scholarly journals Ultrasound-Guided Percutaneous Release Procedures in the Lumbar Ligamentum Flavum by Acupotomy: A Cadaveric study

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Xinyue Zhu ◽  
Yifeng Shen ◽  
Zixiang Liu ◽  
Peiliang Gu ◽  
Shiliang Li ◽  
...  
Keyword(s):  
Ultrasound Guidance ◽  
Ligamentum Flavum ◽  
Spinous Process ◽  
Correlation Coefficients ◽  
Longitudinal Axis ◽  
Ultrasound Images ◽  
Ultrasound Guided ◽  
Transverse Axis ◽  
Needle Penetration ◽  
Percutaneous Release

Objective. This study aims to determine the methods of percutaneous release procedures in the lumbar ligamentum flavum (LF) under ultrasound guidance by acupotomy and provide an anatomical basis for intrusive treatment of lumbar disc herniation and lumbar spinal canal stenosis. Methods. Twelve cadavers including 4 females and 8 males aged 60 to 90 years (73.42 ± 14.57 years), without formalin fixation, were selected. Guided by an ultrasound transducer, we punctured acupotomy to release lumbar LF in L3/L4, L4/L5, and L5/S1 segments. In the transverse-axis approach, the probe was placed transversely, while in the longitudinal-axis approach, the probe was placed longitudinally. The depth of needle penetration (A), the distance between the puncture point and spinous process (B), and the distance between the puncture point and sacral cornu (C) were measured on cadavers, and the depth of needle penetration (U-A), the distance between the puncture point and spinous process (U-B), and the angle for acupotomy (D) on ultrasound images were also measured. Statistical analyses were carried out using SPSS. Paired sample t-tests and homogeneity of variance tests and one-way analysis of variance (ANOVA) were performed. The Pearson correlation coefficients and linear correlation coefficients were calculated for the data obtained from ultrasound and cadaver measurements. Results. No obvious blood vessels and nerves were observed in the puncture path, and the spinal dura was intact. There was no statistical difference between the left and right side measurements obtained from the ultrasound images and the cadavers. The penetration depth in the transverse-axis approach was less than that in the longitudinal-axis approach, and the angle of the needle in the transverse-axis approach was greater than that in the longitudinal-axis approach. The measured data for the transverse-axis approach for L3/L4, L4/L5, and L5/S1 segments showed that there were no differences in the needle angle, the depth of needle penetration, and the distance from the spinous process to the puncture point among the three segments. There was a strong correlation between the depth of needle penetration and the distance from the spinous process to the puncture point on the ultrasonic images and the cadavers on the path of acupotomy. Linear equation A = 2.02 + 0.83 ∗ U-A, R2 = 0.352; B = 1.37 + 0.71 ∗ U-B, R2 = 0.252, where A/B refers to the data measured on the cadavers and U-A/U-B refers to the data measured on the ultrasound images. Conclusion. In this study, ultrasound guidance was applied, which better guaranteed the safety and feasibility of acupotomy therapy. Before performing the treatment, the depth of needle penetration in the human body can be determined by measuring the distance between the needle point and the target position on the ultrasound image. Under ultrasound guidance, the transverse-axis approach has a smaller puncture depth and greater puncture angle than the longitudinal-axis approach. Hence, this study believes that the transverse-axis approach is safer for the clinical application of ultrasound-guided LF acupotomy lysis.

Different Approaches to Ultrasound-guided Thoracic Paravertebral Block

2015 ◽  
Vol 123 (2) ◽  
pp. 459-474 ◽  
Author(s):  
Annelot C. Krediet ◽  
Nizar Moayeri ◽  
Geert-Jan van Geffen ◽  
Jörgen Bruhn ◽  
Steven Renes ◽  
...  
Keyword(s):  
Cross Sections ◽  
Ultrasound Guidance ◽  
Ultrasound Images ◽  
Ultrasound Guided ◽  
Paravertebral Space ◽  
Cross Sectional ◽  
Comprehensive Information ◽  
Anatomical Images ◽  
Human Specimen ◽  
Fast Development

