Evaluating the efficacy of percutaneous puncture biopsy guided by contrast-enhanced ultrasound for peripheral pulmonary lesions

BACKGROUND The incidence and mortality of lung cancer have increased annually.Accurate diagnosis can help improve therapeutic efficacy of interventions and prognosis.Percutaneous lung biopsy is a reliable method for the clinical diagnosis of lung cancer.Ultrasound-guided percutaneous lung biopsy technology has been widely promoted and applied in recent years.AIM To investigate the diagnostic value of contrast-enhanced ultrasound(CEUS)-guided percutaneous biopsy in peripheral pulmonary lesions.METHODS We retrospectively collected data on 237 patients with peripheral thoracic focal lesions who underwent puncture biopsy at Wuxi People’s Hospital.The patients were randomly divided into two groups:The CEUS-guided before lesion puncture group(contrast group)and conventional ultrasound-guided group(control group).Analyze the diagnostic efficacy of the puncture biopsy,impact of tumor size,and number of puncture needles and complications were analyzed and compared between the two groups.RESULTS Accurate pathological results were obtained for 92.83%(220/237)of peripheral lung lesions during the first biopsy,with an accuracy rate of 95.8%(113/118)in the contrast group and 89.9%(107/119)in the control group.The difference in the area under the curve(AUC)between the contrast and the control groups was not statistically significant(0.952 vs 0.902,respectively;P>0.05).However,when the lesion diameter≥5 cm,the diagnostic AUC of the contrast group was higher than that of the control group(0.952 vs 0.902,respectively;P<0.05).In addition,the average number of puncture needles in the contrast group was lower than that in the control group(2.58±0.53 vs 2.90±0.56,respectively;P<0.05).CONCLUSION CEUS guidance can enhance the efficiency of puncture biopsy of peripheral pulmonary lesions,especially for lesions with a diameter≥5 cm.Therefore,CEUS guidance has high clinical diagnostic value in puncture biopsy of peripheral focal lung lesions.

Ultrasound Guidance and Nerve Stimulation Combined Versus Nerve Stimulation alone for Lumbar Plexus Block:A Randomized Controlled Trial

A nerve stimulation-guided lumbar plexus block is a well-established technique.It is not clear whether ultrasound guidance has additional value for this deep block technique.This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space(PMTS-ITS)approach in combination with nerve stimulation reduces the onset time of a complete sensory block.Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score(UVS)of≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group(group U-N)or nerve stimulation group(group N)in this prospective,randomized,parallel-group,active-controlled study.The primary outcome was the onset time of a complete sensory block.The results showed that the onset time of a complete sensory block to pinprick and cold was 10(10–40)min and 10(10–40)min in group U-N,respectively,and 30(10–40)min and 20(10–40)min in group N(P=0.005,P=0.004),respectively.The performance time was 658±87 s in group U-N and 528±97 s in group N(P<0.001).There was no(0%)patient who required 5 or more needle passes in group U-N and 6(27.3%)in group N(P=0.028).The block failure rate was 9.1%in group U-N and 31.8%in group N(P>0.05).In conclusion,ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS≥10.Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.

Accuracy of shoulder joint injections with ultrasound guidance:Confirmed by magnetic resonance arthrography

BACKGROUND Intra-articular glenohumeral joint injections are essential procedures for treating various shoulder disorders. Fluoroscopy-guided injections have been extensively used;however, they pose a risk of radiation exposure and are expensive and timeconsuming. Recently, it has been suggested that ultrasound-guided injections are accurate and cost effective procedures.AIM To evaluate the accuracy of ultrasound-guided glenohumeral injections using a posterior approach that is confirmed using magnetic resonance arthrography(MRA).METHODS The study included 179 shoulders of patients with recurrent anterior instability(150 patients;103 and 76 right and left shoulders, respectively;160 males and 19 females;average age = 20.5 years;age range: 14-63 years) who underwent MRA for preoperative diagnosis. They were injected with 12 m L lidocaine(1%) using the ultrasound-guided posterior approach and then underwent magnetic resonance imaging. Two shoulder surgeons, except for the injector, evaluated the transverse relaxation(T2)-weighted images of axial planes and classified the intraarticular condition of injected contrast into three groups based on one of the three following scenarios: no leakage, injection into the glenohumeral joint without leakage;minor leakage, practical intra-articular injection with some leakage outside the posterior rotator cuffs;and major leakage, inaccurate injection with mass leakage without any contrast into the joint. The inter-rater reliability between two assessors was also evaluated by calculating Cohen’s kappa coefficient. The learning curve was assessed regarding the inaccurate injection rate by analyzing Spearman’s rank correlation coefficient.RESULTS Of the 179 injections, 163 shoulders(91.0%) had no leakage, 10 shoulders(5.6%) had minor leakage, and six shoulders(3.4%) had major leakage. In total, 173 shoulders(96.6%) were intraarticularly injected;thus, we could detect anterior labrum and capsular pathologies. Regarding the inter-rater reliability, the kappa coefficient was 0.925, indicating consistency in the evaluations by both examiners. Regression analysis of the inaccurate injection rate for assessingtechnical learning showed a logarithmic curve with a downward trend(R;= 0.887, P < 0.001). Three(50%) of the six inaccurate injections classified into “major leakage” were observed in the first 30 injections, indicating that the accurate injection showed a leaning effect.CONCLUSION Ultrasound-guided intra-articular glenohumeral injections using a posterior approach had high accuracy;however, injection accuracy depends on clinical experience.

