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Healthcare-Associated Infections (HAIs): Challenges and Measures Taken by the Radiology Department to Control Infection Transmission. Vaccines (Basel) 2022; 10:vaccines10122060. [PMID: 36560470 PMCID: PMC9781912 DOI: 10.3390/vaccines10122060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Infections contracted during healthcare delivery in a hospital or ambulatory setting are collectively referred to as healthcare-associated infections (HAIs). Healthcare workers and patients alike are vulnerable to serious problems as a result of the risk of HAIs. In the healthcare system, HAIs are considered among the most common and serious health problems. However, the occurrence of HAIs differs between different types of clinical departments within the hospital. Recently, the risk of HAIs has been increasing in radiology departments globally due to the central role of radiology in guiding clinical decisions for the diagnosis, treatment, and monitoring of different diseases from almost all medical specialties. The radiology department is particularly vulnerable to HAIs because it serves as a transit hub for infected patients, non-infected patients, and healthcare workers. Furthermore, as the number of patients referred to radiology and the length of patient contact time has increased, thanks to modern imaging techniques such as computed tomography and magnetic resonance imaging, the risk of HAIs has also increased significantly. With the increasing use of interventional radiological procedures, patients and healthcare workers face a potentially greater risk of contracting HAIs due to the invasive nature of such procedures. Although not exhaustive, we attempted through a literature search to provide a general overview of infection prevention and control practices, address HAIs in the radiology departments, and highlight the challenges and measures taken to control infection transmission in the radiology departments.
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Khurana N, Salei A, Gunn AJ, Huang J. Antibiotics Tubes and Lines. Semin Intervent Radiol 2022; 39:421-427. [PMID: 36406021 PMCID: PMC9671683 DOI: 10.1055/s-0042-1758080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Antibiotic prophylaxis in interventional radiology (IR) is widely used; however, such practice is based on data from the surgical literature. Although published guidelines can help determine the need for prophylactic antibiotic use in the patient undergoing percutaneous procedures, local practice patterns often dictate when such medications are given. In this article, the current state of periprocedural antibiotic use in commonly performed IR procedures (i.e., tube and catheter placements) is presented.
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Affiliation(s)
- Navpreet Khurana
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aliaksei Salei
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew J. Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Junjian Huang
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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3
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Gorelik N, Darwish Y, Walter WR, Burke CJ, Sarpel D, Chong J, Adler RS. Incidence of infectious complications following ultrasound-guided percutaneous musculoskeletal interventions with the use of an uncovered transducer footprint. Eur Radiol 2022; 32:6759-6768. [PMID: 35579710 DOI: 10.1007/s00330-022-08849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the incidence of infectious complications following ultrasound-guided musculoskeletal interventions performed with a disinfected uncovered ultrasound transducer footprint. METHODS Electronic medical records of all patients who underwent an ultrasound-guided musculoskeletal procedure (including injection, calcific lavage, or ganglion cyst aspiration) performed by any of the 14 interventional musculoskeletal radiologists at our institution between January 2013 and December 2018 were retrospectively reviewed to identify procedure site infections. Biopsies and joint aspirations were excluded. The procedures were performed using a disinfected uncovered transducer footprint. First, an automated chart review identified cases with (1) positive answers to the nurse's post-procedure call, (2) an International Classification of Diseases (ICD) diagnostic code related to a musculoskeletal infection, or (3) an antibiotic prescription within 30 days post-procedure. Then, these cases were manually reviewed for evidence of procedure site infection. RESULTS In total, 6511 procedures were included. The automated chart review identified 3 procedures (2 patients) in which post-procedural fever was reported during the nurse's post-procedure call, 33 procedures (28 patients) with an ICD code for a musculoskeletal infection, and 220 procedures (216 patients) with an antibiotic prescription within 30 post-procedural days. The manual chart review of these patients revealed no cases of confirmed infection and 1 case (0.015%) of possible site infection. CONCLUSIONS The incidence of infectious complications after an ultrasound-guided musculoskeletal procedure performed with an uncovered transducer footprint is extremely low. This information allows radiologists to counsel their patients more precisely when obtaining informed consent. KEY POINTS • Infectious complications after ultrasound-guided musculoskeletal procedures performed with a disinfected uncovered transducer footprint are extremely rare.
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Affiliation(s)
- Natalia Gorelik
- Department of Diagnostic Radiology, McGill University Health Center, 1001 Decarie Blvd., Montreal, Quebec, H4A 3J1, Canada. .,Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA.
| | - Yousef Darwish
- , New York City, NY, USA.,Information Technology Department, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
| | - William R Walter
- Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA
| | - Christopher J Burke
- Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA
| | - Dost Sarpel
- Division of Infectious Disease, Milford Regional Medical Center, 14 Prospect St, Milford, MA, 01757, USA
| | - Jaron Chong
- Department of Radiology, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Rd E, C1-609, London, Ontario, N6A 5W9, Canada
| | - Ronald S Adler
- Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA
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Masuda S, Tsukiyama T, Minagawa Y, Koizumi K, Kako M, Kinbara T, Haruki U. Hepatocellular carcinoma effective stereotactic body radiotherapy using Gold Anchor and the Synchrony system: Two case reports and review of literature. World J Clin Cases 2022; 10:2591-2603. [PMID: 35434047 PMCID: PMC8968590 DOI: 10.12998/wjcc.v10.i8.2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/12/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radiotherapy for hepatocellular carcinoma (HCC) is considered to have limited efficacy because of treatment intensity considering that the irradiated area includes the liver, which is highly radiosensitive. In this report, we present two cases in which tumor control by surgical resection, radiofrequency ablation, transcatheter arterial chemoembolization (TACE), and lenvatinib administration was difficult, but stereotactic body radiotherapy (SBRT) using the Synchrony system by Radixact™ and Gold Anchor® (GA) was effective.
