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Fluid Collection (fluid + collection)
Selected AbstractsModel for Ultrasound-Assisted Lumbar Puncture TrainingACADEMIC EMERGENCY MEDICINE, Issue 2009Melissa Bollinger Lumbar puncture is an important diagnostic procedure in emergency medicine. Data have been published showing improved success rate with ultrasound assistance and the ability of emergency medicine physicians to recognize sonographic lumbar spinous anatomy. However, with educational models and the push for improved patient safety, procedural skills should be practiced on phantoms rather than the "see one, do one, teach one" of the past. There are no currently available phantoms for ultrasound-assisted lumbar puncture training. We have produced a phantom that can be used to train physicians on ultrasound-assisted lumbar puncture with respect to both imaging and procedural competency. A plastic fluid-filled bladder was immersed in gelled opacified mineral oil, a safe and easily used tissue mimic that obscures direct visualization of structures. Spinous anatomy is replicated with the use of wooden struts supporting wooden disks that mimic lumbar spinous processes. The spine analog was mounted over the plastic bladder and surrounded with gelled mineral oil. The phantom produces images similar to human lumbar anatomy. The phantom allows insertion of spinal needles into the "interspinous spaces" with inability to pass the needle outside of those locations. Fluid collection and repeated punctures can be performed on the phantom. Appearance and performance of the phantom were evaluated by physicians with expertise in ultrasound-assisted lumbar puncture. The only limitation is that external appearance is not realistic. This model performs well, is made from readily available materials, and can be used to train physicians in ultrasound-assisted lumbar puncture. [source] Conservative management of duodenal perforation following endoscopic sphincterotomyDIGESTIVE ENDOSCOPY, Issue 2 2005Chee Fook Choong Overall endoscopic retrograde cholangiopancreatography (ERCP) complication rates of 4,10% and mortality rates of 1.5% have been reported. For those patients who fail conservative therapy, a mortality rate of almost 50% has been reported. This has led some authors to recommended early operation in all duodenal perforations. We report two cases of duodenal perforations following endoscopic sphincterotomy. Perforation was suspected immediately post-ERCP in one case and, in the second case, perforation was evident during ERCP and a biliary stent was inserted. Both of the patients were managed conservatively with bowel rest, nasogastric suction, analgesia and intravenous antibiotics. Although abdominal XR and CT showed extensive intraperitoneal and retroperitoneal gas, both of the patients made an uneventful recovery without surgical management. Based on our experience and literature review, routine surgery is not required in patients with duodenal perforations following endoscopic sphincterotomy. Surgery should be considered in any patients with clinical signs of sepsis, abscess or fluid collection in the retroperitoneum or peritoneum, documented ERCP perforation with cholelithiasis, choledocholithiasis or retained hardware. There are currently no strong data to support the benefits of early routine surgery and management should be tailored individually according to the patient's clinical condition and response to therapy. [source] Pediatric submandibular triangle masses: a fifteen-year experience,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2004Neil G. Hockstein MD Abstract Background. The purpose of this study was to evaluate the surgical results of pediatric submandibular triangle masses, with specific attention to neoplastic processes. Methods. We retrospectively reviewed the medical records of 105 patients aged 6 months to 21 years who underwent surgery in the submandibular triangle at a major pediatric tertiary care hospital from 1987 to 2001. Results. One hundred five patients who underwent surgery in the submandibular triangle were included in the study. Twenty patients had neoplastic processes, six of which were of primary salivary origin (two mucoepidermoid carcinomas and four pleomorphic adenomas). Twenty-four patients underwent excision of inflamed or infected lymph nodes, and 23 patients underwent excision of inflamed or infected submandibular glands. Thirty-eight patients were included who underwent surgery for sialorrhea or to gain access for another surgical procedure. Complications included tumor recurrence, transient and permanent marginal mandibular nerve weakness, ranula, postoperative fluid collection, and cellulitis. Duration of follow-up ranged from no follow-up to 11 years. Conclusion. Surgical excision of submandibular triangle masses is uncommon. We present our experience with these lesions, with a discussion of diagnosis, surgical indications, and surgical complications. © 2004 Wiley Periodicals, Inc. Head