Radiographic Guidance Research Articles

A novel technique for posterior lumbar interbody fusion to obtain a good local lordosis angle: anterior-release posterior lumbar interbody fusion.

Herein, we describe a novel posterior lumbar interbody fusion (PLIF) technique with annulus fibrosus (AF) release and the use of expandable cages (called "anterior-release PLIF" [ARPLIF]). In this technique, posterior column osteotomy (PCO) and AF release provide excellent intervertebral mobility. AF release involves circumferentially peeling off the AF above or below the endplate between the fixed vertebrae under radiographic guidance without cutting the AF and anterior longitudinal ligament. Subsequently, high-angle variable-angle expandable cages are used to simultaneously expand both sides before inserting the percutaneous pedicle screws and correcting to achieve good local lumbar lordosis. PCO and AF release achieve excellent intervertebral mobility. Intervertebral mobility and simultaneous expansion of both cages disperse the force on the endplates, reducing cage subsidence, and the high-angle cages facilitate high intervertebral angle creation. The novel ARPLIF intervertebral manipulation technique can promote good local lumbar lordosis formation.

Use of a new aiming compression device and technique for the repair of navicular bone fractures in horses: A cadaveric study.

To assess the use of a newly developed aiming compression device (ACD) for screw insertion in non-fractured navicular bones (NB) in cadavers. Cadaveric study. A total of 10 cadaveric front limbs of adult horses. Placement of a 3.5 mm cortical screw in non-fractured NB under radiographic guidance was performed in 10 cadaver limbs in a standing position. An ACD was used to stabilize the NB and to guide the drilling process. Preparation and surgical time as well as the number of radiographic images were noted. A postoperative scoring system was used to assess screw placement by cone beam computed tomography (CBCT) and gross examination by two evaluators. The total procedure time was 25-62 min (median 33.5). During the procedure, 11-21 radiographs (median 18.5) were taken. The postoperative gross examination revealed an excellent screw placement in nine NB and poor in one. This could not be reliably assessed with post-procedure CBCT. The described technique achieves an excellent screw placement in 9/10 bones without disrupting the articular or flexural surface of the NB and with no protrusion of the screw head or tip, in a median procedure time of under 35 min. Adequate screw placement is paramount for NB fracture repair. The described approach under radiographic guidance allows adequate screw placement using the ACD to stabilize the NB by lateral to medial compression. This technique facilitates adequate screw placement within the NB without the use of advanced imaging techniques.

A novel transcoronal surgical technique for the treatment of cystic lesions of the distal phalanx: A cadaveric study.

To assess the feasibility of a novel transcoronal approach for the treatment of axial type 3 cysts of the palmar/plantar aspect of the distal phalanx (P3). Ex vivo, experimental study. Ten cadaveric specimens, four forelimbs and six hindlimbs. All cadaveric specimens underwent radiographically guided drilling, followed by cortical screw placement. The cartilage was macroscopically assessed after disarticulation of the distal interphalangeal joint. The entry point and trajectory were evaluated with computed tomography. Results were categorized as: axial, near-axial and abaxial. The minimal distance from the outer margin of the drill hole and the proximal border of the subchondral bone plate was measured using frontal computed tomographic slices. Eight of the 10 screws were in an axial to near-axial position and nine followed the desired axial to near-axial trajectory. One screw was inserted axially but continued in an abaxial trajectory. Iatrogenic damage to the joint cartilage, flexor cortex and solar canal of P3 was not observed. All cortical screws were placed close to the proximal subchondral bone-plate of P3. The desired axial/near-axial drilling and screw placement, under radiographic guidance, was achieved in nine out of 10 specimens. This novel technique seems promising for the treatment of inaccessible P3 cysts. Additional studies are required to investigate its feasibility in clinical cases, and the long-term outcome following transcystic screw placement of type 3 P3 cysts.

