Average Number Of Punctures Research Articles

Application of wireless ultrasound for guided caudal anesthesia in children undergoing concealed penis surgery

ABSTRACT Caudal anesthesia alleviates the strong pain endured by children during surgical treatment for concealed penis. In the traditional method, anesthesiologists identify the puncture point using the ‘blind probe’ method, which leads to anesthesia induction failure in children. Ultrasound has recently gained wide attention for its guidance in peripheral nerve block analgesia. However, the clinical significance of wireless ultrasound – guided caudal anesthesia technology in children remains unexplored. This study investigated the clinical value of wireless ultrasound – guided caudal anesthesia in children undergoing concealed penis surgery. From April 2022 to August 2022, 120 pediatric patients aged 3–10 years were selected for concealed penis surgery. They were divided into the wireless ultrasound – guided sacral block group (group A) and the traditional sacral block group (group B), with 60 children in each group. Children in group A and group B underwent wireless ultrasound – guided caudal anesthesia and traditional caudal anesthesia, respectively. The success rates of the first puncture and total punctures, time taken for the punctures, and number of punctures were compared between the groups. The success rates of the first puncture (95% vs 68.3%) and total puncture (100% vs 90%) were significantly higher in group A than in group B (P<0.05). The average puncture time and the average number of punctures were, respectively, significantly shorter and lesser in group A than in group B (both P<0.05). Compared with the traditional method, wireless ultrasound visualization technology can effectively improve the success rate of sacral block puncture and reduce puncture time, which is worthy of clinical application.

Application of a new body surface-assisting puncture device in percutaneous transforaminal endoscopic lumbar discectomy

BackgroundAccurate puncture and localization are critical for percutaneous transforaminal endoscopic lumbar discectomy surgery. However, several punctures are often required, followed by X-ray fluoroscopy, which can increase surgical risk and complications. The aim of this study was to demonstrate a new body surface-assisting puncture device that can be used in percutaneous transforaminal endoscopic lumbar discectomy and to assess its clinical effectiveness.MethodsThree hundred and forty-four patients were treated with percutaneous transforaminal endoscopic lumbar discectomy surgery in the Spinal Surgery Department of Taian City Central Hospital, China, between January 2020 and February 2022. Of these, 162 patients (the locator group) were punctured using a body surface-assisting puncture device while and 182 patients (the control group) were punctured using the traditional blind puncture method. The number of punctures, radiation dose during X-ray fluoroscopy, operation time, and surgical complications were compared between the two groups.ResultsThe average number of punctures was 2.15 ± 1.10 in the locator group which was significantly lower than that in the control group (5.30 ± 1.74; P < 0.001). The average X-ray fluoroscopy radiation dose in the locator group was significantly lower at 2.34 ± 0.99 mGy, compared with 5.13 ± 1.29 mGy in the control group (P < 0.001). The mean operation time was also significantly less in locator group (47.06 ± 5.12 vs. 62.47 ± 5.44 min; P = 0.008). No significant differences in surgical complications were found between the two groups (P > 0.05).ConclusionThe use of a new body surface-assisting puncture device in percutaneous transforaminal endoscopic lumbar discectomy surgery can significantly reduce the number of punctures and X-ray fluoroscopy radiation dose, as well as shortening the operation time, without increasing surgical complications. This device is cheap, easy to operate, and suitable for all hospitals and spine surgeons, especially for small hospitals, with also no extra costs for patients.

Finger touching combined X-ray-guided percutaneous nephrolithotomy in 640 cases: an 8-years' experience.

We aimed to evaluate the safety and efficacy of finger touching combined X-ray-guided percutaneous nephrolithotomy, and the feasibility of avoiding damage in medical staff caused by X-ray. From January 2013 to December 2020, 640 cases of percutaneous nephrolithotomy were performed through the 18-24-F channel. Among those cases, 22 (3.4%) cases were double-sided kidney stones surgeries, 294 (45.8%) cases were on the right side and 324 (50.5%) cases were on the left side. The targeted renal calyceal puncture was carried out under the combined guidance of the doctor's finger and X-ray. We assessed the X-ray exposure time of patients and doctors, average number of punctures, postoperative hospitalization, calculus removal rates, and complications. The average number of punctures was 2.8 ± 1.4. Average X-ray exposure time during procedure: 2.8 s (range: 2-8 s). Average surgical time: 106.5 ± 49.4 min. Postoperative hospitalization: 6.8 ± 4.2 d. Average reduced hemoglobin level: 5.9 g/day. Stone-free rate 4 weeks after surgeries: 95.6%. Patients with upper ureteral calculi: 395 cases (61.72%). The calculus residual rate of patients with staghorn renal calculi or multiple renal calculi complementary treatments was 82.9%, including 0 patients who received shock wave lithotripsy, 2 cases of repeated percutaneous nephrolithotomy (PCNL), and 18 cases of ureteroscopy. Postoperative placement of renal drainage tube occurred in 52 cases. As for complications, no perirenal infection occurred, two severe bleeding complication cases occurred, and one case of colon perforation occurred. Finger touching combined X-ray-guided percutaneous nephrolithotomy in patients with renal calculus is safe and can accurately guide the puncture without radiation hazards. The placement of a renal drainage tube was beneficial to reduce renal effusion, hematocele, and infections.