Neck26: 675,680, 2004 [source] Large-volume late-onset pelvic fluid collection after ileal pouch-anal anastomosisINFLAMMATORY BOWEL DISEASES, Issue 4 2009Ling Shen No abstract is available for this article. [source] Sonographic features of xanthogranulomatous pyelonephritisJOURNAL OF CLINICAL ULTRASOUND, Issue 5 2001Chui-Mei Tiu MD Abstract Purpose The purpose of this study was to describe the various sonographic features of xanthogranulomatous pyelonephritis (XGP). Methods We retrospectively reviewed the CT, sonographic, and medical records of patients diagnosed with XGP from January 1981 to December 1998. Twenty-seven patients for whom XGP was histopathologically confirmed were included in the study. There were 12 men and 15 women, with an age range of 21,86 years (mean, 57 years). All patients had undergone sonography of the kidneys. The renal size, shape, and outline were recorded. The presence of perinephric fluid accumulation, of obstructive uropathy, or of internal echoes in the dilated collecting system and the echotexture of the renal parenchyma were documented. Results We categorized the XGP into 4 groups on the basis of the sonographic features: (1) diffuse hydronephrotic, 12 patients (44%); (2) diffuse parenchymal, 9 patients (33%); (3) diffuse contracted, 4 patients (15%); and (4) segmental or focal, 2 patients (7%). A localized perinephric fluid collection was present in 4 patients (15%). The preoperative sonographic diagnoses were pyonephrosis (n = 14, 52%), renal pelvic tumor with possible associated infection (n = 5, 19%), renal parenchymal mass (n = 2, 7%), hydronephrosis (n = 2, 7%), and chronic pyelonephritis with renal atrophy (n = 4, 15%). XGP was considered a possible diagnosis in only 11 patients (41%). Conclusions XGP has no specific sonographic features but is suggested by parenchymal thinning and hydronephrosis, sonographic signs of chronic obstructive uropathy caused by stones; echoes in the dilated collecting system; and a perinephric fluid collection. CT, needle biopsy, or both are recommended to further evaluate and confirm sonographically suspected XGP. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:279,285, 2001. [source] Early and reliable detection of herpes simplex virus type 1 and varicella zoster virus DNAs in oral fluid of patients with idiopathic peripheral facial nerve palsy: Decision support regarding antiviral treatment?JOURNAL OF MEDICAL VIROLOGY, Issue 9 2010Andreas Lackner Abstract Idiopathic peripheral facial nerve palsy has been associated with the reactivation of herpes simplex virus type 1 (HSV-1) or varicella zoster virus (VZV). In recent studies, detection rates were found to vary strongly which may be caused by the use of different oral fluid collection devices in combination with molecular assays lacking standardization. In this single-center pilot study, liquid phase-based and absorption-based oral fluid collection was compared. Samples were collected with both systems from 10 patients with acute idiopathic peripheral facial nerve palsy, 10 with herpes labialis or with Ramsay Hunt syndrome, and 10 healthy controls. Commercially available IVD/CE-labeled molecular assays based on fully automated DNA extraction and real-time PCR were employed. With the liquid phase-based oral fluid collection system, three patients with idiopathic peripheral facial nerve palsy tested positive for HSV-1 DNA and another two tested positive for VZV DNA. All patients with herpes labialis tested positive for HSV-1 DNA and all patients with Ramsay Hunt syndrome tested positive for VZV DNA. With the absorption-based oral fluid collection system, detections rates and viral loads were found to be significantly lower when compared to those obtained with the liquid phase-based collection system. Collection of oral fluid with a liquid phase-based system and the use of automated and standardized molecular methods allow early and reliable detection of HSV-1 and VZV DNAs in patients with acute idiopathic peripheral facial nerve palsy and may provide a valuable decision support regarding start of antiviral treatment at the first clinical visit. J. Med. Virol. 82:1582,1585, 2010. © 2010 Wiley-Liss, Inc. [source] MRCP in the diagnosis of iatrogenic bile duct injuryNMR IN BIOMEDICINE, Issue 8 2003Luis Bujanda Abstract Postoperative biliary tract lesions are becoming increasingly common. The diagnosis is made by direct cholangiography via endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC). The present comparative study evaluates the diagnostic efficacy of magnetic resonance cholangiopancreatography (MRCP) in application to iatrogenic bile duct injury. A prospective blind study was performed, contrasting MRCP and ERCP in 10 patients with suspected postoperative biliary tract lesions. MRCP was performed less than 72,h before ERCP. Final diagnosis was made on the basis of findings at surgery and ERCP. The presence of biliary dilatation, excision injury, stricture, fluid collection and free