Single-stage revision for total shoulder arthroplasty infection. Results at a minimum 2 years follow-up

IntroductionSimilar to the management of periprosthetic joint infections of the lower limb, one-stage revision in total shoulder arthroplasty (TSA) infections is an option that has been highlighted in scientific publications since the early 2010s. However, there are only a few studies which validate this treatment and determine its scope of application in relation to two-stage treatment. HypothesisSingle-stage revision for infected TSA is a reliable treatment allowing good infection control and satisfactory functional results. MethodsThis single-center retrospective series of 34 consecutive patients operated on between 2014 and 2020 for a one-stage prosthetic revision was evaluated at a minimum of 2 years of follow-up. All of the patients included underwent revision shoulder arthroplasty during this period with the diagnosis of infection confirmed by microbiological analysis of surgical samples. Patients who did not benefit from a bipolar revision were excluded. All patients were followed at least 2 years after the intervention. Clinically suspected recurrence of infection was confirmed by a periprosthetic sample under radiographic guidance. Functional clinical outcomes as well as mechanical complications were also reported. ResultsThe average follow-up was 40.4 months (24–102±21.6). A septic recurrence was observed in three patients (8.8%). A mechanical complication was present in four patients (14.7%), and three (11.8%) required at least one surgical revision. The mean Constant-Murley score at the last follow-up was 49 (42–57±21.83). DiscussionSingle-stage revision for shoulder periprosthetic joint infection results in a success rate of 91.2% with satisfactory functional results after more than 2 years of follow-up. Level of evidenceIV; retrospective study.

The efficacy of pediatric elbow radiographic guidance in diagnosis of lateral humeral condyle fracture.

Although lateral humeral condyle fracture is common, the incidence of missed diagnosis is very high. Delayed and missed diagnosis led to significant morbidities and loss of functions. We designed a pediatric elbow radiographic guidance aiming to improve the accuracy of diagnosis. This study was aimed to evaluate the efficacy of the radiographic guidance for the diagnosis of lateral condyle fracture. A cross-sectional study was conducted after defining the essential parameters as a guidance for assessing the pediatric elbow radiographs. We included medical students, emergency medicine, orthopedic, and radiology residents and fellows into this study. A questionnaire was used to evaluate the efficacy of the guidance. All participants underwent a pretest evaluation, followed by studying the guidance, and then finished a posttest evaluation. Baseline characteristics, diagnostic scores, and parameter evaluation scores were collected. The pretest and posttest scores were analyzed using paired t-test. Association between baseline characteristics and diagnostic scores were analyzed using multiple regression analysis. We included 177 participants. Average diagnostic score was significantly increased after using the guidance, from 12.2 ± 1.9 to 13.0 ± 1.7 (p < 0.0001). Medical students showed the most improvement, from 11.9 ± 1.9 to 13.1 ± 1.3 (p <0.001). All means of essential parameter evaluation scores were significantly improved in overall participants.The pediatric elbow radiographic guidance is useful for evaluation and diagnosis of lateral condyle fracture, especially for young physicians and trainees. Therefore, this should be recommended in routine medical education and general practice.

Susceptibility-Weighted MRI Approximates Intraoperative Microelectrode Recording During Deep Brain Stimulation of the Subthalamic Nucleus for Parkinson's Disease

