Base de dados : MEDLINE
Pesquisa : E07.132 [Categoria DeCS]
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  1 / 3100 MEDLINE  
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[PMID]:29480839
[Au] Autor:Zhang L; Wan D; Zhang L; Xu S; Xie H; Lin S
[Ad] Endereço:Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou.
[Ti] Título:Hepatic rupture: A case report of a severe complication of percutaneous catheter drainage.
[So] Source:Medicine (Baltimore);97(2):e9499, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Currently, percutaneous catheter drainage (PCD) is regarded as the first-line treatment modality of pyogenic liver abscess. Severe complications associated with PCD were uncommon. Hepatic rupture is an uncommon but life-threatening liver trauma with high mortality. Its management is challenging because a delay in the diagnosis may lead to fatal hemorrhagic shock. To our knowledge, PCD-associated hepatic rupture has never been reported. PATIENT CONCERNS: We report herein a rare case of PCD-associated hepatic rupture. Its clinical courses and our therapeutic approaches are presented. Moreover, the clinical significance, underlying causes, and current views on severe liver trauma management will be discussed briefly. DIAGNOSES: A diabetic patient suffering from fever and malaise was diagnosed with a pyogenic liver abscess. PCD was performed because intravenous antibiotics were ineffective. The patient developed a liver rupture following PCD, with clinical and imaging confirmation but without further progression. INTERVENTIONS: Surgical repair and vascular intervention were both inappropriate. As a result, medical treatments with supportive care were adopted and were found to be effective. OUTCOMES: The patient's condition improved gradually, with stabilized imaging and laboratory performance. He recovered uneventfully during follow-ups. LESSONS: Hepatic rupture should be listed as an extremely rare but severe complication of PCD. Immediate suspicion and effective intervention may avoid an unfavorable consequence.
[Mh] Termos MeSH primário: Cateteres
Drenagem
Abscesso Hepático Piogênico/terapia
Fígado/lesões
Ruptura/etiologia
[Mh] Termos MeSH secundário: Idoso
Complicações do Diabetes/diagnóstico por imagem
Drenagem/instrumentação
Seres Humanos
Fígado/diagnóstico por imagem
Abscesso Hepático Piogênico/complicações
Abscesso Hepático Piogênico/diagnóstico por imagem
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009499


  2 / 3100 MEDLINE  
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[PMID]:29384560
[Au] Autor:Avila A; Liu J; Kohen MC
[Ti] Título:Horner Syndrome After Epidural Catheter Placement in a 4-Month-Old Child.
[So] Source:J Pediatr Ophthalmol Strabismus;55:e1-e3, 2018 Jan 31.
[Is] ISSN:1938-2405
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Although there are reports of iatrogenic Horner syndrome in the adult population, pediatric cases are rare. The current report presents a case of acquired Horner syndrome that occurred after an epidural catheter was placed for pain control. Horner syndrome completely resolved after removing the catheter and no imaging or further work-up was necessary. [J Pediatr Ophthalmol Strabismus. 2018;55:e1-e3.].
[Mh] Termos MeSH primário: Anestesia Epidural/efeitos adversos
Cateterismo/efeitos adversos
Cateteres/efeitos adversos
Síndrome de Horner/etiologia
Pneumotórax/terapia
[Mh] Termos MeSH secundário: Anestesia Epidural/instrumentação
Pré-Escolar
Remoção de Dispositivo
Feminino
Síndrome de Horner/diagnóstico
Síndrome de Horner/terapia
Seres Humanos
Doença Iatrogênica
Recuperação de Função Fisiológica
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.3928/01913913-20170907-02


  3 / 3100 MEDLINE  
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[PMID]:28459065
[Au] Autor:Keric N; Masomi-Bornwasser J; Müller-Werkmeister H; Kantelhardt SR; König J; Kempski O; Giese A
[Ad] Endereço:Department of Neurosurgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
[Ti] Título:Optimization of Catheter Based rtPA Thrombolysis in a Novel In Vitro Clot Model for Intracerebral Hemorrhage.
[So] Source:Biomed Res Int;2017:5472936, 2017.