fluid was analyzed. The mean patient age was 66.5 years. There were three males and seven females. The type of postoperative lesion (Bergman classification) are five patients type C, three type D, one type B and one type A. Diagnostic failure was recorded in two cases with ERCP, while in five patients it was unable to define a therapeutic approach. In contrast, MRCP correctly diagnosed all patients. MRCP is effective in diagnosing postoperative biliary tract lesions, and can help decide the best therapeutic approach. Copyright © 2003 John Wiley & Sons, Ltd. [source] Early transient leg swelling at the side of renal transplant in two childrenPEDIATRIC TRANSPLANTATION, Issue 1 2006L. Koster-Kamphuis The swelling was located at the side of the renal transplant. The swelling was caused by the compression of the iliac vein by the renal transplant combined with perirenal fluid collection. Doppler flow studies allow the exclusion of thrombosis as an explanation for the swelling. An aggressive treatment should be avoided. However, anticoagulation is required. [source] Retropharyngeal Pseudomeningocele Presenting as Dysphagia After Atlantooccipital Dislocation,THE LARYNGOSCOPE, Issue 9 2006Dr. David M. Cognetti MD Abstract Educational Objective: At the conclusion of this paper, the readers should be able to recognize a retropharyngeal pseudomeningocele as a potential complication of atlanto occipital dislocation. Objectives: To demonstrate how a retropharyngeal pseudomeningocele may present as dysphagia in a patient who is recovering from atlanto occipital dislocation as well as to discuss the treatment options in this situation. Study Design: Case report and literature review. Methods: Analysis of a case through medical record and literature review. Results: A retropharyngeal pseudomeningocele is a very rare complication of atlanto occipital dislocation. It may develop weeks after the initial injury and can present with respiratory or swallowing difficulties. Decompression via a ventriculoperitoneal or lumboperitoneal shunt facilitates resolution of the cerebral spinal fluid collection. Conclusions: A retropharyngeal pseudomeningocele should be considered in all patients status post-atlanto occipital dislocation who are experiencing respiratory distress or dysphagia. [source] The Thanksgiving Turkey Tap: A New and Simple Model for Teaching Ultrasound-guided ThoracentesisACADEMIC EMERGENCY MEDICINE, Issue 2009Derek Richardson Thoracentesis is a critical procedure that every emergency physician must be able to perform comfortably. By introducing ultrasound technology to the procedure, we have the potential to redefine the standard of care for emergency department thoracentesis by effectively decreasing complication rates of this procedure. Ultrasound-guided thoracentesis has been shown to lead to fewer incidents of pneumothorax than the traditional technique; however, due to the complicated anatomy of the chest wall, this skill is difficult to teach without using living patient models. The NewYork-Presbyterian Emergency Medicine Residency Program has developed an effective model for teaching and practicing ultrasound-guided thoracentesis. The Presbyterian model uses a whole turkey with the cavity lined with a water-retaining plastic sheet, containing water and an air-filled balloon. Ultrasound can then be used to visualize the ribs, the underlying fluid, and the balloon representing lung space. By using a standard thoracentesis kit with our model, the complete procedure can be performed and techniques of positioning, entry point, and fluid collection can be demonstrated and practiced. This was performed for 50 medical students, residents, and attending physicians in late November 2008 for under $100. This simple model may be used to introduce new practitioners to thoracentesis, or to update experienced physicians on new techniques to decrease complication rates during procedures with an effective and inexpensive model. [source] A randomised controlled trial of routine suction drainage after elective thyroid and parathyroid surgery with ultrasound evaluation of fluid collectionCLINICAL OTOLARYNGOLOGY, Issue 1 2007S. Ahluwalia Objective:, To determine the need for suction drainage after elective thyroid and parathyroid surgery. Design:, Randomised controlled trial. Setting:, University teaching hospital. Participants:, Patients requiring elective thyroid or parathyroid surgery were recruited and informed consent was obtained (n = 100). Before wound closure, patients were randomised into either group A (to remain without suction drainage) or group B (to receive suction drainage). Excluded patients were those requiring associated neck dissection and those with bleeding diatheses, all of whom would necessarily require drainage in our unit. Main outcome measures:, Primary , ultrasound evaluation of any collection in the thyroid bed, performed 1-day postoperatively. Secondary , postoperative complications; length of in-patient stay. Results:, One