Objective To investigate the placement of a long tube into the small intestine under fluoroscopic guidance and to evaluate its decompression effect on early postoperative small bowel obstruction(EPSBO).Methods Fifty-f...Objective To investigate the placement of a long tube into the small intestine under fluoroscopic guidance and to evaluate its decompression effect on early postoperative small bowel obstruction(EPSBO).Methods Fifty-four patients with EPSBO requiring decompression between April 2010 and July 2014 were enrolled in the study.Insertion of a long tube was guided by fluoroscopy.We first used the guide wire to pass the pylorus and then used the 10 Fr feeding tube as an exchangeable tube to put the superstiff wire into the duodenum.Finally the long tube could be passed over the guide wire through the pylorus into the intestine.The total procedure time,the radiation exposure time,and the incidence of complications were evaluated.Results The long tubes passed into the jejunum on initial insertion for all patients,so the success rate of this technique was 100%.The long tube was inserted into ileum in 18 patients.The mean total procedure time was 34.4±8.6 minutes,and the mean radiation exposure time 18.9±6.8 minutes.A total of 47 patients(87%) experienced full recovery following long-tube decompression and without the need for surgical intervention.Conclusions Using the wire-exchange technique,it is easy to place a long tube into the small bowel under fluoroscopic guidance.This decompression method is safe and effective for management of EPSBO.展开更多
Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for female pelvic organ prolapse. In 2004, this procedure was developed by a French group, and standardized surgical kits are now co...Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for female pelvic organ prolapse. In 2004, this procedure was developed by a French group, and standardized surgical kits are now commercially available in many countries. Although it is less invasive, one of the shortcomings of this procedure is that it involves a single surgeon groping around with their fingers without any intraoperative monitoring. Therefore, using Intraoperative fluoroscopic monitoring during TVM surgery makes it safer, even for beginners. In this case, we performed TVM for the anterior vaginal wall. First, we used the c-arm of a fluoroscope to insert bilateral ureteral stents. A urethral catheter was then used for both urine drainage and contrast medium injection. In all procedures, we were able use fluoroscopic imaging whenever necessary. We were able to easily confirm the positions of the prolapsed bladder and the bilateral ureteral stents with fluoroscopic imaging, and the ischial spine was easy to locate before the procedure. We were also able to confirm the position of the top of the needle with fluoroscopic imaging whenever necessary. If a surgeon is worried about the risk of bladder injury during TVM surgery, they should inject contrast medium into the bladder at the start of the procedure. Intraoperative fluoroscopic monitoring during TVM surgery is easy and makes the procedure safer, even for beginners. Moreover, fluoroscopic imaging also allows intraoperative training. To avoid exposing the body to excess radiation, we must minimize the total length of the fluoroscopic examination.展开更多
BACKGROUND Malignant tumors of the ileocecal region often cause intestinal obstruction.Emergency surgery is the main treatment for patients presenting with an obstruction.However,this procedure is associated with a hi...BACKGROUND Malignant tumors of the ileocecal region often cause intestinal obstruction.Emergency surgery is the main treatment for patients presenting with an obstruction.However,this procedure is associated with a high mortality rate and frequent complications.The placement of colon stents is commonly performed for obstructions in the distal colon and is a less invasive and safer procedure.However,obstructions in the proximal colon are more challenging to treat by stent placement due to the increased distance from the anus.CASE SUMMARY This case report concerns an 88-year-old man with malignant intestinal obstruction in the ileocecal region.He was contraindicated for general anesthesia and surgical enterostomy.The placement of a self-expandable metallic stent seems an alternative to surgery,although stenting in this area is thought to be difficult and few studies have been reported so far.After three attempts at different interventional approaches,a stent was successfully placed in the obstructed segment under fluoroscopic guidance.After the procedure,the patient's abdominal distension and abdominal pain were significantly better than before.CONCLUSION For patients with proximal colonic obstruction,self-expandable metallic stent placement under fluoroscopic guidance could be considered as a feasible treatment to relieve abdominal distension and pain in patients with acute bowel obstruction.It has the characteristics of high safety and high patient tolerance.However,further study is still needed.展开更多
X-ray fluoroscopy has been used not only for diagnoses but also for treatment, as in interventional radiology. The aim of this study is to assess the usefulness of the signal-to-noise ratio (SNR) using the subtraction...X-ray fluoroscopy has been used not only for diagnoses but also for treatment, as in interventional radiology. The aim of this study is to assess the usefulness of the signal-to-noise ratio (SNR) using the subtraction method, which is used in the quality assurance/quality control (QA/QC) of magnetic resonance imaging (MRI) equipment, and image visibility using the Howlett chart method in the fluoroscopic examination. The fluoroscopy unit has a detector with an image intensifier and a color liquid crystal display. A 2620 dosimeter and an ionization chamber were selected for the dose measurement. Fluoroscopic images for visual and physical evaluations were collected as dynamic data. The skin surface absorbed dose rates for each tube current were measured using a dosimeter. The SNR using the subtraction method and image visibility using the Howlett chart method were examined. The results from both indicate that as the SNR improves, visual evaluation increases, but the rate of increase gradually saturates. Therefore, physical and visual evaluations are possible with the SNR using the subtraction method and the image visibility using the Howlett chart method.展开更多
