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Introduction: Intoxications are an important public health problem. The gastric lavage is mainly used when the ingestion of toxic agents occurs orally, however, the knowledge about the best technique to be implemented for the execution of the procedure and it´s indications and contraindication are still dispersed. Objective: Identify and map the scientific evidence available about the gastric lavage on a person victim of acute intoxication that allows the execution of a descriptive summary on the state of the art of this procedure. Methods: A scoping review will be carried out according to the methodology JBI methodology for scoping reviews and will be drafted concurring with the PRISMA-ScR checklist. The review will consider studies including adult individuals, victims of intoxication and submitted to gastric lavage in diverse clinical contexts, whether they are intra or extra-hospital. Studies in English, French, Spanish and Portuguese will be included. The selection of the studies will be carried out by two independent reviewers, using a third one in case of disagreement. The results of this search, selection of studies and inclusive procedure will be presented in a PRISMA flow chart for scoping reviews. The data extraction, evidence analysis and results about the extension and type of evidences will be presented in a chart., Introducción: Las intoxicaciones constituyen un importante problema de salud pública. El lavado gástrico se utiliza sobre todo cuando los agentes tóxicos se ingieren por vía oral, sin embargo, los conocimientos sobre la mejor técnica que debe aplicarse para el lavado gástrico y sus indicaciones y contraindicaciones siguen siendo dispersos. Objetivo: Identificar y cartografiar la evidencia científica disponible sobre el lavado gástrico en la persona víctima de una intoxicación aguda que permita realizar una síntesis descriptiva sobre el estado del arte de este procedimiento. Métodos: Se realizará una revisión scoping de acuerdo con la metodología del JBI para revisiones de scoping y se redactará de acuerdo con la lista de verificación PRISMA-ScR. La revisión considerará estudios que incluyan individuos en edad adulta, víctimas de intoxicación, sometidos a lavado gástrico en diversos contextos clínicos, ya sean intra o extrahospitalarios. Se incluirán estudios en inglés, francés, español y portugués. La selección de los estudios será realizada por dos revisores independientes, recurriendo a un tercer revisor en caso de desacuerdo. Los resultados de la búsqueda, la selección de estudios y el proceso de inclusión se presentarán en un diagrama de flujo PRISMA para revisiones de alcance. La extracción de datos, el análisis de la evidencia y los resultados sobre el alcance y el tipo de evidencia se presentarán en una tabla., Introdução: As intoxicações são um importante problema de saúde pública. A lavagem gástrica, maioritariamente, é usada quando há ingestão de agentes tóxicos por via oral, no entanto, o conhecimento sobre qual a melhor técnica a ser implementada para a execução da lavagem gástrica e quais as suas indicações e contraindicações ainda é disperso. Objetivo: Identificar e mapear a evidência científica disponível sobre a lavagem gástrica à pessoa vítima de intoxicação aguda que possibilite realizar uma síntese descritiva sobre o estado de arte deste procedimento. Métodos: Será realizada uma revisão scoping de acordo com a metodologia JBI methodology for scoping reviews e será redigida de acordo com a checklist PRISMA-ScR. A revisão considerará estudos que incluem indivíduos em idade adulta, vítimas de intoxicação, submetidos a lavagem gástrica nos diversos contextos clínicos, sejam eles intra ou extra-hospitalares. Serão incluídos estudos em inglês, francês, espanhol e português. A seleção dos estudos será realizada por dois revisores independentes, utilizando um terceiro revisor em caso de discordância. Os resultados da pesquisa, seleção de estudos e processo de inclusão serão apresentados num fluxograma PRISMA para revisões de escopo. A extração dos dados, análise de evidências e resultados sobre a extensão e tipo de evidências serão apresentados numa tabela.