CASE SUMMARY A 60-year-old man had a single 10-cm HCC in the right lobe. Viable lesions remained after TACE, and levels of alpha-fetoprotein and protein induced by vitamin K antagonists II (PIVKA-II) decreased and quickly re-elevated. We performed SBRT with GA. Three weeks after implantation, localized radiotherapy (SBRT; 40 Gy/5 fractions) was performed using the Synchrony system by Radixact™. Four weeks later, the viable lesion had disappeared, and the PIVKA-II levels decreased. A 77-year-old man had a single 12-cm HCC in the right lobe. The patient experienced recurrence after hepatectomy. Further recurrence occurred after TACE, and we performed SBRT with GA. Because of the proximity of the HCC to the gastrointestinal tract, localized radiotherapy (SBRT; 39 Gy/13 fractions) to the HCC was performed 3 wk after implantation using the Synchrony system by Radixact™. Four weeks later, the viable lesion had disappeared on computed tomography, and the PIVKA-Ⅱ levels decreased.
CONCLUSION SBRT using the Synchrony system and GA can deliver a large dose accurately and safely, and could have a high therapeutic effect.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Toshitaka Tsukiyama
- Department of Interventional Radiology Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Yumiko Minagawa
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Kazuya Koizumi
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Makoto Kako
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Takeshi Kinbara
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Uojima Haruki
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
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Variability in personal protective equipment in cross-sectional interventional abdominal radiology practices. Abdom Radiol (NY) 2022; 47:1167-1176. [PMID: 35013750 PMCID: PMC8744567 DOI: 10.1007/s00261-021-03406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/19/2022]
Abstract
Purpose To determine institutional practice requirements for personal protective equipment (PPE) in cross-sectional interventional radiology (CSIR) procedures among a variety of radiology practices in the USA and Canada. Methods Members of the Society of Abdominal Radiology (SAR) CSIR Emerging Technology Commission (ETC) were sent an eight-question survey about what PPE they were required to use during common CSIR procedures: paracentesis, thoracentesis, thyroid fine needle aspiration (FNA), superficial lymph node biopsy, deep lymph node biopsy, solid organ biopsy, and ablation. Types of PPE evaluated were sterile gloves, surgical masks, gowns, surgical hats, eye shields, foot covers, and scrubs. Results 26/38 surveys were completed by respondents at 20/22 (91%) institutions. The most common PPE was sterile gloves, required by 20/20 (100%) institutions for every procedure. The second most common PPE was masks, required by 14/20 (70%) institutions for superficial and deep procedures and 12/12 (100%) institutions for ablation. Scrubs, sterile gowns, eye shields, and surgical hats were required at nearly all institutions for ablation, whereas approximately half of institutions required their use for deep lymph node and solid organ biopsy. Compared with other types of PPE, required mask and eye shield use showed the greatest increase during the SARS-CoV-2 pandemic. Conclusion PPE use during common cross-sectional procedures is widely variable. Given the environmental and financial impact and lack of consensus practice, further studies examining the appropriate level of PPE are needed. Graphical abstract ![]()
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Ensuring competence in ultrasound-guided procedures-a validity study of a newly developed assessment tool. Eur Radiol 2022; 32:4954-4966. [PMID: 35195745 DOI: 10.1007/s00330-022-08542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 11/17/2021] [Accepted: 12/16/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the validity of the Interventional Ultrasound Skills Evaluation (IUSE) tool for assessment of procedural competence in ultrasound-guided procedures in a clinical environment, including a pass/fail score. METHODS Novices and experienced radiologists were recruited from four hospitals and were observed and assessed while performing ultrasound-guided procedures. Performances were assessed using the IUSE tool by two independent raters. Validity evidence was gathered in accordance with Messick's framework: response process was ensured by standardisation of written rater instructions. Internal structure was explored using Cronbach's alpha for internal consistency reliability; inter-rater reliability was calculated as Pearson's r independently across all ratings, and test-retest reliability was reported using Cronbach's alpha. Relationship to other variables was investigated by comparing performances of the participants in each group. Consequences evidence was explored by calculating a pass/fail standard using the contrasting groups method. RESULTS Six novices and twelve experienced radiologists were enrolled. The IUSE tool had high internal consistency (Cronbach's alpha = 0.96, high inter-rater reliability (Pearson's r = 0.95), and high test-retest reliability (Cronbach's alpha = 0.98), and the mean score was 33.28 for novices and 59.25 for experienced with a highly significant difference (p value < 0.001). The pass/fail score was set at 55 resulting in no false positives or false negatives. CONCLUSIONS Validity evidence from multiple sources supports the use of the IUSE tool for assessment of competence in ultrasound-guided procedures in a clinical environment and its use in high-stakes assessment such as certification. A credible pass/fail criterion was established to inform decision-making. KEY POINTS • A multi-site validity investigation established that the Interventional Ultrasound Skills Evaluation (IUSE) tool can be used to assess procedural competence in ultrasound-guided procedures. • Validity evidence was gathered according to Messick's framework validity from the following sources: response process, internal structure, relationship to other variables, and consequences evidence. • The IUSE tool can be used for both formative and summative assessment, and a credible pass/fail score was established to help inform decision-making such as certification.
