Asunto(s)
Agujas , Humanos , Femenino , Agujas/efectos adversos , Técnicas Cosméticas/efectos adversos , Técnicas Cosméticas/instrumentación , Ultrasonografía , Granuloma de Cuerpo Extraño/etiología , Granuloma de Cuerpo Extraño/diagnóstico por imagen , Adulto , Terapia por Radiofrecuencia , Inducción Percutánea del ColágenoRESUMEN
PURPOSE: To discuss potential causes of broken dental needles during dental anesthesia and features of this complication, including the anatomical location of fragments in tissues, symptoms, complications, and therapeutic approaches. METHODS: Twelve cases of broken dental needles occurring during dental anesthesia and subsequently referred to Hospital de Base do Distrito Federal, Brazil, between 1992 and 2019 were selected. In addition, similar cases reported in the literature over the past 50 years were reviewed. RESULTS: Needle fractures occur most frequently during inferior alveolar nerve blocks and in younger patients. The leading cause is unexpected patient movement during the anesthetic procedure. The needle fragment is most commonly found in the pterygomandibular space or the deep spaces of the head and neck region. Needle migration is a particular concern; although rare, it is unpredictable and potentially life-threatening. CONCLUSIONS: Needle fracture is an intraoperative complication which has the potential to cause severe patient damage. It is essential that practitioners have knowledge of this possible complication and understand the technical considerations for its prevention. The existing literature and the results of this case series analysis suggest that removal of the fractured needle fragment should be attempted as soon as possible.
Asunto(s)
Anestesia Dental , Cuerpos Extraños , Bloqueo Nervioso , Humanos , Agujas/efectos adversos , Cuerpos Extraños/etiología , Cuerpos Extraños/cirugía , Anestesia Dental/efectos adversos , Falla de Equipo , Bloqueo Nervioso/efectos adversosAsunto(s)
Inyecciones Intravenosas/efectos adversos , Agujas/efectos adversos , Sepsis/etiología , Cateterismo Periférico , Equipos Desechables , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Inyecciones Intravenosas/instrumentación , Pediatría/historia , Publicaciones Periódicas como Asunto/historia , Politetrafluoroetileno , Poliuretanos , Edición , Sepsis/prevención & controlRESUMEN
BACKGROUND: Fine needle biopsy (FNB) histological samples by endoscopic ultrasound. It is important to obtain representative histological samples of solid biliopancreatic lesions without a clear indication for resection. The role of new needles in such task is yet to be determined. AIM: To compare performance assessment between 20G double fine needle biopsy (FNB) and conventional 22G fine needle aspiration (FNA) needles for endoscopic ultrasound (EUS)-guided biopsy. METHODS: This prospective study examined 20 patients who underwent the random puncture of solid pancreatic lesions with both needles and the analysis of tissue samples by a single pathologist. RESULTS: The ProCore 20G FNB needle provided more adequate tissue samples (16 vs. 9, p=0.039) with better cellularity quantitative scores (11 vs. 5, p=0.002) and larger diameter of the histological sample (1.51±1.3 mm vs. 0.94±0.55 mm, p=0.032) than the 22G needle. The technical success, puncture difficulty, and sample bleeding were similar between groups. The sensitivity, specificity, and diagnostic accuracy were 88.9%, 100%, and 90% and 77.8%, 100%, and 78.9% for the 20G and 22G needles, respectively. CONCLUSIONS: The samples obtained with the ProCore 20G FNB showed better histological parameters; although there was no difference in the diagnostic performance between the two needles, these findings may improve pathologist performance.