Therapeutic plasmapheresis is a therapeutic procedure in which the patient's blood is passed through a medical device which separates out plasma from other components of blood. The plasma is removed and replaced with a replacement solution. Studies on the use of plasmapheresis in critically ill patients are scarce. The aim of this study was to review all therapeutic plasmapheresis sessions carried out in the Hospital Beatriz Ângelo intensive care unit.An observational retrospective study was conducted between April 2012 and March 2019. All patients who underwent therapeutic plasmapheresis in the intensive care unit were included, and plasmapheresis sessions held outside the intensive care unit were excluded.Of 46 patients, 63% were men (n = 29), with a median age of 53 years. The most frequent diagnoses were hypertriglyceridemia-induced pancreatitis, vasculitis, autoimmune haemolytic anaemia, and atypical haemolytic-uremic syndrome. A total of 198 plasmapheresis sessions were carried out in the intensive care unit. Most of the used replacement solutions were fresh frozen plasma (34.4%), albumin/crystalloid (24.2%), and albumin/fresh frozen plasma (19.2%). The most common complications were hydroelectrolytic changes (84; 42.4%) and coagulation disorders/thrombocytopenia (65; 32.8%). There was no need to interrupt any plasmapheresis session due to complications related to the patient.Therapeutic plasmapheresis is an urgent procedure that can reduce morbidity and mortality in critically ill patients. This justifies that 37% of patients started the technique before the diagnostic confirmation. The indications for plasmapheresis and the choice of replacement solution were in agreement with the guidelines. Despite the risk of bleeding, no haemorrhagic complications were recorded.Therapeutic plasmapheresis is a complex technique that requires specific training. The indications are diverse, and some are not consensual. Complications were frequent, but they did not increase morbidity.Introdução: A plasmaferese terapêutica é um procedimento em que o sangue passa por um circuito extracorpóreo que separa o plasma dos outros componentes do sangue. O plasma removido é substituído por soluções de reposição. Os estudos sobre a utilização de plasmaferese terapêutica no doente crítico são escassos. O objetivo do estudo foi rever todas as sessões de plasmaferese realizadas no serviço de Medicina Intensiva do Hospital Beatriz Ângelo. Material e Métodos: Estudo observacional retrospetivo de todos os doentes admitidos no serviço de Medicina Intensiva entre abril de 2012 e março de 2019. Foram selecionados os doentes submetidos a plasmaferese e excluídas as sessões realizadas fora do serviço de Medicina Intensiva. Resultados: No período de estudo foram incluídos 46 doentes. A maioria eram homens (n = 29; 63%) com uma idade mediana de 53 anos. Os diagnósticos mais frequentes foram pancreatite secundária a hipertrigliceridemia, vasculite, anemia hemolítica autoimune e síndrome hemolítica urémica atípica. Foram realizadas 198 sessões de plasmaferese no serviço de Medicina Intensiva. As soluções de substituição mais utilizadas foram plasma fresco congelado (34,4%), albumina/cristalóide (24,2%) e albumina/plasma (19,2%). As complicações mais comuns foram alterações hidroeletrolíticas (84; 42,4%), e distúrbios da coagulação/plaquetas (65; 32,8%). Em nenhum dos casos a técnica teve que ser interrompida por complicações relacionadas com o doente. Discussão: A plasmaferese terapêutica é um procedimento urgente capaz de reduzir a morbilidade e mortalidade no doente crítico. Isto justifica que 37% dos doentes tenham iniciado a técnica antes da confirmação diagnóstica. As indicações e soluto de reposição escolhido foram de acordo com as recomendações. Apesar do risco hemorrágico, nenhuma complicação desta natureza foi reportada. Conclusão: A plasmafere terapêutica é uma técnica complexa que requer treino específico. As indicações são diversas e algumas não consensuais. As complicações foram frequentes, mas não condicionaram morbilidade associada.

Objective Stereoelectroencephalography (sEEG) is an intracranial encephalography method of expanding use. The need for increased epilepsy surgery access has led to the consideration of sEEG adoption by new or expanding surgical epilepsy programs. Data regarding safety and efficacy are uncommon outside of high‐volume, well‐established centers, which may be less applicable to newer or low‐volume centers. The objective of this study was to add to the sEEG outcomes in the literature from the perspective of a rapidly expanding center. Methods A retrospective chart review of consecutive sEEG cases from January 2016 to December 2019 was performed. Data extraction included demographic data, surgical data, and outcome data, which pertinently examined surgical method, progression to therapeutic procedure, clinically significant adverse events, and Engel outcomes. Results One hundred and fifty‐two sEEG procedures were performed on 131 patients. Procedures averaged 10.5 electrodes for a total of 1603 electrodes. The majority (84%) of patients progressed to a therapeutic procedure. Six clinically significant complications occurred: three retained electrodes, two hemorrhages, and one failure to complete investigation. Only one complication resulted in a permanent deficit. Engel 1 outcome was achieved in 63.3% of patients reaching one‐year follow‐up after a curative procedure. Significance New or expanding epilepsy surgery centers can appropriately consider the use of sEEG. The complication rate is low and the majority of patients progress to therapeutic surgery. Procedural safety, progression to therapeutic intervention, and Engel outcomes are comparable to cohorts from long‐established epilepsy surgery programs.