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Zandee EY, Wu J, Deshmukh S. Troubleshooting Challenging Musculoskeletal Tumor Biopsies: Tricks of the Trade. Semin Roentgenol 2022; 57:275-290. [DOI: 10.1053/j.ro.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
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Cipolletta E, Filippucci E, Incorvaia A, Schettino M, Smerilli G, Di Battista J, Tesei G, Cosatti MA, Di Donato E, Tardella M, Di Matteo A, Di Carlo M, Grassi W. Ultrasound-Guided Procedures in Rheumatology Daily Practice: Feasibility, Accuracy, and Safety Issues. J Clin Rheumatol 2021; 27:226-231. [PMID: 32000229 DOI: 10.1097/rhu.0000000000001298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE The aims of this study were to describe in detail the ultrasound (US)-guided procedures in our daily rheumatology practice, to evaluate the feasibility and accuracy of US-guided procedures, and to test the efficacy of our disinfection protocol in preventing infectious complications. METHODS This was a cross-sectional and monocentric study. Information regarding patients' age, sex, body mass index, rheumatic disease, US pathological findings, aspirated and/or injected anatomical site, US equipment (ie, probe type and frequency), and needle type was consecutively collected for each US-guided procedure in a third-level rheumatology center. RESULTS A total of 643 US-guided procedures were performed, with a mean of 5.2 procedures per working-day. In 94.2% of the patients, only one procedure was carried out, whereas in 5.8%, more than one. The mean time was 7 ± 2.5 minutes. Ultrasound-guided procedures were highly accurate (accuracy rate higher than 95%) and safe (adverse events were reported in 0.8%). Our disinfection protocol was effective in preventing infectious complications. Probes with frequency values between 8 to 13 MHz and 20-, 21-, and 22-gauge needles were the most frequently used at shoulder, knee, wrist, elbow, and ankle level. High-frequency linear probes (ranging between 18 and 22 MHz) and 23- and 25-gauge needles were used for injecting small joints of the hands and feet. Convex low-frequency probe (2-7 MHz) and 18- and 20-gauge needles were the most used for performing hip joint aspirations and/or injections. CONCLUSIONS This study reports useful information for setting up a service providing US-guided procedures in rheumatology and supports the feasibility, accuracy, and safety of US-guided procedures.
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Affiliation(s)
- Edoardo Cipolletta
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Emilio Filippucci
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Antonella Incorvaia
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Martina Schettino
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Gianluca Smerilli
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Jacopo Di Battista
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Giulia Tesei
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Micaela Ana Cosatti
- Rheumatology and Immunology Unit, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina
| | - Eleonora Di Donato
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Marika Tardella
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | | | - Marco Di Carlo
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Walter Grassi
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
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The need for participation in the development and critical review of recommendations for infection control policies involving vascular ultrasound. J Vasc Surg Venous Lymphat Disord 2021; 9:1025-1030. [PMID: 33737261 DOI: 10.1016/j.jvsv.2021.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/25/2021] [Indexed: 11/21/2022]
Abstract
Recently reported guidelines from the Society of Diagnostic Medical Sonography regarding disinfection of ultrasound probes and infection control policies for ultrasound procedures conflict with accepted clinical norms in vein practices and recommendations from the American Institute for Ultrasound in Medicine. We have provided a review of these conflicting policy recommendations and new proposed practice recommendations and a call for physicians who perform ultrasound-guided procedures to be involved in the process of development and critical review of societal recommendations.
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10
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Yiannakopoulos CK, Megaloikonomos PD, Foufa K, Gliatis J. Ultrasound-guided versus palpation-guided corticosteroid injections for tendinosis of the long head of the biceps: A randomized comparative study. Skeletal Radiol 2020; 49:585-591. [PMID: 31712838 DOI: 10.1007/s00256-019-03315-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare accuracy, patient discomfort, and clinical outcome of ultrasound-guided versus palpation-guided corticosteroid injections to the bicipital groove in patients with long head of biceps (LHB) tendinosis. MATERIALS AND METHODS Forty-four patients with primary LHB tendinosis were randomized into two groups (group A, n = 22; group B, n = 22). All patients underwent treatment with a single corticosteroid injection to the bicipital groove. Injections in group A were performed under ultrasound-guidance, while in group B using a palpation-guided technique. The duration of each procedure was recorded. To assess accuracy, ultrasound examination was performed in both groups after injection. Patient discomfort was evaluated with visual analogue scale (VAS) for pain. The clinical outcome was assessed comparing the VAS, the Single Assessment Numeric Evaluation (SANE) score and the QuickDASH score before treatment and after 4 weeks and 6 months. RESULTS The mean duration of the procedure was 64 ± 6.87 s in group A and 81.91 ± 8.42 s in group B (p < 0.001). Injection accuracy in group A was 100% and in group B 68.18%. Discomfort was lower in group A, as compared to group B (22.10 vs. 35.50; p < 0.001). Symptoms, as measured by VAS, SANE and QuickDASH scores, improved in both groups at 4 weeks and 6 months (p < 0.05). Superior clinical improvement was recorded in group A in both time points (p < 0.05). CONCLUSIONS Corticosteroid injections are an effective treatment for primary LHB tendinosis. Under ultrasound guidance, injections to the bicipital groove are faster and produce lower discomfort. Superior accuracy and clinical outcomes can be achieved using the ultrasound-guided technique. LEVEL OF EVIDENCE Level II; Prospective Randomized Comparative Study.
