Subcutaneous Puncture Research Articles

Surgical Technique of Endovascular Ablation for Primary Lower Extremity Varicose Veins: Ablation Catheter Subcutaneous Puncture to Extend the Ablation Length

Surgical Technique of Endovascular Ablation for Primary Lower Extremity Varicose Veins: Ablation Catheter Subcutaneous Puncture to Extend the Ablation Length

Genomics and proteomics combined analysis revealed the toxicity response of silkworm Bombyx mori to the environmental pathogen Bacillus cereus ZJ-4

Bacterial contamination has caused a major public health problem worldwide. Bacillus cereus is a conditional environmental pathogenic bacteria that can cause food poisoning. Whether environmental pathogens can cause widespread transmission in the insect kingdom is unclear. In this study, a Bacillus cereus ZJ-4 was isolated from the hospital environment of Zhenjiang City, Jiangsu Province, China. It was fatal by injection into the silkworm hemolymph. To investigated the potential toxic factors of ZJ-4 and clarified the toxicity response mechanism of silkworm by the ZJ-4 infection. Then, the whole genome of ZJ-4 was sequenced, and the immune mechanism of silkworm fat body to ZJ-4 pathogen was studied by HE pathological section and proteomics. Bacterial genome sequencing indicated that ZJ-4 had 352 drug resistance genes and 6 virulence genes. After 36 h of subcutaneous puncture with ZJ-4 suspension, the pathological changes were obviously found in HE pathological sections of fat body tissue. Comparative proteomic results indicated that differentially expressed proteins are mainly involved in stress reactions, biological regulation, and innate immunity. The qRT-PCR analysis showed that the expressions of β-GRP, Spaetzle, MyD88, Tube and Dorsal genes in Toll pathway were up-regulated, while Pell and Cactus genes were down-regulated; in the antimicrobial peptide pathway, Glv2, Lzm, Mor, and Leb3 genes were up-regulated, while attacin1 and defensin genes were down-regulated; Sod gene was up-regulated, while Cat gene was down-regulated in the antioxidant pathway; Ldh, Sdh, and Mdh genes were down-regulated in glucose metabolism pathway. These results indicated that ZJ-4 can damage the innate immune pathway of silkworm, and also affect the normal immune function of fat body cells.

Scenario for the use of effusion–peritoneal shunt necessary against subdural effusion secondary to decompressive craniectomy

ObjectivesThis study aimed to summarize the surgical strategies for subdural effusion secondary to decompressive craniectomy (SESDC) and discuss the applicable scenarios of effusion–peritoneal shunt (EP shunt). MethodsA total of 53 consecutive patients with SESDC were screened out of 7569 cases. The SESDC was divided into five types, and the treatment methods of each type were analyzed and compared. According to the implementation strategy of cranioplasty (CP), patients were divided into CP-first and delayed-CP groups. The differences in surgical methods were compared between the two groups. ResultsAll patients with SESDC in this cohort had undergone cranioplasty. Subcutaneous puncture and aspiration (SPAA) proved ineffective. Only 2/30 patients in the CP-first group used EP shunt, while 6/19 patients in the delayed-CP group used EP shunt; the difference was statistically significant (P = 0.03). A significant difference was found in the use of EP shunt among type 1, type 2, and type 5 SESDC (χ2 = 6.778, P = 0.034). ConclusionsCP combined with other treatments could cure most SESDC. EP shunt should be used preferentially in some specific scenarios in which CP cannot be performed first, rather than as a backup measure that can only be used when other preceding treatments fail.

Successful bailout procedure for acute popliteal artery occlusion associated with EXOSEAL\xae vascular closure device: a case report

BackgroundVascular closure devices have been widely used to achieve rapid hemostasis after percutaneous catheterization procedures via the common femoral artery. The EXOSEAL vascular closure device is a device that can deliver a bioabsorbable polyglycolic acid plug to fill the subcutaneous puncture route at the groin for rapid hemostasis, and this device has a lower risk of arterial occlusion than other vascular closure devices.Case presentationAn 83-year-old Japanese man underwent percutaneous coronary intervention for a proximal stenosis in his left circumflex artery through a 7-Fr sheath from his right common femoral artery. We encountered acute popliteal artery occlusion associated with EXOSEAL vascular closure device. We detected the plug material of this device at the occluded lesion by intravascular ultrasound, and performed successful bailout stenting after pulling the embolus with an inflated balloon catheter up to the superficial femoral artery from the popliteal artery.ConclusionAcute limb ischemia caused by an EXOSEAL vascular closure device is a very rare complication. Balloon angioplasty and stenting are considered to be effective options to deal with the plug dislodgement of an EXOSEAL vascular closure device. We must be prepared for every rare complication during endovascular treatment.