Ilaj bi’l tadbeer (regimenal therapy) is one of the preferred treatment methods used in Unani system of medicine since ancient times. Ḥijāma is one of the effective modalities of treatment in Ilaj bi’l tadbeer. It is a unique therapeutic procedure in which cup like vessels are placed on the body surface by creating a vacuum to either let out blood from below the skin surface or just plain suction without bloodletting. The objective of this comprehensive review paper is to address the claims of Unāni physicians and clinical studies conducted on the efficacy of Ḥijāma. Various published clinical trials showed the efficacy of Ḥijāma in the management of a number of diseases. Though, the effect showed by some clinical trials was short term. Hence, it is suggested that rigorous, well-designed, controlled, randomized and long duration follow up clinical trials on large sample size are to be conducted by trained clinicians or researchers to establish the efficacy of Ḥijāma in the management of various diseases. Keywords: Ilaj bi’l tadbeer, Ḥijāma, Therapeutic Benefits

Stellate ganglion block (SGB) has been applied in clinic for almost a century as a therapeutic procedure to alleviate pain-related syndromes and vascular deficits in the upper extremities. A great number of causative side effects and complications due to technological insufficiency and anatomical variations called for the popularity of ultrasound-guided SGB which has made tremendous contribution for clinical diagnosis and therapy, primarily in postoperative pain and cardiac and vascular disorders. This work was aimed at systematically summarizing the current clinical application of ultrasound-guided SGB and putting forward the potential prospective application in future. By searching ultrasound-guided SGB-related works on PubMed database, we mainly elucidated the analgesic effect of preoperative SGB in patients undergoing surgical procedures and substantial reduction in patients with ventricular arrhythmias. The volume of local anesthetics used in ultrasound-guided SGB has been diminished in the recent few years' investigations and successful operation of ultrasound-guided SGB could be achieved with minimal safe volume of local anesthetics. This invasive and safe procedure shows vast potential for future development in clinical treatment for autonomic nervous system and autoimmune disorders. We also put forward hypothesis that ultrasound-guided SGB could be applied combined with controlled hypotension to reduce the intraoperative complications in orthopedic surgery such as insufficiency of cerebral blood flow and reflexive tachycardia. Thus, it is of vital essence to improve the professional skills of physicians for the high rate of success and explore more effective measures which could enhance therapeutic effects when combined with ultrasound-guided SGB in alleviating misery of patients.

ZusammenfassungDie allogene hämatopoietische Stammzelltransplantation (allo-SZT) stellt eine komplexe Therapie mit vielen auch gastrointestinalen Nebenwirkungen und Komplikationen dar. Eine frühzeitige Diagnose und Behandlung von mit allo-SZT assoziierten Komplikationen ist daher von großer Bedeutung, um das Überleben dieser Patienten zu verbessern. Die Sonografie stellt eine schnell verfügbare Methode dar, die am Krankenbett durchgeführt werden kann. In den Händen eines sonografieerfahrenen Untersuchers können wichtige transplantationsbedingte Komplikationen sofort diagnostiziert oder ausgeschlossen werden. Das Ziel der Arbeit ist es, den diagnostischen und klinischen Wert von Ultraschall vor, während und nach der allo-SZT darzustellen.

Severe allergic reactions to vaccines are very rare Single severe reactions have occurred worldwide after vaccination with the new mRNA-based COVID-19 vaccines PEG2000 is discussed as a possible trigger We provide guidance on risk assessment regarding COVID-19 vaccination in patients with allergic diseases and suggest a standardized, resource-oriented diagnostic and therapeutic procedure Reports of severe allergic reactions in the context of COVID-19 vaccination can be made via www anaphylaxie net using an online questionnaire

Distal clavicle resection is an accepted surgical treatment option for unremitting acromioclavicular joint arthritis. Indirect arthroscopic approach is preferred when an additional subacromial or glenohumeral diagnostic or therapeutic procedure is contemplated. However, concomitant subacromial decompression and acromial overhang removal, which is integral to indirect approach vis-a-vis direct approach, have additional risks of stiffness and acromial fracture. A modification in indirect approach technique is demonstrated which not only reduces these risks but also improves accuracy and safety of distal clavicle resection. The pros and cons are discussed in detail with reference to relevant literature.

The variety of etiological factors contributing to the development of distal bite various form, as well as the structures that are affected by the disorders determine the deegre of complexity of the malocclusion itself, and thus the choice of therapeutic procedure by which it will be treated. An 11-year-old female patient was diagnosed with this type of malocclusion with a certain degree of presence of other irregularities. After a detailed diagnostic procedure, and determining the type of growth, we approach the therapeutic procedure in two phases. By applying the funcional therapy in the first phase, we correct the vertical growth type, and then in the second phase of therapy using a fixed technique we achieve harmonious intermaxillary relations, an adequate molar and canine Class I relationship as well, thus improving the aesthetics of the patient's face.

Severe allergic reactions to vaccines are very rare. Single severe reactions have occurred worldwide after vaccination with the new mRNA-based COVID-19 vaccines. PEG2000 is discussed as a possible trigger. We provide guidance on risk assessment regarding COVID-19 vaccination in patients with allergic diseases and suggest a standardized, resource-oriented diagnostic and therapeutic procedure. Reports of severe allergic reactions in the context of COVID-19 vaccination can be made via www.anaphylaxie.net using an online questionnaire.