Automatically Addressing System for Ultrasound-Guided Renal Biopsy Training Based on Augmented Reality.

Chronic kidney disease has become one of the diseases with the highest morbidity and mortality in kidney diseases, and there are still some problems in surgery. During the operation, the surgeon can only operate on two-dimensional ultrasound images and cannot determine the spatial position relationship between the lesion and the medical puncture needle in real-time. The average number of punctures per patient will reach 3 to 4, Increasing the incidence of complications after a puncture. This article starts with ultrasound-guided renal biopsy navigation training, optimizes puncture path planning, and puncture training assistance. The augmented reality technology, combined with renal puncture surgery training was studied. This paper develops a prototype ultrasound-guided renal biopsy surgery training system, which improves the accuracy and reliability of the system training. The system is compared with the VR training system. The results show that the augmented reality training platform is more suitable as a surgical training platform. Because it takes a short time and has a good training effect.

Ultrasound-Guided Biopsy of Pleural-Based Pulmonary Lesions by Injection of Contrast-Enhancing Drugs.

In this study, a total of 58 patients with single subpleural pulmonary lesions (males: 36, females: 22, mean age: 63 ± 16.2 years) who underwent contrast-enhanced ultrasonography (CEUS) and had a definite diagnosis (benign lesions:25, malignant lesions:33) were enrolled. The number of biopsies, diagnostic accuracy rate, and the incidence of complications were recorded. The nodules were divided into two size subgroups: ≥5 cm (group 1), and <5 cm (group 2). The display rate of internal necrosis and change of pre-scheduled puncture paths were compared between subgroups. Also, the arrival times, intensity and uniformity of enhancement after the contrast agent injection, as well as the display rate of internal necrosis were recorded and compared between malignant and benign lesions. Finally, the average number of punctures was 2.9 ± 0.7 times. The total diagnosis rate was 98.3%. Local pneumothorax occurred in 2 patients. Hemoptysis occurred in 1 patient. No serious complications occurred. Internal necrosis was demonstrated in 20 of 58 lesions (34.5%). Sixteen of them had changed the planned puncture path due to the large necrosis area (80%, 16/20). For lesions in group 1, necrosis was found in 15 lesions and there was a statistically significant difference in the necrosis rate between the two subgroups (15/26 vs 5/32, p = 0.001). The change in the pre-scheduled puncture path occurred in 12 patients in group 1 while 4 patients in group 2 exhibited a change in the planned puncture path (p = 0.004). There was a statistically significant difference in the arrival times and intensity of enhancement between benign and malignant lesions (p < 0.05). In conclusion, CEUS guided biopsy is an effective, sensitive, and safe method for the diagnosis of pleural-based pulmonary lesions by facilitating a distinction between necrosis and active tissue. The current findings indicated that CEUS before a biopsy may be especially vital in lesions ≥5 cm.

Oviposition preference of Ceratitis capitata (Diptera: Tephritidae) at different times after pruning 'Italia' table grapes grown in Brazil.

Studies investigating oviposition preference of Ceratitis capitata (Wiedemann, 1824) in table grapes (Vitis vinifera L.) cultivated in the São Francisco River Valley can provide important information to guide control measures, therefore minimizing damage caused by this species in the region. The aim of this study was to evaluate the oviposition preference of C. capitata females for berries cv. ‘Italia’ collected at five different times (60, 70, 80, 90, and 100 d after production pruning [DAPP]), representing five grapevine growth stages. We also assessed the performance of immature stages of C. capitata regarding the physiological development of the berry. The total soluble solid content was significantly higher in berries at more advanced physiological developmental stages (90 and 100 DAPP). Conversely, these berries showed the lowest values of firmness and titratable acidity. With the onset of physiological development, the average number of punctures per berry increased and reached 5.2 per berry in 100 DAPP berries. The infestation level and pupal weight showed a positive correlation with the growth stage. The highest recovery of pupae was observed in 100 DAPP berries (1.54). Pupal viability values ranged from 50.9 to 64.7% independent of berry maturity stage. The physiological developmental stage of the berry did not affect offspring sex ratio. Results obtained suggest that regardless of the female preference for laying eggs on berries in a more advanced physiological developmental stage, females can initiate the attack to bunches of this cultivar at 60 DAPP, even if the berries have unfavorable physicochemical parameters for oviposition and development of larvae.

