The Effect of Endovascular Revascularization of Common Iliac Artery Occlusions on Erectile Function

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Gur, Serkan, E-mail: mserkangur@yahoo.com [Sifa Hospital, Department of Radiology (Turkey); Ozkan, Ugur [Baskent University, Department of Radiology, Faculty of Medicine (Turkey); Onder, Hakan; Tekbas, Gueven [Dicle University, Department of Radiology, Faculty of Medicine (Turkey); Oguzkurt, Levent [Baskent University, Department of Radiology, Faculty of Medicine (Turkey)

2013-02-15

To determine the incidence of erectile dysfunction in patients with common iliac artery (CIA) occlusive disease and the effect of revascularization on erectile function using the sexual health inventory for males (SHIM) questionnaire. All patients (35 men; mean age 57 {+-} 5 years; range 42-67 years) were asked to recall their sexual function before and 1 month after iliac recanalization. Univariate and multivariate analyses were performed to determine variables effecting improvement of impotence. The incidence of impotence in patients with CIA occlusion was 74% (26 of 35) preoperatively. Overall 16 (46%) of 35 patients reported improved erectile function after iliac recanalization. The rate of improvement of impotence was 61.5% (16 of 26 impotent patients). Sixteen patients (46%), including seven with normal erectile function before the procedure, had no change. Three patients (8%) reported deterioration of their sexual function, two of whom (6%) had normal erectile function before the procedure. The median SHIM score increased from 14 (range 4-25) before the procedure to 20 (range 1-25) after the procedure (P = 0.005). The type of recanalization, the age of the patients, and the length of occlusion were related to erectile function improvement in univariate analysis. However, these factors were not independent factors for improvement of erectile dysfunction in multivariate analysis (P > 0.05). Endovascular recanalization of CIA occlusions clearly improves sexual function. More than half of the patients with erectile dysfunction who underwent endovascular recanalization of the CIA experienced improvement.

UVB-activated psoralen reduces luminal narrowing after balloon dilation because of inhibition of constrictive remodeling

NARCIS (Netherlands)

Perrée, Jop; van Leeuwen, Ton G.; Velema, Evelyn; Smeets, Mirjam; de Kleijn, Dominique; Borst, Cornelius

2002-01-01

In this study we have explored the potential of PUVB (8-MOP + UVB) therapy for the reduction of luminal narrowing after arterial injury. In 15 rabbits, balloon dilation of iliac arteries was performed. In 20 arteries, dilation was combined with the delivery of pulsed ultraviolet light B (UVB)

Endoluminal embolization of bilateral atherosclerotic common iliac aneurysms with fibrin tissue glue (Beriplast)

International Nuclear Information System (INIS)

Beese, Richard C.; Tomlinson, Mark A.; Buckenham, Timothy M.

2000-01-01

The standard surgical approach to nonleaking iliac aneurysms found at repair of a leaking abdominal aortic aneurysm is to minimize the operative risk by repairing the abdominal aorta only. This means that the bypassed iliac aneurysms may have to be repaired later. As this population of patients are usually elderly with coexisting medical problems, interventional radiology is being used to embolize these aneurysms, thus avoiding the morbidity and mortality associated with further general anesthesia and surgery. Various materials and stents have been reported to be effective in the treatment of iliac aneurysms. We report the successful use of endoluminal fibrin tissue glue (Beriplast) to treat two large iliac aneurysms in a patient who had had a previous abdominal aortic aneurysm repair. We discuss the technique involved and the reasons why we used tissue glue in this patient.

A quadriplegic patient's cholescintigraphic findings: delayed gallbladder visualization and common bile duct dilation.

Science.gov (United States)

Shih, W. J.; Magoun, S.; Lu, G.

1996-01-01

A Tc-99m DISIDA cholescintigraphic study of a 37-year-old patient with a 20-year history of quadriplegia demonstrated dilation of the common bile duct and delayed gallbladder visualization. A concurrent sonographic study showed an enlarged gallbladder with stones and dilation of the common bile duct. These findings were proved by autopsy. Quadriplegia secondary to a high level of spinal cord injury may result in gallbladder dysfunction. Images Figure PMID:8776068

Perigraft Plug Embolization of the Internal Iliac Artery and Implantation of a Bifurcated Stentgraft: One Treatment Option for Insufficient Tubular Stentgraft Repair of a Common Iliac Artery Aneurysm

Energy Technology Data Exchange (ETDEWEB)

Goltz, Jan Peter, E-mail: janpeter.goltz@uksh.de; Loesaus, Julia; Frydrychowicz, Alex; Barkhausen, Jörg [University Hospital of Schleswig-Holstein, Department for Radiology and Nuclear Medicine (Germany); Wiedner, Marcus [University Hospital of Schleswig-Holstein, Clinic for Surgery (Germany)

2016-02-15

We report an endovascular technique for the treatment of type Ia endoleak after a plain tubular stentgraft had been implanted for a large common iliac artery aneurysm with an insufficient proximal landing zone and without occlusion of the hypogastric in another hospital. CT follow-up showed an endoleak with continuous sac expansion over 12 months. This was classified as type Ia by means of dynamic contrast-enhanced MRI. Before a bifurcated stentgraft was implanted to relocate the landing zone more proximally, the still perfused ipsilateral hypogastric artery was embolized to prevent a type II endoleak. A guidewire was manipulated alongside the indwelling stentgraft. The internal iliac artery could then be selectively intubated followed by successful plug embolization of the vessel’s orifice despite the stentgraft being in place.

Treatment of Ureterointestinal Anastomotic Strictures by Diathermal or Cryoplastic Dilatation

International Nuclear Information System (INIS)

Orsi, Franco; Penco, Silvia; Matei, Victor; Bonomo, Guido; Vigna, Paolo Della; Monfardini, Lorenzo; Cobelli, Ottavio De

2007-01-01

Background. Ureterointestinal anastomotic strictures (UAS) complicate 10-15% of surgeries for urinary diversion and are the main cause of deterioration in renal function. Treatments are surgical revision, management with autostatic stent, balloon dilatation, endoscopic incision, and percutaneous transrenal diathermy (Acucise). A new option is cryoplastic dilatation (Polar-Cath). Purpose. To assess the feasibility, complications, and preliminary results of UAS treatment using the Acucise and Polar-Cath systems. Methods. Nineteen UAS, diagnosed by ultrasonography or computed tomography and sequential renal scintigraphy, occurred in 15 cancer patients after radical cystectomy and urinary diversion. Fifteen were managed with balloon diathermy and 4 by balloon cryoplasty in a three-stage procedure-percutaneous nephrostomy, diathermal or cryoplastic dilatation, and transnephrostomic control with nephrostomy removal-each separated by 15 days. All patients gave written informed consent. Results. Dilatations were successful in all cases. The procedure is simple and rapid (about 45 min) under fluoroscopic control and sedation. Procedural complications occurred in 1 (5%) patient with UAS after Wallace II uretero-ileocutaneostomy: a common iliac artery lesion was induced by diathermal dilatation, evident subsequently, and required surgical repair. Patency with balloon diathermy was good, with two restenoses developing over 12 months (range 1-22) of follow-up. With balloon cryoplastic dilatation, one restenosis developed in the short term; follow-up is too brief to assess the long-term efficacy. Conclusion. Our short-term results with diathermal and cryoplastic dilatation to resolve UAS are good. If supported by longer follow-up, the techniques may be considered as first-choice approaches to UAS. Surgery should be reserved for cases in which this minimally invasive technique fails

Common iliac vein thrombosis as a result of proximal venous stenosis following renal transplantation: A case report

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Atish Chopra

2016-12-01

Full Text Available Proximal iliac vein stenosis resulting in iliac vein thrombus and venous outflow obstruction in renal transplant patients is an exceedingly rare occurrence. We present a case of a 63-year-old male who underwent deceased donor renal transplantation and presented 12 days later with ipsilateral lower extremity swelling and plateauing serum creatinine. Further work-up demonstrated proximal iliac vein deep venous thrombosis and anticoagulation was initiated. However, propagation of the thrombus developed despite receiving therapeutic anticoagulation. Subsequent venography demonstrated proximal iliac venous stenosis and the patient underwent successful catheter-directed alteplase thrombolysis, inferior vena cava filter placement and iliac vein stenting with salvage of the renal allograft. A diagnostic strategy and management algorithm for iliac vein stenosis and thrombosis in a renal transplant recipient is proposed.

Fracture and Collapse of Balloon-Expandable Stents in the Bilateral Common Iliac Arteries Due to Shiatsu Massage

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Ichihashi, Shigeo, E-mail: shigeoichihashi@yahoo.co.jp; Higashiura, Wataru; Itoh, Hirofumi; Sakaguchi, Shoji; Kichikawa, Kimihiko [Nara Medical University, Department of Radiology (Japan)

2012-12-15

We report a case of stent fracture and collapse of balloon-expandable stents caused by shiatsu massage. A 76-year-old man presented with complaints of intermittent claudication of the right lower extremity. Stenoses of the bilateral common iliac arteries (CIAs) were detected. Balloon-expandable stents were deployed in both CIAs, resulting in resolution of symptoms. Five months later, pelvis x-ray showed collapse of both stents. Despite the stent collapse, the patient was asymptomatic, and his ankle brachial index values were within the normal range. Further history showed that the patient underwent daily shiatsu therapy in the umbilical region, which may have triggered collapse of the stent. Physicians should advise patients to avoid compression of the abdominal wall after implantation of a stent in the iliac artery.