Bronchoscopy is an extremely useful diagnostic and therapeutic procedure that finds an invaluable place in Pulmonology practice. Due to aerosol generation, bronchoscopy carries a high risk of infection transmission to health care workers and other patients. This fact is even more important in the present times of COVID-19 pandemic owing to its droplet- (and possibly aerosol-) mediated spread. With this background, a working group extracted literature through electronic search of PubMed and Google Scholar databases. All relevant documents were comprehensively reviewed and consensus recommendations formulated based on the level of available evidence. Where evidence was insufficient, Usual Practice Points were formulated based on expert opinion. This resultant document attempts to present clinical recommendations for performing flexible bronchoscopy in COVID-19 suspect/confirmed patients. It outlines important general considerations for bronchoscopy in these cases, provides an algorithmic approach to patient selection for bronchoscopy during these extraordinary times, and enlists critical do's and don'ts that should be followed before, during, and after the procedure. To conclude, flexible bronchoscopy must be cautiously performed amid the COVID-19 crisis. Judicious case selection and meticulous contact and airborne precautions are important to minimise infection transmission.

The evolution of endoscopic ultrasound (EUS) from a diagnostic to a therapeutic procedure has resulted in a paradigm shift toward endoscopic management of disease states that previously required percutaneous or surgical approaches. The past few years have seen additional techniques and devices that have enabled endoscopists to expand its diagnostic and therapeutic capabilities. Some of these techniques initially were reported more than a decade ago; however, with further device development and refinement in techniques there is potential for expanding the application of these techniques and new technologies to a broader group of interventional gastroenterologists. Lack of formalized training, devices, and prospective data regarding their use in addition to a scarcity of guidelines on implementation of these technologies into clinical practice are contributing factors impeding the growth of the field of interventional EUS. In April 2019, the American Gastroenterological Association's Center for Gastrointestinal Innovation and Technology conducted its annual Tech Summit and a key session focused on interventional EUS. This article is a White Paper generated from the conference, discusses the published literature pertaining to the topic of interventional EUS, and outlines a proposed framework for the implementation of interventional EUS techniques into clinical practice. Three primary areas of interventional EUS are addressed: (1) EUS-guided access; (2) EUS-guided tumor ablation; and (3) endohepatology. There was general agreement among participants on several key components. The introduction of these novel interventions requires better tools, more data on safety/outcomes, and improved training for endoscopists. Participants also agreed that widespread implementation and use of these techniques will require support from Gastrointestinal Societies and other key stakeholders including payers. Continued work by the Gastrointestinal Societies and manufacturers to provide training programs, appropriate equipment/work environments, and policies that motivate endoscopists to adopt new techniques is essential for growing the field of interventional EUS.

Was ist neu? Vortestwahrscheinlichkeit In den aktualisierten Leitlinien der Europäischen Gesellschaft für Kardiologie (European Society of Cardiology, ESC) wird die stabile koronare Herzkrankheit zum chronischen Koronarsyndrom (CCS) umbenannt. Unter CCS werden 6 verschiedene Szenarien definiert, die der Heterogenität Rechnung tragen. Die diagnostische Beurteilung der Vortestwahrscheinlichkeit spielt auch in der aktuellen Leitlinie bei möglichem Vorliegen einer stenosierenden KHK eine wichtige Rolle. Die Hinzunahme von Dyspnoe und der klinischen Wahrscheinlichkeit als zusätzliche Variablen zur besseren Abschätzung der Vortestwahrscheinlichkeit sind 2 wichtige Neuerungen. Diagnostische Verfahren Bildgebende Verfahren wie die CT-Angiografie wurden als diagnostische Verfahren zur Detektion von KHK deutlich aufgewertet, während das Belastungs-EKG diesbezüglich nicht mehr routinemäßig empfohlen wird. Die invasive Koronarangiografie mit Revaskularisationsoption bleibt ein zentrales diagnostisches und therapeutisches Verfahren. Therapie Neben der antianginösen, lipidsenkenden und antithrombotischen Therapie wird in der aktuellen CCS-Leitlinie ein besonderes Augenmerk auf Prävention mittels Lebensstilmodifikation gelegt.

Liver transplantation has become established as a standard procedure in the treatment of end-stage liver diseases. Despite intense efforts by all parties involved up to the amendment of the German Transplantation Act, the lack of suitable donor organs was still one of the limiting factors of this therapeutic procedure. One way out of this problem is to make so-called marginal organs usable, e.g. with the help of machine perfusion or by utilizing living liver donation, which are used in some countries for more than 90% of organ donations. In general, there is no difference in the indications for liver transplantation between a (partial) organ obtained by post-mortem or living donation. Before any living donation, a thorough evaluation of the donor is carried out in order to minimize postoperative morbidity as far as possible. Technically the partial liver donation is based on the oncological liver resection, while the partial liver transplantation is a further development of split liver transplantation after post-mortem liver donation. In specialized centers comparable or even better results can nowadays be achieved using living liver donation instead of post-mortem donation.