Epidural analgesia in 20 parturients at the Sylvanus Olympio University Hospital Center in Lomé (Togo)

Etude prospective et descriptive sur la pratique de l’analgésie péridurale (APD) obstétricale au CHU Sylvanus Olympio (CHU SO) de Lomé. Etude menée de février à juin 2014. Après accord des gestantes choisies au hasard et en l’absence de contre-indication à l’issue de la consultation d’anesthésie, faite au 8ème mois de la grossesse, des femmes ont été retenues pour l’étude. Sur 29 gestantes retenues, 20 (69%) ont bénéficiées de l’APD. Age moyen 30,6±6,6 ans, primigestes : 35%, multipares 50%, Obèses (BMI>30): 25%. Nombre moyen de ponctions: 1,2±0,5; reflux de sang dans le cathéter: 5%, brèche dure-mérienne : 0. Délai moyen d’installation: 8,5 ±2,2mn. Quantité moyenne de bupivacaine isobare à 0,125%: 28,8±8ml; Echelle Numérique à T10min < 3 pour toutes les parturientes. Bloc moteur: 0. Hypotension: 1cas (5%). Mode d’accouchement: voie basse: 19 (95%), césarienne: 1 (5%). Détresse respiratoire à la naissance du nouveau né: 0. Note de satisfaction: 9,8±0,5 /10. L’APD obstétricale est possible au CHU Sylvanus Olympio de Lomé. En attendant sa vulgarisation à toutes les parturientes par la disponibilité des moyens humains et matériels, la réaliser pour ses indications médicales serait un premier pas.

Clinical value of contrast-enhanced ultrasound in improving diagnostic accuracy rate of transthoracic biopsy of anterior-medial mediastinal lesions.

ObjectiveTo evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in transthoracic biopsy of anterior-medial mediastinal lesions.MethodsA total of 123 patients with anterior or middle mediastinum lesions required ultrasound guided transthoracic biopsy for pathological diagnosis. Among them, 72 patients received CEUS examinations before biopsy. After CEUS, 8 patients were excluded from biopsy and the rest 64 patients underwent biopsy (CEUS group). During the same period, 51 patients received biopsy without CEUS examination (US group). The ultrasonography characteristics, the number of biopsy puncture attempts, diagnostic accuracy rate and the incidence of complications were recorded and compared between the two groups.ResultsA large portion of necrosis area or superficial large vessels was found in 8 patients, so the biopsy was cancelled. The internal necrosis was demonstrated in 43.8% of the lesions in CEUS group and in 11.8% of US group (P>0.001). For thymic carcinoma, CEUS increased the detection rate of internal necrosis and pericardial effusion than conventional ultrasound (62.5% vs. 18.8%, P=0.012; 56.3% vs. 12.5%, P=0.023). The average number of punctures in CEUS group and US group was 2.36±0.70 and 2.21±0.51 times, respectively (P>0.05). The diagnostic accuracy rate of biopsy in CEUS group (96.9%, 62/64) was significantly higher than that in US group (84.3%, 43/51) (P=0.022). In US group, 2 patients suffered from mediastinal bleeding (3.9%), while no major complications occurred in CEUS group. ConclusionsCEUS examination provided important information before transthoracic mediastinum biopsy and improved diagnostic accuracy rate in biopsy of anterior and middle mediastinum lesions than conventional ultrasound.

Statistical analysis of entropy correction from topological defects in loop black holes

In this paper we discuss the entropy of quantum black holes in the LQG formalism when the number of punctures on the horizon is treated as a quantum hair, that is we compute the black hole entropy in the grand canonical (area) ensemble. The entropy is a function of both the average area and the average number of punctures and bears little resemblance to the Bekenstein-Hawking entropy. In the thermodynamic limit, both the "temperature" and the chemical potential can be shown to be functions only of the average area per puncture. At a fixed temperature, the average number of punctures becomes proportional to the average area and we recover the Bekenstein-Hawking area-entropy law to leading order provided that the Barbero-Immirzi parameter, $\gamma$, is appropriately fixed. This also relates the chemical potential to $\gamma$. We obtain a sub-leading correction, which differs in signature from that obtained in the microcanonical and canonical ensembles in its sign but agrees with earlier results in the grand canonical ensemble.

