Flexible Cannula Research Articles

236 Bilateral Intrathalamic Infusion of rAAVrh8-Hexa/Hexb in a Phase 1/2 Clinical Trial for Gene Therapy in Infantile and Juvenile Tay-Sachs and Sandhoff Disease; Surgical Technique

INTRODUCTION: Tay-Sachs (TSD) and Sandhoff (SD) diseases are rare,monogenic and severe neurodegenerative disorders due to Hexosaminidase A deficiency. We performed the first-in-human bilateral thalamic (BiTh) delivery of rAAVrh8-HEXA/HEXB in 8 children in a Phase 1/2 clinical trial. METHODS: Stereotactic infusion cannula placement was performed using ROSA robotic platform. Bilateral trajectories were planned via the trans-frontal route..Head stabilization was accomplished using radiolucent horse-shoe head rest and radiolucent pin-skull clamps. Flexible infusion cannulas were placed through small drill holes using ROSA guidance. Cannula stabilization was achieved using a construct which combined the Navigus brain biopsy platform and flexible cannula bolt. Insertion accuracy was verified with intraoperative CT images. Patients received one of the three doses in each thalamus: 180 mcl (5.87E + 12vg), 360 mcl (1.17E + 13vg) or 720 mcl (2.35E + 13vg). Drug infusion rate was 4 mcl/minute and completed in 90-360 minutes depending on drug dosage. RESULTS: Eight patients received treatment; 5 infants (6, 11, 13, 17, and 20 months) and 3 juvenile (5, 6, 12 years). Duration of follow up was 2-28 months. Outcome assessments included safety, CSF biochemistry, MRI/MRS/DTI, and neurodevelopmental observations. Surgery and drug infusions were well-tolerated. Post-infusion MRIs showed signal enhancement volume coverage in thalamus from 8%-44% parallel to escalating doses. The only surgery related complication was superficial wound dehiscence in two patients. Infants showed partial stabilization or improvement, including in oral feeding and myelination. In juveniles, dystonic posturing worsened after dosing in all 3 patients treated. Two patients died much later from reasons unrelated to surgery or drug infusion. CONCLUSIONS: Surgery for BiTh infusion of rAAVrh8-HEXA/HEXB for gene therapy in infants with TSD and SD is well-tolerated. Patients respond well to treatment with some stabilization or improvement.

Hysteroscopic morcellation vs. curettage for removal of retained products of conception: a multicenter randomized controlled trial

To study the comparison between hysteroscopic morcellation (HM) of retained products of conception (RPOC) with ultrasound (US)-guided electric vacuum aspiration in terms of intrauterine adhesion (IUA) formation, efficacy, and complications. A randomized controlled, nonblinded trial. Three teaching hospitals and one university hospital from April 2015 to June 2022. A total of 133 women with RPOC on US, ranging from 1-4 cm, were randomized to receive either HM or electric vacuum aspiration. Hysteroscopic morcellation was performed with the TruClear System (Medtronic, Minneapolis, MN, USA). Electric vacuum aspiration was performed using an 8- or 10-mm flexible plastic Karman cannula under US guidance. Women allocated to vacuum aspiration underwent the procedure as soon as possible. In the HM group, an office diagnostic hysteroscopy was planned a minimum of 6 weeks after the end of pregnancy, followed by retained product of conception removal at least 8 weeks after the end of the pregnancy. Postoperatively, an office second-look hysteroscopy was scheduled to assess the primary outcome of IUAs. Postoperative IUAs were seen in 14.3% (9/63) of patients in the HM group and 20.6% (13/64) of patients in the vacuum aspiration group (-6% [-19.1% to 7.1%]). Significantly more RPOC were removed completely by HM compared with vacuum aspiration (95.2% vs. 82.5% (-14% [-24.9% to -3.1%]), and additional operative hysteroscopy was less frequently necessary in the HM group (12.5%) compared with the vacuum aspiration group (31.3%) (-20.1% [-34.3% to -6%]). The median operating time was shorter for vacuum aspiration compared with HM (5.80 minutes vs. 7.15 minutes). No differences were observed between HM and vacuum aspiration for the occurrence of intraoperative or postoperative complications (5.5% vs. 5.0% and 2.7% vs. 1.3%, respectively). In our randomized controlled trial, no significant differences were found in the occurrence of IUAs and complications. However, the RPOC were more often completely removed by HM than vacuum aspiration, and the HM group required fewer additional hysteroscopic treatments. NTR4923 (https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923). Date of registration: November 23, 2014, date of initial participant enrollment: January 1, 2015.