Objective To study the effect of using improved 2D computer-assisted fluoroscopic navigation through simulating 3D vertebrae image to guide pedicle screw internal fixation.Methods Posterior pedicle screw internal fixa...Objective To study the effect of using improved 2D computer-assisted fluoroscopic navigation through simulating 3D vertebrae image to guide pedicle screw internal fixation.Methods Posterior pedicle screw internal fixation,distraction展开更多
<b>Background and Aims:</b> Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Ch...<b>Background and Aims:</b> Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Chronic LBP (CLBP) was estimated to be between 5% and 10%, defined as LBP that lasts for 12 weeks. The most common causes of CLBP with radiculopathy are lumbar disc prolapse (LDP) and degenerative facet osteoarthropathy (DFO);the aim of this study is to investigate the efficacy of ultrasound (US) guided, fluoroscopy (FL) guided, Caudal Epidural Steroid Injection (CESI), lumbar epidural steroid injections (LESI), and blinding lumbosacral steroid injections (LSPSI) in patients with CLBP with radiculopathy. <b>Patients and Methods:</b> This is a randomized prospective study that was conducted at the department of rheumatology at Al Azhar University Hospital in Egypt between November 2020 and August 2021. A total of 100 patients with refractory CLBP with radiculopathy were enrolled in the study. Consequently, they were divided into 2 groups: the first consisted of fifty patients with CLBP and radiculopathy caused by LDP, as determined by lumbosacral magnetic resonance imaging (MRI), and the second group consisted of fifty patients with refractory low back pain and radiculopathy caused by DFO, as determined by lumbosacral plain x-rays and lumbosacral MRI. The following procedures were performed: US-guided CESI, FL-guided CESI, FL-guided LESI, US-guided LESI, and blinding LSPSI. <b>Results:</b> In the LDP group, there is a statistically significant difference between considered spinal nerve roots as regards Visual Analogue Scale (VAS) (at 2 months). Likewise, a statistically significant difference was found between blinding LSPSI and US-Guided LESI with respect to VAS (baseline) and VAS (2 months) (P-value = 0.018 and 0.003, respectively). Statistically significant differences were reported in VAS (2 months) for both FL-guided LESI and FL-guided CESI groups. Considering the VAS of studied spinal nerve roots in the DFO group, there is a statistically significant difference between the examined spinal nerve roots with respect to Oswestry Disability Index (ODI) (2 months). Similarly, there is a statistically significant difference in VAS (2 months) between US-guided LESI and para-spinal roots and FL-guided LESI and para-spinal roots (P-value = 0.038 and 0.021, respectively). Additionally, there is a statistically significant difference between the US-guided CESI, FL-guided CESI, FL-guided LESI, and spinal nerve roots with respect to ODI (at 2 months). (P-value = 0.033, 0.025 and 0.005, respectively). <b>Conclusion:</b> US is excellent in guiding CESI and LESI and should be the preferred alternative when FL is not provided, with a similar treatment outcome compared to FL-CESI and LESI.展开更多
Background:Foot kinematics,such as excessive eversion and malalignment of the hindfoot,are believed to be associated with running-related injuries.The maj ority of studies to date show that different foot strike patte...Background:Foot kinematics,such as excessive eversion and malalignment of the hindfoot,are believed to be associated with running-related injuries.The maj ority of studies to date show that different foot strike patterns influence these specific foot and ankle kinematics.However,technical deficiencies in traditional motion capture approaches limit knowledge of in vivo joint kinematics with respect to rearfoot and forefoot strike patterns(RFS and FFS,respectively).This study uses a high-speed dual fluoroscopic imaging system(DFIS)to determine the effects of different foot strike patterns on 3D in vivo tibiotalar and subtalar joints kinematics.Methods:Fifteen healthy male recreational runners underwent foot computed tomography scanning for the construction of 3-dimensional models.A high-speed DFIS(100 Hz)was used to collect 6 degrees of freedom kinematics for participants’tibiotalar and subtalar joints when they adopted RFS and FFS in barefoot condition.Results:Compared with RFS,FFS exhibited greater internal rotation at 0%-20%of the stance phase in the tibiotalar joint.The peak internal rotation angle of the tibiotalar joint under FFS was greater than under RFS(p<0.001,Cohen’s d=0.92).RFS showed more dorsiflexion at 0%-20%of the stance phase in the tibiotalar joint than FFS.RFS also presented a larger anterior translation(p<0.001,Cohen’s d=1.28)in the subtalar joint at i nitial contact than FFS.Conclusion:Running with acute barefoot FFS increases the internal rotation of the tibiotalar joint in the early stance.The use of high-speed DFIS to quantify the movement of the tibiotalar and subtalar joint was critical to revealing the effects of RF S and FFS during running.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulati...Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use inthese complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.展开更多