Fracture and Collapse of Balloon-Expandable Stents in the Bilateral Common Iliac Arteries Due to Shiatsu Massage

International Nuclear Information System (INIS)

Ichihashi, Shigeo; Higashiura, Wataru; Itoh, Hirofumi; Sakaguchi, Shoji; Kichikawa, Kimihiko

2012-01-01

We report a case of stent fracture and collapse of balloon-expandable stents caused by shiatsu massage. A 76-year-old man presented with complaints of intermittent claudication of the right lower extremity. Stenoses of the bilateral common iliac arteries (CIAs) were detected. Balloon-expandable stents were deployed in both CIAs, resulting in resolution of symptoms. Five months later, pelvis x-ray showed collapse of both stents. Despite the stent collapse, the patient was asymptomatic, and his ankle brachial index values were within the normal range. Further history showed that the patient underwent daily shiatsu therapy in the umbilical region, which may have triggered collapse of the stent. Physicians should advise patients to avoid compression of the abdominal wall after implantation of a stent in the iliac artery.

Effect of cause of iliac vein stenosis and extent of thrombus in the lower extremity on patency of iliac venous stent placed after catheter-directed thrombolysis of acute deep venous thrombosis in the lower extremity

International Nuclear Information System (INIS)

Jung, Sung Il; Choi, Young Ho; Yoon, Chang Jin; Lee, Min Woo; Chung, Jin Wook; Park, Jae Hyung

2003-01-01

To assess the CT findings of acute deep venous thrombosis (DVT) in a lower extremity prior to catheter-directed thrombolysis, and to evaluate their relevance to the patency of an iliac venous stent placed with the help of CT after catheter-directed thrombolysis of DVT. Fourteen patients [M:F=3:11; age, 33-68 (mean, 50.1) years] with acute symptomatic DVD of a lower extremity underwent CT before and after catheter-directed thrombolysis using an iliac venous stent. The mean duration of clinical symptoms was 5.0 (range, 1-14 days. The CT findings prior to thrombolysis were evaluated in terms of their anatomic cause and the extent of the thrombus, and in all patients, the patency of the iliac venous stent was assessed at CT performed during a follow-up period lasting 6-31 (mean, 18.9) months. All patients were assigned to the patent stent group (n=9) or the occluded stent group (n=5). In the former, the anatomic cause of patency included typical iliac vein compression (May-Thurner syndrome) (n=9), and a relatively short segmental thrombus occurring between the common iliac and the popliteal vein (n=8). Thrombi occurred in the iliac vein (n=3), between the common iliac and the femoral vein (n=3), and between the common iliac and the popliteal vein (n=2). In one case, a relatively long segmental thrombus occurred between the common iliac vein and the calf vein. In the occluded stent group, anatomic causes included atypical iliac vein compression (n=3) and a relatively long segmental thrombus between the common iliac and the calf vein (n=4). Typical iliac vein compression (May-Thurner syndrome) occurred in two cases, and a relatively short segmental thrombus between the external iliac and the common femoral vein in one. Factors which can affect the patency of an iliac venous stent positioned after catheter-directed thrombolysis are the anatomic cause of the stenosis, and the extent of a thrombus revealed at CT of acute DVT and occurring in a lower extremity prior to

Effect of cause of iliac vein stenosis and extent of thrombus in the lower extremity on patency of iliac venous stent placed after catheter-directed thrombolysis of acute deep venous thrombosis in the lower extremity

Energy Technology Data Exchange (ETDEWEB)

Jung, Sung Il; Choi, Young Ho; Yoon, Chang Jin; Lee, Min Woo; Chung, Jin Wook; Park, Jae Hyung [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

2003-10-01

To assess the CT findings of acute deep venous thrombosis (DVT) in a lower extremity prior to catheter-directed thrombolysis, and to evaluate their relevance to the patency of an iliac venous stent placed with the help of CT after catheter-directed thrombolysis of DVT. Fourteen patients [M:F=3:11; age, 33-68 (mean, 50.1) years] with acute symptomatic DVD of a lower extremity underwent CT before and after catheter-directed thrombolysis using an iliac venous stent. The mean duration of clinical symptoms was 5.0 (range, 1-14 days. The CT findings prior to thrombolysis were evaluated in terms of their anatomic cause and the extent of the thrombus, and in all patients, the patency of the iliac venous stent was assessed at CT performed during a follow-up period lasting 6-31 (mean, 18.9) months. All patients were assigned to the patent stent group (n=9) or the occluded stent group (n=5). In the former, the anatomic cause of patency included typical iliac vein compression (May-Thurner syndrome) (n=9), and a relatively short segmental thrombus occurring between the common iliac and the popliteal vein (n=8). Thrombi occurred in the iliac vein (n=3), between the common iliac and the femoral vein (n=3), and between the common iliac and the popliteal vein (n=2). In one case, a relatively long segmental thrombus occurred between the common iliac vein and the calf vein. In the occluded stent group, anatomic causes included atypical iliac vein compression (n=3) and a relatively long segmental thrombus between the common iliac and the calf vein (n=4). Typical iliac vein compression (May-Thurner syndrome) occurred in two cases, and a relatively short segmental thrombus between the external iliac and the common femoral vein in one. Factors which can affect the patency of an iliac venous stent positioned after catheter-directed thrombolysis are the anatomic cause of the stenosis, and the extent of a thrombus revealed at CT of acute DVT and occurring in a lower extremity prior to

An unusual case: right proximal ureteral compression by the ovarian vein and distal ureteral compression by the external iliac vein

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Halil Ibrahim Serin

2015-12-01

Full Text Available A 32-years old woman presented to the emergency room of Bozok University Research Hospital with right renal colic. Multidetector computed tomography (MDCT showed compression of the proximal ureter by the right ovarian vein and compression of the right distal ureter by the right external iliac vein. To the best of our knowledge, right proximal ureteral compression by the ovarian vein together with distal ureteral compression by the external iliac vein have not been reported in the literature. Ovarian vein and external iliac vein compression should be considered in patients presenting to the emergency room with renal colic or low back pain and a dilated collecting system.

Duplex-guided percutaneous transluminal angioplasty in iliac arterial occlusive disease.

Science.gov (United States)

Krasznai, A G; Sigterman, T A; Welten, R J; Heijboer, R; Sikkink, C J J M; van de Akker, L H J M; Bouwman, L H

2013-11-01

Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance. Duplex-guided infra-inguinal interventions and access-related interventions have been reported. Duplex-guided iliac interventions have not been performed to any extent because of the anatomic location. In our study we evaluated the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in iliac arteries. From June 2012 until February 2013, 31 patients (35 iliac lesions), underwent DuPTA. Indications ranged from Rutherford 3 to 5. Preoperative evaluation included Ankle Brachial Index (ABI), Duplex and MRA. Procedural success was defined as crossing the lesion with a guidewire and dilating or stenting the lesion. Clinical success was defined as 50% reduction in peak systolic velocity (PSV) or clinical improvement. PSV was evaluated after PTA, then at 2 weeks. Clinical results were assessed 2 weeks after the procedure. Procedural success was achieved in 94% of patients (33/35), all of whom also had clinical success. Post-procedural PSV reduction showed an average improvement of 63% (431 cm/s to 153 cm/s). Mean preoperative ABI was 0.72 and improved to 0.88 postoperatively. PTA using Duplex-guidance in significant iliac stenosis is a safe method with major advantages in patients at high risk for developing contrast-induced nephropathy. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Dual compression is not an uncommon type of iliac vein compression syndrome.

Science.gov (United States)

Shi, Wan-Yin; Gu, Jian-Ping; Liu, Chang-Jian; Lou, Wen-Sheng; He, Xu

2017-09-01

Typical iliac vein compression syndrome (IVCS) is characterized by compression of left common iliac vein (LCIV) by the overlying right common iliac artery (RCIA). We described an underestimated type of IVCS with dual compression by right and left common iliac arteries (LCIA) simultaneously. Thirty-one patients with IVCS were retrospectively included. All patients received trans-catheter venography and computed tomography (CT) examinations for diagnosing and evaluating IVCS. Late venography and reconstructed CT were used for evaluating the anatomical relationship among LCIV, RCIA and LCIA. Imaging manifestations as well as demographic data were collected and evaluated by two experienced radiologists. Sole and dual compression were found in 32.3% (n = 10) and 67.7% (n = 21) of 31 patients respectively. No statistical differences existed between them in terms of age, gender, LCIV diameter at the maximum compression point, pressure gradient across stenosis, and the percentage of compression level. On CT and venography, sole compression was commonly presented with a longitudinal compression at the orifice of LCIV while dual compression was usually presented as two types: one had a lengthy stenosis along the upper side of LCIV and the other was manifested by a longitudinal compression near to the orifice of external iliac vein. The presence of dual compression seemed significantly correlated with the tortuous LCIA (p = 0.006). Left common iliac vein can be presented by dual compression. This type of compression has typical manifestations on late venography and CT.

Effect of aorto-iliac bifurcation and iliac stenosis on flow dynamics in an abdominal aortic aneurysm

Science.gov (United States)

Patel, Shivam; Usmani, Abdullah Y.; Muralidhar, K.

2017-06-01

Physiological flows in rigid diseased arterial flow phantoms emulating an abdominal aortic aneurysm (AAA) under rest conditions with aorto-iliac bifurcation and iliac stenosis are examined in vitro through 2D PIV measurements. Flow characteristics are first established in the model resembling a symmetric AAA with a straight outlet tube. The influence of aorto-iliac bifurcation and iliac stenosis on AAA flow dynamics is then explored through a comparison of the nature of flow patterns, vorticity evolution, vortex core trajectory and hemodynamic factors against the reference configuration. Specifically, wall shear stress and oscillatory shear index in the bulge portion of the models are of interest. The results of this investigation indicate overall phenomenological similarity in AAA flow patterns across the models. The pattern is characterized by a central jet and wall-bounded vortices whose strength increases during the deceleration phase as it moves forward. The central jet impacts the wall of AAA at its distal end. In the presence of an aorto-iliac bifurcation as well as iliac stenosis, the flow patterns show diminished strength, expanse and speed of propagation of the primary vortices. The positions of the instantaneous vortex cores, determined using the Q-function, correlate with flow separation in the bulge, flow resistance due to a bifurcation, and the break in symmetry introduced by a stenosis in one of the legs of the model. Time-averaged WSS in a healthy aorta is around 0.70 N m-2 and is lowered to the range ±0.2 N m-2 in the presence of the downstream bifurcation with a stenosed common iliac artery. The consequence of changes in the flow pattern within the aneurysm on disease progression is discussed.