784-P: An Insulin Infusion Set with Novel Kink-Free Flexible Cannula: In-Vitro/In-Vivo Studies

Objective: The wear duration of insulin infusion sets (IIS) is impacted by initial local trauma caused by cannula insertion and sustained inflammation due mostly to insulin infusion, both of which affect insulin absorption. Efforts have been made to mitigate cannula kinking at insertion and during use, and other site reactions that contribute to IIS failures. This Medtronic preclinical study investigated performance of a novel flexible and kink-free soft cannula. Method: In-vitro tests (included buckling kink test, inflammatory macrophage cell culture, and insulin compatibility test by USP insulin monographic methods) were conducted on the Flexible cannula and commercial Teflon cannulas. In-vivo study of 3-day sets with both cannulas were conducted on diabetic swine by having animals wear one set multiple times (on the abdomen) while receiving Novolog™ insulin subcutaneously via a pump for 7 days or until set failure, determined by (1) blood glucose (BG) value not decreasing by ≥50 mg/dL an hour after a correction bolus for a BG level >350 mg/dL, or (2) evidence of infection at the infusion site. Result: Compared to the control Teflon cannula, kink resistance of the Flexible cannula was significantly improved (Kinked: Teflon 6/6, Flexible 0/6) . In the inflammatory in-vitro cell culture model, the pro-inflammatory cytokines generated by the Flexible cannula trended less (mean MCP-1: Teflon -9.7 ng/mL, Flexible - 7.7 ng/mL; mean MIP-1α: Teflon -24.1 ng/mL, Flexible - 24.0 ng/mL) . Tested by the USP methods, both cannulas were insulin compatible. In the swine diabetes model, the 3-day IIS with the Flexible cannula had a greater 7-day survival rate (50%, n=10) than the corresponding control (36%, n=56) , although not statistically different. No significant increase in total daily dose of insulin was observed. Conclusion: Preliminary in-vitro and in-vivo test results indicate that the novel Flexible cannula is ideally suited for IIS device performance. Further product development is ongoing. Disclosure C.Chiu: Employee; Medtronic. G.Zhang: Employee; Medtronic. S.Chattaraj: Employee; Medtronic. R.Gottlieb: Employee; Medtronic.

Computational fluid dynamics analysis of endoluminal aortic perfusion.

In peripheral percutaneous (VA) extracorporeal membrane oxygenation (ECMO) procedures the femoral arteries perfusion route has inherent disadvantages regarding poor upper body perfusion due to watershed. With the advent of new long flexible cannulas an advancement of the tip up to the ascending aorta has become feasible. To investigate the impact of such long endoluminal cannulas on upper body perfusion, a Computational Fluid Dynamics (CFD) study was performed considering different support levels and three cannula positions. An idealized literature-based- and a real patient proximal aortic geometry including an endoluminal cannula were constructed. The blood flow was considered continuous. Oxygen saturation was set to 80% for the blood coming from the heart and to 100% for the blood leaving the cannula. 50% and 90% venoarterial support levels from the total blood flow rate of 6 l/min were investigated for three different positions of the cannula in the aortic arch. For both geometries, the placement of the cannula in the ascending aorta led to a superior oxygenation of all aortic blood vessels except for the left coronary artery. Cannula placements at the aortic arch and descending aorta could support supra-aortic arteries, but not the coronary arteries. All positions were able to support all branches with saturated blood at 90% flow volume. In accordance with clinical observations CFD analysis reveals, that retrograde advancement of a long endoluminal cannula can considerably improve the oxygenation of the upper body and lead to oxygen saturation distributions similar to those of a central cannulation.

Pain Relief in a Trigeminal Neuralgia Model via Optogenetic Inhibition on Trigeminal Ganglion Itself With Flexible Optic Fiber Cannula.