[Is] ISSN:2314-6141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Hematoma lysis with recombinant tissue plasminogen activator (rtPA) has emerged as an alternative therapy for spontaneous intracerebral hemorrhage (ICH). Optimal dose and schedule are still unclear. The aim of this study was to create a reliable in vitro blood clot model for investigation of optimal drug dose and timing. An in vitro clot model was established, using 25 mL and 50 mL of human blood. Catheters were placed into the clots and three groups, using intraclot application of rtPA, placebo, and catheter alone, were analyzed. Dose-response relationship, repetition, and duration of rtPA treatment and its effectiveness in aged clots were investigated. A significant relative end weight difference was found in rtPA treated clots compared to catheter alone ( = 0.002) and placebo treated clots ( < 0.001). Dose-response analysis revealed 95% effective dose around 1 mg rtPA in 25 and 50 mL clots. Approximately 80% of relative clot lysis could be achieved after 15 min incubation. Lysis of aged clots was less effective. A new clot model for in vitro investigation was established. Our data suggest that current protocols for rtPA based ICH therapy may be optimized by using less rtPA at shorter incubation times.
[Mh] Termos MeSH primário: Hemorragia Cerebral
Fibrinólise/efeitos dos fármacos
Modelos Biológicos
Terapia Trombolítica/métodos
Trombose/tratamento farmacológico
Ativador de Plasminogênio Tecidual
[Mh] Termos MeSH secundário: Cateteres
Hemorragia Cerebral/fisiopatologia
Hemorragia Cerebral/terapia
Relação Dose-Resposta a Droga
Seres Humanos
Ativador de Plasminogênio Tecidual/farmacologia
Ativador de Plasminogênio Tecidual/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
EC 3.4.21.68 (Tissue Plasminogen Activator)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1155/2017/5472936


  4 / 3100 MEDLINE  
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[PMID]:29254585
[Au] Autor:Jaselske E; Adliene D; Rudzianskas V; Urbonavicius BG; Inciura A
[Ad] Endereço:Physics Department of Kaunas University of Technology, Studentu str. 50, Kaunas, Lithuania. Electronic address: evelina.jaselske@ktu.edu.
[Ti] Título:In vivo dose verification method in catheter based high dose rate brachytherapy.
[So] Source:Phys Med;44:1-10, 2017 Dec.
[Is] ISSN:1724-191X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:In vivo dosimetry is a powerful tool for dose verification in radiotherapy. Its application in high dose rate (HDR) brachytherapy is usually limited to the estimation of gross errors, due to inability of the dosimetry system/ method to record non-uniform dose distribution in steep dose gradient fields close to the radioactive source. In vivo dose verification in interstitial catheter based HDR brachytherapy is crucial since the treatment is performed inserting radioactive source at the certain positions within the catheters that are pre-implanted into the tumour. We propose in vivo dose verification method for this type of brachytherapy treatment which is based on the comparison between experimentally measured and theoretical dose values calculated at well-defined locations corresponding dosemeter positions in the catheter. Dose measurements were performed using TLD 100-H rods (6 mm long, 1 mm diameter) inserted in a certain sequences into additionally pre-implanted dosimetry catheter. The adjustment of dosemeter positioning in the catheter was performed using reconstructed CT scans of patient with pre-implanted catheters. Doses to three Head&Neck and one Breast cancer patient have been measured during several randomly selected treatment fractions. It was found that the average experimental dose error varied from 4.02% to 12.93% during independent in vivo dosimetry control measurements for selected Head&Neck cancer patients and from 7.17% to 8.63% - for Breast cancer patient. Average experimental dose error was below the AAPM recommended margin of 20% and did not exceed the measurement uncertainty of 17.87% estimated for this type of dosemeters. Tendency of slightly increasing average dose error was observed in every following treatment fraction of the same patient. It was linked to the changes of theoretically estimated dosemeter positions due to the possible patient's organ movement between different treatment fractions, since catheter reconstruction was performed for the first treatment fraction only. These findings indicate potential for further average dose error reduction in catheter based brachytherapy by at least 2-3% in the case that catheter locations will be adjusted before each following treatment fraction, however it requires more detailed investigation.