Hip arthroscopy is a minimally invasive therapeutic and diagnostic procedure appropriate for an evolving list of conditions. It is routinely used for the treatment of intra- and extra-articular pathology of the hip joint. The development of endoscopy paved the way for the development of arthroscopy. Hip arthroscopy was first described in 1931 by Michael Burman, and its widespread adoption was only achieved some 60 years later during the 1990s. Dr. Watanabe, from Japan, has been credited with the development of modern arthroscopy for his work in developing a practical arthroscope and advancement of both explorative arthroscopy and surgical arthroscopic techniques. More recently, the use of distraction proved as a significant step in the utility of hip arthroscopy and paved the way for future innovations in the procedure. The authors provide a brief overview of the history hip arthroscopy, relevant developments which have paved the way for this procedure and the current state of arthroscopy as a diagnostic and therapeutic procedure.

Colonoscopy is a routine diagnostic and therapeutic procedure. Along with the increase in the complexity of the procedures performed, the risk of complications increases. In 2017, WSES (World Society of Emergency Surgery) published the principles of safe colonoscopy. Intestinal perforation is one of the most common complications. The risk of perforation in treatment procedures such as mucosectomy or endoscopic dissection is significantly greater than the risk of diagnostic colonoscopy. The basic rule of procedure in case of suspected perforation is close supervision over the patient's condition and as soon as possible repair of damage. The role of the endoscopist is not only to recognize, but also to treat the damage early. Immediate endoscopic treatment of lesions is an effective, final and acceptable management strategy. In patients who have undergone imaging diagnostics for another reason free gas in the peritoneal cavity can be recognized. It does not have to mean the need for urgent surgical intervention. Patients with asymptomatic pneumoperitoneum after colonoscopy should, however, be treated as patients with suspected perforation of the large intestine and undergo careful clinical observation in accordance with WSES recommendations. Colonoscopy is a procedure with a risk of complications, which should be reported to patients qualified for endoscopy, but appropriate management reduces the risk of morbidity and mortality associated with this procedure.

Pneumonia associated with the 2019 novel coronavirus (2019-nCoV) is continuously and rapidly circulating at present. No effective antiviral treatment has been verified thus far. We report here the clinical characteristics and therapeutic procedure for four patients with mild or severe 2019-nCoV pneumonia admitted to Shanghai Public Health Clinical Center. All the patients were given antiviral treatment including lopinavir/ritonavir (Kaletra®), arbidol, and Shufeng Jiedu Capsule (SFJDC, a traditional Chinese medicine) and other necessary support care. After treatment, three patients gained significant improvement in pneumonia associated symptoms, two of whom were confirmed 2019-nCoV negative and discharged, and one of whom was virus negative at the first test. The remaining patient with severe pneumonia had shown signs of improvement by the cutoff date for data collection. Results obtained in the current study may provide clues for treatment of 2019-nCoV pneumonia. The efficacy of antiviral treatment including lopinavir/ritonavir, arbidol, and SFJDC warrants further verification in future study.

Ultrasound-activated therapies have been regarded as the efficient strategy for tumor treatment, among which sonosensitizer-enabled sonodynamic oxidative tumor therapy features intrinsic advantages as compared to other exogenous trigger-activated dynamic therapies. Nanomedicine-based nanosonosensitizer design has been extensively explored for improving the therapeutic efficacy of sonodynamic therapy (SDT) of tumor. This review focuses on solving two specific issues, i.e., precise and enhanced sonodynamic oxidative tumor treatment, by rationally designing and engineering multifunctional composite nanosonosensitizers. This multifunctional design can augment the therapeutic efficacy of SDT against tumor by either improving the production of reactive oxygen species or inducing the synergistic effect of SDT-based combinatorial therapies. Especially, this multifunctional design is also capable of endowing the nanosonosensitizer with bioimaging functionality, which can effectively guide and monitor the therapeutic procedure of the introduced sonodynamic oxidative tumor treatment. The design principles, underlying material chemistry for constructing multifunctional composite nanosonosensitizers, intrinsic synergistic mechanism, and bioimaging guided/monitored precise SDT are summarized and discussed in detail with the most representative paradigms. Finally, the existing critical issues, available challenges, and potential future developments of this research area are also discussed for promoting the further clinical translations of these multifunctional composite nanosonosensitizers in SDT-based tumor treatment.