Cutaneous Scar sarcoidosis on venous and subcutaneous puncture areas

Cutaneous Scar sarcoidosis on venous and subcutaneous puncture areas

Nursing experience in treatment of contrast agent leakage by compression with multi-point puncture

Objective To investigate the effect of multi-point puncture of subcutaneous soft tissue swelling area and 50% magnesium sulfate and 2% lidocaine cold treatment contrast agent leakage in CT enhancement scanning. Methods Severe contrast agent leakage occurred when the enhanced CT scans in 13 patients, the use of disposable 5 ml syringe, parts of the leakage multi-point subcutaneous puncture, squeeze with 50% magnesium sulfate and 2% lidocaine sterile gauze cold processing. Results Thirteen cases of severe leakage of patients within 18-36 h swelling, skin color was normal, no patient experienced local skin ulcers, skin or subcutaneous tissue necrosis. Conclusions This method can subside tissue edema in a short time, reduce swelling, relieve the suffering of patients, effective in preventing complications. Key words: Magnesium sulfate; Lidocaine; Multi point puncture; Contrast agent leakage

Clinical application of totally implantable central venous port

To summarize the disposal methods and the reasons of complications in operation of totally implantable central venous port (TICVP). A total of 2 007 patients were enrolled in this observational, single-center study between December 2008 and March 2013. TICVP implantation was performed with one small skin incision and subcutaneous puncture of subclavian or jugular vein. Patient's profiles, indications of port system, early and delayed complications, and disposal methods were evaluated. There were 38 male and 1 969 female patients, aged from 21 to 85 years, with a mean of 47.6 years. The mean duration of the TICVP system was (242 ± 12) days, ranging from 9 to 1 243 days. The achievement rate of puncture in the right jugular vein (99.76%) was the highest. Sonographic approach using the internal jugular vein were better than the external landmark-guided technique (99.80% vs. 96.34%, χ² = 29.905, P = 0.000). The rate of immediate complication was 0.80%, which included pneumothorax, hemothorax, lymphatic fistula and thrombosis. Early complications rate was 0.10%, which included pocket hematoma, catheter migration, venous thrombosis, port pocket infection, fibrin sheath formation. Late complications rate was 7.87%, which included catheter fracture, pinch-off syndrome, catheter-related bloodstream infection, fibrin sheath formation, catheter migration, extravasation, port inversion and port reveal. The rate of removal due to complications was 1.34% (27/2 007), and the early complication was higher (χ² = 8.053, P = 0.011). The low incidence of complications suggests that TICVP is safe and reliable for long term intermittent venous access. The results support the use of TICVP in the oncology patients and patients requiring long-term intravenous therapy.

Safety of a Totally Implantable Central Venous Port System with Percutaneous Subclavian Vein Access

BackgroundThe role of totally implantable central venous port (TICVP) system is increasing. Implantation performed by radiologist with ultrasound-guided access of vein and fluoroscope-guided positioning of catheter is widely accepted nowadays. In this article, we summarized our experience of TICVP system by surgeon and present the success and complication rate of this surgical method.Materials and MethodsBetween March 2009 and December 2010, 245 ports were implanted in 242 patients by surgeon. These procedures were performed with one small skin incision and subcutaneous puncture of subclavian vein. Patient's profiles, indications of port system, early and delayed complications, and implanted period were evaluated.ResultsThere were 82 men and 160 women with mean age of 55.74. Port system was implanted on right chest in 203, and left chest in 42 patients. There was no intraoperative complication. Early complications occurred in 11 patients (4.49%) including malposition of catheter tip in 6, malfunction of catheter in 3, and port site infection in 2. Late complication occurred in 12 patients (4.90%).ConclusionSurgical insertion of TICVP system with percutaneous subclavian venous access is safe procedures with lower complications. Careful insertion of system and skilled management would decrease complication incidence.