[Mh] Termos MeSH primário: Braquiterapia/instrumentação
Cateteres
Dosimetria in Vivo/métodos
Dose de Radiação
[Mh] Termos MeSH secundário: Neoplasias da Mama/radioterapia
Neoplasias de Cabeça e Pescoço/radioterapia
Seres Humanos
Dosagem Radioterapêutica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180130
[Lr] Data última revisão:
180130
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE


  5 / 3100 MEDLINE  
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[PMID]:28741663
[Au] Autor:Stehouwer MC; de Vroege R; Hoohenkerk GJF; Hofman FN; Kelder JC; Buchner B; de Mol BA; Bruins P
[Ad] Endereço:Department of Extracorporeal Circulation, St Antonius Hospital, Nieuwegein, The Netherlands.
[Ti] Título:Carbon Dioxide Flush of an Integrated Minimized Perfusion Circuit Prior to Priming Prevents Spontaneous Air Release Into the Arterial Line During Clinical Use.
[So] Source:Artif Organs;41(11):997-1003, 2017 Nov.
[Is] ISSN:1525-1594
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Recently, an oxygenator with an integrated centrifugal blood pump (IP) was designed to minimize priming volume and to reduce blood foreign surface contact even further. The use of this oxygenator with or without integrated arterial filter was compared with a conventional oxygenator and nonintegrated centrifugal pump. To compare the air removal characteristics 60 patients undergoing coronary artery bypass grafting were alternately assigned into one of three groups to be perfused with a minimized extracorporeal circuit either with the conventional oxygenator, the oxygenator with IP, or the oxygenator with IP plus integrated arterial filter (IAF). Air entering and leaving the three devices was measured accurately with a bubble counter during cardiopulmonary bypass. No significant differences between all groups were detected, considering air entering the devices. Our major finding was that in both integrated devices groups incidental spontaneous release of air into the arterial line in approximately 40% of the patients was observed. Here, detectable bolus air (>500 µm) was shown in the arterial line, whereas in the minimal extracorporeal circulation circuit (MECC) group this phenomenon was not present. We decided to conduct an amendment of the initial design with METC-approval. Ten patients were assigned to be perfused with an oxygenator with IP and IAF. Importantly, the integrated perfusion systems used in these patients were flushed with carbon dioxide (CO ) prior to priming of the systems. In the group with CO flush no spontaneous air release was observed in all cases and this was significantly different from the initial study with the group with the integrated device and IAF. This suggests that air spilling may be caused by residual air in the integrated device. In conclusion, integration of a blood pump may cause spontaneous release of large air bubbles (>500 µm) into the arterial line, despite the presence of an integrated arterial filter. CO flushing of an integrated cardiopulmonary bypass system prior to priming may prevent spontaneous air release and is strongly recommended to secure patient safety.
[Mh] Termos MeSH primário: Dióxido de Carbono
Ponte Cardiopulmonar/instrumentação
Cateteres
Ponte de Artéria Coronária
Embolia Aérea/prevenção & controle
Oxigenação por Membrana Extracorpórea/instrumentação
Coração Auxiliar
Oxigenadores
Perfusão/instrumentação
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Ponte Cardiopulmonar/efeitos adversos
Ponte de Artéria Coronária/efeitos adversos
Embolia Aérea/diagnóstico
Embolia Aérea/etiologia
Oxigenação por Membrana Extracorpórea/efeitos adversos
Feminino
Seres Humanos
Masculino
Meia-Idade
Perfusão/efeitos adversos
Desenho de Prótese
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
142M471B3J (Carbon Dioxide)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE
[do] DOI:10.1111/aor.12909


  6 / 3100 MEDLINE  
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[PMID]:28458604
[Au] Autor:Kim YP; Haam SJ; Lee S; Lee GD; Joo SM; Yum TJ; Lee KH
[Ad] Endereço:Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University Health System, Seoul 06273, Korea.
[Ti] Título:Effectiveness of Ambulatory Tru-Close Thoracic Vent for the Outpatient Management of Pneumothorax: A Prospective Pilot Study.
[So] Source:Korean J Radiol;18(3):519-525, 2017 May-Jun.
