Evacuation Of Fluid Research Articles

Subxiphoid Mediastinoscopic Autonomous Double Fenestration.

The coexistence of pleural and pericardial effusions in frail patients with or without confirmed neoplasia necessitates the use of a minimally invasive technique that has a minor impact on the patient's general status and allows for fast fluid evacuation and biopsy sampling if necessary. We present a subxiphoid mediastinoscopic autonomous (simultaneous noncommunicating) double fenestration approach for these patients with both diagnostic and therapeutic advantages in selected cases. Using the mediastinoscope alone through the subxiphoid incision can considerably reduce the duration of operation, allow for fluid evacuation, and significantly alleviate the patient's symptoms. This method enables the sampling of pleural and pericardial fluids and targeted tissue, if necessary.

Does surgical position affect infective complications in percutaneous nephrolithotomy?

The downward orientation of the access sheath during supine percutaneous nephrolithotomy (PCNL) allows the faster evacuation of fluids and stone fragments. It theoretically can contribute to the reduction of the high intrarenal pressure-associated complications. We aimed to investigate whether there is a difference between prone and supine PCNL in terms of infective complications. This retrospective study includes 182 patients who underwent supine and prone PCNL due to kidney stones in our clinic between April 2020 and May 2022. Demographic (age, sex, body mass index, comorbidities), radiological (cumulative stone burden, stone density, number of stones, stone localization, stone laterality, presence of hydronephrosis), clinical (previous stone surgery, previous urinary tract) and perioperative (prone or supine position, surgery duration, hospitalization, success, non-infective and infective complications) data of all patients were evaluated. All patients were divided into two groups, the prone position group, and the supine position group. These two groups were compared in terms of pre and postoperative data above. Infective complications were observed in 16 (18%) patients in the prone position group and in 7 (7.5%) patients in the supine position group, and this difference was statistically significant (p = 0.034). Surgery duration (OR = 1.041; 95% CI 1.021-1.061; p < 0.001), number of stones (OR = 4.09; 95% CI 1.093-7.309; p = 0.036), previous urinary tract infection (OR = 6.272; 95% CI 1.936-9.317; p = 0.002) and prone position (OR = 4.511; 95% CI 1.265-7.087; p = 0.02) were found as independent risk factors for infective complications. Prone position was proved as an independent predictor of postoperative infectious events. Supine PCNL will be further adopted as the standard PCNL approach by a continuously growing proportion of endourologists.

Renal Preservation Increases Survival Rate in Critically Ill COVID-19 Patients

BACKGROUND: COVID-19 infection tends to cause organ dysfunction and disrupts immunity due to cytokine storm. In addition to pulmonary distress and myocarditis due to the aforementioned cytokine storm, another prominent clinical feature of this disease is kidney failure. Maintaining good kidney function, normal creatinine levels, removing cytokine, avoiding fluid overload, and implementing higher level additional measures such as early (renal replacement therapy) are expected to increase survival in critically ill COVID-19 patients. AIM: We aimed to analyze whether renal preservation increases survival rate in critically ill COVID-19 patients METHODS: An observational analytic study was conducted in 53 critically ill COVID-19 patients treated in the ICU (Intensive Care Unit). All patients were treated with either standard therapy with additional renal-focused fluid evacuation and cytokine removal method such as CRRT (continuous RRT) or cytokine removal only with plasmapheresis. RESULTS: investigation through Cox regression analysis revealed that only cumulative balance an creatinine have a significant relationship with mortality (p &lt; 0.05). CONCLUSION: Maintenance of cumulative balance and serum creatinine will increase survival rates.

Safety barrier performance assessment by integrating computational fluid dynamics and evacuation modeling for toxic gas leakage scenarios

