Safe Invasive Procedure Research Articles

Trans-Catheter Palliation in Tetralogy of Fallot Patients: Complications & Challenges

Objective: To identify the complications of Transcatheter palliation in Tetralogy of Fallot patients. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Paediatric Cardiology Department, AFIC/NIHD, Rawalpindi Pakistan, from Jul to Dec 2022. Methodology: This Analytical Cross-sectional study was conducted in n=54 patients of Tetralogy of Fallot (TOF) who underwent Transcatheter palliation procedure. Cases were selected by using non-probability consecutive sampling. Patients with isolated pulmonary stenosis, complex congenital heart and Tetralogy of Fallot with pulmonary atresia were excluded from the study. Data was entered and analyzed by using SPSS version-24:00. In descriptive statistics, Mean±SD were calculated for continuous variables while frequency (%) for categorical variables. To find out the association between categorical variables, Chi-square test was used. p-value of <0.05 was taken as statistically significant. Results: Out of 54 patients, 32(59.3%) were males and females were 22(40.7%). Mean age was 11.87±7.34 months. Right ventricular outflow tract ballooning was done in 39(72.2%) and right ventricular outflow tract stenting was done in 15(27.8%) patients. Transient arrhythmias 28(51.9%) were the most commonly encountered complications. Conclusion: Transcatheter palliation is becoming the first line of management in Tetralogy of Fallot patients because of better outcomes, ease of performance and safety profile. Working professionally can yield a safe invasive procedure of balloon pulmonary valvotomy and stenting in these patients.

Diagnostic Evaluation of Haematological Diseases Based on Bone Marrow Examination

Background: Bone marrow examination is a safe invasive procedure and can provide sufficient explanation for unexplained cytopenias, leukaemia and other haematological disorders including metastases to the marrow by detailed morphological description of the marrow elements. Objective: To see the importance of bone marrow examination for the diagnosis of haematological disorders. Materials and Methods: It was a descriptive cross-sectional study comprising 196 patients who underwent bone marrow examination for evaluation of haematological disorders in the Department of Haematology, Enam Medical College and Hospital during the period of July 2012 to December 2019. Results: Total number of cases were 196, male to female ratio was 1.56:1 and majority of the patients were >18 years of age (84.69%). Common indications for bone marrow examination were pancytopenia (33.67%) and diagnosis of leukaemia/ myeloproliferative neoplasm (23.98%). In our study, haematological conditions were 79.08%. Among these malignant conditions were 55.10% and nonmalignant conditions were 23.98%. Aplastic anaemia (14.29%) and immune thrombocytopenia (7.65%) were the most common nonmalignant disorders. Common malignant disorders were acute myelogenous leukaemia (20.41%) and multiple myeloma (9.69%). Conclusion: Bone marrow examination is a simple and effective procedure in reaching the final diagnosis of haematological diseases. J Enam Med Col 2021; 11(1): 34-38

A Prospective and Retrospective Study of Bone Marrow in Patients with Pancytopenia– A Study of 150 Cases

Abstract BACKGROUND : The bone marrow is widely distributed organ and is the principle site for blood cells formation. The broad spectrum of disorders affects the marrow primarily or secondarily with presentation of peripheral pancytopenia. Hence, bone marrow examination is extremely helpful in evaluation of pancytopenia. This study emphasizes the different causes of pancytopenia and bone marrow morphology in cases of pancytopenia. MATERIALS & METHODS: The present study is a retrospective and prospective study done in the department of Pathology, for a period of two years. All the relevant history, clinical details, radiological details, and biochemistry parameters were considered. RESULTS: Out of 150 cases,96 were males and 54 were females. Majority of the patients were in the age group of 41-60 years (54%) amongst whom Megaloblastic anaemia was the most important cause of pancytopenia. CONCLUSION: Bone marrow aspiration is relatively a very safe invasive procedure and primarily permits cytological assessment since the underlying pathology determines the management and prognosis of the patients.