Asunto(s)
Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/normas , Agujas/clasificación , Páncreas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/instrumentación , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agujas/efectos adversos , Páncreas/patología , Neoplasias Pancreáticas/diagnóstico por imagen , Estudios Prospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
La presencia de elementos extraños dentro del canal raquídeo es infrecuente y no hay claro consenso respecto de su tratamiento. Las publicaciones sobre fragmentos de proyectil de arma de fuego intracanal recomiendan la exéresis de los fragmentos ante la posibilidad de migración, sobre todo, cuando están en una zona próxima al cono medular. Se debería proceder del mismo modo ante una aguja dentro del canal espinal. Presentamos a una paciente con dolor radicular invalidante provocado por un fragmento de aguja dentro del canal espinal luego de una cesárea. Nivel de Evidencia: IV
The presence of foreign elements within the spinal canal is rare and there is no clear consensus regarding its treatment. The publications on intracanal firearm projectile fragments recommend exeresis of the fragments due to the possibility of migration, especially when they are in an area close to the medullary cone. The same procedure should be applied to a needle inside the spinal canal. We present a patient with disabling radicular pain caused by a needle fragment within the spinal canal after cesarean section. Level of Evidence: IV
Asunto(s)
Adulto , Rotura , Enfermedades de la Columna Vertebral , Punción Espinal , Cesárea/efectos adversos , Anestesia Epidural/efectos adversos , Agujas/efectos adversosRESUMEN
OBJECTIVES: to report a clinical case of needle phobia which culminated in cardiac arrest and describe the outcome of a care plan based on fear and anxiety diagnoses, using the Roy adaptation model as the framework. METHODS: case study conducted in a chemotherapy outpatient unit in Rio de Janeiro. Care was guided by the nursing process and the use of instruments to assess the venous network, anxiety and fear. RESULTS: the Roy adaptation model enabled proposing nursing interventions that allowed the study subject to adapt to the external and internal stimuli triggered by vasovagal syndrome. The instruments indicated the choice of an adequate semi-implanted venous access device and led to improved levels of anxiety and fear. FINAL CONSIDERATIONS: after carrying out the nursing activities, anxiety was reduced, and the patient achieved greater control over fear.
Asunto(s)
Quimioterapia/enfermería , Agujas/efectos adversos , Trastornos Fóbicos/enfermería , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Brasil , Humanos , Masculino , Atención de Enfermería/métodos , Trastornos Fóbicos/psicología , Adulto JovenRESUMEN
AIMS: Intraoperative complications in cataract surgery are more common in diabetic patients. Solving aphakia in these circumstances remains a challenge, as the scleral structure has been shown to be different in diabetes. This study aims to analyze the role of a secondary sutureless scleral intraocular lens (IOL) flanged fixation in diabetic patients without capsular support and to compare the anatomical and functional outcomes using a 30 gauge (G) ultrathin wall needle vs. a 27G needle. METHODS: Retrospective, observational cohort study. 105 eyes (105 patients) who underwent PPV with secondary IOL fixation using a sutureless 27G (n = 51) or a 30G ultrathin wall (UTW) needle technique (n = 54) and had a 24 months postoperative follow up. Consecutive patients' records were reviewed for lens stability and centration parameters, intra- and postoperative complications at 7 days, 1, 3, 6, 12, and 24 months after surgery. Correlations between outcome measures and needle size (27G vs. 30G UTW) were analyzed. RESULTS: IOL displacement occurred in 30 patients (41.2%) in the 27G group and did not occur in the 30G UTW needle group (p < 0.001). Mean time until IOL displacement was 10.5 ± 7.0 months (range: 7 days-24 months). IOL centricity was significantly better in the 30G ultrathin wall needle group compared to 27 G (p = 0.001). Additional surgical interventions were necessary only in the 27G group (n = 14). CONCLUSIONS: Sutureless IOL flanged technique using a 30G UTW needle is more predictable and has less complications in aphakic diabetic patients, compared to a 27G needle technique.