Toxic gas leakage represents a type of major process accident scenario threatening human life. Technical and non-technical safety barriers are employed to prevent toxic gas leakage accidents or mitigate the possible catastrophic consequences. Evacuation must be executed in severe toxic gas release scenarios. The performance assessment of technical safety barriers and evacuations in these accident scenarios, although very important, has never been investigated in previous studies. This paper proposes an approach integrating event tree analysis (ETA), computational fluid dynamics (CFD) simulation, and evacuation modeling (EM), for risk assessment of toxic gas leakage accidents in chemical plants. In the proposed approach, the spatiotemporal distribution of toxic gas is predicted by CFD simulations. A dynamic evacuation is determined by a cellular automaton (CA)-based model. Synergistic interventions resulting from technical safety barriers and evacuations are considered in the risk assessment. Considering safety barrier failures in the event tree analysis, individual fatality risks due to toxic gas leakage scenarios are calculated. For illustrative purposes, the proposed method is applied to a case of ammonia leakage. The results show that worse scenarios would be ignored without considering the failure probabilities of technical safety barriers, which can cause underestimated individual fatality risks. Timely gas detection & alarm has the potential to expedite the starting time of evacuations and thus may shorten the time that evacuees stay in the toxicity area to reduce individual fatality risks.

Successful treatment of congenital chylothorax using povidone iodine in trisomy 21 newborn

Congenital chylothorax is known as abnormal leakage and accumulation of chyle in the pleural space. As one of the minimally invasive treatments, chemical pleurodesis has been more frequently used in treating pediatric chylothorax in recent years. We report through this observation the clinical case of a newborn male with Down’s syndrome born at 38 weeks of amenorrhea admitted to our unit for a respiratory distress after his birth. On exploration we concluded right unilateral congenital chylothorax. Treatment consisted in an evacuation of pleural fluid with a chemical pleurodesis based on povidone iodine with good clinical and radiological outcome. Keywords: congenital chylothorax; chemical pleurodesis; down’s syndrome; povidone iodine.

Skin Layer Thickness and Shear Wave Elastography Changes Induced by Intensive Decongestive Treatment of Lower Limb Lymphedema.

Background: A detailed quantitative evaluation would be beneficial for management of patients with limb lymphedema.Methods and Results: In 47 patients with lower limb lymphedema at International Society of Lymphology clinical stage 2A (18 limbs), 2B (41 limbs), and 3 (13 limbs), we measured the limb circumference and thickness of epidermis, dermis, and subcutis layers with B-mode ultrasonography and subcutis elastic modulus with ultrafast shear wave velocity (ultrasound elastography) at 5 anatomical levels (M1 to M5) before and after a 3- to 5-day intensive decongestive therapy (IDT) session. Limb circumference and thickness of the epidermis, dermis, and subcutis were greater in the 72 limbs with lymphedema than in the 22 unaffected limbs before and after IDT. The affected limb volume was 10,980 [8458–13,960] mL before and 9607 [7720–11,830] mL after IDT (p < 0.0001). The IDT-induced change in subcutis thickness was −9 [−25 to 13]% (NS), −11 [−26 to 3]% (p = 0.001), −18 [−40 to −1]% (p < 0.0001), −15 [−35 to 3]% (p = 0.0003), and −25 [−45 to −4]% (p < 0.0001) and significantly correlated with the change in elastic modulus, which was 13 [−21 to 90]% (p = 0.004), 33 [−27 to 115]% (p = 0.0002), 40[−13 to 169]% (p < 0.0001), 9 [−36 to 157]% (p = 0.024), and −13 [−40 to 97]% (NS), respectively, at the M1, M2, M3, M4, and M5 levels. Intraobserver reproducibility was satisfactory for skin thickness and fairly good for elastography, but interobserver reproducibility was poor or unacceptable.Conclusions: IDT reduced the circumference and subcutis thickness of lower limbs with lymphedema and increased their elastic modulus, implying greater tissue stiffness probably due to fluid evacuation. Although subcutis thickness measurement proved to be reliable, technological and methodological improvements are required before ultrasonographic elastography can be used in clinical practice.

A Novel Internal Negative Pressure Delivery System in Prepectoral Breast Reconstruction-Preliminary Experience.