Summary Medical procedures can disperse infectious agents and spread disease. Particularly, dental procedures may pose a high risk of disease transmission as they use high-powered instruments operating within the oral cavity that may contain infectious microbiota or viruses. Here we assess the ability of powered dental devices in removing the biofluid films and identified mechanical, hydrodynamic, and aerodynamic forces as the main underlying mechanisms of removal and dispersal processes. Our results indicate that potentially infectious agents can be removed and dispersed immediately after dental instrument engagement with the adherent biofluid film, while the degree of their dispersal is rapidly depleted owing to the removal of the source and dilution by the coolant water. We found that droplets created by high-speed drill interactions typically travel ballistically, while aerosol-laden air tends to flow as a current over surfaces. Our mechanistic investigation offers plausible routes for reducing the spread of infection during invasive medical procedures., Graphical abstract, Highlights • Mechanical, hydrodynamic, and aerodynamic forces drive removal/dispersal processes • The air-rotor has the highest ability to remove and disperse infectious agents • The aerosol cloud flows as a current and continuously settles • Manipulating rheological properties of the fluids can suppress aerosol generation, Dentistry; Therapeutic procedure; Applied physics

BackgroundPeritonsillar abscess, or quinsy, is one of the most common emergency presentations to ENT departments, and is the most common deep tissue infection of the head and neck. In the UK, junior members of the ENT team are regularly required to independently assess, diagnose and treat patients with peritonsillar aspiration or incision and drainage.IssueInexperienced practitioners can stumble at several obstacles: poor access due to trismus; poor lighting; difficulty in learning the therapeutic procedure; and difficulty in accurately documenting findings and treatment.SolutionTo counter these and other difficulties, the authors describe the routine use of video endoscopy as a training tool and therapeutic adjunct in the management of quinsy.

Arthroscopy was first reported by Severin Nordentoft in Denmark in 1912. However, it was the Japanese surgeons Kenji Takagi and Masaki Watanabe who developed the arthroscopic equipment and techniques that transformed arthroscopy from an unreliable fragile device that provided a dim view of the joint to now be an advanced therapeutic procedure.

Peritoneal carcinomatosis, as well as the presence of liver metastases from colorectal cancer, has been long considered as the sign of a systemic disease, transforming the patient into a candidate for palliation and best supportive care. However, in recent decades, progress in the field of medical and surgical oncology has allowed scientists worldwide to produce curative therapeutic strategies for these cases such as hyperthermic intraperitoneal chemotherapy (HIPEC) or extended liver resection. In addition, the association of these two therapies has also been performed with encouraging results. The aim of the current study was to review articles published thus far in regard to the association of these two therapeutic strategies, in order to identify which cases can benefit the most, which is the most efficient agent or combination of agents, and whether these types of therapy should be performed as monotherapy or as a two-stage procedure.

Non-invasive mechanical ventilation (NIMV) is a therapeutic procedure that aims to supplement or improve ventilatory function. In recent decades, its benefit and multiple indications, have been demonstrated in the treatment of patients with chronic heart failure (CHF) and its acute complications [1]. However, the use of this therapy, in patients with chronic heart failure is not exempt from risks and complications, so it must be carefully individualized and requires close monitoring when ischaemic heart disease and/or arterial hypotension also coexist. Special mention requires the revision of the indication of servo ventilation in patients with severe chronic heart failure, due to its possible adverse effects.

Headaches may appear after performing diagnostic and / or therapeutic procedures with close temporal relationship to these events. The objective of this research was to know the clinical characteristics of headache secondary to diagnostic and / or therapeutic procedures. We reviewed secondary headaches according to ICHD-3, and searched for those that arose after performing a diagnostic and / or therapeutic procedure. A total of 11 different diagnoses of headache attributed to diagnostic and / or therapeutic procedures were found. Some secondary headaches are due to diagnostic and / or therapeutic procedures.

Sentinel node biopsy has dramatically altered the treatment of breast cancer worldwide. The author's investigation into its use in breast cancer began nearly 30 years ago and evolved from simply identifying a node predictive of the axillary status to being a therapeutic procedure eliminating axillary dissection for selected node-negative and some node-positive women. This paper summarizes a personal experience with the evolution of this technique.

Background: Endoscopic retrograde cholangiopancrea-tography (ERCP) is considered as a diagnostic and therapeutic procedure used to treat problems associated with biliary and pancreatic diseases. The benefits of ERCP over surgical treatment are well documented; however, there is complications including infection, pancreatitis, hemorrhage, and perforation can occur even in expert hands. Several factors may affect, such as patient selection, skills of the operator, and the how complex the procedure was. This work studies ERCP compli-cation rates, predictive factors for incidence and management plans to improve outcomes.Aim of Study: To spot complications that happened post-ERCP and how to manage it.Patients and Methods: In a prospective, 2-years study from September 2017 to September 2019 of 50 patients underwent ERCP and notice if complications happened and the risk factors for that complication.Results: 20% had post-ERCP complications, with pancre-atitis (8%), perforation (8%) and infection (cholangitis and cholecystitis) (4%). Perforation was considered the most serious complication of ERCP. It demands early diagnosis and good management. Surgical intervention the urgent solu-tion to manage post-ERCP perforation (3 of the 4 perforated patients underwent surgical intervention.Conclusion: ERCP is a safe and widely used all over the world. To overcome its complications it demands good prep-aration for patients, increase our experience, short procedure especially in risky patients, and close observation post-ERCP patients aiming at early diagnosis of complications and early management if happened.