Effect of aorto-iliac bifurcation and iliac stenosis on flow dynamics in an abdominal aortic aneurysm

International Nuclear Information System (INIS)

Patel, Shivam; Usmani, Abdullah Y; Muralidhar, K

2017-01-01

Physiological flows in rigid diseased arterial flow phantoms emulating an abdominal aortic aneurysm (AAA) under rest conditions with aorto-iliac bifurcation and iliac stenosis are examined in vitro through 2D PIV measurements. Flow characteristics are first established in the model resembling a symmetric AAA with a straight outlet tube. The influence of aorto-iliac bifurcation and iliac stenosis on AAA flow dynamics is then explored through a comparison of the nature of flow patterns, vorticity evolution, vortex core trajectory and hemodynamic factors against the reference configuration. Specifically, wall shear stress and oscillatory shear index in the bulge portion of the models are of interest. The results of this investigation indicate overall phenomenological similarity in AAA flow patterns across the models. The pattern is characterized by a central jet and wall-bounded vortices whose strength increases during the deceleration phase as it moves forward. The central jet impacts the wall of AAA at its distal end. In the presence of an aorto-iliac bifurcation as well as iliac stenosis, the flow patterns show diminished strength, expanse and speed of propagation of the primary vortices. The positions of the instantaneous vortex cores, determined using the Q -function, correlate with flow separation in the bulge, flow resistance due to a bifurcation, and the break in symmetry introduced by a stenosis in one of the legs of the model. Time-averaged WSS in a healthy aorta is around 0.70 N m −2 and is lowered to the range ±0.2 N m −2 in the presence of the downstream bifurcation with a stenosed common iliac artery. The consequence of changes in the flow pattern within the aneurysm on disease progression is discussed. (paper)

Effect of aorto-iliac bifurcation and iliac stenosis on flow dynamics in an abdominal aortic aneurysm

Energy Technology Data Exchange (ETDEWEB)

Patel, Shivam; Usmani, Abdullah Y; Muralidhar, K, E-mail: kmurli@iitk.ac.in [Department of Mechanical Engineering, Indian Institute of Technology Kanpur, Kanpur 208016 (India)

2017-06-15

Physiological flows in rigid diseased arterial flow phantoms emulating an abdominal aortic aneurysm (AAA) under rest conditions with aorto-iliac bifurcation and iliac stenosis are examined in vitro through 2D PIV measurements. Flow characteristics are first established in the model resembling a symmetric AAA with a straight outlet tube. The influence of aorto-iliac bifurcation and iliac stenosis on AAA flow dynamics is then explored through a comparison of the nature of flow patterns, vorticity evolution, vortex core trajectory and hemodynamic factors against the reference configuration. Specifically, wall shear stress and oscillatory shear index in the bulge portion of the models are of interest. The results of this investigation indicate overall phenomenological similarity in AAA flow patterns across the models. The pattern is characterized by a central jet and wall-bounded vortices whose strength increases during the deceleration phase as it moves forward. The central jet impacts the wall of AAA at its distal end. In the presence of an aorto-iliac bifurcation as well as iliac stenosis, the flow patterns show diminished strength, expanse and speed of propagation of the primary vortices. The positions of the instantaneous vortex cores, determined using the Q -function, correlate with flow separation in the bulge, flow resistance due to a bifurcation, and the break in symmetry introduced by a stenosis in one of the legs of the model. Time-averaged WSS in a healthy aorta is around 0.70 N m{sup −2} and is lowered to the range ±0.2 N m{sup −2} in the presence of the downstream bifurcation with a stenosed common iliac artery. The consequence of changes in the flow pattern within the aneurysm on disease progression is discussed. (paper)

Iliac Vein Compression Syndrome due to Bladder Distention Caused by Urethral Calculi

Directory of Open Access Journals (Sweden)

Akiko Ikegami

2015-01-01

Full Text Available We report a rare case of iliac vein compression syndrome caused by urethral calculus. A 71-year-old man had a history of urethral stenosis. He complained of bilateral leg edema and dysuria for 1 week. Physical examination revealed bilateral distention of the superficial epigastric veins, so obstruction of both common iliac veins or the inferior vena cava was suspected. Plain abdominal computed tomography showed a calculus in the pendulous urethra, distention of the bladder (as well as the right renal pelvis and ureter, and compression of the bilateral common iliac veins by the distended bladder. Iliac vein compression syndrome was diagnosed. Bilateral iliac vein compression due to bladder distention (secondary to neurogenic bladder, benign prostatic hyperplasia, or urethral calculus as in this case is an infrequent cause of acute bilateral leg edema. Detecting distention of the superficial epigastric veins provides a clue for diagnosis of this syndrome.

Postoperative follow-up studies in congenital dilatation of the common bile duct using hepatobiliary scintigraphy

Energy Technology Data Exchange (ETDEWEB)

Hirobe, Seiichi; Ishida, Haruo; Hayashi, Akira; Kamagata, Shoichiro; Fuchimoto, Yasufumi; Mizuno, Dai; Yano, Tsunehiro [Tokyo Metropolitan Kiyose Children`s Hospital (Japan); Ishii, Katsumi

1995-03-01

Follow-up studies in congenital dilatation of the common bile duct were done in 20 cases ranging 3 to 20 years after operation. Operative cholangiography had shown dilatation of the intrahepatic bile ducts in 15 patients (75%), of these, 7 patients had cystic dilatation. Five cases of these 7 patients showed prolonged stasis of the nuclide in the cystic dilated intrahepatic bile ducts by {sup 99m}Tc-PMT hepatobiliary scintigraphy in the follow-up studies even at 10 years after operation. But none of 20 cases had complication such as intrahepatic lithiasis, cholangitis, and liver dysfunction. Hepatobiliary scintigraphy could provide moderate anatomic and excellent functional information which were useful for these follow-up studies and careful follow-up should be done in the case of cystic dilatation of the intrahepatic bile ducts. (author).

[Cockett's syndrome, May-Thurner syndrome, or iliac vein compression syndrome].

Science.gov (United States)

Gil Martín, A R; Carreras Aja, M; Arrieta Ardieta, I; Labayen Azparren, I

2014-01-01

Iliac vein compression syndrome (also known as May-Thurner syndrome or Cockett's syndrome) is a rare clinical entity in which the left common iliac vein is compressed when it passes between the right common iliac artery and the spine. The sustained compression and trauma caused by the pulsatile force of the artery on the vein damage the intima and lead to the formation of membranes or bands in the vascular lumen that hinder or obstruct the flow of blood in the vein, favoring thrombus formation. The current treatment strategy of choice is endovascular vein patch angioplasty and stenting with the aim of improving the caliber of the lumen and enabling normal venous drainage. We present two cases of May-Thurner syndrome and review the clinical and CT findings. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: an underdiagnosed entity.

Science.gov (United States)

Hingorani, Anil P; Ascher, Enrico; Marks, Natalie; Shiferson, Alexander; Patel, Nirav; Gopal, Kapil; Jacob, Theresa

2009-09-01

Early limb occlusions following endovascular treatment of aorto-iliac aneurysmal disease is not uncommon (4%-13%). To assess whether the femoral artery entry site could potentially cause this complication, we prospectively evaluated the ipsilateral common femoral artery (CFA) and distal external iliac artery (EIA) with intraoperative duplex scans (IDS). There were 134 patients with infrarenal nonruptured abdominal aorto-iliac aneurysms treated with endografts since 2002 at our institution. Age ranged from 65 to 89 years (mean: 77 +/- 7 years). Aneuryx (n = 41), Zenith (n = 50), and Excluder (n = 43) endografts were used for repair. All procedures were performed via open exposure of the CFA. Introducer diameter varied from 12 mm to 22 mm. All patients underwent IDS of the CFA and distal EIA after repair of the arteriotomies. In 34 patients (25%), we documented intimal dissections causing severe (>70%) stenoses. Of the 271 arteries that were examined, 38 (14%) had abnormal findings that demanded intervention. These were repaired with flap excision, tacking sutures revision, or patch angioplasty (n = 36). Repeat IDS confirmed the adequacy of the repair. No statistical difference was noted if the site of larger introducer sheath and the incidence of flap formation. In addition, 10 small flaps or plaques were visualized but did not create significant stenosis. No differences were noted in the incidence of positive duplex exams between each type graft (P = .4). No early or late iliac limb occlusions were noted. Follow-up of 94% was obtained. Completion arterial duplex scans are helpful in detecting a substantial number of clinically unsuspected technical defects caused by introducer sheaths. Timely diagnosis and repair of these defects may decrease the incidence of early limb occlusion following endograft placement.

EVALUATION OF RIGHT ILIAC FOSSA MASS-A RETROSPECTIVE STUDY

OpenAIRE

Raja Billy Graham; Vijayabhasker

2016-01-01

Mass in right iliac fossa is one of the common clinical surgical entity with varied etiologies, involving intra peritoneal organs like vermiform appendix, caucus, ileum, retroperitoneal structures like kidneys, blood vessels etc., and abdominal wall masses like desmoids tumor. To know the etiology and the various pattern of presentation of right iliac fossa mass in our institution a retrospective study was designed including all adult patients diagnosed to have a mass in right ili...

A novel application of the culotte stent technique to bail out a jailed common iliac artery

Directory of Open Access Journals (Sweden)

Hideto Sangen, MD

2017-12-01

Full Text Available Implanting a self-expandable stent at the ostium of the common iliac artery (CIA may lead to coverage of the orifice of the contralateral CIA. Here, we describe a novel application of the culotte stent technique using a balloon-expandable stent to bail out an ostial stenotic legion of a jailed CIA due to prior self-expandable stent placement. The bilateral CIAs were revascularized by culotte stenting, and patency of the stents was confirmed 3 years after the procedure. The culotte stent technique was successfully applied to an ostial stenotic lesion of a jailed CIA.