The trigeminal ganglion (TG) is the primary site of aberration in trigeminal neuralgia (TN), and hence a crucial site where afferent input can be modulated. Here, we postulated that inhibiting TG via optogenetics using flexible optic cannula would diminish brainstem trigeminal nucleus caudalis (TNC) neuronal activity and pain behavior in TN rat model. Infraorbital nerve constriction was employed to induce TN in female Sprague-Dawley rats, while naive and sham rats served as controls. TG-directed microinjections of AAV virus containing either the optogenetic or null vector were delivered to rats in each group. In vivo electrophysiological responses were obtained from the ventral posteromedial nucleus (VPm) of the thalamus with simultaneous TG optogenetic stimulation using flexible optic cannula as well the effects on behavioral responses were investigated. Recordings in TN rats revealed a decrease in burst firing activity during yellow laser driven inhibition on TG, as well as considerably improved behavioral responses. In contrast, we noticed persistent hypersensitivity and increased tonic firing with blue laser stimulation which indicates that TG inhibition can synchronize trigeminal pain signal transmission in a TN animal model. The potential of an optogenetic approach in TG itself with flexible optic fiber to directly disrupt the trigeminal pain circuitry delivers fundamental underpinnings toward its prospective as a trigeminal neuralgia management.

Can hysteroscopy be substituted to hysterosalpingography in the assessment of infertility? Methods of showing tubal transition as hysteroscopic

Background: The main goal of this study was to prove that hysteroscopy is a superior method compared to hysterosalpingography in the evaluation of tubal passage and the uterine cavity in infertile women. Methods: The study was carried out on 30 volunteer women for whom evaluation of the uterine cavity and transit through the tubules was required due to infertility. In the evaluation of the hysteroscopic tubal passage, a 6Fr feeding cannula was advanced from the hysteroscope barrel, and firstly methylene blue and then an air bubble were applied to the fluid-filled uterine cavity through this flexible cannula. Results: When the reference method was taken as hysterosalpingography, the specificity of hysteroscopy was found to be 85.71% (95% CI (confidence interval): 42.13%–99.64%), sensitivity 94.74% (95% CI: 85.38–98.90%). The positive predictive value of hysteroscopy was calculated as 98.18% (95% CI: 89.78%–99.70%) and the negative predictive value was 66.67% (95% CI: 38.96%–86.24%). Observing the bubble and swirl effect together in the evaluation of the tube opening increases the diagnostic accuracy. And benefit of hysteroscopy in the evaluation of tubal passage was statistically significantly higher than hysterosalpingography. Conclusion: Considering the cellular damages that can be caused by hysterosalpingraphy and the real observation power provided by hysteroscopy, simultaneous evaluation and the comfort of making intervention possible, hysteroscopy will be a more useful and useful application.

A design and application method of the thoracic puncture cannula

Thoracentesis is common in daily medical practice. During the operation, it is easy to cause complications such as re-expansion pulmonary edema, pulmonary hypotension, liver and spleen injury, pleural reaction, intercostal artery injury, pneumothorax, and so on. If the operator does not master procedures properly, it is easy to damage the thoracic organs. Therefore, the department of the general practice of the First Hospital of Jiaxing improved the puncture needle device based on thoracic puncture cannula, developed a new type of disposable thoracic puncture cannula, and obtained the National Utility Model Patent of China (patent number: ZL 2019 2 2112955.7). New type of disposable thoracic puncture cannula comprises a flexible puncture cannula, a steel needle, a limit structure, and a second bolt. In the process of puncture, the length of the puncture is limited by the limit structure. If the puncture force is too strong, the limit structure will prevent further penetration of the needle. The device is easy to use, flexible to operate, easy to master, and can reduce the risk of thoracentesis, which is worth of clinical promotion.

The effect of active gas aspiration to reduce pain after laparoscopic sleeve gastrectomy for morbid obesity: a randomized controlled study