Plasma exchange (PEX) is a therapeutic procedure used to treat diseases caused by pathogenic antibodies or immune-complexes through the removal and the replacement of plasma. The frequency of complications and reactions associated with PEX are mild and of limited duration. In systemic autoimmune diseases and in a variety of other conditions, PEX might be use in association with intravenous immunoglobulin (IVIg) or therapeutic monoclonal antibodies for the management of acute or refractory patients to achieve a durable remission.

Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure that is widely used by endoscopists and has a robust therapeutic profile. It uses endoscopy and imaging for a variety of diagnostic as well as therapeutic purposes. It is used for the management of a lot of pancreaticobiliary diseases such as obstructive jaundice, obstruction related to bile ducts, pancreatic biliary tumors, and traumatic or iatrogenic damage to the bile ducts. Other therapeutic interventions that can be done via ERCP include sphincterotomy, dilation of strictures, removal of biliary stones and placement of stents. Air embolism presents with cardiovascular, pulmonary, and neurologic signs and symptoms. Treatment of air embolism should be started early in suspected cases, and it should be in the differential diagnoses of various complications secondary to high risk of ERCP, especially if a cardiopulmonary compromise is present. Air embolism is rare but a serious complication associated with ERCP. The physicians must keep this in mind while performing ERCP in patients with predisposing risk factors. This review highlights the mechanism, causes, risk factors, pathophysiology, clinical signs, diagnostic modalities, treatment, and preventive measures to deal with this catastrophic complication.

Background Pyogenic spondylodiscitis is diagnosed in recent years at higher rates due to the aging population, increased survival of chronic and immune suppressed patients, and the higher rate of invasive procedures leading to bacterial seeding or direct contamination of the disc space. Treatment guidelines encourage bacterial sampling before initiation of antibiotic therapy, and drainage of pus collections. We present our experience with percutaneous CT-guided drain insertion into the disc space itself as a one-step procedure for both culturing and subsequent continuous drainage of the infected disc space. Materials and methods We retrospectively reviewed all cases of pyogenic spondylodiscitis admitted to our spine surgery unit during the past five years and treated with CT-guided percutaneous drain insertion into the infected disc space. All patients were followed until complete resolution of the infection. Results We retrieved electronic records of 12 patients, none presenting with neurological compression symptoms. Cultures taken at the time of drain insertion were positive in 10 patients (83.3%), much higher than the reported yield for needle aspiration (14–48%) and comparable to the yield of open biopsy. In all patients complete resolution of the infection was reached, determined by clinical, laboratory, and imaging parameters. Conclusions Our retrospective case series demonstrates the feasibility and effectiveness of intra-discal CT-guided drainage of an infected disc space. The procedure does not add much burden to current practice as disc-space sampling for culture is commonly performed anyway, and adds the benefit of direct drainage of the pus at its source.

Whole lung lavage (WLL) is a therapeutic procedure to remove accumulated material by infusing and draining the lungs with lavage fluid. This procedure has been regarded as the current standard of care to treat pulmonary alveolar proteinosis. However, the WLL protocol has not yet been standardized and the technique has been refined and modified a number of times. A rapid infusion system is a device used to infuse blood or other fluids at precise rates and normothermic conditions. This device is not typically used in WLL, which relies on the passive infusion of fluids using the gravitational force. However, in this study we performed WLL using a rapid infusion system, since we aimed to take advantage of its shorter operation time and greater degree of control over fluid volume and temperature. The patient's symptoms improved without the occurrence of any complications.

Insight into how cognitive behavioral therapy (CBT) works is urgently needed to improve depressive outcome. First, we discuss the role of learning in CBT for depression by reviewing evidence for learning processes involved in the development and maintenance of depression. Second, we investigate the role of learning capacity as a moderator by reviewing empirical evidence for the relation between (a) CBT procedures and learning processes, (b) learning processes and CBT treatment processes, and (c) learning processes and CBT outcome. We propose that learning capacity moderates the relation between CBT procedures and change in CBT treatment processes and explains why therapeutic procedures lead to process change and long-term success in some but not all patients. Third, we identify procedures that lead to successful therapeutic learning and describe how experimental studies help to better explain causal mechanisms of change and the role of learning capacity in CBT for depression.