Iliac Artery Stent Placement Relieves Claudication in Patients with Iliac and Superficial Femoral Artery Lesions

International Nuclear Information System (INIS)

Ichihashi, Shigeo; Higashiura, Wataru; Itoh, Hirofumi; Sakaguchi, Shoji; Kichikawa, Kimihiko

2013-01-01

Purpose. To evaluate the efficacy of iliac artery stent placement for relief of claudication in patients with both iliac and superficial femoral artery (SFA) lesions. Methods. Stent placement for only iliac artery occlusive disease was performed in 94 limbs (74 patients) with both iliac and SFA occlusive disease on the same limb. All procedures were performed because intermittent claudication did not improve after continuation of antiplatelet medication therapy and home-based exercise for 3 months. Rutherford classification was 2 in 20 limbs and 3 in 74 limbs. Patients with critical limb ischemia were excluded. Median duration of follow-up was 40 months. Primary patency rates of the iliac stent, clinical improvement rates, and risk factors for requiring additional SFA procedures were evaluated. Results. Primary patency rates of the iliac stent at 1, 3, 5, and 7 years were 97, 93, 79, and 79 %, respectively. The initial clinical improvement rate was 87 %. Continued clinical improvement rates at 1, 3, 5, and 7 years were 87, 81, 69, and 66 %, respectively. SFA Trans-Atlantic Inter-Society Consensus (TASC) II C/D lesion was a significant risk factor for requiring additional SFA procedures. Conclusion. Intermittent claudication was relieved by iliac stent placement in most patients with both iliac and SFA lesions. Thus, the indications for treatment of the SFA intended for claudicants should be evaluated after treatment of the iliac lesion.

The use of endoscopic ultrasonography in the diagnosis of the causes of common bile duct dilation

International Nuclear Information System (INIS)

Sajewicz, Z.; Wozniak-Stolarska, B.; Salomon, A.; Poniewierka, E.; Kempinski, R.

2006-01-01

Background. Ultrasonography (US) does not come up to the expectations in the diagnosis of the causes of common bile duct (CBD) dilation. Objectives. An assessment of the usefulness of endoscopic ultrasonography (EUS) in the diagnosis of the causes of CBD dilation. Material and Methods. The authors examined 30 persons (16 females and 14 males) with CBD dilated > 7 mm in US. In these patients the authors performed EUS with the usage of Pentax FG-38UX echoendoscope of 5-10 MHz frequency connected with EUB 6000 Hitachi ultrasonograph looking for the cause of CBD dilation. Findings gathered were verified with the usage of endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP). Results. In 16 patients the authors found stones in CBD. In ERCP or MRCP the frequency of CBD stones was a bit higher. In these examinations CBD stones were found in 18 patients. The authors found out that pancreatic head carcinoma was the cause of CBD dilation in 8 patients; in 2 patients the authors diagnosed ampullary carcinoma and in 1 patient - carcinoma of distal part of CBD. In 1 patient the authors pointed out a benign stricture of CBD with dilation above the stricture. Conclusions. EUS is a useful diagnosing method of the causes of CBD dilation. (authors)

Stent Fracture and Reocclusion After Placement of a Single Self-Expanding Stent in the Common Iliac Artery and Endovascular Treatment

International Nuclear Information System (INIS)

Higashiura, Wataru; Sakaguchi, Shoji; Morimoto, Kengo; Kichikawa, Kimihiko

2008-01-01

We present a case of fracture of a single self-expanding stent placed in the common iliac artery (CIA). An 80-year-old woman underwent placement of a self-expanding stent for CIA occlusion. Stent fracture and reocclusion were detected after 18 months. Successful revascularization was achieved using a stent-in-stent maneuver. The possibility of stent fracture with reocclusion should be considered following treatment with a single self-expanding stent for CIA occlusion.

Sequential Hybrid Repair of Aorta and Bilateral Common Iliac Arteries Secondary to Chronic Aortic Dissection with Extensive Aneurysmal Degeneration in a Marfan Patient.

Science.gov (United States)

Hinojosa, Carlos A; Anaya-Ayala, Javier E; Laparra-Escareno, Hugo; Lizola, Rene; Torres-Machorro, Adriana

2017-09-01

Marfan syndrome is a connective tissue disorder associated with aortic dissection, aneurysmal degeneration and rupture. These cardiovascular complications represent the main cause of mortality, therefore repair is indicated. We present a 35-year-old woman who experienced acute onset of chest pain. Her imaging revealed a chronic DeBakey type I dissection with aortic root dilation and descending thoracic aneurysmal degeneration. She underwent a Bentall procedure and endovascular exclusion of the descending thoracic aortic aneurysm. She was closely followed and 2 years later a computed tomography angiography (CTA) revealed the aneurysmal degeneration of the thoracoabominal aorta and bilateral iliac arteries. The patient underwent a composite reconstruction using multi-visceral branched and bifurcated Dacron grafts. At 5 years from her last surgery, a CTA revealed no new dissection or further aneurysmal degenerations. Aortic disease in Marfan patients is a complex clinical problem that may lead to secondary or tertiary aortic reconstructions; close follow-up is mandatory.

Lower gastrointestinal bleeding due to iliac artery-cecal fistulax: A late presentation of blunt injury abdomen

Directory of Open Access Journals (Sweden)

Ambrish Kumar

2017-01-01

Full Text Available We report a case of an arterio-enteric fistula between an Right iliac artery and otherwise healthy cecum, presenting with torrential lower gastrointestinal bleed in an 14-year-old patient. Whilst fistulization to the aorta and common iliac arteries has been reported, to our knowledge no previous cases of post traumatic fistulization between an right iliac artery and normal cecum has been reported. Successful open exploration primary repair of iliac artery rent with ileostomy and colostomy was done. Later stoma reversal was done successfully.

Hybrid management of a spontaneous ilio-iliac arteriovenous fistula: a case report

LENUS (Irish Health Repository)

O'Brien, Gavin C

2011-08-22

Abstract Introduction Spontaneous iliac arteriovenous fistulae are a rare clinical entity. Such localized fistulation is usually a result of penetrating traumatic or iatrogenic injury. Clinical presentation can vary greatly but commonly includes back pain, high-output congestive cardiac failure and the presence of an abdominal bruit. Diagnosis, therefore, is often incidental or delayed. Case presentation We report a case of a spontaneous ilio-iliac arteriovenous fistula in a 68-year-old Caucasian man detected following presentation with unilateral claudication and congestive cardiac failure. Following computed tomography evaluation, the fistula was successfully treated with a combined endovascular (aorto-uni-iliac device) and open (femoro-femoral crossover) approach. Conclusion Endovascular surgery has revolutionized the management of such fistulae and we report an interesting case of a high-output iliac arteriovenous fistulae successfully treated with a hybrid vascular approach.

Collapse of the balloon-expandable stent in the common iliac artery due to minor external compression in a lean patient

International Nuclear Information System (INIS)

Park, Sung Eun; Choi, Ho Cheol; Choi, Dae Seob; Lee, Sang Min; Lee, Jung Eun; Cho, Su Beom; Ahn, Jong Hwa

2017-01-01

A 60-year-old lean man with claudication due to severe stenosis of the right common iliac artery (CIA) underwent balloon-expandable stent deployment. Nineteen months later, claudication and lower limb ischemia in the patient recurred after minor external pressure and computed tomography indicated collapse of the right CIA stent. We performed balloon angioplasty again and self-expandable stent deployment was performed, and the patient's symptoms were relieved. We suggest that the CIA in a lean person could be susceptible to external pressure

Bi-iliac distance and iliac bone position compared to the vertebral column in normal fetal development

DEFF Research Database (Denmark)

Hartling, U B; Fischer Hansen, B; Skovgaard, L T

2001-01-01

Prenatal standards of bi-iliac width were not found in the literature based on autopsy investigations, nor was the caudo-cranial position of the ilia compared to the vertebral column. The first purpose of the present study was to establish normal standard values for the bi-iliac distance in fetal...... life, the second to evaluate the level of the iliac bones proportional to the ossified vertebral column. Whole body radiographs in antero-posterior projections from 98 human fetuses (36 female and 44 male fetuses, as well as 18 fetuses on which the sex had not been determined) were analyzed...... caliper. The caudo-cranial position of the iliac bones was evaluated. The present study shows that in normal fetal development there is a continuous linear enlargement of the pelvic region in the transverse and vertical planes. The upper iliac contour stays at the level of the first sacral vertebral body...

Hybrid treatment of bullet embolism at the abdominal aortic bifurcation, complicated with thoracoabdominal aorta pseudoaneurysm and common iliac artery occlusion: case report

Directory of Open Access Journals (Sweden)

Patrick Bastos Metzger

2014-03-01

Full Text Available Embolization due to a firearm projectile entering the bloodstream is a rare event that is unlikely to be suspected during initial treatment of trauma patients. We describe and discuss a case of bullet embolism of the abdominal aortic bifurcation, complicated by a pseudoaneurysm of the thoracoabdominal aorta and occlusion of the right common iliac artery, but successfully treated using a combination of endovascular methods and conventional surgery.

Investigation of adverse events associated with an off-label use of arterial stents and CE-marked iliac vein stents in the iliac vein: insights into developing a better iliac vein stent.

Science.gov (United States)

Shida, Takuya; Umezu, Mitsuo; Iwasaki, Kiyotaka

2018-06-01

We analyzed the adverse events associated with an off-label use of arterial stents and CE-marked iliac vein stents for the treatment of iliac venous thromboembolism and investigated their relationships with the anatomical features of the iliac vein, to gain insights into the development of a better iliac vein stent. Reports of adverse events following the use of stents in the iliac vein were retrieved from the Manufacturer and User Facility Device Experience (MAUDE) database that contain suspected device-associated complications reported to the Food and Drug Administration. Data from 2006 to 2016 were investigated. The literature analysis was also conducted using PubMed, Cochrane Library, EMBASE, and Web of Science focusing on English articles published up to 4 October 2016. The analysis of 88 adverse events from the MAUDE database and 182 articles from the literature revealed that a higher number of adverse events had been reported following the use of arterial stents in the iliac vein compared to CE-marked iliac vein stents. While stent migration and shortening were reported only for the arterial stents, stent fracture and compression occurred regardless of the stent type, even though a vein does not pulsate. A study of the anatomical features of the iliac vein implies that bending, compression, and kink loads are applied to the iliac vein stents in vivo. For designing, developing, and pre-clinical testing of stents intended for use in the iliac vein, the above mechanical load environments induced by the anatomical features should be considered.