Deep brain stimulation of the subthalamic nucleus (STN-DBS) for Parkinson's disease can be performed with intraoperative neurophysiological and radiographic guidance. Conventional T2-weighted magnetic resonance imaging sequences, however, often fail to provide definitive borders of the STN. Novel magnetic resonance imaging sequences, such as susceptibility-weighted imaging (SWI), might better localize the STN borders and facilitate radiographic targeting. We compared the radiographic location of the dorsal and ventral borders of the STN using SWI with intraoperative microelectrode recording (MER) during awake STN-DBS for Parkinson's disease. Thirteen consecutive patients who underwent placement of 24 STN-DBS leads for Parkinson's disease were analyzed retrospectively. Preoperative targeting was performed with SWI, and MER data were obtained from intraoperative electrophysiology records. The boundaries of the STN on SWI were identified by a blinded investigator. The final electrode position differed significantly from the planned coordinates in depth but not in length or width, indicating that MER guided the final electrode depth. When we compared the boundaries of the STN by MER and SWI, SWI accurately predicted the entry into the STN but underestimated the length and ventral boundary of the STN by 1.2 mm. This extent of error approximates the span of a DBS contact and could affect the placement of directional contacts within the STN. MER might continue to have a role in STN-DBS. This could potentially be mitigated by further refinement of imaging protocols to better image the ventral boundary of the STN.

Computed tomography and fluoroscopy versus radiographic guidance for internal fixation of simulated dorsomedial-plantarolateral central tarsal bone fractures in nonracehorses.

The aim of this study was to assess screw placement in simulated dorsomedial-plantarolateral central tarsal bone (CTB) fractures using two imaging guidance techniques - computed tomography (CT) with fluoroscopy compared to digital radiography alone (DR). Experimental study. Equine cadaver hindlimbs (n = 10 pairs). One tarsus per pair was randomly assigned to have a 4.5 mm cortical screw placed across the CTB using CT and fluoroscopy (CT/F group) or digital radiography alone (DR group). Postoperative CT was performed on all limbs. Variables related to marker placement, procedure time, and screw positioning were recorded and compared using a paired t-test for dependent means (p < .05). Time for marker placement was longer for the CT/F group (p = .001), with no difference in total procedure time (p = .12). CT/F was not superior to radiography alone (p > .05) for parameters related to screw positioning. Based on the 95% CI, there was greater range in relative screw length using radiography (76.5%-91.2%) versus CT/F (78.4%-84.0%). Internal fixation of CTB fractures can be successfully performed using either technique for imaging guidance. CT and fluoroscopy did not result in faster or more accurate screw placement compared to radiographs alone, except in determining screw length. Mild adjustments in fluoroscopic or radiographic angle appeared to be a point of variability in the perception of screw placement. While CT is recommended for improved understanding of fracture configuration and surgical planning, radiographic guidance may be a suitable alternative for internal fixation of dorsomedial-plantarolateral fractures.

Duplex ultrasound-guided angioplasty of hemodialysis vascular access

ObjectiveDuplex ultrasound-guided angioplasty (DA) for hemodialysis vascular accesses remains questionable regarding its feasibility and safety. Minor complications (requiring no more treatment than nominal therapy) might be over-reported. Our hypothesis is that this procedure has no significant differences between observed rates and the recommended threshold of main outcomes of the procedure defined by the standards of arteriovenous fistulas (AVF) angioplasty. MethodsIn a single-center retrospective study, 298 DA performed on 141 patients from 2015 to 2019 were analyzed. Occluded AVF or concomitant use of radiographic guidance were excluded. Duplex ultrasound parameters were collected up to 1 month before, at the end of angioplasty, and on day 30 after the procedure. Complications were registered, and patency rates were studied at 24 months of follow-up. ResultsAnatomical success was achieved in 142 procedures (47.7%), clinical success in 284 (95.3%), and hemodynamic success in 283 (95.0%). Major complications—requiring at least a specific therapy—were reported in 8 procedures (2.7%) and minor complications—requiring no adjunctive therapy—in 157 (52.7%). At 24 months, overall postintervention primary patency was 34.0%, primary-assisted patency 87.4%, and secondary patency 92.5%. There were no significant differences of patency rates between groups with or without minor complications (P value for primary patency, 0.08; primary-assisted patency, 0.08; secondary patency, 0.23) or 30% residual stenosis (P value for primary patency, 0.82; primary-assisted patency, 0.46; secondary patency: 0.63). Duplex parameters further improved at postoperative day 30 after angioplasty. ConclusionsDA of AVF is feasible, safe—despite over-reported minor complications having no impact on postintervention patency rates—and efficient. A minor complication can be seen as an event without bad or good consequences. Anatomical definition of success does not fit on DA for hemodialysis vascular access. Further studies are required to define the duplex parameter threshold for efficacy.