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation (RFA) of the feeding artery of hepatocellular carcinoma (HCC) in reducing the blood-flow-induced heat-sink effect of RFA. A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups. Seventy-one patients with 75 HCCs (average tumor size, 4.3 +/- 1.1 cm) were included in group A, in which the feeding artery of HCC was identified by color Doppler flow imaging, and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery (PAA)] before routine RFA treatment of the tumor. Eighty-three patients with 102 HCC (average tumor size, 4.1 +/- 1.0 cm) were included in group B, in which the tumors were treated routinely with RFA. Contrast-enhanced computed tomography was used as post-RFA imaging, when patients were followed-up for 1, 3 and 6 mo. In group A, feeding arteries were blocked in 66 (88%) HCC lesions, and the size of arteries decreased in nine (12%). The average number of punctures per HCC was 2.76 +/- 1.12 in group A, and 3.36 +/- 1.60 in group B (P = 0.01). The tumor necrosis rate at 1 mo post-RFA was 90.67% (68/75 lesions) in group A and 90.20% (92/102 lesions) in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% (13/75) in group A and 31.37% (32/102) in group B (P = 0.04). PAA blocked effectively the feeding artery of HCC. Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC.

CT fluoroscopy-assisted needle puncture and ethanol injection for hepatocellular carcinoma: a preliminary study.

We assessed the usefulness of real-time CT fluoroscopy for needle guidance and evaluated the clinical usefulness of a unified CT fluoroscopy and angiography system in the treatment of hepatocellular carcinoma. A single-session percutaneous ethanol injection was performed with CT fluoroscopy guidance and monitoring for 15 hepatocellular carcinomas with an average size of 2.5 cm (range, 0.7-4.7 cm) in 10 consecutive patients. Of these, seven lesions were not seen on sonography. To mark the lesion for puncture, we performed CT arteriography or arterial injection of iodized oil. A puncture guide was applied to 12 lesions. The average depth from the skin's surface to the lesion was 9.3 cm (range, 4.5-11.5 cm), and the puncture route was transthoracic in five lesions and transabdominal in 13. The overall success rate in puncturing the lesions was 94.4% (17/18 sessions). The average number of punctures was 3.3, and it significantly decreased after introduction of a puncture guide compared with freehand puncture (p < .01). The average amount of injected ethanol was 12.7 ml (range, 4-27 ml). The ratio of injected ethanol dose to calculated ethanol dose was 0.6. Local recurrence occurred in four (26.7%) of 15 lesions after an average of 5 months. Using CT fluoroscopy for guidance of the needle and for monitoring ethanol infusion in the target lesion, we have found single-session percutaneous ethanol injection to be possible for hepatocellular carcinomas smaller than 5 cm or not revealed by sonography. The puncture guidance equipment was helpful for accurate insertion of the needle into the lesion, allowing a minimum number of punctures and minimal radiation exposure.

Sonographically guided placement of peripherally inserted central venous catheters: review of 355 procedures.

This paper reviews our experience using sonographic guidance in the insertion of peripherally inserted central venous catheters (PICCs). Three hundred fifty-five PICCs were placed in 262 patients, 19-92 years old, over a 24-month period using sonographic guidance for the initial venous cannulation. The average number of punctures was 1.2, with an average procedure time of 21 min. Our overall success rate to achieve the initial venous access was 99%. I.v. contrast material was used in only 2% of the cases, after successful initial venous access with sonographic guidance alone, to allow demonstration of anatomic variations or lesions that interfered with the completion of the procedure. Two immediate minor complications occurred. A high margin of safety was provided by avoiding the use of iodinated contrast medium and by visualizing the artery and its anatomic relation to the vein before and during needle placement. Sonographic guidance yielded superior three-dimensional localization of the selected vein and its precise anatomic relationship to the artery. Our experience has led us to conclude that sonographically guided placement of PICCs is a fast, safe, efficient, and inexpensive technique and should be the preferred method for PICC placement, especially in patients with no clinically identifiable peripheral vein.

Transjugular liver biopsy: a review of 77 biopsies using a spring-propelled cutting needle (biopsy gun).

Seventy-seven transjugular liver biopsies were performed with a coaxial, spring-loaded, 18-gauge cutting needle, the Biopty gun (Bard Biopsy System, Covington, GA, USA) on consecutive patients between July 1993 and February 1995. Fifty men and 27 women were included in the study; the mean age was 45 years (range 15-69 years). The average number of punctures per patient was 5.2, with a range of 2-9, yielding an average of 4.8 samples per patient (range 1-7). The length of the samples varied from 10 to 22 mm with a constant diameter of 1 mm. The mean time required to complete the procedure was 48 min (43-52 min). Histological diagnoses were obtained in 74 of 77 patients (96%), with non-diagnostic specimens attributed to excessive fragmentation (3 cases). Complications occurred in 10 patients (puncture site hematoma, carotid artery puncture, abdominal pain, vasovagal reaction, hepatic capsule perforation, and hemobilia). The latter two complications were self-limited. In our experience this transjugular hepatic biopsy method is promising for performing biopsies in patients with chronic liver disease, due to its high success rate and low morbidity rate.