Background:Seroma remains a common complication after breast surgery, despite meticulous surgical technique to obliterate dead space and use of standard postsurgical drains for fluid evacuation. Therefore, novel approaches are needed. The Interi System is an internal, negative-pressure delivery system consisting of a manifold that is a silicone tubing with a central trunk and three peel-apart channeled branches connected to an external therapy unit, which simultaneously delivers continuous negative pressure of 125 mm Hg and removes excess fluid from internal tissue planes. This retrospective study evaluated the safety and effectiveness of Interi compared with standard drains in consecutive patients undergoing immediate, prepectoral, acellular dermal matrix-assisted, and implant-based breast reconstruction.Methods:Patient records were reviewed, and data on demographics, mastectomy, and reconstructive variables, postoperative complications, fluid output volume, and manifold/drain duration were retrieved and compared between the two groups.Results:Interi was used in 23 patients (38 breasts) and standard drains in 23 patients (39 breasts). Patients in both groups were well matched in all demographic, reconstructive, and mastectomy variables. Interi duration was significantly shorter than drains (16.7 versus 19.7 days; P = 0.020). There were no instances of seroma formation after removal of the manifold, edematous flap, or reconstructive failure with Interi. Seroma rate was 20.5% after drain removal (P = 0.005). All other complications were similar between the two groups.Conclusion:Interi effectively removed excess fluid from internal tissue compartments in prepectoral breast reconstruction and may offer significant improvement over current standards of care for seroma prevention in this procedure.

Стратегія менеджменту гіповолемії у дітей з тяжким сепсисом і септичним шоком

В статті проаналізовано основні фактори, що впливають на вибір об’єму та якісного складу рідини для волемічної ресусцитації у дітей з тяжким сепсисом і септичним шоком. Розглянуто фізіологію водного балансу та системи виділення у дітей різних вікових груп, проаналізовано критерії визначення достатнього рівня інфузійної терапії при критичній гіповолемії в фазах ресусцитації, оптимізації, стабілізації й евакуації рідини. Перевантаження інтерстицію рідиною та критична гіпоальбумінемія несприятливо впливають на кінцевий результат надання медичної допомоги дітям із тяжким сепсисом і септичним шоком.

COMPREHENSIVE TREATMENT OF COMPLICATED COURSE OF LIVER CIRRHOSIS IN CASE OF BLEEDING FROM THE VARICOS VEINS OF ESOPHAGUS, ENCEPHALOPATHY AND ASCITES

Aim: To develop a complex treatment for patients with decompensated cirrhosis in case of bleeding from the varicose veins of the esophagus. Material and methods: With bleeding from varicose veins of the esophagus for the period 2015–2020. in the clinic of the Transcarpathian Regional Clinical Hospital. A. Novak examined and treated 64 patients with C-class liver cirrhosis according to the Child-Turcotte-Pugh criteria. Results: In 17 patients they used extracorporeal ultrafiltration of ascitic fluid with it’s subsequent intravenous reinfusion. In the subgroup of 39 patients with effective sclerotherapy the mortality rate was 23.1%. In the subgroup of 25 patients where the ES was ineffective and the Blackmore tube was applied, the mortality rate was 32%. Among the 20 patients after laparocentesis with ascitic fluid evacuation 8 (40%) died. In the 17 patients after extracorporeal ultrafiltration of ascitic fluid with its subsequent intravenous reinfusion 2 (11.8%). In the subgroup where albumin peritoneal dialysis was applied 7 patients died (25.9%). Conclusions: The prognostic factors for the lethal outcome of bleeding from varicose veins of the esophagus in patients with decompensated liver cirrhosis are: the ineffectiveness of endoscopic sclerotherapy as a means of primary hemostasis, bleeding recurrence in the first 5 days. The use of staged treatment using extracorporeal methods can significantly improve the results of treatment, reduce mortality.

P12‐18: Comparison between manual vs other techniques of pleural fluid evacuation during thoracentesis: A meta‐analysis

P12‐18: Comparison between manual vs other techniques of pleural fluid evacuation during thoracentesis: A meta‐analysis

Intrapleural port systems as a technology for the control of recurrent metastatic exudative pleurisy. first experience