Massive hemothorax following internal jugular vein catheterization under ultrasound guidance:A case report

BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SUMMARY A 75-year-old male patient was admitted for laparoscopic radical nephrectomy.Under ultrasound guidance,right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt.Sudden hypotension developed after surgical positioning and persisted until the end of the operation,lasting for about 4 h.In the recovery room,a massive hemothorax was identified on chest radiography and computed tomography.The patient recovered following chest tube drainage of 1.6 L blood.CONCLUSION Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance.So the proper use of ultrasound is important.

Treatment of Popliteal Cyst through Radiofrequency Thermocoagulation under Ultrasound Guidance

Objective: The purpose of this study was to explore the clinical efficacy and security of the treatment of popliteal cyst through radiofrequency thermocoagulation (RFT) under ultrasound guidance. Methods: The clinical data of 35 patients with popliteal cyst, who were treated by RFT under ultrasound guidance from June 2019 to June 2020, were retrospectively analyzed. The Visual Analogue Scores (VAS) and the size of cyst before and after treatment were recorded at the first month, the third month, the sixth month. After six months, the recovery rate of Rauschning and Lindgren classification (R-L classification) level 0, 0 - I were counted. All the complications of the patients were observed. Results: 32 patients were followed up for six months. The scores and cyst sizes of each patient before and after the treatment were on a normal distribution curve. There was no significant difference in VAS scores before and after the treatment (P > 0.05). However, there was a significant difference in cyst sizes before and after the treatment (P < 0.05). Moreover, there was no significant difference in VAS scores and cyst sizes in each period after treatment (P > 0.05). According to the R-L classification in 6 months after treatment: the recovery rate of class 0 was 62.5% and class 0 - I level was 87.5%. There were no serious complications in the process. Conclusion: Treatment of popliteal cyst through RFT under ultrasound guidance is a simple, easy, reliable method that is worthy of clinical promotion.

Artificial intelligence technology and ultrasound-guided nerve block for analgesia in total knee arthroplasty

BACKGROUND Knee diseases are more common in middle-aged and elderly people,so artificial knee replacement is also more used in middle-aged and elderly people.Although the patient’s pain can be reduced through surgery,often accompanied by moderate pain after surgery and neutralization,which not only increases the psychological burden of the patient,but also greatly reduces the postoperative recovery effect,and may also lead to the occurrence of postoperative adverse events in severe cases.AIM To investigate the analgesic effect of artificial intelligence(AI)and ultrasoundguided nerve block in total knee arthroplasty(TKA).METHODS A total of 92 patients with TKA admitted to our hospital from January 2021 to January 2022 were opted and divided into two groups according to the treatment regimen.The control group received combined spinal-epidural anesthesia.The research group received AI technique combined with ultrasound-guided nerve block anesthesia.The sensory block time,motor block time,visual analogue scale(VAS)at different time points and complications were contrasted between the two groups.RESULTS The time of sensory block onset and sensory block perfection in the research group was shorter than those in the control group,but the results had no significant difference(P>0.05).Duration of sensory block in the research group was significantly longer than those in the control group(P<0.05).The time of motor block onset and motor block perfection in the research group was shorter than those in the control group,but the results had no significant difference(P>0.05).Duration of motor block in the research group was significantly longer than those in the control group.The VAS scales of the research group were significantly lower than that of the control group at different time points(P<0.05).The postoperative hip flexion and abduction range of motion in the research group were significantly better than those in the control group at different time points(P<0.05).The incidence of complications was significantly lower in the research group than in the control group(P=0.049).CONCLUSION In TKA,the combination of AI technology and ultrasound-guided nerve block has a significantly effect,with fewer postoperative complications and significantly analgesic effect,which is worthy of application.

