Explore the vast range of titles available.

Apheresis is an increasingly important procedure in the treatment of a variety of conditions, sometimes performed via peripheral access because of concern over major complications associated with central venous catheter (CVC) placement. This study sought to determine the safety and success for ultrasound and fluoroscopically guided, non-tunneled dual lumen CVCs placed for apheresis. Prospective data collection was made of 200 attempted CVC placements in the radiology department utilizing real time sonographic guidance. The complications relating to placement were noted in all and the number of passes required for venepuncture and whether a single wall puncture was achieved was recorded in 185 cases. Duration of catheterization and reason for line removal were recorded in all. Our study group included 71 donors providing peripheral blood stem cells for allogeneic transplant. CVCs were successfully placed in all patients, 191 lines in the internal jugular and seven in the femoral vein. 86.5% required only a single pass and 80.5% with only anterior wall puncture. Inadvertent but clinically insignificant arterial puncture occurred in six (3%) cases. In no case did this prevent line placement. There were no other procedure-related complications. 173 (87.4%) catheters were removed the same day. No catheters were removed prematurely. There was one case of prolonged venous bleeding. Our study demonstrates the safety of central venous catheters for apheresis provided that duration of catheterization is short and real-time sonographic guidance is used for the puncture, and guide wire and catheter placement are confirmed fluoroscopically.

Abstract Introduction Over the last few years, the use of smart devices, including smartphone and tablets, has been increasing rapidly. Several studies showed that excessive use of smart device among children and adolescents may affect sleep quality. However, most existing studies relied on self-report sleep quality with questionable validity. Here, we examined the association between smart device usage and objectively-measured sleep efficiency in a cross-sectional study conducted in Hong Kong. Methods In 2016, 198 children and adolescents aged 7–16 (mean 11.9, 47.5% boys) were recruited in three schools. They have completed a self-administered questionnaire about their smart device usage and worn an ActiGraph GT3X accelerometer for seven consecutive days. Sleeping time was determined using Sadeh’s algorithm and sleep efficiency was defined as total sleep time divided by total sleeping period. Multiple linear regression (adjusted for age, sex, parental educational level, and family income) was used to examine the association between smart device usage and sleep efficiency. Results On average, participants spent 128.7 minutes per school day and 230.7 minutes per holiday using a smartphone, and spent 37.3 minutes per school day and 78.2 minutes per holiday using a tablet. The participants had a good sleep efficiency with mean of 95.3%. Regression results showed that (1) one additional hour spent on tablet per school day was associated with 0.64% decrease in sleep efficiency (95% CI 0.23%-1.05%, p=0.02); (2) one additional hour spent on tablet per holiday was associated with 0.24% decrease in sleep efficiency (95% CI 0.01%-0.47%, p=0.04); (3) time spent on smartphone, regardless of per school day or per holiday, had insignificant association with sleep efficiency (ps>0.05). Conclusion Tablet usage was negatively associated with sleep efficiency among Hong Kong Children and adolescents. Support (If Any) The Food and Health Bureau of the Hong Kong Special Administrative Region, China provided financial support in the form of Health and Medical Research Fund (Ref 13144041). The sponsor had no role in the design or conduct of this research.

A variety of sites for CVC insertion are available: right internal jugular vein (IJV), left IJV, subclavian veins and femoral veins (Fig. 3). Venous access can also be gained by means of recanalization of occluded veins, translumbar and transhepatic hepatic venous approaches, but these are uncommon.(9) IJVs are preferable to subclavians (SCVs) for central access sites because stenosis rates are as high as 50% in the latter.(3)(5)(6)(8)(10) The right IJV is preferred because the path to the superior vena cava - right atrium (SVC-RA) is short and straight and is commonly larger calibre than the left;(8) this reduces the difficulty when inserting left CVCs around several curvatures(2)(7)(8) (Fig. 4). If the calibre of the right IJV is suboptimal or occluded, the left IJV should be used. In HD patients, the order of decreasing preference of potential central venous access is: SCV, the femoral (right then left) and, lastly, the IVC by means of a translumbar approach.(4) There are lower rates of thrombosis, stenosis and occlusion with indwelling tunnelled IJV CVCs than with SCV CVCs.(11) The CVC is then advanced through the tunnel using the tapered CVC trocar (Fig. 21). Commonly, the most resistance through the tunnel is at the clavipectoral fascia or where the platysma inserts onto the clavicle. Steady and firm pressure is required to control any forceful manoeuvres and prevent inadvertent trocar advancements. Then, the trocar tip is manipulated out of the skin puncture site. The hub of the tunnelled CVC should be buried up to the skin entry site, further into the tunnel than required, allowing for subsequent partial withdrawal should a CVC kink occur.(6) This allows the CVC tip position to be altered. It is important to confirm the correct orientation of the tip of the HD CVC -- the venous (blue) port is the laterally positioned port on the anterior thoracic surface. Some interventionalists request that the patient voluntarily inhale, hold their breath, and then Valsalva while the introducer-CVC exchange is made. However, others do not rely on patient compliance, and instruct their surgical nurse to remove the guide wire and sheath introducer en bloc. This allows the radiologist the opportunity to readily pinch and occlude the hub of the sheath in one hand while the dilator is removed and to insert the tip of the CVC with the other (which lies millimetres away from the sheath orifice) (Fig. 25). Unreliable and uncooperative patients may require the use of the latter process, but longer sheaths that extend into the IVC, a supra-atmospheric environment, a Trendelenburg position or having someone lift the patient's legs will help raise central venous pressures. The safest method would be to use of a peel-away sheath with a 1-way hemostatic valve. Eventually, the CVC is inserted and the peel-away sheath is separated and removed, pulling the opposing sides away from one another with a digit on the apex of the CVC.