Asunto(s)
Diabetes Mellitus/cirugía , Retinopatía Diabética/cirugía , Implantación de Lentes Intraoculares/instrumentación , Agujas , Procedimientos Quirúrgicos sin Sutura/instrumentación , Adulto , Anciano , Afaquia/epidemiología , Afaquia/cirugía , Argentina/epidemiología , Estudios de Cohortes , Diabetes Mellitus/epidemiología , Retinopatía Diabética/epidemiología , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Implantación de Lentes Intraoculares/efectos adversos , Implantación de Lentes Intraoculares/métodos , Lentes Intraoculares , Masculino , Persona de Mediana Edad , Agujas/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Esclerótica/cirugía , Procedimientos Quirúrgicos sin Sutura/efectos adversos , Procedimientos Quirúrgicos sin Sutura/métodos , Agudeza VisualRESUMEN
ABSTRACT Background: It is important to obtain representative histological samples of solid biliopancreatic lesions without a clear indication for resection. The role of new needles in such task is yet to be determined. Aim: To compare performance assessment between 20G double fine needle biopsy (FNB) and conventional 22G fine needle aspiration (FNA) needles for endoscopic ultrasound (EUS)-guided biopsy. Methods: This prospective study examined 20 patients who underwent the random puncture of solid pancreatic lesions with both needles and the analysis of tissue samples by a single pathologist. Results: The ProCore 20G FNB needle provided more adequate tissue samples (16 vs. 9, p=0.039) with better cellularity quantitative scores (11 vs. 5, p=0.002) and larger diameter of the histological sample (1.51±1.3 mm vs. 0.94±0.55 mm, p=0.032) than the 22G needle. The technical success, puncture difficulty, and sample bleeding were similar between groups. The sensitivity, specificity, and diagnostic accuracy were 88.9%, 100%, and 90% and 77.8%, 100%, and 78.9% for the 20G and 22G needles, respectively. Conclusions: The samples obtained with the ProCore 20G FNB showed better histological parameters; although there was no difference in the diagnostic performance between the two needles, these findings may improve pathologist performance.
RESUMO Racional: As lesões sólidas pancreáticas não ressecáveis cirurgicamente demandam boa amostragem tecidual para definição histológica e condução oncológica . O papel das novas agulhas de ecopunção no aprimoramento diagnóstico ainda necessita elucidação. Objetivo: Comparar as biópsias guiadas por ecoendoscoopia com a nova agulha 20G de bisel frontal duplo (FNB) com a agulha de aspiração fina 22G convencional. Métodos: Este estudo prospectivo avaliou 20 pacientes submetidos à punção de lesões pancreáticas sólidas com ambas agulhas e envolveu análise de amostras teciduais por um único patologista. Resultados: A agulha FNB 20G forneceu amostras de tecido mais adequadas (16 vs. 9, p=0,039) com melhores escores quantitativos de celularidade (11 vs. 5, p=0,002) e maior diâmetro máximo da amostra histológica (1,51±1,3 mm vs. 0,94±0,55 mm, p=0,032) que a agulha 22G. O sucesso técnico, dificuldade de punção e sangramento da amostra foram semelhantes entre os grupos. A sensibilidade, especificidade e acurácia diagnóstica foram 88,9%, 100% e 90% e 77,8%, 100% e 78,9% para as agulhas 20G e 22G, respectivamente. Conclusão: As amostras obtidas com a FNB 20G apresentaram melhores parâmetros histológicos, embora não tenha havido diferença no desempenho diagnóstico entre as duas agulhas.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Páncreas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/normas , Agujas/clasificación , Páncreas/patología , Neoplasias Pancreáticas/diagnóstico por imagen , Estudios Prospectivos , Sensibilidad y Especificidad , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/instrumentación , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Agujas/efectos adversosRESUMEN
ABSTRACT Objectives: to report a clinical case of needle phobia which culminated in cardiac arrest and describe the outcome of a care plan based on fear and anxiety diagnoses, using the Roy adaptation model as the framework. Methods: case study conducted in a chemotherapy outpatient unit in Rio de Janeiro. Care was guided by the nursing process and the use of instruments to assess the venous network, anxiety and fear. Results: the Roy adaptation model enabled proposing nursing interventions that allowed the study subject to adapt to the external and internal stimuli triggered by vasovagal syndrome. The instruments indicated the choice of an adequate semi-implanted venous access device and led to improved levels of anxiety and fear. Final Considerations: after carrying out the nursing activities, anxiety was reduced, and the patient achieved greater control over fear.