Introduction.To evaluate the immediate results of the first experience of implantation of an interpleural port system in comparison with traditional methods of pleural fluid evacuation and improve the quality of life of patients with recurrent metastatic pleurisy.Materials and methods.A prospective study of 14 cases with recurrence of metastatic pleurisy in 6 months was carried out. 2020 year. The patients were divided into group A (traditional methods of pleurisy evacuation) and group B (implantation of an interpleural port system). The manipulations were performed under local anesthesia.Results. Pneumothorax was diagnosed in 6 patients (43%) after thoracocentesis and implantation of the port system. In group B, 3 people (21%) had a small pneumothorax, the air was evacuated with a Huber needle. In group A, 3 people (21%) required drainage of the pleural cavity, which delayed hospitalization. In 11 people (78%), of which 7 people (50%) from group B, a clinical decrease in respiratory failure up to stage II. 7 patients (50%) from group B noted the absence of pain and discomfort after surgery. 14 (100%) patients were diagnosed with a recurrence of metastatic pleurisy on day 21, which required hospitalization of patients from group A to a hospital for drainage of the pleural cavity. In group B patients, fluid evacuation was performed on an outpatient basis, thereby not lengthening the period of systemic anticancer therapy. 4 patients (28%) managed to continue antitumor therapy on time. Infectious complications in 3 patients (21%) from group A, where air leakage persisted against the background of tumor disintegration.Conclusion.The intrapleural port system improves the quality of life, eliminating complications from repeated punctures of the pleural cavity. Simple installation under local anesthesia with the possibility of discharge from the hospital on the 2nd day. Evacuation of pleurisy through the port system by nurses on an outpatient basis. Possibility of intrapleural antitumor therapy and pleural obliteration through the port system.

Experience with Percutaneous Drainage of Body Fluids in a Tertiary Center in Benin City

Background: Percutaneous drainage is the evacuation of body fluids either using needle aspiration or by catheter placement under imaging guidance. Abnormal collections in the body which may be idiopathic, postinfectious, posttraumatic, or postsurgical (iatrogenic) can be free (e.g., ascites) or loculated (e.g. cysts and abscesses). Most cases of significant fluid accumulation require evacuation. Interventional radiology offers treatment and even cure to such patients who may be too ill to withstand surgery or not able to afford the cost of open surgery. The aim of this article is to review the common percutaneous drainage procedures done in the Radiology department of the University of Benin teaching hospital. Materials and Methods: A retrospective analysis of percutaneous drainage requests to the department of radiology of the hospital from January 2017 to march 2020 was performed. Data on age, gender, clinical diagnosis, the radiologic findings, procedures, and instrumentation utilized were retrieved and analyzed using IBM SPSS version 23. Results: A total of 49 patients' data were recruited for this study; 40 (81.6%) were female. The most common indication for intervention was liver abscess (14.3%), followed by liver cyst, endometriosis, obstructive jaundice, and pelvic abscess. The IV cannula/sheath was the most widely used instrument, followed by the pigtail catheter. All patients had their procedures done under antibiotic cover and the cases of hepatic cysts had albendazole added to their drug regimen. Conclusion: Despite the limited availability of resources for interventional radiology, basic procedures like cyst and abscess drainages can be successfully carried out using available materials and catheters.

Sensor placement optimization for fenceline monitoring of toxic gases considering spatiotemporal risk of the plant-urban interface

Toxic gas leak accidents can lead to significant casualties. The damage from a leak accident will be greater if toxic gas spreads to places where population density is high or vulnerable facilities with people who have difficulty evacuating. And the damage from leak accidents will also be greater if there is no evacuation warning from the plant despite the significant leak. Therefore, it is necessary to design the fenceline monitoring system through sensor placement optimization that reduces the risk toward the community. In this study, a mixed-integer linear programming formulation is proposed for sensor placement minimizing the risk by reflecting the characteristics of nearby areas. In order to quantitatively estimate the risk toward the community, the risk is calculated using dispersion data from computational fluid dynamics simulations and evacuation vulnerability and population density that define characteristics of a community. A case study is conducted to validate the efficiency of the proposed method. Exposed area and residual risk fraction are compared according to sensor placements from different conditions. Top-3 risk leak scenarios are analyzed quantitatively to manage the worst leak accident. It is validated that the proposed method is more efficient especially for the community that has uneven characteristics distribution.

Back to the 60s: The Heimlich Valve A patient- and family-centered care perspective

Abstract In this case report we present a 5-year old boy with a bronchopleural fistula with persistent air leak following complicated empyema. Treatment with antibiotics and pleural drainage did not stop the air leak and consequently prolonged drainage of the pleural cavity was needed. As this would account for weeks of hospitalization, we decided together with the parents, following the main principles of Patient-and-Family Centered Care, to treat the child at home with the use of a Heimlich valve. A Heimlich valve may be an old-fashioned, but effective one-way-valve permitting evacuation of air and fluid from the thoracic cavity without the need of high technology solutions and with minimal risk to the patient. This may prevent prolonged hospitalization, increase quality of life of the patient and save medical costs. After 2 months the chest tube with Heimlich valve was successfully removed. Recovery was uneventful; long term follow up showed restricted lung function with a total lung capacity of around 78% and fibrotic changes of the right upper lobe on chest CT scan.