The Roth Net at 40 years: celebrating the spirit of innovation

The Roth Net at 40 years: celebrating the spirit of innovation

Thoracoscopic removal with fluoroscopic radiographic guidance of thoracoamniotic shunting catheters in newborns.

Fetal thoracoamniotic shunting (TAS), which drains pleural effusion, is a treatment for severe primary fetal pleural effusion. While TAS is an effective treatment, its complications include bleeding and the catheter becoming dislodged, and also penetrating the thoracic cavity or chest wall. Catheters dislodged into the thoracic cavity in TAS can be removed by thoracoscopy. However, if there are adhesions in the thoracic cavity, finding the TAS catheter with a thoracoscope can be difficult. We used fluoroscopic radiography in addition to a thoracoscope to remove a TAS catheter in four patients. A 5-mm trocar was inserted into the thoracic cavity, and a 2.7-mm scope and 3-mm forceps were inserted into the trocar. We searched for TAS catheters using a thoracoscope and fluoroscopic radiography. If there are adhesions in the thoracic cavity and removing the TAS catheter is difficult, the combined use of a thoracoscope and fluoroscopic radiography may prove helpful.

Novel Minimally Invasive Sliding Calcaneal Osteotomy: A Case Series

Category:Hindfoot; AnkleIntroduction/Purpose:Sliding calcaneal displacement osteotomy is a mainstay in the treatment of hindfoot deformity. A lateral oblique or L shaped incision and direct visualization of the calcaneus is the traditional open approach to this osteotomy.Complications of this approach are not common and include wound dehiscence, delayed union, neurovascular damage, tarsal tunnel syndrome, symptomatic bony overhang and peroneal fibrosis. Several techniques have been developed to address the limitations of the open approach including osteotomy with a Gigli saw, percutaneous endoscopic assisted osteotomy, and most recently minimally invasive osteotomy (MICO) with a low speed, high torque burr. Each of these techniques has limitations. This report presents a simple minimally invasive technique that may help mitigate wound issues without the technical hurdles of a steep learning curve.Methods:Patients undergoing MICO procedures with the senior author from February 2019 - June 2020 who had not undergone previous foot/ankle surgery were retrospectively enrolled. Patients underwent clinical and radiographic assessment preoperatively as well as at 2, 6, 12, and 24 weeks postoperatively. The technique utilizes a 1.5cm incision along the plane of osteotomy, centered about a K-wire placed through both cortices of the calcaneus at the midpoint of the osteotomy plane. The plane and K-wire placement are determined under radiographic guidance. A micro-sagittal saw is rested on the K-wire and used as a cutting block in the coronal plane. After the osteotomy is created and mobility of the calcaneus confirmed, the K-wire is removed. The mobile segment is adjusted as needed, held in placed by dorsiflexing the ankle, and fixed using two posterior-to-anterior 6.5 cannulated screws, one 1cm superior to the other. The wounds can then be irrigated and closed.Results:37 patients were treated using this technique. 24 (65%) patients were female, with average age 56.9 years. Osteotomies were performed concomitantly with procedures including flexor digitorum longus transfer, subtalar fusion, triple arthrodesis, talonavicular fusion, hallux valgus corrective osteotomy, and Strayer gastrocnemius recession. Thirty-five (95%) patients achieved radiographic fusion within 1 year postoperatively with 28 (76%) fusing by 3-month follow up. Two (5%) patients developed a radiographic non-union without instability and opted to be managed expectantly. Of note, one patient is a diabetic current smoker with Rheumatoid Arthritis, while the other is a non-diabetic former smoker. A single patient was readmitted within 90 days for incision and debridement of a dehisced wound from subtalar fusion performed concomitantly. One patient underwent eventual removal of the screw compressing the calcaneal osteotomy site due to hardware prominence. No patients reported peroneal symptoms postoperatively. No patients reported any other complications related to the osteotomy.Conclusion:Sliding calcaneal displacement osteotomy is a well-established component in the treatment of hindfoot deformity. Although larger lateral oblique and L shaped incisions allow direct visualization of the osteotomy, more minimally invasive approaches have been used. The proposed technique in the current report offers a low non-union rate, minimal surgical footprint, easily available surgical instruments, reliable osteotomy plane, and short surgical time.

