Maximizing Visualization of the Needle During Ultrasound Procedures

Safe and successful ultrasound-guided interventional procedures depend on the ability to visualize both anatomical structures of interest and the advancing needle. This chapter describes various strategies for optimizing needle visualization and tip localization during freehand guidance of a needle to a tissue target using ultrasound. Challenges to needle visualization include the poor echogenicity of standard needles at insertion angles steeper than 30–45 degrees to the horizontal, the difficulty of aligning the needle with the ultrasound beam, and manipulation in three dimensions based on two-dimensional visual information. Attention to ergonomics improves probe and needle control and facilitates alignment. Needle echogenicity can be improved by using a shallower angle, where possible, and echogenic needle technology. Hand movements of probe and needle should be kept small and controlled. Indirect cues of needle tip location are also extremely useful and should be utilized routinely.

A Clinical Study of the Modified Thread Carpal Tunnel Release

Background: Previous studies have indicated that the thread carpal tunnel release (TCTR) is a safe and effective technique. Through a study on 11 cadaveric wrists, the TCTR procedure was modified and the needle control accuracy was improved to 0.15 to 0.2 mm, which is precise enough to preserve superficial palmar aponeurosis (SupPA), Berrettini branch, and common digital nerves. The aim of the present study was to verify the modified TCTR clinically. Methods: The modified TCTR was performed on 159 hands of 116 patients. The Boston Carpal Tunnel Syndrome Questionnaire was used for assessing the outcomes. Statistical analyses were used to compare the outcomes with the available data from the literature for the open and endoscopic techniques. Results: TCTR led to significant improvement in the short-term results, and the outcomes were better in long-term results compared with the open or endoscopic release. The SupPA, Berrettini branch, and common digital nerves were protected. There was no neurovascular complication for any case. Significant relief of symptoms was observed 3 to 5 hours post procedure. Most patients used their hands on the day of the procedure for simple daily activity. Patients reported their sleep quality was improved on the surgical day. Most patients with office jobs were able to return to work on postoperative day 1, and those with repetitive jobs returned to work in about 2 weeks. The statistical evidence proves that the modified TCTR procedure results in improved clinical outcomes as compared with open carpal tunnel release (CTR) and endoscopic CTR. Conclusions: The TCTR procedure has been shown to be a safe and effective technique for CTR. The modified TCTR procedure minimizes postoperative complications, such as pillar pain, scar tenderness, or functional weakness, by avoiding unnecessary injuries to the surrounding structures around the transverse carpal ligament during the procedure.

Pelton Turbine Needle Control Model Development, Validation, and Governor Designs

Underspeed needle control of two Pelton turbine hydro units operating in a small power system has caused many incidents of partial system blackouts. Among the causes are conservative governor designs with regard to small signal stability limits, nonminimum phase power characteristics, and long tunnel-penstock traveling wave effects. A needle control model is developed from “water to wires” and validated for hydro-turbine dynamics using turbine test data. Model parameters are tuned using a trajectory sensitivity method. In the governor design proposed here the needle regulation gains are distributed into the power and frequency governor loops with a multi-timescale approach. Elements of speed loop gain scheduling and a new inner-loop pressure stabilization circuit are devised to improve the frequency regulation and to damp the traveling wave effects. Simulation studies show the improvements of the proposed control designs.

Applicability of auriculotherapy in reducing stress and as a coping strategy in nursing professionals

AIMS: randomized clinical trial aimed at evaluating the auriculotherapy in reducing stress levels in 75 nursing professionals and analyze the coping domains that have changed after treatment. METHODOLOGY: volunteers were divided into 3 groups (Control, Needles and Seeds) and received eight sessions at Shenmen, Kidney and Brainstem points. The Control Group didn't receive any intervention. RESULTS: ANOVA test showed statistical differences in stress levels for Needle/Control Groups in the third and fourth assessments, according to Stress Symptoms List when compared the three groups in four assessments. For the Inventory of Folkman/Lazarus, a significant difference was obtained for Spacing domain between needle/control. In analysis within the same group, differences were found for Confrontation in fourth assessment between Needle/Control Groups and for Social Support in the third one between Seeds/Control Groups. CONCLUSION: The auriculotherapy decreased stress levels, changed Coping domains after treatment, suggesting that both Auriculotherapy with needles and seeds can produce positive impact to improve strategy Coping in the nursing team. However, more studies are needed to conceive the extent of the technique.