hundred patients completed the study, and groups A and B comprised 50 patients each. Patients in each group exhibited a mean age of 49 years, and a male to female ratio of 1 : 9. Both groups were also well-matched regarding type of operation, size of tumour and histopathological diagnosis. Modal and median postoperative neck collection volume on ultrasound examination was 0 and 0 cm3 respectively (range 0,16 cm3) in group A and was 0 and 0 cm3 (range 0,70 cm3) in group B. This difference was not statistically significant, but three patients with a haematoma were all in the suction drainage group. Difference in complication rates between groups was also not statistically significant. Modal and median length of in-patient stay was 2 and 2 days respectively (range 2,3 days) in group A and 3 and 3 days (range 2,4 days) in group B, and this difference was statistically significant (P = 0.0006). Conclusion:, Routine suction drainage after uncomplicated elective thyroid and parathyroid surgery appears unnecessary, and prolongs in-patient stay. [source] Effect of Age and Abomasal Puncture on Peritoneal Fluid, Hematology, and Serum Biochemical Analyses in Young CalvesJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2005Luiz Claudio N. Mendes The goals of this study were to evaluate techniques for collection of peritoneal fluid from calves, establish reference ranges for fibrinogen in peritoneal fluid during the 1st month of life, and determine if abomasal puncture would alter peritoneal fluid or hematologic variables. Twenty-two healthy Holstein calves underwent 3 peritoneal fluid collections on day 1, day 15, and day 30 of age. Fibrinogen concentration in peritoneal fluid was 0.20 g/dL and 0.10 g/dL (P < .05) for day 1 and day 30, respectively, and 0.10 at day 15 (P > .05) for calves without abomasal puncture. Plasma fibrinogen concentration was 0.60 g/dL and 0.70 g/dL (P < .05) for days 15 and 30, respectively, in calves without abomasal puncture. There were no significant differences (P, .05) in peritoneal fluid and peripheral blood total protein and fibrinogen concentrations, specific gravity, total and differential cell count, or erythrocyte counts between calves with or without abomasal puncture. We concluded that the reference ranges established for fibrinogen and total protein concentration are important for accurate evaluation of peritoneal fluid in calves for further comparison with similar-aged animals with gastrointestinal-tract or abdominal-cavity disease. Additionally, accidental abomasal puncture does not alter values of fibrinogen, total protein, and nucleated cell count in peritoneal fluid and does not cause apparent clinical abnormalities. [source] Four faces of a parapneumonic effusion: Pathophysiology and varied radiographic presentationsRESPIROLOGY, Issue 4 2007Jay HEIDECKER Abstract: We report a patient methicillin-resistant Staphylococcus aureus pneumonia who developed fluid collections in three spaces in the thorax, the pleural space, the pericardial space, and a pre-existing bulla, in addition to mediastinal oedema. We discuss the universal pathogenesis for the development of these fluid collections and the explanation for the most common presentation being a parapneumonic effusion. [source] Comparison of magnetic resonance cholangiography and percutaneous transhepatic cholangiography in the evaluation of bile duct strictures after cholecystectomyBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2002Dr A. Chaudhary Background: Percutaneous transhepatic cholangiography (PTC) has been the preferred investigation to delineate the anatomy of the biliary tract in a patient with a bile duct stricture after cholecystectomy. Recently magnetic resonance cholangiography (MRC) has been described to evaluate the obstructed biliary tract. This paper reports a comparison of MRC with PTC in evaluating patients with an iatrogenic bile duct stricture. Methods: This was a prospective study of 26 patients who had surgery for a bile duct stricture after cholecystectomy. Before operation all patients underwent both MRC and PTC, the results of which were compared with the intraoperative findings. Results: Both PTC and MRC were comparable with regard to image quality, detection of intrahepatic bile duct dilatation, assessment of the level of injury and detection of abnormalities such as intraduct calculi, cholangitic liver abscesses and atrophy of liver lobes. MRC provided additional information in four patients, including detection of associated fluid collections (n = 3) and portal hypertension (n = 1). In eight patients more than one puncture had to be performed during PTC to delineate the complete anatomy. Conclusion: MRC is an accurate and non-invasive imaging procedure for preoperative evaluation of patients with a bile duct injury after cholecystectomy, and is capable of providing additional information which may not be available with PTC. © 2002 British Journal of Surgery Society Ltd [source] | |||||||||||||||||||