RESUMEN Objetivos: informar sobre un caso clínico de fobia a las agujas derivado en paro cardiorrespiratorio, describir los resultados de un plan de atención orientado a diagnósticos de miedo y ansiedad, sobre referencial del Modelo de Adaptación de Roy. Métodos: estudio de caso observado en ambulatorio de quimioterapia de Rio de Janeiro. El trabajo profesional estuvo orientado por el proceso de enfermería, respaldado por utilización de instrumentos evaluadores de la red venosa, ansiedad y miedo. Resultados: el Modelo de Adaptación de Roy ofreció la propuesta de intervenciones de enfermería que le faciliten al sujeto estudiado adaptación a los estímulos externos e internos disparadores del síncope vasovagal. Los instrumentos indicaron que el catéter semiimplantado es el dispositivo de acceso venoso más adecuado, resultando en mejoras de los niveles de ansiedad y miedo. Consideraciones Finales: una vez realizadas las actividades de enfermería, la ansiedad disminuyó y el paciente obtuvo mayor autocontrol del miedo.
RESUMO Objetivos: reportar um caso clínico de fobia de agulha que culminou em parada cardiorrespiratória e descrever os resultados de um plano assistencial voltado aos diagnósticos de medo e ansiedade, tendo como referencial o Modelo de Adaptação de Roy. Métodos: estudo de caso, desenvolvido em ambulatório de quimioterapia do Rio de Janeiro. A atuação profissional foi orientada pelo processo de enfermagem e subsidiada pelo uso de instrumentos de avaliação da rede venosa, ansiedade e medo. Resultados: o Modelo de Adaptação de Roy facultou a proposição de intervenções de enfermagem que permitiram ao sujeito do estudo uma adaptação aos estímulos externos e internos desencadeadores de síndrome vasovagal. Os instrumentos indicaram a escolha de um cateter semi-implantado como dispositivo de acesso venoso adequado que resultou na melhora dos níveis de ansiedade e medo. Considerações Finais: após o desenvolvimento das atividades de enfermagem, a ansiedade diminuiu e o paciente obteve maior autocontrole do medo.
Asunto(s)
Humanos , Masculino , Adulto Joven , Trastornos Fóbicos/enfermería , Quimioterapia/enfermería , Agujas/efectos adversos , Trastornos Fóbicos/psicología , Brasil , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Atención de Enfermería/métodosRESUMEN
OBJECTIVE: To assess the efficacy and safety of a virtual reality distraction for needle pain in 2 common hospital settings: the emergency department (ED) and outpatient pathology (ie, outpatient laboratory). The control was standard of care (SOC) practice. STUDY DESIGN: In 2 clinical trials, we randomized children aged 4-11 years undergoing venous needle procedures to virtual reality or SOC at 2 tertiary Australian hospitals. In the first study, we enrolled children in the ED requiring intravenous cannulation or venipuncture. In the second, we enrolled children in outpatient pathology requiring venipuncture. In the ED, 64 children were assigned to virtual reality and 59 to SOC. In pathology, 63 children were assigned to virtual reality and 68 to SOC; 2 children withdrew assent in the SOC arm, leaving 66. The primary endpoint was change from baseline pain between virtual reality and SOC on child-rated Faces Pain Scale-Revised. RESULTS: In the ED, there was no change in pain from baseline with SOC, whereas virtual reality produced a significant reduction in pain (between-group difference, -1.78; 95% CI, -3.24 to -0.317; P = .018). In pathology, both groups experienced an increase in pain from baseline, but this was significantly less in the virtual reality group (between-group difference, -1.39; 95% CI, -2.68 to -0.11; P = .034). Across both studies, 10 participants experienced minor adverse events, equally distributed between virtual reality/SOC; none required pharmacotherapy. CONCLUSIONS: In children aged 4-11 years of age undergoing intravenous cannulation or venipuncture, virtual reality was efficacious in decreasing pain and was safe. TRIAL REGISTRATION: Australia and New Zealand Clinical Trial Registry: ACTRN12617000285358p.