文摘Objective To investigate the placement of a long tube into the small intestine under fluoroscopic guidance and to evaluate its decompression effect on early postoperative small bowel obstruction(EPSBO).Methods Fifty-four patients with EPSBO requiring decompression between April 2010 and July 2014 were enrolled in the study.Insertion of a long tube was guided by fluoroscopy.We first used the guide wire to pass the pylorus and then used the 10 Fr feeding tube as an exchangeable tube to put the superstiff wire into the duodenum.Finally the long tube could be passed over the guide wire through the pylorus into the intestine.The total procedure time,the radiation exposure time,and the incidence of complications were evaluated.Results The long tubes passed into the jejunum on initial insertion for all patients,so the success rate of this technique was 100%.The long tube was inserted into ileum in 18 patients.The mean total procedure time was 34.4±8.6 minutes,and the mean radiation exposure time 18.9±6.8 minutes.A total of 47 patients(87%) experienced full recovery following long-tube decompression and without the need for surgical intervention.Conclusions Using the wire-exchange technique,it is easy to place a long tube into the small bowel under fluoroscopic guidance.This decompression method is safe and effective for management of EPSBO.
文摘Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for female pelvic organ prolapse. In 2004, this procedure was developed by a French group, and standardized surgical kits are now commercially available in many countries. Although it is less invasive, one of the shortcomings of this procedure is that it involves a single surgeon groping around with their fingers without any intraoperative monitoring. Therefore, using Intraoperative fluoroscopic monitoring during TVM surgery makes it safer, even for beginners. In this case, we performed TVM for the anterior vaginal wall. First, we used the c-arm of a fluoroscope to insert bilateral ureteral stents. A urethral catheter was then used for both urine drainage and contrast medium injection. In all procedures, we were able use fluoroscopic imaging whenever necessary. We were able to easily confirm the positions of the prolapsed bladder and the bilateral ureteral stents with fluoroscopic imaging, and the ischial spine was easy to locate before the procedure. We were also able to confirm the position of the top of the needle with fluoroscopic imaging whenever necessary. If a surgeon is worried about the risk of bladder injury during TVM surgery, they should inject contrast medium into the bladder at the start of the procedure. Intraoperative fluoroscopic monitoring during TVM surgery is easy and makes the procedure safer, even for beginners. Moreover, fluoroscopic imaging also allows intraoperative training. To avoid exposing the body to excess radiation, we must minimize the total length of the fluoroscopic examination.
文摘BACKGROUND Malignant tumors of the ileocecal region often cause intestinal obstruction.Emergency surgery is the main treatment for patients presenting with an obstruction.However,this procedure is associated with a high mortality rate and frequent complications.The placement of colon stents is commonly performed for obstructions in the distal colon and is a less invasive and safer procedure.However,obstructions in the proximal colon are more challenging to treat by stent placement due to the increased distance from the anus.CASE SUMMARY This case report concerns an 88-year-old man with malignant intestinal obstruction in the ileocecal region.He was contraindicated for general anesthesia and surgical enterostomy.The placement of a self-expandable metallic stent seems an alternative to surgery,although stenting in this area is thought to be difficult and few studies have been reported so far.After three attempts at different interventional approaches,a stent was successfully placed in the obstructed segment under fluoroscopic guidance.After the procedure,the patient's abdominal distension and abdominal pain were significantly better than before.CONCLUSION For patients with proximal colonic obstruction,self-expandable metallic stent placement under fluoroscopic guidance could be considered as a feasible treatment to relieve abdominal distension and pain in patients with acute bowel obstruction.It has the characteristics of high safety and high patient tolerance.However,further study is still needed.
文摘X-ray fluoroscopy has been used not only for diagnoses but also for treatment, as in interventional radiology. The aim of this study is to assess the usefulness of the signal-to-noise ratio (SNR) using the subtraction method, which is used in the quality assurance/quality control (QA/QC) of magnetic resonance imaging (MRI) equipment, and image visibility using the Howlett chart method in the fluoroscopic examination. The fluoroscopy unit has a detector with an image intensifier and a color liquid crystal display. A 2620 dosimeter and an ionization chamber were selected for the dose measurement. Fluoroscopic images for visual and physical evaluations were collected as dynamic data. The skin surface absorbed dose rates for each tube current were measured using a dosimeter. The SNR using the subtraction method and image visibility using the Howlett chart method were examined. The results from both indicate that as the SNR improves, visual evaluation increases, but the rate of increase gradually saturates. Therefore, physical and visual evaluations are possible with the SNR using the subtraction method and the image visibility using the Howlett chart method.