Abstract Given the fast development and increasing clinical relevance of ultrasound guidance for thoracic paravertebral blockade, this review article strives (1) to provide comprehensive information on thoracic paravertebral space anatomy, tailored to the needs of a regional anesthesia practitioner, (2) to interpret ultrasound images of the thoracic paravertebral space using cross-sectional anatomical images that are matched in location and plane, and (3) to briefly describe and discuss different ultrasound-guided approaches to thoracic paravertebral blockade. To illustrate the pertinent anatomy, high-resolution photographs of anatomical cross-sections are used. By using voxel anatomy, it is possible to visualize the needle pathway of different approaches in the same human specimen. This offers a unique presentation of this complex anatomical region and is inherently more realistic than anatomical drawings.

scholarly journals AB0642 SACROILIAC JOINT INJECTIONS PERFORMED WITH ULTRASOUND GUIDANCE IN PATIENTS WITH SACROILIITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1615.2-1616
Author(s):  
A. R. Cunha ◽  
C. Mazeda ◽  
R. Aguiar ◽  
A. Barcelos
Keyword(s):  
Sacroiliac Joint ◽  
Ultrasound Guidance ◽  
Disease Duration ◽  
Corticosteroid Injection ◽  
Controlled Study ◽  
Ultrasound Guided ◽  
Sonographic Guidance ◽  
Number Of Patients ◽  
Joint Injections

Background:Sacroiliitis is the hallmark of axial Spondyloarthritis (axSpA). ASAS-EULAR management recommendations for axSpA, consider glucocorticoid injections directed to the local site of musculoskeletal inflammation as a treatment option for pain relief, besides treatment with oral non-steroidal anti-inflammatory (NSAIDs) before starter biotechnological treatment. However, there are few studies to evaluate efficacy of this technique with a small number of patients and a short follow-up. Ultrasonography has been used as a valuable option to guide this technique.Objectives:To evaluate the efficacy and safety of ultrasound-guided injections of sacroiliac joints (SIJs) in patients with sacroiliitis using clinical and laboratory outcomes at baseline and at 4-6thweeks.Methods:This study involved patients with axSpA with acute sacroiliitis, ≥18 and ≤ 65 years old, with body mass index (BMI) < 30kg/m2attending the Rheumatology Outpatient Clinic, which had been poorly controlled (ASDAS>2.1) by conventional therapy (physiotherapy, NSAIDs at maximum tolerated dosing during ≥ 4 weeks). Sociodemographic, clinical (disease duration, BMI, BASDAI, BASFI, ASDAS) and laboratory (CRP) data was collected from the medical records at baseline and at 4-6thweeks.Statistical analyses were conducted using SPSS version 25. Continuous variables were described with mean/median ± standard deviation (SD).SIJs injection was performed, under ultrasound guidance, using standard procedures with 2mL of lidocaine 1% and 40mg of methylprednisolone, with a 22-gauge needle. The procedure was performed by the same operator. Written informed consents were obtained from all patients.Results:We performed eleven sacroiliac injection in eleven consecutive patients (one procedure per patient). Nine patients (81.8%) were female, mean age (±SD) of 40.6(±9.4) years, median disease duration(±SD) of 0.9(±6.2) years and median BMI(±SD) of 24.2(±3.3). Eight patients (72.7%) had Nr-axSpA. All patients were non-responders to NSAIDs.At 4-6thweeks there was a decreased in median (±SD) BASDAI (5.4±1.9 vs 4.1±1.9), BASFI (4.2±1.4 vs 3.5±2.3) and ASDAS (3.2±0.8 vs 2.2±0.6) indexes.Conclusion:As previous studies demonstrated, this technique seems to be safe and quite effective.Our goal is to increase the number of patients undergoing this technique and have a longer follow up to evaluate its efficacy. The study has several limitations: the mid- and long-term effects should be evaluated in the future based on the results of the short-term effects and the study was not conducted as a double-blinded, controlled study.References:[1]van der Heijde D, Burgos-Vargas R, Ramiro S.,et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2017; 76:978–991[2]Maugars Y, Mathis C, Vilon P, Prost A. Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy. Arthritis Rheum 1992; 35:564–8.[3]Pekkafahli MZ, Kiralp MZ, Basekim CC et al. Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med 2003;22:553–9[4]Klauser A, De Zordo T, Feuchtner G et al. Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis Rheum 2008; 59:1618–1624.Disclosure of Interests:Ana Rita Cunha: None declared, Carolina Mazeda: None declared, Renata Aguiar: None declared, Anabela Barcelos Speakers bureau: Bene, Eli-Lilly, Pfizer, MSD, Novartis

scholarly journals Pulse-Spray Pharmacomechanical Thrombolysis of Native Arteriovenous Fistulas and Grafts under Ultrasound Guidance: Our Initial Experience