Endoscopic High-speed Curettage and Bone Grafting of Unicameral Bone Cyst in Young Children: A Case Report

Curettage and bone grafting are the most effective methods used in the treatment of unicameral and aneurysmal bone cysts. Endoscopic curettage and bone grafting are minimally invasive methods for the treatment of these bone cysts. We report a case report of a unicameral bone cyst of the calcaneus in a 9-year-old girl treated successfully with endoscopic high-speed curettage and bone grafting. Complete healing of the unicameral bone cyst of the calcaneus, according to the Modified Neer’s Classification Scale, was achieved 4.5 months postoperatively. Complete healing without recurrence, in 5 years follow-up, was evident. Endoscopic high-speed curettage allows a precise, thorough, and aggressive resection of the cyst’s tumor tissue, which is the key to successful and complete healing of the cysts. For the successful endoscopic bone cyst curettage, radiographic control guidance is necessary to avoid growth plate damage. Level of Evidence: Diagnostic Level IV—therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

A BRIEF HIATUS: PARAESOPHAGEAL HERNIA REPAIR COMPLICATED BY THORACIC HERNIA SAC

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Paraesophageal herniation (PH) is the displacement of abdominal viscera, particularly the stomach, through the diaphragm into the thorax. Surgical fundoplication can infrequently lead to post-operative complications. We present a unique case of stage IV PH complicated by post-fundoplication insufflated hernia sac causing hemodynamic instability. CASE PRESENTATION: A 77-years-old woman with hypertension presented with dysuria and abdominal discomfort and was found to have hypokalemia, atrial fibrillation (AF), and pyuria. A stage IV PH was noted on computed tomography (CT). She underwent laparoscopic Nissen fundoplication for hernia repair. Postoperatively, she had worsening chest pain, dyspnea and tachycardia. CT scan revealed a large hernia sac with air-fluid level within the thorax causing cardiac shift and compression. The patient was intubated for worsening dyspnea and started on pressors for refractory hypotension. A pigtail catheter was placed under radiographic guidance into the displaced hernia sac with decompression of air and retrieval of fluid with rapid improvement in hemodynamics and cardiac shift. Fluid analysis showed low cell counts and negative cytology with yeast in culture. As tube feeds were introduced, the formulation drained through the hernia sac catheter with an elevated fluid amylase level of 895 raising concern for an esophageal leak. The patient was extubated to high-flow nasal cannula but intermittent hypotension, dyspnea, and overall failure to thrive prompted her family to pursue hospice care. DISCUSSION: PH can cause herniation of abdominal contents into the thorax causing significant morbidity with median age of presentation between 65-75 years (1). With large phrenoesophageal membrane defects, organs including stomach, spleen, and small intestine can herniate. Diagnosis is made by barium swallow, endoscopy or CT (2). Treatment for advanced, symptomatic disease refractory to medical treatment is surgical. Given the need to insufflate the peritoneal cavity, laparoscopic repair can occasionally lead to insignificant surgical emphysema and pneumomediastinum or small pneumothorax (3). However, this can infrequently cause hemodynamic instability, and to our knowledge, there is no literature reporting an inflated visceral peritoneal sac protruding into the thorax causing tension physiology as in our patient. Diagnosis is based on clinical findings of shock and imaging showing mediastinal structure compression and shift. Treatment is based on decompression and, in patients stable for surgery, resection of the hernia sac. CONCLUSIONS: Visceral peritoneal sac herniation and insufflation with air-fluid level causing tension physiology is a rare phenomenon post-PE repair that can cause significant hemodynamic instability and morbidity. Clinical exam and radiographic imaging followed by quick decompression play a key role in swift recognition and urgent treatment. REFERENCE #1: Lebenthal A, Waterford SD, Fisichella PM. Treatment and controversies in paraesophageal hernia repair. Front Surg. 2015;2:13. REFERENCE #2: Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ. 2014;349(oct23 1):g6154-g6154. REFERENCE #3: Singhal T, Balakrishnan S, Hussain A, Grandy-Smith S, Paix A, El-Hasani S. Management of complications after laparoscopic Nissen's fundoplication: a surgeon's perspective. Ann Surg Innov Res. 2009;3:1. DISCLOSURES: No relevant relationships by Pavan Bhat, source=Web Response no disclosure on file for Robert Cole; No relevant relationships by Theodore Plush, source=Web Response