IntroductionResidual, intra-abdominal CO<sub>2</sub> contributes to abdominal distension and pain after laparoscopic surgery. Our aim was to investigate the effects of active gas aspiration on postoperative outcomes and pain following laparoscopic sleeve gastrectomy.Material and methodsPatients were randomly assigned to either the active gas reduction group (Group 1, n = 69) or the control group (Group 2, n = 74). After completion of the operative procedures, residual gas was aspirated with a flexible cannula in Group 1. In Group 2, gas release from the abdomen was performed using the port site by opening the gas tap only. The demographic data, body mass index, educational status, operation time, insufflated CO<sub>2</sub> volume during the operation, and intraabdominal pressure were recorded. Postoperative pain assessment was performed using a numerical pain intensity scale (NPIS) at the 1st h, the 24th h, and the 3rd day.ResultsNPIS scores at the 24th h were significantly lower in Group 1 (p < 0.001). However, there were no significant differences in the NPIS scores following the 1st h and the 3rd day. No differences were found in the operation time (p > 0.05). According to the correlation analysis between the operation time and NPIS scores between the groups, in Group 1 the duration of surgery was significantly proportional to NPIS24. All patients were discharged from the hospital on the 4th postoperative day.ConclusionsActive aspiration of the remaining gas just before the removal of the trocars is a simple procedure that reduces pain, leading to a more comfortable hospital stay.

Retraction: Research on Force Analysis and Path Planning of Flexible Needle Puncture Bending Modelling (J. Phys.: Conf. Ser. 1952 042058)

This article has been retracted by the authors following an admission that this article uses work from [1] without attribution. IOP Publishing has investigated in line with the COPE guidelines, and agree the article should be retracted. The authors agree to this retraction and apologise to the original creator of the work.1. Shi Kaiming 2019 Research on Movement Modeling and Path Planning of Flexible Cannula Needle Based on Finite Deformation Theory PhD Thesis Harbin University of Science and Technology, China (https://t.cnki.net/kcms/detail?v=zDWWPGpj7XNIYVmjPzotLQQrqE5suL8UT58pa0eYSzNWTc6cTneXhheuT3eZOa2hfsihnencE2errhffb1l--WQrpYCErNwN730qt90Gb_CdjKxkPFYC1Ppuj1cZoBQyYGNMZRph70O-WGDNoSWGdk1rtHYrxJSM&uniplatform=%20NZKPT)Retraction published: 03 December 2021

Stimulation of Upper Airway Afferents with Capsaicin and Section of the Superior Laryngeal Nerve Modulate Mechanically Induced Coughing from the Tracheobronchial Airways in Male But Not Female Cats

Airway diseases that induce coughing often involve perturbation of sensory feedback from both the upper and lower airways. We speculated that stimulation of upper airway TRPV-1 receptors with capsaicin would enhance coughing induced from the tracheobronchial airways. Further, we hypothesized that this enhancement would be eliminated by section of the superior laryngeal nerves, a primary sensory pathway from the larynx. Cats of either sex (n=5 males, 5 females) were anesthetized, tracheotomized and allowed to spontaneously breathe. The upper airway was isolated by sealing the mouth around a cannula and inserting a port into the upper trachea rostral to the tracheal cannula. Humidified air or humidified air plus capsaicin (55 mM, ultrasonic nebulizer) (500 ml/min) was passed into the mouth and out the trachea at the level of the 4th tracheal ring. Parasternal and abdominal muscle EMGs were recorded along with esophageal pressure. Cough was elicited by mechanical stimulation of the tracheobronchial airways with a flexible cannula. Aerosolization of capsaicin into the upper airway had no effect on cough number in males or females. In males but not females, SLN section resulted in an increase in cough number of approximately 20% that was not affected by capsaicin administration. Esophageal pressure, parasternal and abdominal muscle EMGs all significantly increased by up to 50% during capsaicin administration in males but not females. These effects in males were eliminated by section of the superior laryngeal nerves (SLN), whereas SLN section had no effect on esophageal pressure or respiratory muscle EMG magnitudes during coughing in females. These results support a complex and sex specific role for SLN afferents in the regulation of tracheobronchial cough. In males, elimination of SLN afferent feedback disinhibits cough number but blocks the enhancement of cough intensity by capsaicin-sensitive afferents in the upper airways. Given that our method of administration exposed the entire upper airway to capsaicin, it is possible that our results revealed multiple actions of upper airway afferents traveling in SLN and non-SLN pathways. The role of non-SLN mediated upper airway afferents in the regulation of cough is poorly understood. Our results suggest that in an animal model, the regulation of cough from the lower airways in males significantly differs than in females.