Evaluation of short-and medium-term efficacy and complications of ultrasound-guided ablation for small liver cancer

BACKGROUND To ensure clinical efficacy and prolong patient survival,treatments such as surgery and microwave ablation(MWA)are used for early liver cancer.MWA is preferred because it effectively preserves the normal liver tissue and causes transient coagulation necrosis of local liver tumor cells.However,due to technical limitations,the cancerous liver tissue cannot be completely ablated;therefore,the probability of local tumor recurrence is high.AIM To investigate the clinical efficacy and safety of ultrasound-guided percutaneous MWA in the treatment of small liver cancer.METHODS A total of 118 patients treated for small liver cancer in The Central Hospital of Yongzhou from January 2018 to April 2019 were selected.Sixty-six patients received ultrasound-guided percutaneous MWA(MWA group)and 52 received laparoscopic surgery(laparoscope group).The operation time,blood loss,hospital stay,and medical expenses of both groups were statistically analyzed.Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin(ALB),alpha fetal protein(AFP),carcinoembryonic antigen(CEA),and peripheral blood regulatory T lymphocytes(Treg)levels were evaluated pre-and post-operatively.The cross-sectional area of tumors measured before and after ablation was analyzed statistically;the therapeutic effect was compared between both groups in terms of surgical complications,2-year progression-free survival rate,and overall survival rate.RESULTS The operation time,blood loss,hospital stay,and medical expenses in the MWA group were lower than those of the laparoscope group,and the differences were significant(P<0.05);these parameters,and ALT,AST,TBIL,and ALB levels were compared preoperatively between both groups,and there was no significance(P>0.05).The operation time,blood loss,hospital stay,and medical expenses for 2 d and 1 wk after surgery,the ALT and AST of the MWA group were lower than those of the laparoscope group,and the difference was significant(P<0.05).The operation time,blood loss,hospital stay,and medical expenses,and serum AFP,CEA,and Treg levels were measured preoperatively and 4 and 8 wk postoperatively,and there were no significant differences between the two groups(P>0.05).Compared with preoperative levels,serum AFP,CEA,and Treg levels in both groups were decreased(P<0.05).The lesion in the MWA group had a maximum area of 4.86±0.90 cm2,1.24±0.57 cm2,and 0.31±0.11 cm2 preoperatively,1 and 3 mo postoperatively,respectively.Fifty-eight of them achieved complete response and eight achieved a partial response.After 2 years of followup,the progression-free and overall survival rates in the MWA group were 37.88%and 66.67%,respectively,compared with 44.23%and 76.92%in the laparoscope group,with no significant difference(P>0.05).CONCLUSION The effects of ultrasound-guided percutaneous MWA in the treatment of small liver cancer are similar to those of laparoscopic surgery.However,ablation causes less trauma and liver dysfunction.

Clinical efficacy of ultrasound-guided pulsed radiofrequency combined with ganglion impar block for treatment of perineal pain

BACKGROUND Ganglion impar block alone or pulsed radiofrequency alone are effective options for treating perineal pain.However,ganglion impar block combined with pulsed radiofrequency(GIB-PRF)for treating perineal pain is rare and the puncture is usually performed with X-ray or computed tomography guidance.AIM To evaluate the safety and clinical efficacy of real-time ultrasound-guided GIBPRF in treating perineal pain.METHODS Thirty patients with perineal pain were included and were treated by GIB-PRF guided by real-time ultrasound imaging between January 2015 and December 2016.Complications were recorded to observe the safety of the ultrasound-guided GIB-PRF procedure,and visual analogue scale(VAS)scores at 24 h before and after treatment and 1,3,and 6 mo later were analyzed to evaluate clinical efficacy.RESULTS Ultrasound-guided GIB-PRF was performed successfully in all patients,and no complications occurred.Compared with pretreatment scores,the VAS scores were significantly lower(P<0.05)at the four time points after treatment.The VAS scores at 1 and 3 mo were slightly lower than those at 24 h(P>0.05)and were significantly lower at 6 mo after treatment(P<0.05).There was a tendency toward lower VAS scores at 6 mo after treatment compared with those at 1 and 3 mo(P>0.05).CONCLUSION Ultrasound-guided GIB-PRF was a safe and effective way to treat perineal pain.The 6-mo short-term clinical efficacy was favorable,but the long-term outcomes need future study.