Factors affecting successful ultrasound-guided injection into the podotrochlear bursa using a palmarolateral approach.

To evaluate potential factors affecting ultrasonographic visibility of the suprasesamoidean region and the success rate of ultrasound-guided injection (USGI) into the podotrochlear bursa (PB). Ex vivo, experimental study. 24 cadaveric forelimbs. The PB was distended with 0, 1, or 2ml of iodinated contrast material and saline under radiographic guidance. Ultrasonographic visibility of the suprasesamoidean region and PB was graded before and after distention with the limb loaded in three positions (vertical, cranial and caudal). Two operators with different experience levels performed an USGI into the PB with methylene blue (12 limbs each [four limbs with each of three volumes of PB distension]) using a palmarolateral approach and caudal foot placement. Limbs were frozen and sectioned to assess accuracy. Ultrasonographic visibility scores of the suprasesamoidean region (p=.0081) and PB (p < .0001) were improved using a caudal foot placement. Higher visibility grades of the suprasesamoidean region were associated with higher injection success rate (p=.047). The injection success was 75% (9/12) for the experienced versus 41.6% (5/12) for the less experienced operator (p=.14). PB distension improved visibility during caudal foot placement (p=.013) but not injection success rates (p=.78). Caudal foot placement enhances visibility of the PB and suprasesamoidean region. Limbs with poor visibility of the suprasesamoidean region are more likely to undergo a failed USGI. The lateral USGI approach should be performed only in cases of optimal visibility. The reported success rates support the technical challenge of PB injections.

CEREBROSPINAL FLUID SAMPLING IN A BOTTLENOSE DOLPHIN (TURSIOPS TRUNCATUS) UNDER GENERAL ANESTHESIA

Brucella ceti, associated with neurobrucellosis, has been isolated from cerebrospinal fluid (CSF) of postmortem cetaceans. A 106-kg, stranded female bottlenose dolphin (Tursiops truncatus) presented with serum antibodies to Brucella spp. via competitive enzyme-linked immunosorbent assay and fluorescence polarization assay. Polymerase chain reaction (PCR) and culture of whole blood, bronchoalveolar fluid, and rectal, nasal, and genital swabs for Brucella spp. were consistently negative. Serial computed tomography revealed mild focal dilatation of brain ventricles. CSF sampling was warranted to exclude neurobrucellosis. Sedation was achieved with 30 mg diazepam (0.28 mg/kg) orally 2.5 hours prior to arrival in hospital, followed by 5.3 mg midazolam (0.05 mg/kg) intramuscularly, and anesthetic induction with 2.5 mg midazolam (0.02 mg/kg) and 200 mg propofol (2 mg/kg) administered slowly intravenously, followed by intubation and maintenance on sevoflurane using controlled mechanical and apneustic anesthesia ventilation. The atlanto-occipital joint was opened by flexing the upper cervical region with the animal in left lateral recumbency. A 20-ga × 6-inch spinal needle was advanced into the cisterna magna using radiographic guidance. CSF was collected successfully with no neurological deficits appreciable on recovery. Brucella spp. was not identified via PCR or culture. This represents the first report of an antemortem CSF tap in a cetacean.