Kinetensin Increases Blood Pressure by Activation of Angiotensin‐II Type 1 Receptors, in Isoflurane Anesthetized Male Mice

Kinetensin, a peptide consisting of nine amino acids, originally isolated from pepsin-treated human plasma, shows sequence homology with serum albumin, angiotensin (Ang)-II and neurotensin (Mogard et al., 1986). Due to its interesting homology with the C-terminal end of neurotensin and Ang-II, it was earlier suggested that this peptide might have neurotensin- or Ang-II-like biological activity. Earlier, in-vitro studies revealed the functional role of kinetensin in releasing histamine from mast cells (Sydbom et al., 1989); however, the cardiovascular role of kinetensin, in-vivo, has never been established. In the present study, we investigated first the functional role of kinetensin on blood pressure (BP) and heart rate (HR) variables in mice. Under isoflurane anaesthesia, 12 male C57Bl6/J mice (30-33 g) were implanted with a Millar catheter into their left common carotid artery for continuous recording of BP and HR. The right jugular vein was implanted with flexible cannula for intravenous administration of drugs or saline. Raw traces were obtained using PowerLab (ADInstruments) and analogue signals were digitized using LabChart8 software. Under stable baselines, kinetensin was administered intravenously (1, 10, 100 μg in 0.1 mL of saline). In comparison to vehicle, kinetensin dose-dependently increased BP (2 ±0, 8 ±1, 29 ±4 mmHg, respectively) with a variable response in HR (-6 ±6, -7 ±16, 2 ±11 bpm, respectively), log-dose regression R2 = 0.77, p<0.001 for BP and R2 = 0.001, p<0.91 for HR, n=6. BP responses were precisely reproducible at approximately 10 min intervals and there was no desensitization effect observed for the highest kinetensin dose of 100 μg, 29±4 and 33±4, p=0.268, n=6. Interestingly, pre-treatment with an AT1-receptor antagonist (losartan, 15 mg/kg, i.v.), completely eliminated the kinetensin-mediated (100 μg dose) BP increase (pre-losartan 29±4 versus post-losartan -3±1 mmHg, respectively, p<0.001). In another cohort (n=6), pre-treatment with a ganglionic-blocker (chlorisondamine, 5 mg/kg) substantially reduced baseline BP, however subsequent administration of kinetensin i.v. produced delayed (~ 1 min) with much bigger and prolonged increases in BP responses (55±5 mmHg; p<0.001) compared to untreated mice (~ 5 sec, 29 ±4 mmHg, p<0.001). Our preliminary results show for the first time that kinetensin increases BP in a dose-dependent manner via activation of AT1 receptors, similar to Ang-II. Blockade of autonomic nervous control innervating vasculature produces similar increases in BP with much longer latencies strongly suggests a potential neuropeptide secretion role, such as arginine vasopressin. Further studies are needed to explore the kinetensin role in the central nervous system-mediated autonomic and neuroendocrine functions.

Rumen Cannulation of the Red Sokoto (Maradi) Goats for Nutritional Studies in Nigeria

TWO techniques for cannulating the rumen of the Red Sokoto goat of Nigeria are described. Stump type cannulae made of rigidblack., vulcathene1 material with screwable corks were found to be more suitable than the flexible cannulae made of plastisol2. They appeared to be well tolerated and remained in situ inspite of the animals’ nervous temperament and somewhat flabby abdominal wall. Experiences with some forty five of such cannulations performed between October 1970 and January 1975 are reported. These showed that although the double abdominal wall incision approach offered a better technique for cannulae implantation into the rumen of goats, strict routine post-operative attention was essential to avoid a range of post cannulation problems, such as pericannulae necrosis and infection, excessive leakage of the rumen liquor and partial or complete rejection of feed by the cannulated animals consequent upon such complications.