[Is] ISSN:2005-8330
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This study aimed to assess the technical feasibility, procedural safety, and long-term therapeutic efficacy of a small-sized ambulatory thoracic vent (TV) device for the treatment of pneumothorax. MATERIALS AND METHODS: From November 2012 to July 2013, 18 consecutive patients (3 females, 15 males) aged 16-64 years (mean: 34.7 ± 14.9 years, median: 29 years) were enrolled prospectively. Of these, 15 patients had spontaneous pneumothorax and 3 had iatrogenic pneumothorax. A Tru-Close TV with a small-bore (11- or 13-Fr) catheter was inserted under bi-plane fluoroscopic assistance. RESULTS: Technical success was achieved in all patients. Complete lung re-expansion was achieved at 24 hours in 88.9% of patients (16/18 patients). All patients tolerated the procedure and no major complications occurred. The patients' mean numeric pain intensity score was 2.4 (range: 0-5) in daily life activity during the TV treatment. All patients with spontaneous pneumothorax underwent outpatient follow-up. The mean time to TV removal was 4.7 (3-13) days. Early surgical conversion rate of 16.7% (3/18 patients) occurred in 2 patients with incomplete lung expansion and 1 patient with immediate pneumothorax recurrence post-TV removal; and late surgical conversion occurred in 2 of 18 patients (11.1%). The recurrence-free long-term success rate was 72.2% (13/18 patients) during a 3-year follow-up period from November 2012 to June 2016. CONCLUSION: TV application was a simple, safe, and technically feasible procedure in an outpatient clinic, with an acceptable long-term recurrence-free rate. Thus, TV could be useful for the immediate treatment of pneumothorax.
[Mh] Termos MeSH primário: Drenagem/métodos
Pneumotórax/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Cateteres
Drenagem/instrumentação
Feminino
Seguimentos
Seres Humanos
Pulmão/fisiopatologia
Masculino
Meia-Idade
Pacientes Ambulatoriais
Projetos Piloto
Estudos Prospectivos
Recidiva
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180102
[Lr] Data última revisão:
180102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.3348/kjr.2017.18.3.519


  7 / 3100 MEDLINE  
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[PMID]:28455601
[Au] Autor:Saeki N; Sugimoto Y; Mori Y; Kato T; Miyoshi H; Nakamura R; Koga T
[Ad] Endereço:Department of Anesthesiology and Critical Care, Hiroshima University Hospital, 1-2-3 Kasumi, Hiroshima, Hiroshima, 734-8551, Japan. nsaeki@hiroshima-u.ac.jp.
[Ti] Título:Paravertebral block catheter breakage by electrocautery during thoracic surgery.
[So] Source:J Anesth;31(3):463-466, 2017 Jun.
[Is] ISSN:1438-8359
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Advantages of thoracic paravertebral analgesia (TPA) include placement of the catheter closer to the surgical field; however, the catheter can become damaged during the operation. We experienced a case of intraoperative TPA catheter breakage that prompted us to perform an experiment to investigate possible causes. A 50-year-old male underwent a thoracoscopic lower lobectomy under general anesthesia with TPA via an intercostal approach. Following surgery, it was discovered that the catheter had become occluded, as well as cut and fused, so we reopened the incision and removed the residual catheter. From that experience, we performed an experiment to examine electrocautery-induced damage in normal (Portex™, Smith's Medical), radiopaque (Perifix SoftTip™, BBraun), and reinforced (Perifix FX™, BBraun) epidural catheters (n = 8 each). Chicken meat was penetrated by each catheter and then cut by electrocautery. In the normal group, breakage occurred in 8 and occlusion in 6 of the catheters, and in the radiopaque group breakage occurred in 8 and occlusion in 7. In contrast, breakage occurred in only 3 and occlusion in none in the reinforced group, with the 5 without breakage remaining connected only by the spring coil. Furthermore, in 7 of the reinforced catheters, electric arc-induced thermal damage was observed at the tip of the catheter. A TPA catheter for thoracic surgery should be inserted via the median approach, or it should be inserted after surgery to avoid catheter damage during surgery.
[Mh] Termos MeSH primário: Cateteres/efeitos adversos
Eletrocoagulação/efeitos adversos
Bloqueio Nervoso/métodos
Procedimentos Cirúrgicos Torácicos/métodos
[Mh] Termos MeSH secundário: Analgesia/métodos
Anestesia Epidural/métodos
Anestesia Geral/métodos
Cateterismo/efeitos adversos
Eletrocoagulação/métodos
Seres Humanos
Masculino
Meia-Idade
Manejo da Dor
Vértebras Torácicas
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171207
[Lr] Data última revisão:
171207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1007/s00540-017-2361-z


  8 / 3100 MEDLINE  
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[PMID]:29029718
[Au] Autor:Sista AK; Moriarty JM
[Ad] Endereço:Division of Interventional Radiology, Langone School of Medicine, New York University, New York, NY.