Background and purpose: Knee osteoarthritis (OA) is one of the most prevalence musculoskeletal problems causing disability in the elderly population. Community Rehabilitation Network of The Hong Kong Society for Rehabilitation has provided community aquatic exercise programme for the people with knee OA. This study aimed to explore the effects of a community-based hydrotherapy classes on pain, balance, exercise capacity, daily functional outcome, and quality of life. Methods: 40 subjects with knee pain participated in the land-based control group (n=20) or pool-based intervention group (n=20). The intervention group underwent a 5-week physiotherapist-led community aquatic exercise programme with 50-minute exercise training per week. The control group was self-administered and given OA knee management pamphlet and joint caring advice by the physiotherapist. Subjects were assessed immediately before and after the programme. The primary outcome was pain (numeric pain rating scale). Secondary outcomes were self-reported questionnaire on lower limb arthritis (Western Ontario and McMaster Osteoarthritis Index), balance (functional reach test), exercise capacity (6-minute-walk test), and psychological status (SF-12). Results: The aquatic exercise group demonstrated significant improvement on pain, balance, and mental component of SF-12, compared with the control group. The control group reported significant improvement in the change of 6-minute-walk test compared with the aquatic exercise group. Secondary outcomes were not significantly different between groups. Conclusion: A 5-week community aquatic exercise programme focusing on range of motion, proprioception, strengthening, and balancing of lower limbs produced favourable outcome on pain and balance in people with OA knee.

Inferior vena cavae (IVC) can be of unusual geometry, often having odd shapes and being oriented (in long axes) away from the horizontal plane. However, after insertion of a filter, most IVC adopt a circular cross-section. The objective of this study was to determine if the IVC diameter estimated by frontal measurement (cavogram equivalent) reflects the true circular diameter of the infrarenal vena cava. Diameter estimation is clinically important in the correct selection of a filter, because mega cavae (diameter 28 mm or greater) require a particular filter. The infrarenal IVC was measured on computed tomographic (CT) scans in 136 patients. The frontal diameter was recorded as that which would be obtained by a cavogram. Corrected circular diameter was obtained by mapping the circumference of each cross-section on CT to a straight line and calculating diameter from circumference. The average frontal caval diameter was 20.5 (standard deviation 3.7) mm, whereas the average corrected circular diameter was 23.0 (standard deviation 3.4) mm. By frontal measurements, 6 IVC diameters were 28.0 mm or greater. Similarly, by corrected circular diameter, 6 IVC diameters were 28.0 mm or greater. However, of the 6 mega cavae extrapolated to cavograms, only 3 corresponded to mega cavae when corrected for true circular diameter. Yet, of the 6 mega cavae identified by corrected circular diameter measurement, 3 were not identified by frontal diameter assessment. Of the 6 patients with true mega cavae, 2 were being evaluated for right lower quadrant pain, 2 for lymphoma, 1 for a pelvic mass, and 1 for staging of a head and neck cancer. Cavograms can over- or underestimate the true diameter of an IVC, and may thus lead to incorrect filter choice. It is recommended that a sonogram or CT scan be obtained to visualize the IVC in cases of suspected mega cava, and that true circular diameters be used for selection and placement of IVC filters.