Collapse of the balloon-expandable stent in the common iliac artery due to minor external compression in a lean patient

Energy Technology Data Exchange (ETDEWEB)

Park, Sung Eun; Choi, Ho Cheol; Choi, Dae Seob; Lee, Sang Min; Lee, Jung Eun [Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju (Korea, Republic of); Cho, Su Beom; Ahn, Jong Hwa [Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon (Korea, Republic of)

2017-08-15

A 60-year-old lean man with claudication due to severe stenosis of the right common iliac artery (CIA) underwent balloon-expandable stent deployment. Nineteen months later, claudication and lower limb ischemia in the patient recurred after minor external pressure and computed tomography indicated collapse of the right CIA stent. We performed balloon angioplasty again and self-expandable stent deployment was performed, and the patient's symptoms were relieved. We suggest that the CIA in a lean person could be susceptible to external pressure.

Transpedal approach for iliac artery stenting: A pilot study

Energy Technology Data Exchange (ETDEWEB)

Zachariah, Jips J., E-mail: jzachariah@chpnet.org [Mount Sinai Beth Israel Hospital, New York, NY (Israel); Ratcliffe, Justin A.; Ruisi, Michael; Puma, Joseph [Mount Sinai Beth Israel Hospital, New York, NY (Israel); Bertrand, Olivier [Quebec Heart and Lung Institute, Quebec (Canada); Kwan, Tak [Mount Sinai Beth Israel Hospital, New York, NY (Israel)

2016-12-15

Objective: To demonstrate the safety and feasibility of the transpedal approach as an alternate arterial access site for iliac artery intervention. Background: The common femoral artery is the traditional access site for the endovascular treatment of iliac artery stenoses. However, this approach is associated with complication rates as high as 2%, including retroperitoneal bleeding which carries high patient morbidity and mortality. Furthermore, the standard femoral approach is associated with longer recovery times and longer time to ambulation which are important considerations especially when performing procedures in an ambulatory setting. Methods: Twelve patients were prospectively followed after treatment for symptomatic iliac artery stenosis via transpedal access. Under ultrasound guidance, one of the pedal arteries was visualized and accessed, and stenting of the iliac arteries were performed as per protocol. The patient was monitored immediately post procedure and clinical follow up was performed at one week and one month later. Results: The average age of the patients was 71 years old. 58% were male. Most patients had Rutherford class III symptoms. Successful stent placement was achieved in all 12 patients via transpedal access. No conversion to femoral access was required. No complications immediately post procedure nor at any time period during follow up were noted. Lower extremity arterial duplex at one month showed patent stents and patent pedal access site vessels in all patients. Conclusion: Transpedal arterial access may be a safe and feasible approach for iliac artery stenting. Given the possible benefits of avoiding femoral artery access, larger studies should be conducted directly comparing the different approaches.

Excessive urinary tract dilatation and proteinuria in pregnancy: a common and overlooked association?

Science.gov (United States)

Piccoli, Giorgina B; Attini, Rossella; Parisi, Silvia; Vigotti, Federica N; Daidola, Germana; Deagostini, Maria Chiara; Ferraresi, Martina; De Pascale, Agostino; Porpiglia, Francesco; Veltri, Andrea; Todros, Tullia

2013-02-27

Proteinuria and dilatation of the urinary tract are both relatively common in pregnancy, the latter with a spectrum of symptoms, from none to severe pain and infection. Proteinuria is a rare occurrence in acute obstructive nephropathy; it has been reported in pregnancy, where it may pose a challenging differential diagnosis with pre-eclampsia.The aim of the present study is to report on the incidence of proteinuria (≥ 0.3; ≥ 0.5 g/day) in association with symptomatic-severe urinary tract dilatation in pregnancy. Case series. Nephrological-Obstetric Unit dedicated to pregnancy and kidney diseases (January 2000-April 2011). database prospectively updated since the start of the Unit. Retrospective review of clinical charts identified as relevant on the database, by a nephrologist and an obstetrician. From January 2000 to April 2011, 262 pregnancies were referred. Urinary tract dilatation with or without infection was the main cause of referral in 26 cases (predominantly monolateral in 19 cases): 23 singletons, 1 lost to follow-up, 1 twin and 1 triplet. Patients were referred for urinary tract infection (15 cases) and/or renal pain (10 cases); 6 patients were treated by urologic interventions ("JJ" stenting). Among them, 11 singletons and 1 triple pregnancy developed proteinuria ≥ 0.3 g/day (46.1%). Proteinuria was ≥ 0.5 g/day in 6 singletons (23.1%). Proteinuria resolved after delivery in all cases. No patient developed hypertension; in none was an alternative cause of proteinuria evident. No significant demographic difference was observed in patients with renal dilatation who developed proteinuria versus those who did not. An association with the presence of "JJ" stenting was present (5/6 cases with proteinuria ≥ 0.5 g/day), which may reflect both severer obstruction and a role for vescico-ureteral reflux, induced by the stent. Symptomatic urinary tract dilatation may be associated with proteinuria in pregnancy. This association should be kept in mind in

A study on iliac index in Koran children

International Nuclear Information System (INIS)

Kim, Chu Wan

1973-01-01

Abnormal pelvic configuration with resultant abnormal value of acetabular angle, iliac angle and iliac index is well known in some congenital and hereditary diseases and its measurement is valuable in establishing diagnosis in these diseases. Considering that there is no available standard values of Korean children, we measured acetabular angles, iliac angles and iliac indices in 150 normal Korean children, 10 cases of congenital dislocation of hip and 2 cases of mongolism. The results are as follows: 1. The values of acetabular angle, iliac angle and lilac index are significantly lower than those of American children. 2. Significant increase in acetabular angle is observed in patients with congenital dislocation of hip and significant decrease in iliac index in patients with mongolism is observed. 3. Iliac index seems to be more reliable than either of acetabular angle and iliac angle in the detection of abnormal pelvic contuor in patients with mongolism. We considered that the pelvic mensuration should be done in large number of normal and patients and further study in this fields should be carried out

Unusual case of left iliac vein compression secondary to May-Thurner syndrome and crossed fused renal ectopia

International Nuclear Information System (INIS)

Elsharawy, Mohamed A.; Moghazy, Kahled M.; Alsaif, Hind S.; Al-Asiri, Mosad M.

2008-01-01

External compression of the left iliac vein against the fifth lumbar vertebra by the right iliac artery (May and Thurner Syndrome) is a well known anatomic variant. We identified a rare case of May-Thurner syndrome associated with crossed fused renal ectopia on the left side. The patient presented with complete thrombosis of the left common iliac vein down to the popliteal vein. He was treated with catheter directed thrombolysis followed by anticoagulant therapy. (author)

Pnematic Dilation in Achalasia

Directory of Open Access Journals (Sweden)

Maximilian Bittinger

2001-01-01

Full Text Available Pneumatic dilation is the most common first-line therapy for the treatment of achalasia. The aim of dilation is a controlled disruption of circular muscle fibres of the lower esophageal sphincter to reduce the functional obstruction. Several types of dilators and different dilation techniques are used, but the achieved results are similar. The mean success rate is about 80% in the short term, but some patients need redilation in the further course (particularly young patients. Best long term results are obtained if the lower esophageal sphincter pressure can be reduced below 10 mmHg. Major complications are rare after pneumatic dilation; the most serious complication is esophageal perforation, which occurs at a mean rate of about 2.5%. Considering the pros and cons of other effective forms of treatment of achalasia (esophagomyotomy and intrasphincteric injection of botulinum toxin, pneumatic dilation is still the treatment of choice in the majority of patients with achalasia.

Short bi-iliac distance in prenatal Ullrich-Turner syndrome

DEFF Research Database (Denmark)

Hartling, Ulla B; Hansen, Birgit Fischer; Keeling, Jean W

2002-01-01

The purpose of the present study is to evaluate the bi-iliac distance and the caudo-cranial position of the iliac bones in Ullrich-Turner syndrome (UTS) fetuses compared to recently published standards for normal fetuses. Whole-body radiographs in antero-posterior projections of 24 UTS fetuses...... in normal fetuses. The bi-iliac distance and the iliac bone position have not previously been described in Ullrich-Turner syndrome fetuses....

Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass.