[Ti] Título:The Future of Catheter-Directed Therapy: Data Gaps, Unmet Needs, and Future Trials.
[So] Source:Tech Vasc Interv Radiol;20(3):224-226, 2017 Sep.
[Is] ISSN:1557-9808
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This article will focus on 3 avenues for future research: (1) addressing the lack of short- and long-term clinical outcome research on catheter-directed therapy; (2) determining the safety and efficacy of novel thrombus removal devices; and (3) translating our knowledge of the pathobiology and pathophysiology of pulmonary embolism into novel diagnostic and therapeutic strategies.
[Mh] Termos MeSH primário: Cateterismo de Swan-Ganz/tendências
Cateteres/tendências
Ensaios Clínicos como Assunto/métodos
Fibrinolíticos/administração & dosagem
Lacunas da Prática Profissional/tendências
Embolia Pulmonar/terapia
Projetos de Pesquisa/tendências
Terapia Trombolítica/tendências
[Mh] Termos MeSH secundário: Cateterismo de Swan-Ganz/efeitos adversos
Cateterismo de Swan-Ganz/instrumentação
Difusão de Inovações
Desenho de Equipamento
Fibrinolíticos/efeitos adversos
Previsões
Seres Humanos
Infusões Intra-Arteriais
Embolia Pulmonar/diagnóstico
Embolia Pulmonar/fisiopatologia
Fatores de Risco
Terapia Trombolítica/efeitos adversos
Terapia Trombolítica/instrumentação
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Fibrinolytic Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171015
[St] Status:MEDLINE


  9 / 3100 MEDLINE  
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[PMID]:29029714
[Au] Autor:Kesselman A; Kuo WT
[Ad] Endereço:Division of Vascular and Interventional Radiology, Stanford University Medical Center, Stanford, CA.
[Ti] Título:Catheter-Directed Therapy for Acute Submassive Pulmonary Embolism: Summary of Current Evidence and Protocols.
[So] Source:Tech Vasc Interv Radiol;20(3):193-196, 2017 Sep.
[Is] ISSN:1557-9808
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Treatment of acute submassive pulmonary embolism (PE) with thrombolytic therapy remains an area of controversy. For patients who fail or who have contraindications to systemic thrombolysis, catheter-directed therapy (CDT) may be offered depending on the patient's condition and the available institutional resources to perform CDT. Although various CDT techniques and protocols exist, the most studied method is low-dose catheter-directed thrombolytic infusion without mechanical thrombectomy. This article reviews current protocols and data on the use of CDT for acute submassive pulmonary embolism.
[Mh] Termos MeSH primário: Cateterismo de Swan-Ganz/instrumentação
Cateteres
Protocolos Clínicos
Medicina Baseada em Evidências
Fibrinolíticos/administração & dosagem
Embolia Pulmonar/tratamento farmacológico
Terapia Trombolítica/instrumentação
[Mh] Termos MeSH secundário: Doença Aguda
Cateterismo de Swan-Ganz/efeitos adversos
Desenho de Equipamento
Fibrinolíticos/efeitos adversos
Seres Humanos
Infusões Intra-Arteriais
Embolia Pulmonar/diagnóstico por imagem
Embolia Pulmonar/fisiopatologia
Fatores de Risco
Terapia Trombolítica/efeitos adversos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Fibrinolytic Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171015
[St] Status:MEDLINE


  10 / 3100 MEDLINE  
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[PMID]:29019873
[Au] Autor:Zhang JQ; Yu RH; Liang JB; Long Y; Sang CH; Ma CS; Dong JZ
[Ad] Endereço:aDepartment of Cardiovascular Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai bBeijing Anzhen Hospital, Capital Medical University, Beijing cJuxian People Hospital, Shandong Province 276500,China.