Adverse effects following dental local anesthesia: a literature review

Local anesthesia is indispensable in dentistry. Worldwide, millions of local anesthetic injections are administered annually, and are generally considered safe invasive procedures. However, adverse effects are possible, of which dentists should be aware of. This scoping review aimed to provide an extensive overview of the reported literature on the adverse effects of dental local anesthesia. The types of papers, what is reported, and how they are reported were reviewed. Additionally, the incidence and duration of adverse effects and factors influencing their occurrence were also reviewed. An electronic search for relevant articles was performed in PubMed and Embase databases from inception to January 2, 2020. The titles and abstracts were independently screened by two reviewers. The analysis was narrative, and no meta-analysis was performed. This study included 78 articles. Ocular and neurological adverse effects, allergies, hematomas, needle breakage, tissue necrosis, blanching, jaw ankylosis, osteomyelitis, and isolated atrial fibrillation have been described. Multiple adverse effects of dental local anesthesia have been reported in the literature. The results were heterogeneous, and detailed descriptions of the related procedures were lacking. Vital information concerning adverse effects, such as the dosage or type of anesthetic solution, or the type of needle used, was frequently missing. Therefore, high-quality research on this topic is needed. Finally, the adverse effects that are rarely encountered in real-world general practice are overrepresented in the literature.

Fetal loss following second trimester amniocentesis. Who is at greater risk? How to counsel pregnant women?

Objective: The purpose of this retrospective observational cohort study was to determine the impact of certain risk factors on fetal loss, after mid-trimester amniocentesis. Material and methods: Six thousand seven-hundred and fifty-two (6752) consecutive amniocenteses with known pregnancy outcome performed during a 7-year period (2004–2010) were included in this study. Different maternal-, fetal- and procedure-related factors were evaluated in this study. Results: During this 7-year period, 6752 cases who underwent amniocentesis, with complete data available were evaluated for the outcome and risk factors mentioned. Total fetal loss rate (FLR) up to the 24th week was 1.19%. Risk factors associated with increased risk of fetal loss after amniocentesis were maternal age (OR:2.0), vaginal spotting (OR:2.2) and serious bleeding (OR:3.5) during pregnancy, history of 2nd trimester termination of pregnancy (OR:4.0), history of more than three spontaneous (OR:3.0) or surgical first trimester abortions (OR:2.1), fibromas (OR:3.0) and stained amniotic fluid (OR:6.1). Conclusions: Amniocentesis is a safe-invasive procedure for prenatal diagnosis with total FLR of 1.19% in our institution during the study period. The present study has emphasized the significance of certain risk factors for adverse outcome and therefore the need to individualize the risk.

English

BACKGROUND: Hematological diseases are quite frequent in population and mostly present with anemia. Although diagnosed mostly by clinical examination and simple investigations, bone marrow examination is confirmatory for the diagnosis. Bone marrow aspiration is simple and safe invasive procedure. Spectrum of hematological diseases in the developing countries is different from those observed in developed countries. OBJECTIVE: There is a lack of information about the exact relative prevalence of hematological disorders especially in Central India that’s why this study was undertaken to correlate clinico-hematological and bone marrow findings. MATERIAL AND METHODS: It is a retrospective study of 345 cases who underwent bone marrow examination in Department Of Pathology, Gandhi Medical College, Bhopal. RESULTS: In our study age range of cases was 2-80 years with male: female ratio of 1.28:1. Most common diseases observed were megaloblastic anemia (41.81%), dimorphic anemia (16.72%), hypoplastic anemia (9.09%), ITP (8.36%) and infective pathology (4.72%). In Hematological malignancies (20.28%), most common were AML (6.95% of overall & 34.28% of malignant diseases %) followed by ALL (4.92 % overall and 24.28% % of malignancies). 3 cases of Gaucher’s disease were also reported.96.81% patients were anemic while 44.92% were pancytopenic. Most common presenting symptoms were fever (44.92%) and bleeding manifestations (30.14%) which include ecchymosis, epistaxis, petechiae, melena, hematuria and hematemesis. Splenomegaly, hepatomegaly and lymphadenopathy were found in 35.65%, 21.15% and 14.78% of cases respectively. CONCLUSION: In our study final diagnosis could be made in majority of cases (92.76%) by bone marrow examination, although having varied clinical presentations such as fever, bleeding manifestations, ascites, hepatomegaly, splenomegalyetc and usually associated with anemia / pancytopenia/ thrombocytopenia.All hematological cases must undergo bone marrow examination to conclude the exact underlying pathology for appropriate treatment.