Science.gov (United States)

Mansukhani, Neel A; Havelka, George E; Helenowski, Irene B; Rodriguez, Heron E; Hoel, Andrew W; Eskandari, Mark K

2017-07-01

Diminished pelvic arterial flow as a result of intentional coverage/embolization of internal iliac arteries (IIA) during isolated endovascular common iliac artery aneurysm (CIAA) repair or endovascular repair of abdominal aortic aneurysms (EVAR) may result in symptomatic pelvic ischemia. Although generally well tolerated, in severe cases, pelvic ischemia may manifest as recalcitrant buttock claudication, vasculogenic impotence, or perineal, vesicle, rectal, and/or spinal cord ischemia. Branched graft technology has recently become available; however, many patients are not candidates for endovascular repair with these devices. Therefore, techniques to preserve pelvic arterial flow are needed. We reviewed our outcomes of isolated endovascular CIAA repair or EVAR in conjunction with unilateral external-internal iliac artery bypass. Single-center, retrospective review of 10 consecutive patients who underwent hybrid endovascular abdominal aortic aneurysm (AAA) or CIAA repair with concomitant external-internal iliac artery bypass between 2006 and 2015. Demographics, index procedural details, postoperative symptoms, hospital length of stay (LOS), follow-up imaging, and bypass patency were recorded. The cohort of 10 patients was all men with a mean age of 71 years (range: 56-84). Hybrid repair consisted of contralateral IIA coil embolization followed by EVAR with external iliac artery-internal iliac artery (EIA-IIA) bypass. All EIA-IIA bypasses were performed via a standard lower quadrant retroperitoneal approach with a prosthetic bypass graft. Technical success was 100%, and there were no perioperative deaths. One patient developed transient paraplegia, 1 patient had buttock claudication on the side of his hypogastric embolization contralateral to his iliac bypass, and 1 developed postoperative impotence. 20% of patients sustained long-term complications (buttock claudication and postoperative impotence). Mean LOS was 2.8 days (range: 1-9 days). Postoperative imaging

Metallic stent implantation in patients with iliac artery occlusion: long-term patency rate and factors related to recurrence

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Chung, Seok Kyun; Kim, Jae Kyu; Yoon, Woong; Kim, Jeong; Park, Jin Gyoon; Kang, Heoung Keun; Choi, Soo JinNa [Chonnam National University Hospital School of Medicine, Gwangju (Korea, Republic of)

2003-09-01

To determine the long-term patency rate in 68 patients with iliac artery occlusion who underwent metallic stent implantation, and to analyze the factors related to recurrence. Sixty-eight patients with occlusive disease of the iliac artery underwent implantation of a self-expandable metallic stent. The clinical symptoms were intermittent claudication (n=48), resting pain (n=11), and gangrene (n=9). Stent patency was determined by follow-up angiography and color Doppler imaging, and the cumulative patency rate using the Kaplan-Meier method. Cox's proportional hazard model was used to analyse recurrence-related factors involving clinical symptoms (Fontaine stage), risk factors, and anatomical factors such as lesion location, length, and the development of collaterals. The duration of follow-up varied from 1 day to 73 months (mean, 23.8 months). Arterial occlusion recurred in 16 of 68 patients (23.5%), and the cumulative patency rate was as follows: 95.4% at one month, 93.2% at six months, 80.1% at one year, 73.2% at two years, 68.9% at three years, and 62% at five years. According to a statistical analysis of risk factors, the recurrence (p=0.04) than in those without it, but in patients who smoked, hypertension, DM, and previous cerebrovascular disease were not statistically significant. With regard to anatomical factors, the recurrent rate for lesions involving the external iliac artery was 6.5 times higher (p=0.02) than for those involving the common iliac artery. Variations in the fontaine stage were not statistically significant indicators of recurrence. The recurrence rate after implantation of an iliac artery stent is higher in patients with heart disease than in those without it, and higher for occlusive lesions involving the external iliac artery than for those of the common iliac artery.

Metallic stent implantation in patients with iliac artery occlusion: long-term patency rate and factors related to recurrence

International Nuclear Information System (INIS)

Chung, Seok Kyun; Kim, Jae Kyu; Yoon, Woong; Kim, Jeong; Park, Jin Gyoon; Kang, Heoung Keun; Choi, Soo JinNa

2003-01-01

To determine the long-term patency rate in 68 patients with iliac artery occlusion who underwent metallic stent implantation, and to analyze the factors related to recurrence. Sixty-eight patients with occlusive disease of the iliac artery underwent implantation of a self-expandable metallic stent. The clinical symptoms were intermittent claudication (n=48), resting pain (n=11), and gangrene (n=9). Stent patency was determined by follow-up angiography and color Doppler imaging, and the cumulative patency rate using the Kaplan-Meier method. Cox's proportional hazard model was used to analyse recurrence-related factors involving clinical symptoms (Fontaine stage), risk factors, and anatomical factors such as lesion location, length, and the development of collaterals. The duration of follow-up varied from 1 day to 73 months (mean, 23.8 months). Arterial occlusion recurred in 16 of 68 patients (23.5%), and the cumulative patency rate was as follows: 95.4% at one month, 93.2% at six months, 80.1% at one year, 73.2% at two years, 68.9% at three years, and 62% at five years. According to a statistical analysis of risk factors, the recurrence (p=0.04) than in those without it, but in patients who smoked, hypertension, DM, and previous cerebrovascular disease were not statistically significant. With regard to anatomical factors, the recurrent rate for lesions involving the external iliac artery was 6.5 times higher (p=0.02) than for those involving the common iliac artery. Variations in the fontaine stage were not statistically significant indicators of recurrence. The recurrence rate after implantation of an iliac artery stent is higher in patients with heart disease than in those without it, and higher for occlusive lesions involving the external iliac artery than for those of the common iliac artery

Tearing of the left iliac vessels in lumbar surgery revealed by multiphase post-mortem CT-angiography (MPMCTA).

Science.gov (United States)

Vilariño Villaverde, Raquel; Bruguier, Christine; Zerlauth, Jean-Baptiste; De Froidmont, Sébastien; Grabherr, Silke

2016-05-01

Lumbar surgery is regularly applied in cases of discal hernia and acquired lumbar stenosis. In this report, we present a case of a laceration in the left common iliac artery and iliac vein during a lumbar surgery and discuss the literature concerning this kind of event. In the present case, the surgical procedure was followed by a sudden decrease in blood pressure, and the surgeon discovered an intra-abdominal haemorrhage that led to the patient's death. Postmortem investigation confirmed the intra-abdominal haemorrhage and revealed a laceration of the proximal portion of the left common iliac artery and left iliac vein. The source of bleeding could be detected especially thanks to multi-phase postmortem CT angiography (MPMCTA), which was performed prior to autopsy. We also found a haemorrhagic path through the intervertebral disc between the L4-L5 vertebrae, caused by the surgeon's instrument (pituitary rongeur). To date, a few cases have been described of iatrogenic death resulting from a tear in the iliac vessels during lumbar surgery, but not from the postmortem perspective. Such investigations have recently been modernized thanks to the introduction of forensic imaging. In particular, MPMCTA offers new possibilities in postmortem investigations and can be considered the new gold standard for investigating deaths related to medical intervention. Here we describe the first case of a death during lumbar surgery using this new method. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

False iliac artery aneurysm following renal transplantation

DEFF Research Database (Denmark)

Levi, N; Sønksen, Jens Otto Reimers; Schroeder, T V

1999-01-01

We report a very rare case of a false iliac artery aneurysm following renal transplantation. The patient was a 51-year-old women who presented with a painful 10 x 10 cm pulsating mass in her left iliac fossa. The patient had received a second cadaveric renal transplantation 5 years previously....... The graft never functioned and transplant nephrectomy was performed 2 weeks later. A CT-scanning showed a 10 x 10 cm large aneurysm arising from the left external iliac artery. At operation a large false aneurysm was identified arising from the original transplant anastomotic site. Due to the extent...

Isolated and unexplained dilation of the common bile duct on computed tomography scanscans

Directory of Open Access Journals (Sweden)

Naveen B. Krishna

2012-07-01

Full Text Available Isolated dilation of common bile duct (CBD with normal sized pancreatic duct and without identifiable stones or mass lesion (unexplained is frequently encountered by computed tomography/magnetic resonance imaging. We studied the final diagnoses in these patients and tried to elucidate factors that can predict a malignant etiology. This is a retrospective analysis of prospective database from a University based clinical practice (2002- 2008. We included 107 consecutive patients who underwent endoscopic ultrasound (EUS for evaluation of isolated and unexplained CBD dilation noted on contrast computed tomography scans. EUS examination was performed using a radial echoendoscope followed by a linear echoechoendoscope, if a focal mass lesion was identified. Fine-needle aspirates were assessed immediately by an attending cytopathologist. Main outcome measurements included i prevalence of neoplasms, CBD stones and chronic pancreatitis and ii performance characteristics of EUS/EUS-fine needle aspiration (EUS-FNA. A malignant neoplasm was found in 16 patients (14.9% of the study subjects, all with obstructive jaundice (ObJ. Six patients had CBD stones; three with ObJ and three with abnormal liver function tests. EUS findings suggestive of chronic pancreatitis were identified in 27 patients. EUSFNA had 97.3% accuracy (94.1% in subset with ObJ with a sensitivity of 81.2% and specificity of 100% for diagnosing malignancy. Presence of ObJ and older patient age were only significant predictors of malignancy in our cohort. Amongst patients with isolated and unexplained dilation of CBD, the risk of malignancy is significantly higher in older patients presenting with ObJ. EUS-FNA can diagnose malignancy in these patients with high accuracy besides identifying other potential etiologies including missed CBD stones and chronic pancreatitis.

Simultaneous Iliac Vein Bovine Pericardial Patch Venoplasty and Creation of PTFE Lower Limb Arteriovenous Fistula Graft for Rescue Vascular Access.

Science.gov (United States)

Meecham, Lewis; Fisher, Owain; Kirby, George; Evans, Richard; Buxton, Pauline; Legge, Jocelyn; Rajagopalan, Sriram; Asquith, John; Pherwani, Arun

2016-10-01

We present a case of external iliac vein patch venoplasty to accommodate rescue vascular access via a polytetrafluoroethylene loop arteriovenous fistula graft (AVG) for a patient with multiple central venous stenoses. A 35-year-old female with anti-glomerular basement membrane antibody disease required rescue vascular access for hemodialysis. Repeated occlusion and/or thrombosis of long-term central venous access cannulae, to facilitate dialysis, had caused stenosis of brachiocephalic veins: right external iliac vein and occlusion of the left common iliac vein. A previous right brachiobasilic fistula had occluded within 1 year. No other upper limb options for arteriovenous fistula (AVF) were available. A right external iliac vein bovine patch angioplasty concurrently with a polytetrafluoroethylene AV graft between common femoral artery and common femoral vein was performed to restore venous patency and allow rescue dialysis access. At 3-year follow-up, the fistula remains widely patent with 2 L/min flow rates and no recurrent stenosis to the treated iliac vein. She has not required any further surgical or interventional radiological procedures to maintain fistula or central venous patency. Central venous stenosis or occlusion is common for patients requiring dialysis, especially those with multiple previous long-term central venous cannulations. If restriction of outflow is present, AVF may fail. Venous patch angioplasty in these cases is a successful technique, allowing AVF formation and long-term patency. Central venous stenosis can be treated successfully with patch venoplasty to accommodate AVF/AVG formation for rescue vascular access; this is a potentially lifesaving intervention for patients requiring dialysis. Copyright © 2016 Elsevier Inc. All rights reserved.