[Ti] Título:Reconstruction left atrium and isolation pulmonary veins of paroxysmal atrial fibrillation using single contact force catheter with zero x-ray exposure: A CONSORT Study.
[So] Source:Medicine (Baltimore);96(41):e7726, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Conventional ablation of paroxysmal atrial fibrillation (PAF) is associated with radiation risks for patients and laboratory staff. Three-dimensional (3D) mapping system capable of showing contact force (CF) and direction of catheter tip may compensate for nonfluoroscopic safety issues. OBJECTIVE: The aim of this study was to investigate the feasibility of zero x-ray exposure during reconstruction left atrium (LA) and ablation. METHODS: Single, CF catheter, and 3D mapping system were used to reconstruct LA and isolate pulmonary veins (PV) in all patients. The patients were randomly divided into 2 groups after LA angiography. In group 1, reconstruction LA and isolation PV was performed with the help of 3D system (without x-ray), whereas in group 2, x-ray and 3D system were utilized to reconstruct LA and ablate PV antrum. After ablation, Lasso catheter was used to confirm the PV isolation. All patients were followed up to 12 months. RESULTS: A total of 342 PAF patients were continuously enrolled. The basic clinical characteristics between the 2 groups had no significant difference. Parameters related to the procedure, average procedure time, ablation procedure time, average contact force (CF) applied, the percentage of time within CF settings, and average power applied during radiofrequency application showed no significant difference between the 2 groups. In group 1, the average fluoroscopy time before LA reconstruction was similar to that in group 2 (2.8 ±â€Š0.4 vs. 2.4 ±â€Š0.6 minutes, P = .75). The average fluoroscopy time during ablation was significantly lower than that in group 2 (0 vs. 7.6 ±â€Š1.3 minutes, P < .001). The total x-ray exposure dose of the procedure in group 1 was significantly lower than that in group 2 (19.6 ±â€Š9.4 vs. 128.7 ±â€Š62.5 mGy, respectively, P < .001). Kaplan-Meier analysis indicated that there were no statistical differences in the probability of freedom from atrial arrhythmia (AF/AFL/AT) recurrence at 12 months between group 1 and group 2 (P = .152). The success rate after a single ablation procedure and without drugs (Class I/III AAD) at 12 months was not significantly different between the 2 groups (67.6%, 95% confidence interval [CI]: 62%-79.5% in group 1 and 68.9%, 95% CI: 63%-80.7% in group 2, P = .207). Procedural-related adverse events showed no significant different incidence between group 1 and group 2. A multivariate logistic regression analysis of risk factors was performed to evaluate the effectiveness outcome, which demonstrated that the percentage of CF (within the investigator-selected work ranges) during therapy was significantly associated with positive outcomes (odds ratio: 3.68; 95% CI: 1.65-10.6, P = .008), whereas the LA dimension was negatively associated with effectiveness outcomes (odds ratio: 0.72; 95% CI: 0.52-0.84, P = .016). CONCLUSIONS: Reconstruction LA and isolation PV ablation using single CF-assisted catheter without x-ray exposure was both safe and effective. CF was positively associated with effective outcomes and LA dimensions negatively with effective ones.
[Mh] Termos MeSH primário: Fibrilação Atrial
Ablação por Cateter
Átrios do Coração
Interpretação de Imagem Assistida por Computador/métodos
Exposição Ocupacional/prevenção & controle
Veias Pulmonares
Exposição à Radiação/prevenção & controle
Gestão de Riscos/métodos
[Mh] Termos MeSH secundário: Idoso
Fibrilação Atrial/diagnóstico
Fibrilação Atrial/cirurgia
Ablação por Cateter/efeitos adversos
Ablação por Cateter/instrumentação
Ablação por Cateter/métodos
Cateteres/normas
Eletrocardiografia/métodos
Desenho de Equipamento
Feminino
Fluoroscopia/métodos
Átrios do Coração/diagnóstico por imagem
Átrios do Coração/cirurgia
Seres Humanos
Imagem Tridimensional/métodos
Masculino
Meia-Idade
Segurança do Paciente/normas
Veias Pulmonares/diagnóstico por imagem
Veias Pulmonares/cirurgia
Cirurgia Assistida por Computador/instrumentação
Cirurgia Assistida por Computador/métodos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171012
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007726



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