Use of ureteral catheter for under vision suctioning in rigid therapeutic bronchoscopy in children: A novel approach

Background: Rigid bronchoscopy is a common procedure and treatment of choice for foreign body (FB) in respiratory tract. Blind suctioning using rigid suction cannula is associated with technical difficulties and complications. Under vision flexible cannula are expensive and not commonly available. This led us to discover the alternative of using Ureteral catheters flexible suction cannula for under vision suctioning. Patients and methods: A retrospective study was conducted in the department of Surgery at tertiary hospitals, from January 2015 to March 2020. Medical records and operative videos were analyzed. Forty two Paediatric patients with foreign body in respiratory tractwere subjected to rigid bronchoscopy and Ureteral catheterwas used as flexible suction cannula for under vision suctioning. Results: Forty two patients (12 infants, 30 between age 1to 8 year; 26 males and 16 females) with FB bronchus subjected to rigid bronchoscopy. N = 32 were having organic FB and n = 10 were having inorganic (Graph 1), duration of FB in Respiratory tract ranged from 6 hours to 8 months, 7 in main bronchus, 33 having unilateral and 2 having Bilateral FB. Operative time ranged from 15 minutes to 75 minutes. 4 patients had slight intraoperative bleed due to mucosal injury, postoperative stay ranged from 1 to 4 days. Conclusion: Use of Ureteral catheterfor under vision suctioning in rigid bronchoscopy in children quite feasible and effective technique. The main advantages in are simplicity, short operative time, Less traumatic, Good vision, with minimal complications. Type of study: Treatment Study. Level of evidence: LEVEL IV, Case series with no comparison group.

Case Report of Ogilvie's Syndrome Following Emergency Haemostatic Subtotal Abdominal Hysterectomy at University Teaching Hospital of Butare, Rwanda.

Background:Acute colonic pseudo-obstruction or Ogilvie's syndrome is a rare condition that usually develops due to a dysregulated autonomic nervous system following a medical or surgical condition. With delayed diagnosis, it may lead to bowel ischemia and perforation with poor prognosis.Case:We report a case of a 33 years old female, Gravida 1, Para1, who developed severe abdominal distension following abdominal haemostatic hysterectomy due to a severe postpartum haemorrhage and shock requiring epinephrine infusion after a spontaneous vaginal delivery. The postpartum haemorrhage was due to both atony and posterior cervical tear. Two initial administrations of neostigmine 2 mg mixed with atropine 0.5 mg were unsuccessful, but an insertion of a flexible recto-sigmoid cannula allowed a slight decompression. A subsequent third dose of neostigmine 2 mg mixed with atropine 0.5 mg was followed with a remarkable flatus evacuation and complete decompression.Conclusion:Prompt diagnosis and management of Ogilvie's syndrome is crucial in order to avoid subsequent complications. In case of postoperative cecal and colonic distension without mechanical obstruction, Ogilvie's syndrome should be suspected as this will ensure timely and adequate management of patients at risk including obstetric patients.

A Magnetically Navigated Microcannula for Subretinal Injections.

Retinal disorders, including age-related macular degeneration, are leading causes of vision loss worldwide. New treatments, such as gene therapies and stem cell regeneration, require therapeutics to be introduced to the subretinal space due to poor diffusion to the active component of the retina. Subretinal injections are a difficult and risky surgical procedure and have been suggested as a candidate for robot-assisted surgery. We propose a different actuation paradigm to existing robotic approaches using remote magnetic navigation to control a flexible microcannula. A flexible cannula allows for high dexterity and considerable safety advantages over rigid tools, while maintaining the benefits of micrometer precision, hand tremor removal, and telemanipulation. The position of the cannula is tracked in real-time using near-infrared tip illumination, allowing for semi-automatic placement of the cannula and an intuitive user interface. Using this tool, we successfully performed several subretinal injections in ex-vivo porcine eyes under both microscope and optical coherence tomography visualization.

Pneumothorax as a Complication of Liposuction.

BackgroundPneumothorax is a rare complication of liposuction resulting from injury to the lung parenchyma.ObjectivesThis study aimed to determine the incidence of pneumothorax complicating liposuction, describe an archetypal presentation, identify risk factors, and propose options for risk reduction.MethodsIn a retrospective chart review, liposuction procedures performed over a 16-year period by 8 surgeons in 1 practice were screened for pneumothorax. Cases featuring pneumothorax were analyzed to ascertain risk factors, presentation, and pathogenesis.ResultsAmong the 16,215 liposuction procedures performed during the study period, 7 pneumothoraxes were identified (0.0432%). Six (85.7%) were female. Three (42.9%) had previous liposuction. Six cases (85.7%) included liposuction of the axillary region. All cases featured depression of intra/postoperative oxygen saturations as the initial sign. Three (42.9%) were identified intraoperatively. All patients were transferred to a hospital for imaging. Five (71.4%) underwent chest tube placement. Two (28.6%) were treated with observation alone. Pneumothoraxes were left-sided in 4 cases (57.1%), and right-sided in 3 cases (42.9%). In early cases, 1.5-mm infiltration cannulas were used; in 2016 cannula size was changed to 3-4 mm for infiltration and 4-5 mm for liposuction.ConclusionsPossible risk factors for pneumothorax include liposuction of the axilla, use of flexible infiltration cannulas, and scarring from previous liposuction. We recommend including pneumothorax as a potential complication during informed consent, performing infiltration with a stiff >3.5-mm cannula, minimizing positive-pressure ventilation, emphasized awareness of cannula tip location in all patients but particularly in patients with previous liposuction or scar tissue, and increased caution when operating in the axillary area.Level of Evidence: 4