Asunto(s)
Cateterismo/efectos adversos , Agujas/efectos adversos , Dolor Asociado a Procedimientos Médicos/etiología , Dolor Asociado a Procedimientos Médicos/prevención & control , Flebotomía/efectos adversos , Realidad Virtual , Niño , Preescolar , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
PURPOSE: To compare the use of topical anesthesia and retrobulbar anesthesia during silicone oil removal with a mixed pars plana technique, through evaluating the pain experience of patients. METHODS: We selected patients according to their behavior during previous vitreoretinal surgery and ophthalmologic examinations and divided them into two anesthesia groups: topical (n=36) and retrobulbar (n=33). We used a mixed technique for the passive removal of silicone oil in both groups. During each step of the surgery, the patients' pain experience and the surgeon's comfort were scored according to a pain scale. RESULTS: The pain experienced during the application of the anesthesia was significantly greater in the retrobulbar group (p<0.001). The topical group experienced greater pain during trocar insertion (p<0.001). There was no significant difference between the groups regarding the overall pain experience or complications. CONCLUSIONS: The pain experience of the selected patients during silicone oil removal was comparable between the topical and the retrobulbar anesthesia. Topical anesthesia with the mixed pars plana technique is an effective and safe alternative option for silicone oil removal surgery.
Asunto(s)
Administración Oftálmica , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Inyecciones Intraoculares/métodos , Dimensión del Dolor , Dolor Asociado a Procedimientos Médicos/prevención & control , Aceites de Silicona , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agujas/efectos adversos , Estudios Prospectivos , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Succión/instrumentación , Succión/métodos , Resultado del Tratamiento , Agudeza Visual , Cirugía Vitreorretiniana/efectos adversos , Cirugía Vitreorretiniana/métodos , Adulto JovenRESUMEN
OBJECTIVE: To compare complications of ultrasound-guided percutaneous renal biopsy using two needle gauges (16-G and 18-G). METHODS: A total of 238 individuals with renal biopsy indication were included and randomly separated into two groups: ultrasound-guided percutaneous renal biopsy procedure carried out with a 16-G or 18-G needle. The adequacy of biopsy samples and post-procedure complications were compared between the two groups. RESULTS: The procedures carried out with a 16-G needle collected fragments with a mean of 22.1 ± 10.8 glomeruli, and those carried out with an 18-G needle had a mean of 17.5 ± 9.4 glomeruli. Patients submitted to renal biopsies with a 16-G needle had a higher likelihood of having a complication (OR5.1, 95% CI 1.7-15.4, P = 0.001). The overall mean volume of post-biopsy hematoma in patients with complications was significantly larger than those without complications (44 ± 56.1 mL vs 5.9 ± 6.6 mL; P < 0.001). CONCLUSIONS: Renal biopsies carried out by ultrasonography using an 18-G needle provide adequate histological analysis, showing a lower amount of glomeruli but with similar clinical quality as a 16-G needle. Furthermore, it is associated with a lower risk of procedure-related complications.