2017 ◽  
Vol 01 (01) ◽  
pp. 020-022
Author(s):  
Praveen Vasanthraj ◽  
Varun Bandi ◽  
Venkata Sai ◽  
Manikanthan Shekar
Keyword(s):  
Ultrasound Guidance ◽  
Renal Diseases ◽  
Initial Experience ◽  
Ultrasound Guided ◽  
Arteriovenous Fistulas ◽  
Catheter Directed Thrombolysis ◽  
Trained Personnel ◽  
Av Fistulas ◽  
Care Procedure ◽  
Chronic Renal Diseases

AbstractChronic renal diseases have been on rise with most patients requiring renal transplantation. With advances in treatment, patients undergo hemodialysis through arteriovenous (AV) fistulas and grafts. Thrombosis in these fistulas and grafts are more common and may result in failure. Interventional radiology plays an important role in managing these thromboses through catheter-directed thrombolysis. With success rate of more than 80%, catheter-directed thrombolysis has become the treatment of choice. However, the need of trained personnel, well-equipped catheter laboratories, and expensiveness are its disadvantages. We share our initial experience in two patients in whom we have performed ultrasound-guided percutaneous pulse-spray pharmacomechanical thrombolysis as a day-care procedure. This technique is less expensive, can have a wider outreach, and patients can be benefitted early to avoid new access.

scholarly journals Thoracic Ossification of Ligamentum Flavum Caused By Skeletal Fluorosis: Breaking the Etiopathological Barrier -Answer to the Crippling Disease of the Society

2020 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Ligamentum Flavum ◽  
English Literature ◽  
Spinous Process ◽  
Preventive Measure ◽  
Skeletal Fluorosis ◽  
Fluoride Level ◽  
Type D ◽  
Clinical Series ◽  
Ossification Of Ligamentum Flavum ◽  
A Prospective Study

Background: Thoracic ossification of ligamentum flavum (OLF) caused by skeletal fluorosis is rare [1]. Only six patients had been reported in the English literature. This study is the second study to the best of our knowledge in literature. Aims and Objectives: To evaluate the causation of ossification of ligamentum flavum due to fluorosis in accordance with reports from the first clinical series of this disease. Exact etiopathogenesis of thoracic ossification of yellow ligament is not known and causation due to fluorosis is rare, so this study was hypothesized [2]. Materials and Methods: This is a prospective study of patients with thoracic OLF due to skeletal fluorosis who underwent surgical management at the NIMS hospital between 2017 and 2018. A total of 16 cases were enrolled, (56.25%), 9 males and 7 (43.75%) females, age ranging from 37 to 62 years (mean 50.5 years). Imaging showed OLF together with ossification of interosseous membranes, including interosseous membranes of the forearm (14/16 patients 87.5%).Urinalysis showed a markedly high urinary fluoride level in 15 of 16 patients (93.75%).Ossified ligamentum flavum sent for estimation of fluoride levels in 16 patients showed high fluoride level in the bone ash prepared from the oyl in 15 patients and other structures sent as control were ,spinous process ,interspinous ligaments didn’t show any fluoride deposition. Results: Out of 16 patient 15 patient had fluoride levels more than 6000mg/kg, 7 patient had values between 6,000 – 7,000 mg/kg, 5 patient had values between 7,500 – 9,000 mg/kg and 3 patients had values > 8400 mg/kg. Controls were sent as spinous processes had normal fluoride level between 500-1000 mg/kg and interspinous ligaments sent showed no fluoride levels. Out of 16 patients 9 patients had multiple level dorsal OYL both contiguous and non-contiguous, contiguous in 4 patients and non – contiguous in 5 patients.7 patients had single level dorsal OYL. Most common segment involved in OYL is T9 and D10 level in 14 patients. Sato classification 6 were Type A, 5 were Type B, 3 were Type C, 2 were Type D Conclusion: This is the largest series of ossification of dorsal yellow ligament due to fluorosis. And consideration of fluorosis as one of the important etiological cause for OYL to be kept in mind and all patients with OYL to be screened for Fluorosis and this would also help as a preventive measure for the people around the surroundings of the affected person and would help the society from a crippling disability.