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Affiliation(s)
- Christos K Yiannakopoulos
- Department of Arthroscopic and Shoulder Surgery, Metropolitan General Hospital, Athens, Greece.,Department of Sports Medicine & Exercise Biology, School of Physical Education and Sport Science, National and Kapodistrian, University of Athens, Athens, Greece
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University General Hospital, Athens, Greece.
| | | | - John Gliatis
- Department of Orthopaedics, University of Patras, Patras, Greece
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Westerway SC, Basseal JM, Abramowicz JS. Medical Ultrasound Disinfection and Hygiene Practices: WFUMB Global Survey Results. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:344-352. [PMID: 30409470 DOI: 10.1016/j.ultrasmedbio.2018.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 06/08/2023]
Abstract
As ultrasound technology rapidly evolves and is used more frequently in every area of medical diagnosis and treatment, it may be overlooked as a potential vector in the transmission of a health care-associated infection. A survey on disinfection and hygiene practice in medical ultrasound was disseminated via the World Federation for Ultrasound in Medicine and Biology (WFUMB) to its six member federations and associated ultrasound societies globally. One thousand twenty-nine responses were obtained across a broad range of ultrasound practitioners. A total of 76% of respondents used transducer covers every time to scan open wounds and 71% when blood and bodily fluids were present or for an interventional procedure. Approved high-level disinfectants are not always used, even when blood comes into contact with the transducer or after endocavity scans. Alcohol-based wipes were used by many respondents to clean both external transducers and endocavity transducers. Open-ended responses indicated that a large caseload hindered the time required for cleaning and that access to clear guidelines would be beneficial. Global survey results indicate that some users do not comply with disinfection practice, and there is a gap in knowledge on basic infection prevention and control education within the ultrasound unit. As the infectious status of a patient is not often disclosed prior to an ultrasound examination, training in suitable protocols for the cleaning and disinfection of ultrasound equipment is imperative to mitigate the risk of potential infection.
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Affiliation(s)
- Susan Campbell Westerway
- Department of Dentistry and Health Sciences, Charles Sturt University, New South Wales, Australia; World Federation for Ultrasound in Medicine and Biology (WFUMB), Chicago, Illinois, USA
| | - Jocelyne M Basseal
- Australasian Society for Ultrasound in Medicine, Chatswood, New South Wales, Australia.
| | - Jacques S Abramowicz
- World Federation for Ultrasound in Medicine and Biology (WFUMB), Chicago, Illinois, USA; Department of Obstetrics & Gynecology, University of Chicago, Chicago, Illinois, USA
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12
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Cho J, Jensen TP, Reierson K, Mathews BK, Bhagra A, Franco-Sadud R, Grikis L, Mader M, Dancel R, Lucas BP, Soni NJ. Recommendations on the Use of Ultrasound Guidance for Adult Abdominal Paracentesis: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2019; 14:E7-E15. [PMID: 30604780 PMCID: PMC8021127 DOI: 10.12788/jhm.3095] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
1. We recommend that ultrasound guidance should be used for paracentesis to reduce the risk of serious complications, the most common being bleeding. 2. We recommend that ultrasound guidance should be used to avoid attempting paracentesis in patients with an insufficient volume of intraperitoneal free fluid to drain. 3. We recommend that ultrasound guidance should be used with paracentesis to improve the success rates of the overall procedure. 4. We recommend that ultrasound should be used to assess the volume and location of intraperitoneal free fluid to guide clinical decision making of where paracentesis can be safely performed. 5. We recommend that ultrasound should be used to identify a needle insertion site based on size of the fluid collection, thickness of the abdominal wall, and proximity to abdominal organs. 6. We recommend that the needle insertion site should be evaluated using color flow Doppler ultrasound to identify and avoid abdominal wall blood vessels along the anticipated needle trajectory. 7. We recommend that a needle insertion site should be evaluated in multiple planes to ensure clearance from underlying abdominal organs and detect any abdominal wall blood vessels along the anticipated needle trajectory. 8. We recommend that a needle insertion site should be marked with ultrasound immediately before performing the procedure, and the patient should remain in the same position between marking the site and performing the procedure. 9. We recommend that using real-time ultrasound guidance for paracentesis should be considered when the fluid collection is small or difficult to access. 10. We recommend that dedicated training sessions, including didactics, supervised practice on patients, and simulation-based practice, should be used to teach novices how to perform ultrasound-guided paracentesis. 11. We recommend that simulation-based practice should be used, when available, to facilitate acquisition of the required knowledge and skills to perform ultrasoundguided paracentesis. 12. We recommend that competence in performing ultrasound-guided paracentesis should be demonstrated prior to independently performing the procedure on patients.