Outcomes and Adverse Events of Sub-Tenon's Anesthesia with the Use of a Flexible Cannula in 35,850 Refractive Lens Exchange/Cataract Procedures.

PurposeTo describe our technique of sub-Tenon’s anesthesia and report adverse events and patient comfort.SettingOptical Express, United Kingdom.DesignRetrospective case series.MethodsThe outcomes of 35,850 intraocular procedures (phacoemulsification and implantation of an intraocular lens) were retrospectively reviewed and the incidence of adverse events related to sub-Tenon’s anesthesia was calculated. On the first postoperative day, patients were asked to complete a questionnaire enquiring about their comfort during and after the procedure. The anesthetic solution consisted of a combination of Lidocaine and Hyaluronidase, which was administered into sub-Tenon’s space with a single-use sterile polyurethane 22G x 1” (0.9 x 25 mm) cannula. Mild conscious sedation (midazolam) was used during anesthetic and surgical procedure.ResultsNo significant adverse events that would affect the posterior segment of the eye or result in vision loss were recorded. Subconjunctival haemorrhage related to sub-Tenon’s anesthesia was noted in 4.3% of eyes. Five minutes after the administration of sub-Tenon’s block, 80.6% of eyes had no chemosis, 14.8% had chemosis that affected only 1 quadrant of the eye and 4.5% of eyes had chemosis affecting 2 or more quadrants of the eye. Other adverse events included 14 cases of cyst/granuloma formation in the area of sub-Tenon’s incision and 7 eyes required suturing of the conjunctival cut. Of all patients, 93.2% experienced no or only mild discomfort during or after surgical procedure.ConclusionSub-Tenon’s anesthesia with the use of a flexible cannula is a safe option for ophthalmic anesthesia. No sight-threatening adverse events occurred.

Ruminal Acidosis Caused by Excessive Ingestion of Mango Fruit (Mangifera indica) in Cow

Background: Digestive disturbances in ruminants are associated with forage shortages during periods of dry weather. Foods available at this time are generally of poor quality and low digestibility, which makes it necessary to pursue alternative food sources where available. Grain-heavy diets; concentrated rations rich in rapidly fermenting carbohydrates; and whey, tubers and fruits high in starch and glucose, contribute to ruminal acidosis. Here we report a case of ruminal acidosis due to excessive ingestion of the mango fruit (Mangifera indica), "manguita" cultivate, by an adult bovine.Case: In the municipality of Boa Vista, Roraima, during December, a Dutch female bovine adult, weighing approximately 600 kg, was observed showing signs of apathy for two days with diarrhea. The animal had a rumenostomy with flexible cannula in the left paralumbar fossa and was in the final third of gestation. During clinical examination, the animal was in season, and an increase in the volume of the left dorsal region and changes in physiological variables were observed (lightly pale mucosa, capillary filling time of 4 s, heart rate [HR] of 82 beats per min; respiratory rate (f) of 30 moments per min; absence of ruminal movements and rectal temperature [RT] of 39.5°C). Upon removal of the cannula lid, a considerable amount of liquid and a large quantity of mango (Mangifera indica), "manguita" cultivate, were observed. Blood sample and ruminal fluid were collected and ruminal contents weighing approximately 40 kg were evacuated. Physical-chemical analysis of the ruminal liquid (pH = 4.0, brown color, aqueous consistency and characteristic fruit odor) resulted in a diagnosis of ruminal acidosis. Treatment included administration of fluid therapy (Lactate Ringer; 2 mL/kg/h), hepatoprotector (1 mL/20 kg), antimicrobial (Ampicillin Sodium; 10 mg/kg/IV and Sulfadoxine; 30 mg/kg/IV) and non-steroidal anti-inflammatory (Meloxicam; 0.5 mg/kg/IV) drugs, associated with evacuation of ruminal contents, and administration of grass and transfaunation, for three days. Following treatment, the physiological variables and physical-chemical characteristics of the ruminal liquid returned to normal limits (pH = 6.0, greenish brown coloration, aqueous consistency and aromatic normal ruminal liquid odor). By 30 days of initial care, the animal was active and had given birth, with no abnormal changes in physiological variables and physical-chemical characteristics of the ruminal fluid.Discussion: A decrease in food supplies during the dry season forces animals to seek alternative sources of food to meet their needs, as observed in this case study. Intake of a large amount of mango was the cause of ruminal acidosis due to an overabundance of simple sugars. The measures established for the clinical evaluation, diagnostic methods used, collection of blood sample and rumen fluid, and the adopted therapy, administration of fluid therapy, antimicrobial and non-steroidal anti-inflammatory, associated with evacuation of the ruminal content, transfaunation, administered directly to the rumen, were essential to directing the diagnosis and obtaining a fast recovery time for the female bovine. Therefore, it can be concluded the excessive intake of fruit was the primary cause of rumen acidosis, and efficient case management led to observed clinical improvements in the physical-chemical characteristics of the ruminal liquid, with no recurrence of previous clinical signs.