Real-time ultrasound-guided external intracerebral hemorrhage drain placement

We report a new minimally invasive technique utilizing interventional ultrasound for precise external intracerebral hemorrhage drain(EICHD) placement in pigs.

A novel spherical-headed fascial dilator is feasible for second-stage ultrasound guided percutaneous nephrolithotomy:A pilot study

Objective:In second-stage percutaneous nephrolithotomy(PCNL),because the hydronephrosis has been decompressed,the dilated renal pelvis has resolved and the space is small.Consequently,introduction of the tip of the Amplatz dilator can cause injury to the opposite side of the renal-pelvic mucosa.In this study,we report the experimental and initial clinical performance of a spherical-headed fascial dilator developed specifically for second-stage PCNL.Methods:The novel spherical-headed dilator was compared with existing tapered-headed dilators in configuration and in puncture resistance utilizing a static puncture test.Subsequently,a pilot clinical study was conducted during which patients scheduled to undergo second-stage PCNL from June 2019 to October 2019 in our center were enrolled.A typical ultrasound guided PCNL procedure was performed with the exception that the new spherical-headed fascial dilator was substituted for a tapered-headed one.Results:Experimentally,stab resistance against polyethylene film was significantly increased using the novel spherical-headed dilator compared to the traditional tapered-headed dilators(p<0.005).In the clinical study,the novel dilators were successfully introduced into the renal pelvis and passed down the collecting system in all eight second-stage PCNL cases.There were no cases of renal pelvic perforation or brisk hemorrhage nor need for transfusion.

Ultrasound-Guided Erector Spinae Plane Block for Lumbar Spinal Stenosis Surgery

Background: In this retrospective observational study, we evaluated patients who underwent elective lumbar stenosis surgery between February 1, 2019, and April 1, 2019. Patients who underwent surgery for lumbar spinal stenosis under general anesthesia alone were compared with those who underwent general anesthesia combined with erector spinae plane block. Aims: We aimed to retrospectively evaluate whether erector spinae plane block reduced opioid consumption following surgery for spinal stenosis. Study Design: A retrospective observational study. Methods: We collected data on the pain scores, time for the first requirement for patient-controlled analgesia with tramadol, the cumulative patient-controlled analgesia dose, requirement for rescue analgesia, time to first stand up postoperatively and the incidence of postoperative nausea and vomiting. Results: Sixty patients were included in the study. The numerical rating scale’s pain scores were significantly lower in the erector spinae plane group at 1, 2, 4, 6, 12 and 24 hours than in the general anesthesia group. The cumulative dose of patient-controlled analgesia with tramadol was higher in the general anesthesia group than in the ESP group [212.0 (6.6) mg, vs. 107.3 (36.9 mg), (p <0.001)]. The time to first stand up after surgery was significantly longer in the general anesthesia group (p = 0.011). Conclusion: ESP block appear to be an effective method to relieve pain after lumbar surgery.

Observation on the Anesthesia Effect of Ultrasound-Guided Nerve Block for Elderly Patients with Lower Limb Fractures

Objective:To explore the anesthesia effect of ultrasound-guided nerve block in elderly patients with lower limb fractures.Methods:From November 2017 to November 2020,50 elderly patients with lower limb fractures in our hospital were divided into experimental group(25 cases,general anesthesia+femoral nerve and sciatic nerve block)and control group(25 cases,general body anesthesia).Compare the MAP,HR,anesthesia effect,and adverse reactions between the two groups at each time period.Results:Before induction,the difference in MAP and HR between the two groups of patients did not form,p>0.05;the MAP and HR of the experimental group were compared with the control group at the time of skin incision,1 hour during the operation,and removal of the laryngeal mask,P<0.05;the time of extubation in the experimental group(14.28±3.18)min,awake time(5.57±1.32)min,orientation recovery time(11.89±2.23)min,propofol dosage(191.36±22.48)mg,remifentanil dosage(0.23±0.04)mg,Compared with the control group,P<0.05;the adverse reaction rate of the experimental group(8%,2/25)was lower than that of the control group(32%,8/25),P<0.05.Conclusion:The use of ultrasound-guided femoral nerve and sciatic nerve block for elderly patients with lower limb fractures can enhance the effect of anesthesia,effectively reduce the use of anesthetics,and have fewer adverse reactions.It is worthy of promotion.