Presurgical, ultrasound-guided anchor-wire marking of impalpable cervical lymph nodes

2005 ◽  
Vol 119 (8) ◽  
pp. 627-628 ◽  
Author(s):  
J A Bryant ◽  
N J Siddiqi ◽  
E J Loveday ◽  
G H Irvine
Keyword(s):  
Lymph Node ◽  
High Risk ◽  
Lymph Nodes ◽  
Cervical Lymph Node ◽  
Ultrasound Guidance ◽  
Operating Time ◽  
High Risk Patient ◽  
Wire Localization ◽  
Ultrasound Guided ◽  
Cervical Lymph Nodes

This case illustrates the surgical use of wire localization, a well tried technique from a different field of surgery, in the removal of an ultrasound-detected, impalpable deep lower cervical lymph node in a high-risk patient. A localization needle with an echogenic tip was placed freehand under ultrasound guidance, immediately before surgery. The imaging and marking of the impalpable cervical lymph node resulted in a precise surgical dissection and a reduction in operating time whilst minimizing risks to the patient and staff.

Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy

2018 ◽  
Vol 19 (6) ◽  
pp. 609-614 ◽  
Author(s):  
Soshi Nakamuta ◽  
Toshihiro Nishizawa ◽  
Shiori Matsuhashi ◽  
Arata Shimizu ◽  
Toshio Uraoka ◽  
...  
Keyword(s):  
Success Rate ◽  
Detection Rate ◽  
Ultrasound Guidance ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Ultrasound Guided ◽  
Peripherally Inserted Central Catheters ◽  
X Ray ◽  
Central Catheters

Background and aim: Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. Materials and methods: We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. Results: The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Conclusion: Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

Ultrasound-guided Musculoskeletal Interventions for the Most Common Hip and Pelvis Conditions: A Step-by-Step Approach

2019 ◽  
Vol 23 (03) ◽  
pp. e58-e67 ◽  
Author(s):  
Georgina Allen ◽  
Marina Obradov ◽  
Vito Chianca ◽  
Carmelo Messina ◽  
Luca Maria Sconfienza
Keyword(s):  
Hip Joint ◽  
Ultrasound Guidance ◽  
Pubic Symphysis ◽  
Joint Space ◽  
Common Condition ◽  
Sacroiliac Joints ◽  
Ultrasound Guided ◽  
Therapeutic Procedures

AbstractPain around the hip and pelvis is a very common condition. Pain may be generated within the joint space (i.e. the hip joint itself, the sacroiliac joints or the pubic symphysis) or from surrounding myotendinous, bursal, or nerve structures. Over the years, percutaneous musculoskeletal procedures have become increasingly popular to diagnose and treat painful conditions around the hip and the pelvis. Most intra- and extra-articular procedures are performed under ultrasound guidance. This article reviews the most common diagnostic and therapeutic procedures that can be performed around the hip and the pelvis under ultrasound guidance.

Responses of Purkinje cells of cerebellar vermis to sinusoidal rotation of neck

1980 ◽  
Vol 43 (1) ◽  
pp. 46-59 ◽  
Author(s):  
F. Denoth ◽  
P. C. Magherini ◽  
O. Pompeiano ◽  
M. Stanojevic
Keyword(s):  
Firing Rate ◽  
Mossy Fiber ◽  
Spinous Process ◽  
Cervical Vertebra ◽  
Longitudinal Axis ◽  
Anterior Lobe ◽  
The Body ◽  
Postural Changes ◽  
Neck Rotation ◽  
P Cells