文摘Objective To study the effect of using improved 2D computer-assisted fluoroscopic navigation through simulating 3D vertebrae image to guide pedicle screw internal fixation.Methods Posterior pedicle screw internal fixation,distraction
文摘<b>Background and Aims:</b> Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Chronic LBP (CLBP) was estimated to be between 5% and 10%, defined as LBP that lasts for 12 weeks. The most common causes of CLBP with radiculopathy are lumbar disc prolapse (LDP) and degenerative facet osteoarthropathy (DFO);the aim of this study is to investigate the efficacy of ultrasound (US) guided, fluoroscopy (FL) guided, Caudal Epidural Steroid Injection (CESI), lumbar epidural steroid injections (LESI), and blinding lumbosacral steroid injections (LSPSI) in patients with CLBP with radiculopathy. <b>Patients and Methods:</b> This is a randomized prospective study that was conducted at the department of rheumatology at Al Azhar University Hospital in Egypt between November 2020 and August 2021. A total of 100 patients with refractory CLBP with radiculopathy were enrolled in the study. Consequently, they were divided into 2 groups: the first consisted of fifty patients with CLBP and radiculopathy caused by LDP, as determined by lumbosacral magnetic resonance imaging (MRI), and the second group consisted of fifty patients with refractory low back pain and radiculopathy caused by DFO, as determined by lumbosacral plain x-rays and lumbosacral MRI. The following procedures were performed: US-guided CESI, FL-guided CESI, FL-guided LESI, US-guided LESI, and blinding LSPSI. <b>Results:</b> In the LDP group, there is a statistically significant difference between considered spinal nerve roots as regards Visual Analogue Scale (VAS) (at 2 months). Likewise, a statistically significant difference was found between blinding LSPSI and US-Guided LESI with respect to VAS (baseline) and VAS (2 months) (P-value = 0.018 and 0.003, respectively). Statistically significant differences were reported in VAS (2 months) for both FL-guided LESI and FL-guided CESI groups. Considering the VAS of studied spinal nerve roots in the DFO group, there is a statistically significant difference between the examined spinal nerve roots with respect to Oswestry Disability Index (ODI) (2 months). Similarly, there is a statistically significant difference in VAS (2 months) between US-guided LESI and para-spinal roots and FL-guided LESI and para-spinal roots (P-value = 0.038 and 0.021, respectively). Additionally, there is a statistically significant difference between the US-guided CESI, FL-guided CESI, FL-guided LESI, and spinal nerve roots with respect to ODI (at 2 months). (P-value = 0.033, 0.025 and 0.005, respectively). <b>Conclusion:</b> US is excellent in guiding CESI and LESI and should be the preferred alternative when FL is not provided, with a similar treatment outcome compared to FL-CESI and LESI.
基金provided by the National Natural Science Foundation of China(Grants No.12272238 and No.11932013)the"Outstanding Young Scholar"Program of Shanghai Municipalthe"Dawn"Program of Shanghai Education Commission(Grant No.19SG47)。
文摘Background:Foot kinematics,such as excessive eversion and malalignment of the hindfoot,are believed to be associated with running-related injuries.The maj ority of studies to date show that different foot strike patterns influence these specific foot and ankle kinematics.However,technical deficiencies in traditional motion capture approaches limit knowledge of in vivo joint kinematics with respect to rearfoot and forefoot strike patterns(RFS and FFS,respectively).This study uses a high-speed dual fluoroscopic imaging system(DFIS)to determine the effects of different foot strike patterns on 3D in vivo tibiotalar and subtalar joints kinematics.Methods:Fifteen healthy male recreational runners underwent foot computed tomography scanning for the construction of 3-dimensional models.A high-speed DFIS(100 Hz)was used to collect 6 degrees of freedom kinematics for participants’tibiotalar and subtalar joints when they adopted RFS and FFS in barefoot condition.Results:Compared with RFS,FFS exhibited greater internal rotation at 0%-20%of the stance phase in the tibiotalar joint.The peak internal rotation angle of the tibiotalar joint under FFS was greater than under RFS(p<0.001,Cohen’s d=0.92).RFS showed more dorsiflexion at 0%-20%of the stance phase in the tibiotalar joint than FFS.RFS also presented a larger anterior translation(p<0.001,Cohen’s d=1.28)in the subtalar joint at i nitial contact than FFS.Conclusion:Running with acute barefoot FFS increases the internal rotation of the tibiotalar joint in the early stance.The use of high-speed DFIS to quantify the movement of the tibiotalar and subtalar joint was critical to revealing the effects of RF S and FFS during running.
文摘Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use inthese complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.