BACKGROUND: Therapeutic Plasma Exchange (TPE) is an apheresis treatment in which the plasma component of blood is removed and replaced with supplemental fluids. It is an immunomodulatory treatment that has been reported to be a successful therapeutic procedure for the treatment of severely compromised patients with myasthenia gravis when given at short intervals. TPE is known to have a comparable efficacy to intravenous immunoglobulin (IVIG) in the treatments of patients with moderate to severe myasthenia crisis. METHODOLOGY: We report a case of a 47year old male patient with severe myasthenia crisis. He was managed using cobe spectra version 6.1 to carry out an automated TPE, with a suboptimal response and subsequent use of IVIG resulting in full recovery. This report highlights the possible factors that may hinder optimal response of a patient with Myasthenia crisis to TPE procedure in a poor resource setting. CONCLUSION: TPE is an essential immunomodulatory therapy in the management of acute myasthenia crisis whether given alone or in combination with immunosuppressive drugs. There can be a rebound overproduction of the offending autoantibodies in MG following TPE which can be cleared from circulation using immunosuppressive therapy.

Insight into how cognitive behavioral therapy (CBT) works is urgently needed to improve depressive outcome. First, we discuss the role of learning in CBT for depression by reviewing evidence for learning processes involved in the development and maintenance of depression. Second, we investigate the role of learning capacity as a moderator by reviewing empirical evidence for the relation between (a) CBT procedures and learning processes, (b) learning processes and CBT treatment processes, and (c) learning processes and CBT outcome. We propose that learning capacity moderates the relation between CBT procedures and change in CBT treatment processes and explains why therapeutic procedures lead to process change and long-term success in some but not all patients. Third, we identify procedures that lead to successful therapeutic learning and describe how experimental studies help to better explain causal mechanisms of change and the role of learning capacity in CBT for depression.

The role of endoscopic retrograde cholangiopancreatography (ERCP) has dramatically changed in the last years, mainly into that of a therapeutic procedure. The treatment of benign biliary disease, like “difficult” choledocolithiasis, with endoscopic papillary large balloon dilation combined with endoscopic sphinterotomy has proven an effective and safe technique. Moreover, safety in ERCP has improved as well, with the prevention of post-ERCP pancreatitis and patient-to-patient transmission of infections. The advent of self-expandable metal stenting has radically changed the management of biliopancreatic malignant strictures, while the role for therapy of benign strictures is still controversial. In addition, cholangioscopy (though the direct visualization of the biliopancreatic ductal system) has allowed for characterization of indeterminate biliary strictures and facilitated rescue therapy of large biliary stones deemed removable. Encouraging data from tissue ablation techniques, such as photodynamic therapy and radiofrequency ablation, need to be confirmed by large sample size clinical controlled trials. On the other hand, we have no drug-coated stents yet available to implant and evidence for the use of biodegradable stents is still weak. The competency and privileging of ERCP and endoscopic ultrasonography have been analyzed longer but the switch between the two procedures, at the same time, is becoming ordinary; as such, the endoscopist interested in this field should undergo parallel edification through training plans. Finally, the American Society for Gastrointestinal Endoscopy’s statement on non-anesthesiologist administration of propofol for gastrointestinal endoscopy is not actually endorsed by the European Society of Anaesthesiology, having many medical-legal implications in some European countries.

Mirror therapy is a non-invasive and inexpensive therapeutic procedure indicated for the treatment of post-amputation phantom limb pain. This technique has proven its effectiveness and consists of bringing into play brain plasticity in order to reshape the central body architecture after amputation. This is a quantitative and descriptive study, which aims to objectify the use of mirror therapy on phantom pain in amputees, by combining the results in order to evaluate its effects, its application and its limits in the management of post-amputation.

Background/aim Leptomeningeal carcinomatosis (LMC) with hydrocephalus is particularly difficult to treat, and its prognosis is extremely poor. The therapeutic outcomes of 14 patients with LMC-associated hydrocephalus who were treated with cerebrospinal fluid shunting are reported. Patients and methods The study subjects were 14 LMC patients with solid primary cancer who had developed hydrocephalus. Results Postoperatively, both symptoms and Karnofsky performance status improved in 100% of patients. Postoperative therapy consisted of whole-brain radiotherapy in 4 cases and molecular targeted therapy in 4, with 6 patients not receiving any postoperative treatment. Median overall survival was 3.7 months, with no significant difference between those who underwent postoperative therapy and those who did not. However, two of those who received molecular targeted therapy survived for more than one year. Conclusion Cerebrospinal fluid shunting for LMC-associated hydrocephalus is an effective therapeutic procedure from the palliative viewpoint. Patients for whom molecular targeted therapy is indicated may have better long-term survival.