A “bridge” technique to replace the obstructed single-J stent in the patient with ileal conduit urinary diversion: a case report

The ureteroileal anastomotic stricture is a complication of ileal conduit urinary diversion. To prevent the hydronephrosis and protect the renal function, a single-J ureteral stent may be needed. However, the most common complication of these patients is single-J stent obstruction. To solve this problem, we describe an easy, useful and low-cost technique to replace the obstructed ureteral stent under radiographic guidance without intervention by flexible cystoscopy or percutaneous nephrostomy. The key steps of our procedure are to identify the location of the stricture, to place the super smooth guide wire into pinhole of the obstructed single-J stent and to get the super smooth guide wire and 5-Fr ureteral catheter across the stricture. Our case was a 40-year-old male patient who was diagnosed as pelvic lipomatosis and received ileal conduit urinary diversion 3 years ago. The left-side ureteroileal anastomotic stricture occurred 1 year after surgery. He refused to repair the stricture by open or other minimal invasive surgery. He regularly changed his ureteral stent with intervals of three months. As the stent was obstructed by the stone, the guide wire couldn’t be inserted through the primary ureteral stent. We used our “bridge” technique to solve his problem successfully. No bleeding and no urinary tract infection were observed after intervention. The urine from the ureteral stent was fluent. We think that this “bridge” technique may be a good choice for the replacement of the obstructed single-J stent in the patients of ileal conduit urinary diversion.

Navigating the Paradox of Scarcity-The Case for Physician Extenders.

Scarcely is medical care delivered without imaging. Formerly a diagnostic tool, imaging now verifies procedural success. That not even nasogastric tubes are placed without radiographic guidance affirms our job security. But there is a natural law in economics from which radiologists are not exempt, known as the diamond-water paradox, which is that though water is more useful than diamonds, it is cheaper, because water is ubiquitous and diamonds are scarce [1].

Peripherally Inserted Central Catheter Placement in a Total Artificial Heart Recipient

Highlights The bedside placement of a peripherally inserted central catheter is contraindicated in patients with a total artificial heart. An emergent situation prohibiting radiographic guidance of central line placement in a patient with a total artificial heart is described. Techniques used to successfully place a peripherally inserted central catheter are noted to help guide clinicians faced with vascular access challenges in a patient with a total artificial heart.

Ultrasound-assisted injection of the centrodistal joint in the horse.

Injection of the centrodistal (CD) joint in the horse is a commonly performed procedure for both diagnostic and therapeutic purposes. This procedure can be technically challenging, and while radiographic guidance has been previously used, ultrasound localised injection of the CD joint has not been described. The purpose of this study was to explore the feasibility of using ultrasound localisation to increase the accuracy of CD joint injection. Experimental method assessment. One operator performed the ultrasound and injection of 24 CD joints in 12 sedated horses. The joints were injected with iohexol (2ml), sterile saline (1.5ml) and amikacin (0.5ml). Dorsoplantar and dorsomedial plantarolateral radiographic projections were obtained immediately after injection to evaluate the presence of contrast material in the CD joint. The CD joint was successfully injected in 17/24 joints, representing a 70.8% accuracy. The horses used in this study were from the University research herd, and not clinical cases. One investigator performed all the ultrasonography and CD joint injections. The use of ultrasound localisation could improve success of CD joint injection as well as improve the learning curve of less experienced practitioners learning this procedure.

Radiographic guidance for Turnbull-Weakley blowhole colostomy.

Radiographic guidance for Turnbull-Weakley blowhole colostomy.