Reconstruction of Traumatic External Iliac Artery Dissection Due to Vascular Clamping.

Science.gov (United States)

Kırnap, Mahir; Özçelik, Ümit; Akdur, Aydıncan; Ayvazoğlu Soy, Ebru H; Işıklar, İclal; Yarbuğ Karakayalı, Feza; Moray, Gökhan; Haberal, Mehmet

2017-10-31

Traumatic external iliac artery dissection after renal transplant is a rare complication, but it should be urgently managed due to its devastating effects on graft and lower limb circulation. External iliac artery dissection is seen more in recipients with diabetes mellitus and comorbid disease. Recipients with external iliac artery dissection should be treated immediately by percutaneus angioplasty or surgical reconstruction. In this study, we reported the management of 2 kidney transplant cases with external iliac artery dissection due to vascular clamping of the artery. External iliac artery dissection was diagnosed by ultrasonography in both cases. After failed percutaneous interventional angioplasty, we reconstructed the external iliac artery dissection surgically and replaced the external iliac artery with polytetra-fluoroethylene grafts in both patients. Both patients were discharged with normal functioning grafts showing 0.9 and 0.8 mg/dL serum creatinine levels at month 3 posttransplant. Close monitoring of recipients after transplant is mandatory for early diagnosis and early management of external iliac artery dissection to prevent graft loss and preserve lower limb circulation. Routine Doppler ultrasonography is an inexpensive and useful tool for early diagnosis in cases of sudden cessation or decrease in urine. In cases of failed percutaneous interventional angioplasty, reconstruction with synthetic vascular grafts can be safely applied in external iliac artery dissection.

Results of operative treatment of avulsion fractures of the iliac crest apophysis in adolescents.

Science.gov (United States)

Li, Xigong; Xu, Sanzhong; Lin, Xiangjin; Wang, Quan; Pan, Jun

2014-04-01

Avulsion fracture of the iliac crest apophysis is a rare condition that commonly occurs in adolescent athletes. Conservative treatment for this injury can produce excellent functional outcomes. However, the rehabilitation process requires a rather long immobilisation period. This study aimed to evaluate the use of cannulated screws for fixation of avulsion fractures of iliac crest apophysis. Ten patients with avulsion fractures of iliac crest apophysis were treated by open reduction and internal fixation using cannulated screws. The mean age of patients was 14.6 years (range, 13-15 years). The mean intraoperative blood loss was 14.9 ml (range, 10-25 ml). The mean operative time was 40.3 min (range, 33-52 min). The mean follow-up period was 11.2 months (range, 6-20 months). At the 4-week follow-up, all patients returned to previously normal activity without pain and had no evidence of lower extremity muscle weakness. At the final follow-up, all patients resumed their athletic activity without any complications. Open reduction and internal fixation for the treatment of avulsion fracture of iliac crest apophysis can be recommended for patients requiring rapid rehabilitation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Impairment of flow-mediated dilation correlates with aortic dilation in patients with Marfan syndrome.

Science.gov (United States)

Takata, Munenori; Amiya, Eisuke; Watanabe, Masafumi; Omori, Kazuko; Imai, Yasushi; Fujita, Daishi; Nishimura, Hiroshi; Kato, Masayoshi; Morota, Tetsuro; Nawata, Kan; Ozeki, Atsuko; Watanabe, Aya; Kawarasaki, Shuichi; Hosoya, Yumiko; Nakao, Tomoko; Maemura, Koji; Nagai, Ryozo; Hirata, Yasunobu; Komuro, Issei

2014-07-01

Marfan syndrome is an inherited disorder characterized by genetic abnormality of microfibrillar connective tissue proteins. Endothelial dysfunction is thought to cause aortic dilation in subjects with a bicuspid aortic valve; however, the role of endothelial dysfunction and endothelial damaging factors has not been elucidated in Marfan syndrome. Flow-mediated dilation, a noninvasive measurement of endothelial function, was evaluated in 39 patients with Marfan syndrome. Aortic diameter was measured at the aortic annulus, aortic root at the sinus of Valsalva, sinotubular junction and ascending aorta by echocardiography, and adjusted for body surface area (BSA). The mean value of flow-mediated dilation was 6.5 ± 2.4 %. Flow-mediated dilation had a negative correlation with the diameter of the ascending thoracic aorta (AscAd)/BSA (R = -0.39, p = 0.020) and multivariate analysis revealed that flow-mediated dilation was an independent factor predicting AscAd/BSA, whereas other segments of the aorta had no association. Furthermore, Brinkman index had a somewhat greater influence on flow-mediated dilation (R = -0.42, p = 0.008). Although subjects who smoked tended to have a larger AscAd compared with non-smokers (AscA/BSA: 17.3 ± 1.8 versus 15.2 ± 3.0 mm/m(2), p = 0.013), there was no significant change in flow-mediated dilation, suggesting that smoking might affect aortic dilation via an independent pathway. Common atherogenic risks, such as impairment of flow-mediated dilation and smoking status, affected aortic dilation in subjects with Marfan syndrome.

Short Bi-Iliac Distance in Prenatal Ullrich-Turner Syndrome

DEFF Research Database (Denmark)

Hartling, Ulla B.; Hansen, Birgit Fischer; Keeling, Jean W.

2002-01-01

prenatal; Ullrich-Turner syndrome; pelvis; iliac bone; vertebral column; X chromosome; anthropometry; radiography......prenatal; Ullrich-Turner syndrome; pelvis; iliac bone; vertebral column; X chromosome; anthropometry; radiography...

One-day transhepatic billary stricture dilatation

International Nuclear Information System (INIS)

Mueller, P.R.; Saini, S.; Hahn, P.F.; Silverman, S.G.; Ferrucci, J.T.

1989-01-01

To overcome technical problems in percutaneous transhepatic dilatation or biliary strictures, the authors performed the entire procedure in a single session with the patient under general anesthesia (N = 7). Six patients had a biliary-enteric anastomosis, and one patient had a traumatic mid common bile duct stricture. All bile ducts were of normal caliber or were minimally dilated by US or transhepatic cholangiography. Dilatation was performed via a fresh transhepatic drainage catheter in six patients and via an in-dwelling T-tube in one patient. High-pressure balloons (10-12 mm) were placed after catheter dilation of the tract, and balloons were inflated for 5-10 minutes three to five times. Dilation was stopped with a waist was no longer present. No strictures have recurred in patients followed up to 24 months

Intraoperative intermittent blocking of the common iliac arteries in cases of placenta percreta without the use of fluoroscopy

International Nuclear Information System (INIS)

Heinze, S.; Klinikum Oldenburg; Filsinger, B.; Kastenholz, G.; Schroeder, R.J.

2016-01-01

The number of patients with placenta accreta, percreta and increta is increasing. The morbidity and mortality are higher mostly due to hemorrhage. Therefore, new methods to reduce the risk of severe bleeding are necessary. Three patients were treated in collaboration by obstetricians, urologists, anesthesiologists, and radiologists. An MRI of the pelvis was performed and the diameters and lengths of the iliac arteries were measured to avoid fluoroscopy during the preoperative placement of catheter balloons into the iliac arteries. During the operational procedure the balloons were inflated and deflated depending on the operative site and the occurrence of bleeding. In comparison to the literature, severe bleeding was clearly reduced. No complications of the intervention were observed. The presented method to reduce severe bleeding might represent significant progress in the management of abnormal placenta implantation. Nevertheless, further controlled studies are needed in order to establish evidence-based recommendations.

Technique, Complication, and Long-Term Outcome for Endovascular Treatment of Iliac Artery Occlusion

International Nuclear Information System (INIS)

Ozkan, Ugur; Oguzkurt, Levent; Tercan, Fahri

2010-01-01

The aim of this study was to report technical details, procedure-related complications, and results of endovascular treatment in chronic iliac artery occlusion. Between 2001 and 2008, endovascular treatments of 127 chronic iliac artery occlusions in 118 patients (8 women and 110 men; mean age, 59 years) were retrospectively reviewed. The study was based on Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery Standards). All occlusions were treated with stent placement with or without preliminary balloon angioplasty. Kaplan-Meier estimators were used to determine patency rates. Univariate and multivariate analyses were performed to determine variables affecting successful recanalization, major complications, early stent thrombosis (≤30 days), and primary and secondary patency rates. Initial technical success was achieved in 117 (92%) procedures. Successful recanalization was obtained by antegrade approach in 69 of 77 (90%) procedures and by retrograde approach in 52 of 105 (50%) procedures (p < 0.001). Complications were encountered in 28 (24%) patients [minor in 7 patients (6%) and major in 22 patients (19%)]. One death occurred in the operative period secondary to iliac artery rupture. Early stent thrombosis was seen in eight (7%) patients. Presence of critical limb ischemia (p = 0.03), subintimal recanalization (p = 0.03), and major complication (p = 0.02) were the independent predictors of early stent thrombosis on multivariate analysis. Primary and secondary patency rates at 5 years were 63 and 93%, respectively. Presence of critical limb ischemia, TASC type C iliac lesions, combined occlusions of both common and external iliac arteries, and major complications were associated with decreased patency rates on univariate analysis, whereas these factors were not independent predictors of stent patency on multivariate analysis. In conclusion, endovascular treatment of iliac artery occlusion has a

Emergency Endovascular “Bridge” Treatment for Iliac-Enteric Fistula

International Nuclear Information System (INIS)

Franchin, Marco; Tozzi, Matteo; Piffaretti, Gabriele; Carrafiello, Gianpaolo; Castelli, Patrizio

2011-01-01

Aortic aneurysm has been reported to be the dominant cause of primary iliac-enteric fistula (IEF) in >70% of cases [1]; other less common causes of primary IEF include peptic ulcer, primary aortitis, pancreatic pseudocyst, or neoplastic erosion into an adjacent artery [2, 3]. We describe an unusual case of IEF managed with a staged approach using an endovascular stent-graft as a “bridge” in the emergency setting to optimize the next elective definitive excision of the lesion.