Asunto(s)
Hematoma/epidemiología , Agujas/efectos adversos , Complicaciones Posoperatorias/epidemiología , Insuficiencia Renal Crónica/diagnóstico , Adolescente , Adulto , Anciano , Biopsia con Aguja/efectos adversos , Biopsia con Aguja/instrumentación , Biopsia con Aguja/métodos , Femenino , Hematoma/etiología , Humanos , Biopsia Guiada por Imagen/efectos adversos , Biopsia Guiada por Imagen/instrumentación , Biopsia Guiada por Imagen/métodos , Riñón/diagnóstico por imagen , Riñón/patología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Insuficiencia Renal Crónica/patología , Resultado del Tratamiento , Ultrasonografía Intervencional , Adulto JovenRESUMEN
ABSTRACT Purpose: To compare the use of topical anesthesia and retrobulbar anesthesia during silicone oil removal with a mixed pars plana technique, through evaluating the pain experience of patients. Methods: We selected patients according to their behavior during previous vitreoretinal surgery and ophthalmologic examinations and divided them into two anesthesia groups: topical (n=36) and retrobulbar (n=33). We used a mixed technique for the passive removal of silicone oil in both groups. During each step of the surgery, the patients' pain experience and the surgeon's comfort were scored according to a pain scale. Results: The pain experienced during the application of the anesthesia was significantly greater in the retrobulbar group (p<0.001). The topical group experienced greater pain during trocar insertion (p<0.001). There was no significant difference between the groups regarding the overall pain experience or complications. Conclusions: The pain experience of the selected patients during silicone oil removal was comparable between the topical and the retrobulbar anesthesia. Topical anesthesia with the mixed pars plana technique is an effective and safe alternative option for silicone oil removal surgery.
RESUMO Objetivo: Comparar a sensação de dor de pacientes durante a remoção do óleo de silicone sob anestesia tópica e retrobulbar, usando uma técnica via pars plana combinada. Métodos: Os pacientes foram selecionados, de acordo com suas atitudes durante cirurgia vitreorretiniana prévia e exames oftalmológicos, e divididos em dois grupos: anestesia tópica e retrobulbar. Para a remoção passiva do óleo de silicone, utilizou-se uma técnica combinada em ambos os grupos. A sensação de dor dos pacientes e o conforto do cirurgião foram classificados através de uma escala de dor durante cada etapa da cirurgia. Resultados: Os grupos anestesia tópica e retrobulbar incluíram 36 e 33 pacientes, respectivamente. A sensação de dor durante a aplicação da anestesia foi significativamente maior no grupo retrobulbar (p<0,001). O grupo anestesia tópica sentiu mais dor durante a inserção do trocarte (p<0,001). Não houve diferença significativa entre os grupos em relação à sensação geral de dor e a complicações. Conclusões: A sensação de dor é comparável entre a anestesia tópica e a retrobulbar durante a remoção de óleo de silicone. A combinação de anestesia tópica e uma técnica via pars plana é uma opção alternativa eficaz e segura para a cirurgia de remoção de óleo de silicone.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Dimensión del Dolor , Aceites de Silicona , Estudios Prospectivos , Inyecciones Intraoculares/métodos , Administración Oftálmica , Dolor Asociado a Procedimientos Médicos/prevención & control , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Succión/instrumentación , Succión/métodos , Agudeza Visual , Estadísticas no Paramétricas , Cirugía Vitreorretiniana/efectos adversos , Cirugía Vitreorretiniana/métodos , Agujas/efectos adversosRESUMEN
We describe a unique complication during primary posterior continuous curvilinear capsulorhexis (PCCC) in a patient with megalocornea scheduled for phacoemulsification with toric multifocal intraocular lens (IOL) implantation. After nucleus emulsification and cortex removal, the capsular bag was filled with cohesive viscoelastic in preparation for PCCC to achieve reverse optic capture of the IOL, thus ensuring stability. However, as soon as the initial puncture was made using a 27-gauge needle to start the capsulotomy, the posterior capsule opening extended peripherally from 0º-180º. This capsule extension was similar to the Argentinean-flag sign in hypermature cataracts, and both are caused by excessive intracapsular pressure. Careful bimanual manipulation was performed to implant the IOL on the desired axis, which occurred uneventfully. At a postoperative visit, the patient exhibited excellent uncorrected visual acuity with a well-aligned IOL.