Successful Removal of Metal Objects Causing Penile Strangulation by a Silk Winding Method

Penile strangulation is a challenge to urologists. The decompression of the penis is required to prevent long-term complications. Metal objects are difficult to remove. Cutting is the most common method described. Appropriate cutting tools may be difficult to obtain, and the process may be time-consuming with the possibility of iatrogenic penile injury. In this paper, we will present a simple method to remove such objects by use a silk winding method and subcutaneous puncture.

Multiple Subcutaneous Puncture and Stoma Bag Drainage for Gross Lower Limb Edema: A Case Report

We present a case of gross lower limb edema in a 21-year-old man with an intra-abdominal malignant fibrous histiocytoma. He had a 1-month history of lower limb edema secondary to inferior vena caval obstruction. His edema failed to respond to a combination of diuretics, oral frusemide 40 mg daily and oral spironolactone 100 mg daily. Subcutaneous drainage of both lower limbs with butterfly needles was performed with minimal improvement. However, he gained significant symptomatic relief with multiple subcutaneous punctures and stoma bag drainage. A total of 12.8 L of serous fluid was drained with this simple and effective method. This is the first report of the use of this method.

Effects of Inhibition of the Polyol Pathway during Chronic Peritoneal Exposure to a Dialysis Solution

Peritoneal dialysis with glucose- and lactate-containing dialysis solutions stimulates peritoneal angiogenesis and fibrosis. These serious side effects can also be induced by chronic peritoneal exposure to dialysis solutions in nonuremic rats. The high glucose concentrations of the dialysis solutions may saturate physiological glucose metabolism pathways and stimulate the polyol pathway that has been described to damage nerves and vessels in diabetes mellitus. To investigate the role of the polyol pathway in the development of fibrosis and angiogenesis during chronic peritoneal exposure, the rate-limiting aldose reductase activity in the polyol pathway was inhibited in a chronic peritoneal exposure model in the rat, in which different administration routes were compared. Three groups of rats received daily intraperitoneal infusion with lactate/glucose (3.86%)--containing dialysate via a peritoneal catheter with a subcutaneous puncture device, for 14 weeks: group 1 received only the dialysis solution, groups 2 and 3 received, in addition, zopolrestat, administered either orally (group 2) or intraperitoneally (group 3). After sacrifice, omental tissue was examined by histology for the presence of fibrosis (Picro Sirius Red) and the number of blood vessels (CD31). Histology revealed significantly less Picro Sirius Red-positive tissue in perivascular areas of both experimental groups and submesothelial areas of the oral group in comparison to the control group. There were significantly fewer CD31-positive vessels perfield in both groups treated with zopolrestat compared to the infusion-only group: group 2, 9 (7 - 12); group 3, 17 (13 - 38), compared to group 1, 37 (32 - 39), p < 0.05. The combination of peritoneal exposure to dialysis fluids and administration of zopolrestat, a newly developed inhibitor of aldose reductase activity, resulted in less fibrosis and fewer peritoneal vessels than exposure to dialysis fluids only, in a long-term exposure model in the rat. Inhibition of the polyol pathway may thus offer an important contribution to allow long-term continuation of peritoneal dialysis.

The K-port concept: Proposal for optimising a fully implantable port system

Objective. Typical reasons for the malfunction of implantable central venous catheters involve obstructions caused by blood clots, perforation through the skin, and contamination of the device. The objective of introducing this new port concept is to reduce the incidence of complications by making alterations to the design.Design. The main characteristics of this new port chamber are its drop-shaped interior, which opens into the catheter-connecting piece rather like a funnel, the lateral position of the puncture membrane, and the exchangeable catheter connection device. As a result, the following improvements with regard to conventional port catheters are feasible.Results. The puncture is made laterally next to the port chamber in a large, previously unstressed area of skin. The subcutaneous puncture channel can be used for a greater length of time so as to avoid ascending infections. In the event of an occlusion of the catheter, a wire can be pushed through the cannula to clean it. The puncture cannula lies against the skin and can be attached more readily. Various port chamber sizes can be combined with different catheter thicknesses to best meet the individual requirements of the patient.Current Status. The afore-mentioned port system is still at a conceptional stage of development. There are no data on practical experiences with the K-port, as licensing details have yet to be agreed upon with a manufacturer. We have applied for a patent for this device.

Evacuation with Subcutaneous Puncture of Particular Extradural Hematoma in Infancy

Evacuation with Subcutaneous Puncture of Particular Extradural Hematoma in Infancy