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Affiliation(s)
- Joel Cho
- Department of Hospital Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
| | - Trevor P Jensen
- Division of Hospital Medicine, University of California San Francisco Medical Center at Parnassus, San Francisco, California, USA
| | - Kreegan Reierson
- Department of Hospital Medicine, HealthPartners Medical Group, Regions Hospital, St. Paul, Minnesota, USA
| | - Benji K Mathews
- Department of Hospital Medicine, HealthPartners Medical Group, Regions Hospital, St. Paul, Minnesota, USA
- Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Anjali Bhagra
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ricardo Franco-Sadud
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Loretta Grikis
- White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Michael Mader
- Divisions of General and Hospital Medicine and Pulmonary and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Ria Dancel
- Division of Hospital Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brian P Lucas
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | | | - Nilam J Soni
- Divisions of General and Hospital Medicine and Pulmonary and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
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13
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Smith EMD, Eleuteri A, Goilav B, Lewandowski L, Phuti A, Rubinstein T, Wahezi D, Jones CA, Marks SD, Corkhill R, Pilkington C, Tullus K, Putterman C, Scott C, Fisher AC, Beresford MW. A Markov Multi-State model of lupus nephritis urine biomarker panel dynamics in children: Predicting changes in disease activity. Clin Immunol 2018; 198:71-78. [PMID: 30391651 DOI: 10.1016/j.clim.2018.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/28/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A urine 'biomarker panel' comprising alpha-1-acid-glycoprotein, ceruloplasmin, transferrin and lipocalin-like-prostaglandin-D synthase performs to an 'excellent' level for lupus nephritis identification in children cross-sectionally. The aim of this study was to assess if this biomarker panel predicts lupus nephritis flare/remission longitudinally. METHODS The novel urinary biomarker panel was quantified by enzyme linked immunoabsorbant assay in participants of the United Kingdom Juvenile Systemic Lupus Erythematosus (UK JSLE) Cohort Study, the Einstein Lupus Cohort, and the South African Paediatric Lupus Cohort. Monocyte chemoattractant protein-1 and vascular cell adhesion molecule-1 were also quantified in view of evidence from other longitudinal studies. Serial urine samples were collected during routine care with detailed clinical and demographic data. A Markov Multi-State model of state transitions was fitted, with predictive clinical/biomarker factors assessed by a corrected Akaike Information Criterion (AICc) score (the better the model, the lower the AICc score). RESULTS The study included 184 longitudinal observations from 80 patients. The homogeneous multi-state Markov model of lupus nephritis activity AICc score was 147.85. Alpha-1-acid-glycoprotein and ceruloplasmin were identified to be the best predictive factors, reducing the AICc score to 139.81 and 141.40 respectively. Ceruloplasmin was associated with the active-to-inactive transition (hazard ratio 0.60 (95% confidence interval [0.39, 0.93])), and alpha-1-acid-glycoprotein with the inactive-to-active transition (hazard ratio 1.49 (95% confidence interval [1.10, 2.02])). Inputting individual alpha-1-acid-glycoprotein/ceruloplasmin values provides 3, 6 and 12 months probabilities of state transition. CONCLUSIONS Alpha-1-acid-glycoprotein was predictive of active lupus nephritis flare, whereas ceruloplasmin was predictive of remission. The Markov state-space model warrants testing in a prospective clinical trial of lupus nephritis biomarker led monitoring.
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Affiliation(s)
- E M D Smith
- Department of Women's & Children's Health, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - A Eleuteri
- Medical Physics and Clinical Engineering, and Department of Physics, University of Liverpool, Liverpool, UK.
| | - B Goilav
- Department of Paediatric Nephrology, Albert Einstein College of Medicine, New York, USA.
| | | | - A Phuti
- Paediatric Rheumatology, University of Cape Town, Cape Town, South Africa.
| | - T Rubinstein
- Department of Paediatric Rheumatology, Albert Einstein College of Medicine, New York, USA.
| | - D Wahezi
- Department of Paediatric Rheumatology, Albert Einstein College of Medicine, New York, USA.
| | - C A Jones
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - S D Marks
- Paediatric Nephrology, Great Ormond Street Hospital, London, UK.
| | - R Corkhill
- Department of Women's & Children's Health, University of Liverpool, Liverpool, UK.
| | - C Pilkington
- Paediatric Rheumatology, Great Ormond Street Hospital, London, UK.
| | - K Tullus
- Paediatric Nephrology, Great Ormond Street Hospital, London, UK.
| | - C Putterman
- Department of Rheumatology, Albert Einstein College of Medicine, New York, USA.
| | - C Scott
- Paediatric Rheumatology, University of Cape Town, Cape Town, South Africa.
| | - A C Fisher
- Medical Physics and Clinical Engineering, and Department of Physics, University of Liverpool, Liverpool, UK.