Anticoagulation management.

To perform safe invasive procedures on patients on anticoagulation therapy, management of the patient's anticoagulation status is mandatory. For patients on anticoagulation therapy, a risk analysis of both the procedural risk of bleeding as well as the risk to the patient from discontinuing anticoagulation needs to be performed. For procedures at low risk of bleeding, the procedure may be performed with little change to the patient's anticoagulation regimen. For procedures with significant bleeding risk, however, anticoagulation will need to be held or reversed. Patients at high risk for thromboembolic complications will require bridging therapy if anticoagulation is to be withheld. In this article, a logical assessment of bleeding risk in patients undergoing procedures is presented, and a review of anticoagulation and risk is discussed.

Primary access-related complications in laparoscopic cholecystectomy via the closed technique: experience of a single surgical team over more than 15 years

Laparoscopic cholecystectomy (LC), a common laparoscopic procedure, is a relatively safe invasive procedure, but complications can occur at every step, starting from creation of the pneumoperitoneum. Several studies have investigated procedure-related complications, but the primary access- or trocar-related complications generally are underreported, and their true incidence may be higher than studies show. Major vascular or visceral injury resulting from blind access to the abdominal cavity, although rare, has been reported. Of the two methods for creating pneumoperitoneum, the open access technique is reported to have the lower incidence of these injuries. The authors report their experience with the closed method and show that if performed with proper technique, it can be as rapid and safe as other techniques. However, injuries still happen, and the search for the predisposing factors must be continued. Between January 1992 and December 2007, a retrospective study examined 15,260 cases of LC performed for symptomatic gallstone disease in the authors' institution by a single team of surgeons. The primary access-related injuries in these cases were retrospectively analyzed. In 15,260 cases of LC, 63 cases of primary access-related complications were identified, for an overall incidence of 0.41%. Major injuries in 11 cases included major vascular and visceral injuries, and minor injuries in 52 cases included omental and subcutaneous emphysema. For the closed method, the findings showed an overall incidence of 0.14% for primary access-related vascular injuries and 0.07% for visceral injuries. Primary access-related complications during LC are common and can prove to be fatal if not identified early. The incidence of these injuries with closed methods is no greater than with open methods. No evidence suggests abandonment of the closed-entry method in laparoscopy.

What is the role of diagnostic laparoscopy in a gastroenterology unit?

Diagnostic laparoscopy is known to be a relatively safe invasive procedure. However, its use has decreased owing to the development of imaging techniques, and fewer gastroenterologists now practice diagnostic laparoscopy. Our aim was to examine the role of diagnostic laparoscopy in a gastroenterology unit in the era of advanced imaging techniques. We retrospectively reviewed 855 diagnostic laparoscopy cases. Its safety and efficacy were evaluated for various indications. No mortality was observed, and complications were noted in ten patients (1.2%). Among the indications were evaluation of chronic liver disease (n = 673), liver tumor (n = 15), ascites of unknown origin and peritoneal disease (n = 142), and staging of intra-abdominal malignancy (n = 25). In patients with chronic liver disease, 461 were diagnosed as having chronic viral hepatitis, based on clinical data including imaging studies, but the diagnosis was changed to cirrhosis after a laparoscopic exam in 69 patients (15.0%). In patients with ascites of unknown origin and peritoneal disease, the diagnostic yield was 87.2% (123/141). In 24 (19.5%) of the 123 patients, the diagnosis changed or the less probable diagnosis was confirmed after laparoscopic examination. The confirmed diagnoses were mainly primary peritoneal disease, including peritoneal tuberculosis, in 17 patients, peritoneal metastatic carcinoma in five, and mesothelioma in two. Diagnostic laparoscopy in a gastroenterology unit is safe and useful, especially for confirmation of liver cirrhosis and primary peritoneal disease evaluation.