Surgical removal of submacular perfluorocarbon liquid with a 38-gauge flexible cannula combined with internal limiting membrane peeling and intravitreal air tamponade: a case series

BackgroundTo report a case series in which a modified technique was used to remove retained submacular perfluorocarbon liquid (PFCL) secondary to vitreoretinal surgery for rhegmatogenous retinal detachment.Case presentationFour patients who had undergone pars plana vitrectomy for rhegmatogenous retinal detachment were further treated with surgical intervention because of retained submacular PFCL. With a three-port pars plana approach, after the internal limiting membrane peeling with indocyanine green staining, a 38-gauge flexible cannula was used to aspirate the submacular perfluorocarbon bubble, followed by fluid-air exchange and air injection into vitreous cavity. Submacular perfluorocarbon liquid was removed successfully and visual acuity had an improvement in all cases.ConclusionThe surgical removal of retained submacular PFCL using a 38-gauge flexible cannula combined with internal limiting membrane peeling and intravitreal air tamponade may provide anatomical and visual satisfactory outcomes.

Expansion Vibration Lipofilling: A New Technique in Large-Volume Fat Transplantation.

Despite rapid growth, gluteal fat transplantation is an operation in search of science and a teachable technique. Long operating times, tedious syringe transfers, inability to shape the recipient site, and the risk of fat embolism all headline as impediments to clinical adoption of the procedure. Expansion vibration lipofilling is a syringe-free surgical strategy that is a logical extension of Separation, Aspiration, and Fat Equalization (SAFELipo). In expansion vibration lipofilling, there is simultaneous disruption of recipient-site connective tissue, internal expansion using exploded-tip cannulas, and backfilling of these spaces with roller pump-propelled fat. Two thousand four hundred nineteen consecutive cases of expansion vibration lipofilling fat transplantation to the buttocks were reviewed. Average follow-up was 12 months. The technique of expansion vibration lipofilling is dependent on the use of larger caliber cannulas attached to a roller pump and to an oscillatory power-assisted liposuction device, which is less labor-intensive, potentially allowing for better knowledge of cannula-tip location at all times during the procedure. Operating times averaged 1 hour 40 minutes. The average volume of fat inserted was 1003 cc. Complications included donor-site seroma, infection, and one pulmonary embolism treated with anticoagulation. There were no cases of fat embolism or death. Expansion vibration lipofilling is a new method for large-volume fat transplantation. Avoidance of fatal fat emboli demands a surgeon's complete knowledge of cannula tip location at all times during the procedure. Syringe-free, larger caliber, and less flexible cannulas, combined with techniques requiring less operator upper extremity effort resulting in less fatigue, may contribute to avoidance of this dreadful complication. Therapeutic, IV.