| | - M W Beresford
- Department of Women's & Children's Health, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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Mellouk Aid K, Tchala Vignon Zomahoun H, Soulaymani A, Lebascle K, Silvera S, Astagneau P, Misset B. MOrtality and infectious complications of therapeutic EndoVAscular interventional radiology: a systematic and meta-analysis protocol. Syst Rev 2017; 6:89. [PMID: 28438186 PMCID: PMC5402637 DOI: 10.1186/s13643-017-0474-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 04/05/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Endovascular interventional radiology (EIR) is an increasingly popular, mini invasive treatment option for patient with symptomatic vascular disease. The EIR practiced by qualified hands is an effective, well-tolerated procedure that offers relief of patient's symptoms with a low risk of complications. During acute post procedural period, immediate complications may relate to vascular access, restenosis, thromboembolic events, uterine ischemia, infection, necrosis, sepsis, ICU stay, surgical recovery, pain management, treatment failure, and death. Moreover, additional non-life-threatening complications exist, but they are not well described and represent disparate information. METHODS/DESIGN A range of databases will be screened consulted to identify the relevant studies: PubMed, EMBASE, The Cochrane Library, NosoBase, and Google Scholar (to identify articles not yet indexed). Scientist librarian used Medical Subject Headings (MeSH) and free terms to construct the search strategy in PubMed. This search strategy will be adapted in other databases. Two coauthors will independently select the relevant studies, extract the relevant data, and assess the risk of bias in the included studies. Any disagreements between the two authors will be solved by a third author. DISCUSSION This systematic review will provide a synthesis of EIR complications. The spotlighted results will be analyzed in order to provide a state-of-knowledge synopsis of the current evidence base in relation to the epidemiology of the infectious complications after EIR. In the event of conclusive results, our findings will serve as a reference background to assess guidelines on reality of the problem of the infections linked to endovascular interventional radiology and to formulate of assumptions and propose preventive measures, based on the results of our investigations. These propositions will aim to reduce the risk and/or the severity of these complications in the concerned population in favor a positive medical economics report. It will also aim to decrease the antibio-resistance and in fine will improve health status and security of patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015025594.
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Affiliation(s)
- Kaoutar Mellouk Aid
- Laboratory of Genetics and Biometrics, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
- Clinical Research Centre, Foundation Hospital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France
| | | | - Abdelmajid Soulaymani
- Laboratory of Genetics and Biometrics, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
| | - Karin Lebascle
- Centre for Control of Healthcare-Associated Infections, Paris, France
| | - Stephane Silvera
- Foundation Hospital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France
| | - Pascal Astagneau
- Centre for Control of Healthcare-Associated Infections and Pierre & Marie Curie Faculty of Medicine, Sorbonne Universities, Paris, France
| | - Benoit Misset
- Department of Intensive Care and Clinical Research Centre, Foundation Hospital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France
- Paris Descartes University, Paris, France
- Department of Intensive Care, Rouen, France
- Rouen University Hospital, University of Rouen, Rouen, France
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Schildhouse R, Lai A, Barsuk JH, Mourad M, Chopra V. Safe and Effective Bedside Thoracentesis: A Review of the Evidence for Practicing Clinicians. J Hosp Med 2017; 12:266-276. [PMID: 28411293 DOI: 10.12788/jhm.2716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Physicians often care for patients with pleural effusion, a condition that requires thoracentesis for evaluation and treatment. We aim to identify the most recent advances related to safe and effective performance of thoracentesis. METHODS We performed a narrative review with a systematic search of the literature. Two authors independently reviewed search results and selected studies based on relevance to thoracentesis; disagreements were resolved by consensus. Articles were categorized as those related to the pre-, intra- and postprocedural aspects of thoracentesis. RESULTS Sixty relevant studies were identified and included. Pre-procedural topics included methods for physician training and maintenance of skills, such as simulation with direct observation. Additionally, pre-procedural topics included the finding that moderate coagulopathies (international normalized ratio less than 3 or a platelet count greater than 25,000/μL) and mechanical ventilation did not increase risk of postprocedural complications. Intraprocedurally, ultrasound use was associated with lower risk of pneumothorax, while pleural manometry can identify a nonexpanding lung and may help reduce risk of re-expansion pulmonary edema. Postprocedurally, studies indicate that routine chest X-ray is unwarranted, because bedside ultrasound can identify pneumothorax. CONCLUSIONS While the performance of thoracentesis is not without risk, clinicians can incorporate recent advances into practice to mitigate patient harm and improve effectiveness. Journal of Hospital Medicine 2017;12:266-276.
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Affiliation(s)
- Richard Schildhouse
- Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Division of General Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Andrew Lai
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michelle Mourad
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Vineet Chopra
- Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Division of General Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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JOURNAL CLUB: Ultrasound-Guided Breast Interventions: Low Incidence of Infectious Complications With Use of an Uncovered Probe. AJR Am J Roentgenol 2017; 208:1147-1153. [PMID: 28225634 DOI: 10.2214/ajr.16.16440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the incidence of infectious complications after ultrasound-guided breast interventions performed with an intermediate-level disinfection protocol without an ultrasound probe cover. MATERIALS AND METHODS Two independent institutional databases were searched to identify breast infections in patients who underwent ultrasound-guided interventions between January 2005 and July 2013. The departments of radiology and infectious diseases independently maintained these databases. A comprehensive retrospective chart review based on periprocedural antibiotic use and clinical documentation of infection was also performed to reduce the likelihood of missing potential infectious complications. RESULTS A total of 12,708 ultrasound-guided breast procedures were performed in the time frame of this study. All potential cases of procedure-related infection were included for subspecialist review in an effort to give the most conservative (highest) estimate of infectious complications. Among these cases, 14 documented cases of possible procedure-related infection were identified, for an overall incidence of 0.11%. All infections were localized skin or soft-tissue infections and adequately treated with a short course of oral antibiotics. No cases of more serious infections or sepsis were found. None of the reported infections required IV antibiotic therapy, percutaneous intervention, surgical intervention, or hospitalization. CONCLUSION The incidence of infectious complications after an ultrasound-guided breast intervention without an ultrasound probe cover is extremely low. Physicians can use this information in the development of their disinfection protocols and to provide accurate information in counseling patients during preprocedural consultation.