A Spiral History of the Development of Ways to Identify the Correct Position of the Injection Needle in Relation to the Peripheral Nerve: A Brief Historical Essay

The first way to identify the needle in relation to the peripheral nerve W. Halsted and R. Hall in 1884 performed the first regional blockade (using direct visualization). However, Vassily von Anrep was a few months earlier described the blockade of the peripheral nerve by anatomical landmarks. In 1912, the blockade of the brachial plexus was first performed using electrical stimulation, but this technique has been widely used only since 1962. The most popular way to identify the needle relative to the nerve at the moment remains US guidance. A promising direction may be optical coherence tomography. But this method is under development. In the last decade, a method for determining the pressure of a local anesthetic has been introduced into practice to determine the position of the needle relative to the nerve.

Is the Mock Transfer Enough Reliable to Evaluate Hysterometry for Embryo Transfer?

Objectives: The aim of this study was to assess the reliability of the mock transfer during in vitro fertilization process Method: A case-control study was conducted on 134 patients included in IVF/ICSI cycles. From the hysterometry obtained during the mock transfer, the ideal embryo replacement site, i.e. two cm from the uterine fundus has been determined. Results: Significant differences were noted between the area estimated from the mock transfer and the area where the embryo was deposited during the actual embryo transfer. In fact, 15.9% of the patients had a difference between four and six cm, and 32% of the patients returning for a subsequent transfer had at least 2 cm of difference between the embryo deposit zones. This difference was significant (P 0.00) Conclusion: More than ultrasound guidance, the challenge with embryo transfer is to be able to minimize variations in the length of the uterus. This would make it possible to determine the ideal transfer depot area without multiple manipulations.

Why,who and how should perform liver biopsy in chronic liver diseases

Chronic viral hepatitis is a common disease in the general population.During chronic hepatitis,the prognosis and clinical management are highly dependent on the extent of liver fibrosis.The fibrosis evaluation can be performed by FibroTest(using serological markers),by Elastography or FibroScan(a noninvasive percutaneous technique using the elastic properties of the hepatic tissue) and by liver biopsy(LB),considered to be the "gold standard".Currently,there are three techniques for performing LB:percutaneous,transjugular and laparoscopic.The percutaneous LB can be performed blind,ultrasound(US) guided or US assisted.There are two main categories of specialists who perform LB:gastroenterologists(hepatologists) and radiologists,and the specialty of the individual who performs the LB determines if the LB is performed under ultrasound guidance or not.There are two types of biopsy needles used for LB:cutting needles(Tru-Cut,Vim-Silverman) and suction needles(Menghini,Klatzkin,Jamshidi).The rate of major complications after percutaneous LB ranges from 0.09% to 2.3%,but the echo-guided percutaneous liver biopsy is a safe method for the diagnosis of chronic diffuse hepatitis(cost-effective as compared to blind biopsy) and the rate of complications seems to be related to the experience of the physician and the type of the needle used(Menghini type needle seems to be safer).Maybe,in a few years we will use non-invasive markers of fibrosis,but at this time,most authorities in the field consider that the LB is useful and necessary for the evaluation of chronic hepatopathies,despite the fact that it is not a perfect test.

Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome

Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate whether single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome. Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study. Under ultrasound guidance, 1-2 m L of platelet-rich plasma was injected into the region around the median nerve at the proximal edge of the carpal tunnel. At 1 month after single injection of platelet-rich plasma, Visual Analogue Scale results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients. Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved. In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome.

Modified biological training model for percutaneous renal surgery with ultrasound and fluroscopy guidance