Asunto(s)
Capsulorrexis/efectos adversos , Catarata/complicaciones , Complicaciones Intraoperatorias/etiología , Implantación de Lentes Intraoculares/efectos adversos , Facoemulsificación/efectos adversos , Ruptura de la Cápsula Posterior del Ojo/etiología , Capsulorrexis/métodos , Humanos , Masculino , Persona de Mediana Edad , Agujas/efectos adversos , Cápsula Posterior del Cristalino/lesiones , Cápsula Posterior del Cristalino/patología , Cápsula Posterior del Cristalino/cirugía , Punciones/efectos adversos , Resultado del Tratamiento , Agudeza VisualRESUMEN
ABSTRACT We describe a unique complication during primary posterior continuous curvilinear capsulorhexis (PCCC) in a patient with megalocornea scheduled for phacoemulsification with toric multifocal intraocular lens (IOL) implantation. After nucleus emulsification and cortex removal, the capsular bag was filled with cohesive viscoelastic in preparation for PCCC to achieve reverse optic capture of the IOL, thus ensuring stability. However, as soon as the initial puncture was made using a 27-gauge needle to start the capsulotomy, the posterior capsule opening extended peripherally from 0º-180º. This capsule extension was similar to the Argentinean-flag sign in hypermature cataracts, and both are caused by excessive intracapsular pressure. Careful bimanual manipulation was performed to implant the IOL on the desired axis, which occurred uneventfully. At a postoperative visit, the patient exhibited excellent uncorrected visual acuity with a well-aligned IOL.
RESUMO Os autores demonstram uma complicação durante a realização de uma capsulo tomia circular contínua posterior (CCCP) em um paciente com megalocórnea programado facoemulsificação com implante de lente intraocular (LIO) tórica multifocal. Após a remoção do núcleo e córtex, o saco capsular foi preenchido por viscoelástico coesivo com finalidade de prepará-lo para realização da CCCP e com isso assegurar o correto alinhamento do implante no eixo desejado. Entretanto, assim que a agulha de 27-gauge foi utilizada para confecção puntura inicial da capsulotomia, imediatamente a cápsula posterior se abriu até periferia de 0-180 graus, similar à lesão capsular vista no sinal da Bandeira Argentina em cataratas hipermaduras, ambos causados por pressão excessiva intracapsular. Manipulação cuidadosa foi realizada para implantação da lente no eixo correto, a qual aconteceu sem intercorrências. No pós-operatório, a paciente apresentou uma excelente acuidade visual sem correção com LIO corretamente alinhada no eixo desejado.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Catarata/complicaciones , Facoemulsificación/efectos adversos , Capsulorrexis/efectos adversos , Implantación de Lentes Intraoculares/efectos adversos , Ruptura de la Cápsula Posterior del Ojo/etiología , Complicaciones Intraoperatorias/etiología , Punciones/efectos adversos , Agudeza Visual , Resultado del Tratamiento , Capsulorrexis/métodos , Cápsula Posterior del Cristalino/cirugía , Cápsula Posterior del Cristalino/lesiones , Cápsula Posterior del Cristalino/patología , Agujas/efectos adversosAsunto(s)
Humanos , Femenino , Complicaciones Posoperatorias/etiología , Hematoma Subdural Espinal/etiología , Anestesia Raquidea/efectos adversos , Agujas/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Pérdida de Líquido Cefalorraquídeo/etiología , Persona de Mediana EdadAsunto(s)
Anestesia Raquidea/efectos adversos , Hematoma Subdural Espinal/etiología , Agujas/efectos adversos , Complicaciones Posoperatorias/etiología , Artroplastia de Reemplazo de Rodilla/efectos adversos , Pérdida de Líquido Cefalorraquídeo/etiología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