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Nyhsen CM, Humphreys H, Nicolau C, Mostbeck G, Claudon M. Infection prevention and ultrasound probe decontamination practices in Europe: a survey of the European Society of Radiology. Insights Imaging 2016; 7:841-847. [PMID: 27778309 PMCID: PMC5110482 DOI: 10.1007/s13244-016-0528-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/19/2016] [Accepted: 10/03/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Although ultrasound (US) is considered one of the safest imaging modalities, concerns have been raised regarding potential infection transmission risks through US procedures. A survey was undertaken by the European Society of Radiology (ESR) to establish infection prevention and control measures in US and to highlight the importance of good medical practice. METHODS An online survey was sent to all 22,000 full ESR members. RESULTS The response rate of completed surveys was 4.3 % (946 practitioners, 97 % of which were radiologists, mostly working in larger hospital settings). Among respondents, 29 %, 11 % and 6 % did not disinfect the US probe after every patient when performing standard surface US, endo-cavity US and interventional procedures, respectively. Eleven percent did not always use probe covers for endo-cavity US; for interventional procedures, the proportion was 23 %. A minority used sterile gel sachets in direct patient contact for endo-cavity scans (30 %), and 77.5 % used sterile gel for interventional procedures. CONCLUSIONS The survey results highlight a wide range of practices throughout Europe and the need to raise awareness amongst practitioners regarding the importance of infection prevention and control measures. The development of European recommendations encompassing all US examinations, together with education is a priority. MAIN MESSAGES • Transmission of infection through ultrasound procedures is possible. • There is a wide range of ultrasound probe decontamination practices in Europe. • Not all practitioners use probe covers for endo-cavity or interventional ultrasound. • Not all practitioners use sterile gel for internal and invasive procedures. • Currently there are no European recommendations encompassing all US examinations.
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Affiliation(s)
| | - Hilary Humphreys
- Royal College of Surgeons in Ireland, RCSI Education & Research Centre, Beaumont Hospital, Beaumont Dublin 9, Ireland
| | - Carlos Nicolau
- Hospital Clinic de Barcelona, Villarroel 170, ES 8036 Barcelona, Spain
| | | | - Michel Claudon
- Radiology Department, Hôpital de Brabois, CHRU de Nancy and IADI INSERM U 947, Rue du Morvan, FR 54511 Vandoeuvre Les Nancy Cedex, France
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20
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No association between pseudotumors, high serum metal-ion levels and metal hypersensitivity in large-head metal-on-metal total hip arthroplasty at 5-7-year follow-up. Skeletal Radiol 2016; 45:115-25. [PMID: 26454451 DOI: 10.1007/s00256-015-2264-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 09/21/2015] [Accepted: 09/28/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The relationship between metal wear debris, pseudotumor formation and metal hypersensitivity is complex and not completely understood. The purpose of this study was to assess the prevalence of pseudotumor formation in a consecutive series of metal-on-metal (MoM) total hip arthroplasty (THA) and to investigate its relationship to serum metal-ion levels and hypersensitivity to metal. METHODS Forty-one patients (31 males), mean age 52 (28-68) years, with a total of 49 large-head MoM THA participated in a 5-7-year follow-up study. Patients underwent ultrasonography, serum metal-ion concentrations were measured, metal allergy and atopic dermatitis were evaluated, and the questionnaires of the Oxford Hip Score (OHS), Harris Hip Score (HHS) and the Short-Form Health Survey (SF-36) were completed. RESULTS Pseudotumors were found in eight patients, but they were asymptomatic and their serum metal-ion levels were similar to those observed in patients with no pseudotumors (p > 0.36). The capsule-stem distance of mean 8.6 mm (SD 3.82, 95% CI: 5.40-11.79) was wider (p = 0.02) in patients with pseudotumours than in patients without pseudotumors of mean 5.6 mm (SD 2.89, 95% CI: 4.68-6.58). Positive patch test reactions were seen in three patients. Higher serum metal-ion levels of chromium and cobalt were significantly correlated with steeper cup inclination and smaller femoral head sizes, and were associated with female gender (p < 0.04). CONCLUSION We found no association between pseudotumor formation, serum metal-ion levels, metal patch test reactivity, and atopic dermatitis. However, clinicians should be aware of asymptomatic pseudotumors, and we advise further exploration into the mechanisms involved in the pathogenesis of pseudotumors.