Needle and trocar injuries in diagnostic laparoscopy under local anesthesia: what is the true incidence of these complications?

Laparoscopy is a relatively safe invasive procedure, but complications can occur, mainly related to Veress needle and trocar insertion. The rate of these complications is generally reported to be low, but the true incidence may be higher because of underreporting. We retrospectively studied the records of 2650 consecutive diagnostic laparoscopies performed by the same operator with the aim of assessing the true incidence and nature of these complications. Major complications occurred in 0.41% of cases and included bladder injury, bowel perforation, hemoperitoneum, and abdominal wall hematoma. Minor complications, including omental and subcutaneous emphysema, occurred in 1.58% of cases. Some of these resolved spontaneously, whereas others required surgical or medical treatment. We believe that all laparoscopic complications should be reported to a registry so that their potential risk can be quantified. Simply reporting complications as major or minor on the basis of the follow-up does not allow laparoscopists to understand their true incidence completely.

Are Liver Cirrhosis and Portal Hypertension Associated With an Increased Risk of Bleeding During Laparoscopy? A Retrospective Analysis of 1,000 Consecutive Cases

Laparoscopy is a relatively safe invasive procedure. However, the rate of bleeding complications during this procedure is still debatable. Moreover, it is not clear whether portal hypertension may increase the risk of this event. The authors analyzed retrospectively the records of 1,000 consecutive patients with chronic liver disease undergoing laparoscopy and guided direct-vision hepatic biopsy, and they examined the rate of bleeding complications from the trocar site after insertion of the Veress needle or after liver biopsy. A total of 400 of 1,000 patients had liver cirrhosis. Of these, 22.7% had splenomegaly, 13.0% had laparoscopic signs of portal hypertension, and 8.2% had esophageal varices. Bleeding occurred in 0.9% of patients from the trocar site, in 0.2% from the biopsy site, and in 0% from the Veress needle site. These figures were independent of the presence of advanced liver disease, with or without portal hypertension. Bleeding complications occur rarely during laparoscopy with guided liver biopsy and do not seem to be related per se to the presence of liver cirrhosis and portal hypertension. If anything, bleeding complications represent an unpredictable event in most cases.

Are liver cirrhosis and portal hypertension associated with an increased risk of bleeding during laparoscopy? A retrospective analysis of 1,000 consecutive cases.

Laparoscopy is a relatively safe invasive procedure. However, the rate of bleeding complications during this procedure is still debatable. Moreover, it is not clear whether portal hypertension may increase the risk of this event. The authors analyzed retrospectively the records of 1,000 consecutive patients with chronic liver disease undergoing laparoscopy and guided direct-vision hepatic biopsy, and they examined the rate of bleeding complications from the trocar site after insertion of the Veress needle or after liver biopsy. A total of 400 of 1,000 patients had liver cirrhosis. Of these, 22.7% had splenomegaly, 13.0% had laparoscopic signs of portal hypertension, and 8.2% had esophageal varices. Bleeding occurred in 0.9% of patients from the trocar site, in 0.2% from the biopsy site, and in 0% from the Veress needle site. These figures were independent of the presence of advanced liver disease, with or without portal hypertension. Bleeding complications occur rarely during laparoscopy with guided liver biopsy and do not seem to be related per se to the presence of liver cirrhosis and portal hypertension. If anything, bleeding complications represent an unpredictable event in most cases.