INTRODUCTION: Police officers are at an elevated risk for needle-stick injuries (NSI), which pose a serious and costly occupational health risk for HIV and viral hepatitis. However, research on NSIs among police officers is limited, especially in low- and middle-income countries. Despite the legality of syringe possession in Mexico, half of people who inject drugs (PWID) in Tijuana report extrajudicial syringe-related arrests and confiscation by police, which has been associated with needle-sharing and HIV infection. We assessed the prevalence and correlates of NSIs among Tijuana police officers to inform efforts to improve occupational safety and simultaneously reduce HIV risks among police and PWID. METHODS: Tijuana's Department of Municipal Public Safety (SSPM) is among Mexico's largest. Our binational, multi-sectoral team analyzed de-identified data from SSPM's 2014 anonymous self-administered occupational health survey. The prevalence of NSI and syringe disposal practices was determined. Logistic regression with robust variance estimation via generalized estimating equations identified factors associated with ever having an occupational NSI. RESULTS: Approximately one-quarter of the Tijuana police force was given the occupational health survey (N=503). Respondents were predominantly male (86.5%) and ≤35 years old (42.6%). Nearly one in six officers reported ever having a NSI while working at SSPM (15.3%), of whom 14.3% reported a NSI within the past year. Most participants reported encountering needles/syringes while on duty (n=473, 94%); factors independently associated with elevated odds of NSIs included frequently finding syringes that contain drugs (adjusted odds ratio (AOR): 2.98; 95% confidence interval (CI): 1.56-5.67) and breaking used needles (AOR: 2.25; 95% CI: 1.29-3.91), while protective factors included being willing to contact emergency services in case of NSIs (AOR: 0.39; 95% CI: 0.22-0.69), and wearing needle-stick resistant gloves (AOR: 0.43; 95% CI: 0.19-0.91). CONCLUSIONS: Tijuana police face an elevated and unaddressed occupational NSI burden associated with unsafe syringe-handling practices, exposing them to substantial risk of HIV and other blood-borne infections. These findings spurred the development and tailoring of training to reduce NSI by modifying officer knowledge, attitudes and enforcement practices (e.g. syringe confiscation) - factors that also impact HIV transmission among PWID and other members of the community.
Asunto(s)
Infecciones por VIH/epidemiología , Lesiones por Pinchazo de Aguja/epidemiología , Exposición Profesional/estadística & datos numéricos , Policia , Adulto , Femenino , Infecciones por VIH/etiología , Humanos , Aplicación de la Ley , Masculino , México/epidemiología , Persona de Mediana Edad , Compartición de Agujas/efectos adversos , Agujas/efectos adversos , Lesiones por Pinchazo de Aguja/etiología , Policia/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Abuso de Sustancias por Vía Intravenosa/epidemiología , Encuestas y Cuestionarios , Jeringas , Recursos HumanosRESUMEN
PURPOSE: Small size needles have been regularly used for intradiscal injection of innocuous/potential therapeutic compounds in experimental conditions, but also in clinic procedures, such as discography. Our aim was to investigate if a 30-gauge needle could trigger observable changes on intact intervertebral discs. We compared these effects to those induced by a large size needle (21-gauge), a well-known intervertebral disc degenerative model based on needle puncture. METHODS: Coccygeal intervertebral discs (Co8-9) of adult male Wistar rats were punctured with a 21-gauge needle, while the coccygeal levels Co7-8 and Co9-10 remained intact. The 30-gauge needle was used to inject a safe volume of saline (2 µl) on both intact (Co9-10) and punctured (Co8-9) discs. MRI and histological score were performed at 2, 15 and 42 days after procedure. RESULTS: MRI analyses revealed significant reduction on signal intensity of 21-gauge punctured discs. Intact discs which received a saline injection through a 30-gauge needle also revealed significant alterations in the MRI signal when compared with control discs. No histological changes were observed in the intact saline injected discs at any time analyzed. CONCLUSION: Since significant intervertebral image changes were observed with a 30-gauge needle, cautious interpretation of the pharmacological inoculation findings is required.