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Sutcliffe J, Briggs J, Little M, McCarthy E, Wigham A, Bratby M, Tapping C, Anthony S, Patel R, Phillips-Hughes J, Boardman P, Uberoi R. Antibiotics in interventional radiology. Clin Radiol 2015; 70:223-34. [DOI: 10.1016/j.crad.2014.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 09/28/2014] [Accepted: 09/30/2014] [Indexed: 12/18/2022]
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Stillion JR, Letendre JA. A clinical review of the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2015; 25:113-29. [PMID: 25582193 DOI: 10.1111/vec.12274] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/15/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review the current literature in reference to the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats. ETIOLOGY Pyothorax, also known as thoracic empyema, is characterized by the accumulation of septic purulent fluid within the pleural space. While the actual route of pleural infection often remains unknown, the oral cavity and upper respiratory tract appear to be the most common source of microorganisms causing pyothorax in dogs and cats. In human medicine, pyothorax is a common clinical entity associated with bacterial pneumonia and progressive parapneumonic effusion. DIAGNOSIS Thoracic imaging can be used to support a diagnosis of pleural effusion, but cytologic examination or bacterial culture of pleural fluid are necessary for a definitive diagnosis of pyothorax. THERAPY The approach to treatment for pyothorax varies greatly in both human and veterinary medicine and remains controversial. Treatment of pyothorax has classically been divided into medical or surgical therapy and may include administration of antimicrobials, intermittent or continuous thoracic drainage, thoracic lavage, intrapleural fibrinolytic therapy, video-assisted thoracic surgery, and traditional thoracostomy. Despite all of the available options, the optimal treatment to ensure successful short- and long-term outcome, including the avoidance of recurrence, remains unknown. PROGNOSIS The prognosis for canine and feline pyothorax is variable but can be good with appropriate treatment. A review of the current veterinary literature revealed an overall reported survival rate of 83% in dogs and 62% in cats. As the clinical presentation of pyothorax in small animals is often delayed and nonspecific, rapid diagnosis and treatment are required to ensure successful outcome.
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Affiliation(s)
- Jenefer R Stillion
- Western Veterinary Specialist and Emergency Centre, Calgary, Alberta, Canada
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Ennis J, Schultz G, Perera P, Williams S, Gharahbaghian L, Mandavia D. Ultrasound for Detection of Ascites and for Guidance of the Paracentesis Procedure: Technique and Review of the Literature. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijcm.2014.520163] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Infectious, traumatic, or neoplastic processes in the chest often result in fluid collections within the pleural, parenchymal, or mediastinal spaces. The same fundamental principles that guide drainages of the abdomen can be applied to the chest. This review discusses various pathologic conditions of the thorax that can result in the abnormal accumulation of fluid or air, and their management using image-guided methods.
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Affiliation(s)
- Shaunagh McDermott
- Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Jang SH, Lee SC, Lee JH, Nam SH, Cho KR, Park Y. Comparison of ultrasound (US)-guided intra-articular injections by in-plain and out-of-plain on medial portal of the knee. Rheumatol Int 2013; 33:1951-9. [DOI: 10.1007/s00296-012-2660-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 12/28/2012] [Indexed: 01/12/2023]
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Malavaud S, Joffre F, Auriol J, Darres S. Hygiene recommendations for interventional radiology. Diagn Interv Imaging 2012; 93:813-22. [PMID: 23099034 DOI: 10.1016/j.diii.2012.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S Malavaud
- Service d'épidémiologie et hygiène hospitalière, CHU de Toulouse, groupe Rangueil-Larrey, 1 avenue Jean-Poulhès, Toulouse cedex 9, France
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TING YITIAN, COATES PTOBY, WALKER ROBERTJ, MCLELLAN ALEXANDERD. Urinary tubular biomarkers as potential early predictors of renal allograft rejection. Nephrology (Carlton) 2011; 17:11-6. [DOI: 10.1111/j.1440-1797.2011.01536.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Infectious complications after ultrasound-guided interventional procedures in the liver. AJR Am J Roentgenol 2011; 196:W856; author reply W857. [PMID: 21606282 DOI: 10.2214/ajr.10.5973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Zhang J, Ebraheim N, Lause GE. Ultrasound-guided injection for the biceps brachii tendinitis: results and experience. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:729-733. [PMID: 21458143 DOI: 10.1016/j.ultrasmedbio.2011.02.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/16/2011] [Accepted: 02/21/2011] [Indexed: 05/30/2023]
Abstract
The purpose of this study was to identify the results of ultrasound-guided injection of corticosteroid for biceps brachii tendinitis. In this randomized and prospective study, we evaluated 45 patients who were treated by free-hand injection without ultrasound guidance (group A) and 53 patients who were treated by ultrasound-guided injection (group B). The mean age was 47 y (range, 28 to 72). The average follow-up was 33 weeks (range, 24 to 56). The visual analog scale score decreased from 7.1 ± 2.3 before injection to 4.2 ± 3.1 at follow-up in group A and from 6.9 ± 2.6 to 2.1 ± 1.9 in group B (p < 0.05). The Constant-Murley score improved from 31.4 ± 11.6 before injection to 73.5 ± 19.2 at follow-up in group A and from 32.5 ± 14.7 to 85.5 ± 10.3 (p < 0.01). The ultrasound-guided injection therefore demonstrated a statistically significantly greater degree of pain relief. However, the outcome of injection was not satisfactory for the patients who demonstrated severely frayed tendons at arthroscopy. There were no complications related to the injection in both groups. Corticosteroid injection under ultrasound guidance is a safe and well-tolerated procedure with a satisfactory rate of symptom relief in patients with biceps brachii tendinitis.
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Affiliation(s)
- Jingwei Zhang
- Department of Orthopaedic Surgery, Sixth Hospital of Ningbo, China.
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