Background The 12th rib is an important anatomic marker in the process of percutaneous renal surgery; while the previous models without ribs can not provide close simulation conditions to human upper abdomen. To facilitate the learning and training of percutaneous renal access and intrarenal procedures under ultrasound and fluoroscopy guidance we reported a biological bench model for percutaneous renal surgery. Methods The model was developed using an ex vivo porcine kidney with a longer than 3 cm ureter, a flap of full thickness of thoracic wall with skin, subcutaneous fascia, muscle and two ribs, as well as the standard equipment for percutaneous nephrolithotomy. The porcine kidney with a catheterized ureter was placed within the porcine flap and fixed to a wooden board with two long steel nails. Afterward, contrast medium or physiological saline （0.9% sodium chloride solution） was injected through the ureter, and the urinary system was examined with a fluoroscopy unit or an ultrasound. Artificial stone material was implanted in the renal pelvis. After practicing, the model could be dissected for kidney examination and a technical analysis. Results The advantage of this model was simple to set up and inexpensive, by using widely available material. The biological bench model can be employed for percutanous renal access, tract dilation, nephroscopy, and stone disintegration in the training and learning of clinical practice. Imaging is feasible under fluoroscopic and ultrasound guidance. The kidney models were utilized in hands on courses with over 100 people, and 90.5% attendants rated the porcine kidney model for simulation of percutaneous renal surgery as ＂very helpful＂ or ＂helpful＂. Conclusion This biological training model simulates realistically the clinical procedure of percutaneous nephrolithotomy under fluoroscopic and ultrasound guidance.

Predictive Reliability of the Phoenix Sign for the Outcome of Common Fibular (Peroneal) Nerve Decompression Surgery

A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, demonstrates an improvement in dorsifexion after an ultrasound guided infiltration of a sub-anesthetic dose of lidocaine. Less than 5 cc’s of 1% or 2% lidocaine is utilized and the effect is seen within minutes after the infiltration, but usually lasts only 10 minutes. This effect may be due to the vasodilatory action of lidocaine on the microcirculation in the area of infiltration. This nerve block has significant diagnostic utility as it is highly specific in the confirmation of true focal entrapment of the CFN, has high predictive value for a patient who may undergo surgical nerve decompression if they have demonstrated a positive Phoenix Sign, and may help in the surgical decision-making process in patients who have had a drop foot for many years but still may regain some motor function after decompression. In this retrospective review, 26 patients were tested, and 25 of this cohort demonstrated a Positive Phoenix Sign (an increase in dorsiflexion strength of the Extensor Hallucis Longus muscle (EHL)). One patient had no response to the peripheral nerve block. Of the 25 patients who demonstrated a positive “Phoenix Sign” and underwent nerve decompression of the CFN, and 25 (100%) showed an increase in dorsiflexion strength of the EHL after nerve decompression surgery of the CFN. The one patient in this cohort who did not demonstrate any improvement in dorsiflexion of the EHL after the nerve block did not have any improvement after surgery.

Management of Post-Operative Pain after Gyneco-Obstetrical Surgery: Practice of Transversus Abdominis Plane Bloc (Tap Block) Echoguide at the Ignace Deen National Hospital

Objectives: To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. Methods: This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. Results: In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38;at H12 of 1.15 ± 0.62;at H24 of 0.84 ± 0.51;at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61;at H24 of 1.53 ± 0.56;at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. Conclusion: Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.

Nursing practices for accelerated perioperative recovery of patients undergoing esophageal ultrasound-guided mitral valve chordae tendineae repair at the cardiac apex

Summary of the Experience in Perioperative Accelerated Recovery Care of a Patient with Severe Mitral Valve Regurgitation,Mitral Valve Prolapse,Coronary Heart Disease,and Hypertension Undergoing Transesophageal Echocardiography-Guided Mitral Valve Chord Repair System and Artificial Chord Implantation through the Apex of the Heart The patient had a history of coronary heart disease and hypertension,and was diagnosed with mitral valve prolapse and severe mitral regurgitation at admission.According to the comprehensive evaluation of the patient's condition by the cardiac surgery and MDT(Multidisciplinary Team)team of our hospital before operation,the patient had severe degenerative mitral regurgitation.Considering the high risk of surgical valvuloplasty,the treatment plan of transapical mitral valve artificial chordae implantation with mitral chordae repair system under the guidance of esophageal ultrasound was formulated.Following the guidelines for accelerated recovery,a multidisciplinary approach was taken during the surgery to monitor the patient's condition.Preoperative waiting periods,the postoperative critical period,and the stabilization period were considered,and a rehabilitation program that included exercise,nutritional support,health education,and psychological care was developed for the entire perioperative accelerated recovery process.Nutritional support,health education and psychological nursing were throughout the whole process of perioperative enhanced recovery.The patient was implanted with 4 artificial chordae tendineae.Transesophageal echocardiography monitoring showed that the surgical treatment effect was satisfactory,and no complications occurred during the perioperative period.