antes e durante o desvio direito. RESULTADOS: No momento pré-desvio direito, obtiveramse os seguintes valores médios: PAM = 90,8 mmHg, FC = 101,6 bat/min, SAT O2 = 93,8 por cento, PetCO2 = 28,4 mmHg, T = 36,1ºC. Durante o desvio direito, obtiveram-se os seguintes valores médios: PAM = 88,1 mmHg, FC = 98,0 bat/min, SAT O2 = 93,1 por cento, PetCO2 = 25,3 mmHg e T = 36,9ºC. Comparandose as médias obtidas entre os dois momentos, verificou-se não haver diferenças significantes para a PAM, FC e SAT O2 e diferenças significantes para a PetCO2 e a T. CONCLUSÃO: A cânula bicaval com balonetes promoveu drenagem eficaz de ambas as veias cavas, permitindo a manutenção dos parâmetros hemodinâmicos durante o desvio direito, sendo possível realizar a abordagem da valva pulmonar.

OBJECTIVE: To reproduce the surgery for correction of pulmonary valve anomalies using right heart bypass and a new bicaval cuffed venous cannula for minimal access surgery. METHODS: Fifteen Large-White pigs were used for this study. The standard technique model was established with the first five pigs, the experiment was done with nine animals by sternotomy, and one was submitted to a minimally invasive procedure, but has been excluded of the sample. Bicaval drainage by a single cannula was obtained through the internal jugular vein. The cuffs were inflated to increase blood flow to the machine. The return was established by putting the arterial cannula into the pulmonary artery trunk. Pre-bypass parameters were measured and compared with the parameters during the right bypass: Median Arterial Tension (MAT); Heart Rate (HR); O2 Saturation (SAT O2); end-tidal CO2 measures (etCO2); Temperature (T). The statistical analysis was done comparing the pre-bypass and during bypass values. RESULTS: Pre-bypass values: MAT: 90.8 mmHg; HR = 101.6 beat/min; O2 SAT = 93.8 percent; PetCO2 = 28.4 mmHg; T = 36.1ºC. During bypass the obtained values were: MAT: 88.1 mmHg; HR = 98.0 beat/min; O2 SAT = 93.1 percent; PetCO2 = 25.3 mmHg; T = 36.9ºC. Comparing the average values between the two abovementioned moments, no significant difference occurred in MAT, HR and O2 SAT; PetCO2 and T presented significant differences. CONCLUSIONS: The bicaval cuffed venous cannula showed efficient drainage of both venae cavae with appropriate hemodynamic parameters during right bypass allowing access to the pulmonary valve.