Pleural fluid investigations for pleural infections

: Over 1.5 million patients are admitted to hospital with pneumonia in the United States each year. Up to 50% of them can develop a parapneumonic effusion which is associated with higher mortality. The incidence of pleural infection continues to rise, particularly in the elderly and those with comorbidities. Parapneumonic effusions cover a spectrum of presentations from a free-flowing ‘simple parapneumonic effusion’ to a septated ‘complicated parapneumonic effusion’ (CPE) (usually from bacterial pleural invasion) and ‘empyema’ (presence of pleural pus). Pleural infection is defined as either CPE or empyema, and usually requires evacuation of the infected fluid. Laboratory investigations play an essential part of the diagnosis and management of pleural infection. A parapneumonic effusion is typically a neutrophil-rich exudate. Presence of bacteria from culture of the fluid defines pleural infection but conventional culture methods have a low yield. Surrogate pleural fluid markers are often employed to confirm a CPE, including low pleural fluid pH (<7.2) or glucose (<3.3 mmol/L) and elevated lactate dehydrogenase (LDH). Measurement of pleural fluid triglyceride and chylomicrons (for chylothorax) and cholesterol (for pseudochylothorax) may be needed to separate lipid pleural effusions from empyema. Tuberculous pleural effusions usually result from a hypersensitivity pleuritis and are lymphocyte predominant with elevated pleural fluid adenosine deaminase (ADA) and interferon gamma levels. Culture yield of mycobacteria is typically low. Caseating granulomas on pleural tissue biopsy is often considered diagnostic. Common organisms for community-acquired pleural infection include Streptococcus pneumoniae, Streptococcus anginosus group bacteria and Staphylococcus aureus. Hospital-acquired pleural infections have higher mortality and are often polymicrobial which can include S. aureus, Enterobacteriaceae and anaerobes. Antibiotics and evacuation of the infected fluid, usually by chest tube drainage, remain the mainstay of treatment. Intrapleural fibrinolytic and deoxyribonuclease therapy, or occasionally surgical drainage, may be required.

Uterine perforation during brachytherapy for cervical cancer: Complications, outcomes, and best practices for forward treatment planning and management

PurposeThe purpose of the study was to determine the incidence of uterine perforations, review the associated complications, and propose guidelines for management of perforations after brachytherapy. Methods and MaterialsA retrospective chart review was conducted for all patients with cervical cancer who received single or multiple high-dose-rate brachytherapy implants between April 2006 and May 2017 at a single academic institution. CT and MRI images were retrospectively evaluated to record incidences of uterine perforation of tandem during brachytherapy. Acute and long-term complications during and after treatment were scored using the Common Terminology Criteria for Adverse Events, Version 4.0, of the National Cancer Institute. ResultsA total of 123 patients were included in the study. Perforations were observed in 22 patients (17.9%) with 31 (6.4%) of the 482 total implants. Of the different categories of adverse events, only the rate of acute infectious complications among those with perforations (n = 3, 13.6%) versus those without perforations (n = 3, 3.0%) was significant (p = 0.040). Two of the three perforated patients with acute infections had mild urinary tract infections, and all resolved without complications or treatment delays. The remaining one patient had a frank perforation of the anterior uterine wall with a subsequent Grade 3 pyometra infection despite administration of prophylactic antibiotics and 1-week treatment delay. This case was eventually resolved with cervical dilation and evacuation of fluid. Long-term complications were not different between the two arms. ConclusionsPatients with cervical cancer with uterine perforations may be able to safely proceed with brachytherapy treatment without delay or need for prophylactic antibiotics in the acute setting. Further validating data would be able to assist in establishing a new standard of care and help prevent unnecessary and harmful breaks during treatment.