1. The response of Purkinje (P) cells located in the vermal cortex of the cerebellar anterior lobe to sinusoidal rotation of the neck was investigated in precollicular decerebrate cats. The head of the animal was fixed in a sterotaxic frame while the spinous process of the second cervical vertebra was held by a clamp rigidly fixed to the tilting table. It was then possible to elicit a selective neck input by rotating the neck and the body simultaneously along the longitudinal axis of the animal while maintaining the head in horizontal position. 2. Among the 95 P-cells tested for neck stimulation, 35 units showed a mossy fiber (MF) or a climbing fiber (CF) response to sinusoidal rotation of the axis vertebra at the frequency of 0.026 Hz and at the peak amplitude of displacement of 5--10 degrees. The response consisted in a periodic modulation of the discharge frequency during sinusoidal rotation of the neck. Most of these units were excited during side-down rotation of the neck, but were inhibited during side-up rotation. 3. The threshold amplitude of neck rotation responsible for the MF-induced responses varied in different units from 1 to 3 degrees at the frequency of 0.026 Hz. The sensitivity of the units, expressed in percentage change of the average firing rate per degree of displacement, either did not change or very slightly decreased as a result of increasing amplitude of stimulation from 1--3 degrees to 10--15 degrees at the frequency of 0.026 Hz or by increasing frequency of neck rotation from 0.015 to 0.15 Hz at the amplitude of neck displacement of 5--10 degrees. 4. Changes in amplitude or frequency of stimulation at the parameters reported above did not greatly modify the phase of the unit responses relative to the side-down position of the neck. These findings indicate that the MF and CF responses of P-cells to sinusoidal rotation of the neck depended on changes in neck position and not on changes in velocity of neck rotation. 5. The observation that the majority of responding P-cells located in the vermal cortex of the cerebellar anterior lobe increased their firing rate during side-down rotation of the neck is discussed in relation to the results of stimulation and lesion experiments, indicating that postural changes can be elicited either during asymmetric stimulation of neck receptors or by unilateral interruption of the neck afferents.

Actions of cholecystokinin octapeptide on smooth muscle of isolated dog intestine.

1977 ◽  
Vol 232 (3) ◽  
pp. E306 ◽  
Author(s):  
J J Stewart ◽  
T F Burks
Keyword(s):  
Smooth Muscle ◽  
Mesenteric Artery ◽  
Longitudinal Axis ◽  
Atropine Sulfate ◽  
Intestinal Smooth Muscle ◽  
Transverse Axis ◽  
Muscle Response ◽  
Cholecystokinin Octapeptide ◽  
Perfusion Solution ◽  
Muscle Responses

Adult dogs were anesthetized and segments of small intestine were isolated and perfused via a mesenteric artery with Krebs-bicarbonate solution. Muscle responses along the circular and longitudinal axes were monitored with extraluminal strain gauge transducers. Agonists were administered as intraarterial bolus injections in volumes not exceeding 0.1 ml. Antagonists were dissolved in the Krebs perfusion solution. The C-terminal octapeptide of cholecystokinin (CCK-OP) produced dose-related tonic and phasic contractions of smooth muscle along the transverse axis and tonic and phasic relaxations along the longitudinal axis of the muscle segments. Smooth muscle responses to CCK-OP were reduced by atropine sulfate (0.1 mug/ml) and minimally affected by hexamethonium (10 mug/ml) perfusion. Tetrodotoxin (TTX, 5 ng/ml) selectively reduced muscle responses to dimethylphenylpiperazinium (0.5 mug) and CCK-OP (0.2 mug) but failed to alter responses to bethanechol (BeCh, 5 mug). Higher concentrations of TTX (10 ng/ml) abolished responses to CCK-OP. Depolarizing doses of nicotine (500 mug) selectively antagonized responses to 5-hydroxytryptamine (5HT, 5 mug) and CCK-OP (0.2 mug) but did not alter responses to BeCh (5 mug). Perfusion with tetraethylammonium (1 mg/ml) reduced muscle responses to depolarizing doses of nicotine and abolished the nicotine-induced antagonism of 5HT and CCK-OP. The intestinal smooth muscle response to CCK-OP in the dog is mediated through a neurogenic mechanism. CCK-OP interacts with a nonnicotinic receptor on postganglionic cholinergic neural elements in this preparation.

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