In an effort to expand the group of patients who might benefit from focal therapy, a number of alternatives to surgery have evolved. These include radiofrequency ablation, ethanol injection, focused ultrasonographic ablation, laser therapy and cryosurgery. While ethanol injection has had success, especially against hepatocellular carcinoma, cryosurgery comes closest to surgery in terms of overall efficacy. The other new therapies have a very limited history and are compromised by shortcomings in our ability to monitor their destructive effect on the tumour, making them impractical for treatment with curative intent. By contrast, cryosurgery creates a predictable and well-defined area of necrosis that may be visualized by several imaging modalities. Cryosurgery can be applied to tumours in any hepatic distribution, overcoming a major impediment to surgery. Cryosurgery also increases the number of lesions that may be attacked. Whereas a surgeon will seldom resect more than 3 or 4 lesions, cryosurgery can be safely applied to as many as 5 or, rarely, even up to 8 lesions. The procedure is limited only by the total volume of liver destroyed and by proximity to critical structures. Unfortunately, as with any focal therapy, the likelihood of long-term benefit declines with a greater number of lesions, which in turn is correlated with the probability of occult, synchronous, and metachronous metastases, both within and outside the liver. Successful cryosurgery follows from precise cryoprobe placement at the outset of the procedure and careful monitoring of the ice progression. The latter is complicated by the acoustic impedance of the frozen tissue, which creates both a sharply defined and impenetrably reflective surface. As result, the near ice edge is well seen, but the sonographer is blind to anything beyond. This large \"acoustic shadow\" makes it impossible to monitor the entire circumference of the tumour from a single perspective. As result, the operator must plan the procedure to ensure that the placement of the cryoprobe will produce the desired tumouricidal effect and that the procedure can be monitored even once ice complicates ongoing imaging. This requires very competent intra-operative real-time imaging with the best imaging equipment available.(f.7) These assets are typically outside the scope of most operating theatres, which cannot justify their expense or learning curve. At the World Congress of Cryosurgery meeting in Orlando, Fla., (held in November 1998), one surgeon stated that the main impediment to advancing cryosurgery was the operating team's lack of access to skilled and sophisticated intraoperative imaging. As result, in most institutions, successful cryosurgery will require the close collaboration of interventional radiologists and surgeons.

To determine the safety of venous intervention and the incidence of complications in patients undergoing venous interventional radiological procedures while receiving anticoagulant therapy. Data were collected prospectively for a 1-year period. One hundred patients receiving anticoagulant therapy underwent interventional radiological procedures requiring venous cannulation. Of these, 87 had documented prolonged bleeding times. There were 50 inferior vena cavograms obtained and filters placed (29 transfemoral, 21 transjugular), and 50 transfemoral pulmonary angiogram obtained, all in patients with thrombo-embolic disease who were receiving anticoagulant therapy. In most cases venous access was achieved with real-time sonographic guidance. Venous access was gained in all patients in all groups. There were 41/50 filter placements and 46/50 pulmonary angiograms performed in the patients with prolonged clotting times in or above the therapeutic range. There were no cases of arterial puncture and no cases of venous bleeding either during or after the procedures. No other complications were recorded. Venous intervention in patients receiving therapeutic anticoagulation is safe, with no complications reported in our series. There is no need to discontinue anticoagulant therapy in patients with life-threatening thrombo-embolic disease. Real-time sonographic guidance greatly facilitates venous cannulation and avoids inadvertent arterial puncture.

Pseudoaneurysms of the gluteal arteries are rare, occurring most frequently in the superior gluteal artery.(f.2) Most are preceded by either blunt or penetrating trauma.(f.3) To our knowledge, no reports of superior gluteal artery pseudoaneurysm occurring as a complication of closed bone marrow biopsy have been published. We report such a case, including the ultrasonographic, computed tomographic and angiographic features and the subsequent successful treatment by transcatheter embolization. This case illustrates a previously unreported, potentially serious, complication of bone marrow biopsy, and the management of this complication. A bone marrow biopsy had been performed 17 days previously for the investigation of persistent pancytopenia. The biopsy was performed via a posterior approach to the iliac crest with a 2-in., 16-gauge bone marrow aspiration needle (Monojet, Sherwood Medical, St. Louis, Mo.). The procedure was considered uncomplicated, although a small hematoma at the entry site was noted 2 days later. At the time of the biopsy, both the partial thromboplastin time (PTT) and international normalized ratio (INR) were normal. However, the platelet count was 88 x 10[Symbol Not Transcribed]/L (normal 140-440 x 10[Symbol Not Transcribed]/L), indicating pancytopenia. The bone marrow biopsy showed a normal complement of precursor cells and diffusely hypocellular marrow.