Causes of resistant pleural effusions and efficiency of chemical pleurodesis in these patients

To study the causes of resistant pleural effusions and efficiency of chemical pleurodesis with Betadin, Iodopyrone and concentrated glucose solution in these patients. Resistant pleuritis with daily exudation over 300 ml lasting ≥6 days occurred in 206 (48%) out of 424 cases of pleural effusions. Twenty-seven patients underwent chemical pleurodesis with Betadine, 15 patients - mixture of Iodopyrone with concentrated glucose solution. Solutions were injected via pleural drainage. In multivariate analysis, the risk factors of complicated pleuritis were air leakage, prolonged drainage period, age over 60 years, fluid output volume during thoracoscopy and higher Charlson index. Pleurodesis with a mixture of Betadine 10% 10 ml and glucose 40% 40 ml suppressed exudation in 92.6% of cases. Pleurodesis with a mixture of Iodopyron and glucose solution in the same quantities was effective in 93.4% of cases. If exudation continued, pleurodesis was repeated after 3 days. VAS score of pain syndrome following Iodopyrone injection was 3.0±1.8, in case of Betadine - 3.4±0.3. No significant hemodynamic changes were noted. In case of malignant pleural effusions and low functional parameters after fluid evacuation, favorable effect was obtained after pleurodesis with a mixture of povidone-iodine with glucose through the same catheter and subsequent removal of drainage tube. Resistant pleural effusions with daily exudation over 300 ml for more than 6 days are characterized by advanced risk of infectious and inflammatory complications due to air leakage and duration of drainage. Pleurodesis with mixtures of Betadine or iodopyrone and 40% glucose solution is effective for resistant pleural effusions.

Right Spontaneous Hemopneumothorax Associated with SARS-CoV-2 Infection - Case Presentation

Context: SARS-COV2 infection, the respiratory febrile disease firstly described in China in December 2019, which was declared a pandemic on March 11th, 2020, is associated with multiple air and fluid collections. Spontaneous hemopneumothorax in coronavirus disease 19 (COVID 19) patients is a rare clinical entity described as an unusual complication of severe COVID 19 pneumonia. Objective: The authors used the database of a single COVID 19 treatment center only. In our case series, we encountered a patient with particular hemopneumothorax features that we have decided to present. Method: A 51-year-old non-smoker male with fever and cough lasting for 7 days was admitted to the dedicated COVID 19 unit of “Dr. Carol Davila” Central University Military Hospital Bucharest. The patient developed hemopneumothorax on the 14^th day since the beginning of the symptoms. The thoracic surgeon performed pleural drainage through minimal pleurotomy allowing the evacuation of both air and fluid. Results: Post interventional computed tomography scan showed the remission of hemopneumothorax. The favorable evolution and the negative SARS COV2 screening throat swab test allowed the discharge of the patient on the 25th day after initial diagnosis. Conclusions: In certain situations, COVID 19 pneumopathy may lead to hemopneumothorax with unpredictable evolution, and only a fast therapeutic intervention can save the patient’s life.

Идиопатическая гидроцефалия взрослых: современное состояние проблемы

The term "idiopathic hydrocephalus" in adults is a broader concept that includes larger spectrum of patients compared to "idiopathic normotensive hydrocephalus". It includes both young and elderly patients with various forms of the disease, patients with various levels of obstruction. Th ere is no general classification and general approach to treat patients with such a pathology. Endoscopic triventriculostomy in idiopathic aqueductal stenosis and cerebrospinal fluid shunting after a positive test of cerebrospinal fluid (tap test) evacuation in idiopathic normotensive hydrocephalus are proved to be effective. In patients with other forms of cerebrospinal fluid pathway obstruction, treatment approach is represented by the opinions of some surgeons. At the same time, most surgeons consider the use of cerebrospinal fluid shunting operations to be effective and justified, and they use endoscopic techniques as an option for examining ventricular system and for performing auxiliary manipulations. The high frequency of various complications of bypass surgery and slightly lower efficiency of endoscopic operations indicates the need to systematize patients; to improve selection criteria and to expand the indications for the use of endoscopic surgical techniques.

R11 Digital Chest Drains After Lung Resection: An Australian Experience

Intercostal catheters (ICC) are an integral component of post-operative care following lung resection. Traditionally analogue drains with underwater seals have been used for evacuation of fluid and air from the pleural space. Recently, the emergence of digital chest drains has changed practice regarding management of ICCs. We sought to describe our initial experience with the Thopas+ ™ digital chest drain in non-pneumonectomy lung resection.