Assessment of effectiveness of endovascular treatment of common and external iliac artery stenosis/occlusion using self-expanding Jaguar SM stents

International Nuclear Information System (INIS)

Kordecki, Kazimierz; Łukasiewicz, Adam; Nowicki, Mirosław; Lewszuk, Andrzej; Kowalewski, Radosław; Panek, Bogusław; Zawadzki, Michał; Michalak, Paweł; Gacko, Marek; Łebkowska, Urszula

2012-01-01

The goal of this work was to assess the effectiveness of endovascular treatment of common and external iliac artery stenosis/occlusion classified according to TASC using a self-expanding stent Jaguar SM. The study group included 95 patients (61 men and 34 women) who underwent treatment for stenosis or occlusion of lower limb arteries at the Department of Radiology of the University Hospital in Bialystok and the Diagnostic Radiology Department of the Central Clinical Hospital of the Ministry of Interior (MSWiA) in Warsaw between 2005 and 2007. All arterial lesions were of atherosclerotic etiology. The shortest stenotic fragment was 10 mm long and the longest occluded arterial fragment did not exceed 90 mm. Morphological classification of iliac artery lesions in treated patients was performed according to TASC II classification and included 10 patients with type A, 39 cases of type B, 36 with type C and 10 patients with type D lesions. Endovascular procedure failed to restore flow in five patients with TASC type D lesions, who were later referred for surgery. One patient suffered a complication – vessel perforation during predilatation, and had a stentgraft implanted. In 95% of patients stents were expanded using a balloon after implantation. Good results were achieved in practically all patients who underwent stent implantation. Patients were subjected to follow-up clinical and imaging evaluation during next 1–24 months. Success rate of the performed procedures as well as in a 30-day observation period was 100% in case of stenosis and 80% in case of vessel occlusion. A follow-up after 12 and 24 months showed patency of treated vessels in 84% and 76% of patients, respectively

Computed tomography of sacro-iliac joints

International Nuclear Information System (INIS)

Miquel, A.; Laredo, J.D.

1995-01-01

Actual technologies to explore sacro-iliac joints are conventional radiography, computed tomography , scintigraphy and nuclear magnetic resonance imaging. Standards films are sufficient, except in beginning sacro-iliac septic inflammations where the computed tomography is superior. Two problems are generally posed for the radiologist, to differentiate a septic arthritis from a rheumatic pathology An other problem in diagnosis is to make the difference between a degenerative arthropathy (which does not need a further investigation) and an infectious rheumatic pathology where more exploration is necessary. 28 refs., 3 tabs., 13 figs

Common iliac vein stenosis and risk of symptomatic pulmonary embolism: an inverse correlation.

Science.gov (United States)

Chan, Keith T; Popat, Rita A; Sze, Daniel Y; Kuo, William T; Kothary, Nishita; Louie, John D; Hovsepian, David M; Hwang, Gloria L; Hofmann, Lawrence V

2011-02-01

To test the hypothesis that a common iliac vein (CIV) stenosis may impair embolization of a large deep venous thrombosis (DVT) to the lungs, decreasing the incidence of a symptomatic pulmonary embolism (PE). Between January 2002 and August 2007, 75 patients diagnosed with unilateral DVT were included in a single-institution case-control study. Minimum CIV diameters were measured 1 cm below the inferior vena cava (IVC) bifurcation on computed tomography (CT) images. A significant stenosis in the CIV ipsilateral to the DVT was defined as having either a diameter 4 mm or less or a greater than 70% reduction in lumen diameter. A symptomatic PE was defined as having symptoms and imaging findings consistent with a PE. The odds of symptomatic PE versus CIV stenosis were assessed using logistic regression models. The associations between thrombus location, stenosis, and symptomatic PE were assessed using a stratified analysis. Of 75 subjects, 49 (65%) presented with symptomatic PE. There were 17 (23%) subjects with a venous lumen 4 mm or less and 12 (16%) subjects with a greater than 70% stenosis. CIV stenosis of 4 mm or less resulted in a decreased odds of a symptomatic PE compared with a lumen greater than 4 mm (odds ratio [OR] 0.17, P = .011), whereas a greater than 70% stenosis increased the odds of DVT involving the CIV (OR 7.1, P = .047). Among patients with unilateral DVT, those with an ipsilateral CIV lumen of 4 mm or less have an 83% lower risk of developing symptomatic PE compared with patients with a CIV lumen greater than 4 mm. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries

International Nuclear Information System (INIS)

England, Andrew; Butterfield, John S.; McCollum, Charles N.; Ashleigh, Raymond J.

2008-01-01

The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters 18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1-84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs ≥18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs ≥18 mm (p = 0.232). One-year freedom from IRSI was 92% ± 3% and 84% ± 9% for the <18-mm and ≥18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18-24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.

A case of radionecrosis of the iliac bone

International Nuclear Information System (INIS)

Kondo, Masakazu; Tomishige, Mamoru; Okuda, Tetsuaki; Matsuo, Yoso; Naruto, Yoshio

1975-01-01

Radiation necrosis of the femoral neck in postirradiated carcinoma of the cervix is well known. But, radionecrosis of the iliac bone is rare. The authors have recently experienced such a case. A woman, forty-six years old, had treatment with irradiation for the carcinoma of the cervix eight years ago. In January 1975, she noticed pain in the left leg. A roentgenogram of the pelvis showed fine sclerosis fanning into the left ilium from the sacroiliac joint. Seven months after onset of the pain an oblique fracture in the left iliac wing was observed. Following concervative therapy for four months, osteosynthesis of the iliac wing was done when callus formation of the lesion was seen. The patient was crutch-walking four months after. (J.P.N.)

A predictive model for canine dilated cardiomyopathy-a meta-analysis of Doberman Pinscher data.

Science.gov (United States)

Simpson, Siobhan; Edwards, Jennifer; Emes, Richard D; Cobb, Malcolm A; Mongan, Nigel P; Rutland, Catrin S

2015-01-01

Dilated cardiomyopathy is a prevalent and often fatal disease in humans and dogs. Indeed dilated cardiomyopathy is the third most common form of cardiac disease in humans, reported to affect approximately 36 individuals per 100,000 individuals. In dogs, dilated cardiomyopathy is the second most common cardiac disease and is most prevalent in the Irish Wolfhound, Doberman Pinscher and Newfoundland breeds. Dilated cardiomyopathy is characterised by ventricular chamber enlargement and systolic dysfunction which often leads to congestive heart failure. Although multiple human loci have been implicated in the pathogenesis of dilated cardiomyopathy, the identified variants are typically associated with rare monogenic forms of dilated cardiomyopathy. The potential for multigenic interactions contributing to human dilated cardiomyopathy remains poorly understood. Consistent with this, several known human dilated cardiomyopathy loci have been excluded as common causes of canine dilated cardiomyopathy, although canine dilated cardiomyopathy resembles the human disease functionally. This suggests additional genetic factors contribute to the dilated cardiomyopathy phenotype.This study represents a meta-analysis of available canine dilated cardiomyopathy genetic datasets with the goal of determining potential multigenic interactions relating the sex chromosome genotype (XX vs. XY) with known dilated cardiomyopathy associated loci on chromosome 5 and the PDK4 gene in the incidence and progression of dilated cardiomyopathy. The results show an interaction between known canine dilated cardiomyopathy loci and an unknown X-linked locus. Our study is the first to test a multigenic contribution to dilated cardiomyopathy and suggest a genetic basis for the known sex-disparity in dilated cardiomyopathy outcomes.

A predictive model for canine dilated cardiomyopathy—a meta-analysis of Doberman Pinscher data

Directory of Open Access Journals (Sweden)

Siobhan Simpson

2015-03-01

Full Text Available Dilated cardiomyopathy is a prevalent and often fatal disease in humans and dogs. Indeed dilated cardiomyopathy is the third most common form of cardiac disease in humans, reported to affect approximately 36 individuals per 100,000 individuals. In dogs, dilated cardiomyopathy is the second most common cardiac disease and is most prevalent in the Irish Wolfhound, Doberman Pinscher and Newfoundland breeds. Dilated cardiomyopathy is characterised by ventricular chamber enlargement and systolic dysfunction which often leads to congestive heart failure. Although multiple human loci have been implicated in the pathogenesis of dilated cardiomyopathy, the identified variants are typically associated with rare monogenic forms of dilated cardiomyopathy. The potential for multigenic interactions contributing to human dilated cardiomyopathy remains poorly understood. Consistent with this, several known human dilated cardiomyopathy loci have been excluded as common causes of canine dilated cardiomyopathy, although canine dilated cardiomyopathy resembles the human disease functionally. This suggests additional genetic factors contribute to the dilated cardiomyopathy phenotype.This study represents a meta-analysis of available canine dilated cardiomyopathy genetic datasets with the goal of determining potential multigenic interactions relating the sex chromosome genotype (XX vs. XY with known dilated cardiomyopathy associated loci on chromosome 5 and the PDK4 gene in the incidence and progression of dilated cardiomyopathy. The results show an interaction between known canine dilated cardiomyopathy loci and an unknown X-linked locus. Our study is the first to test a multigenic contribution to dilated cardiomyopathy and suggest a genetic basis for the known sex-disparity in dilated cardiomyopathy outcomes.

Prevalência de marcadores de trombofilia em pacientes portadores da síndrome de May-Thurner e trombose de veia ilíaca comum esquerda Prevalence of thrombophilia factors in patients with May-Thurner syndrome and left common iliac vein thrombosis

Directory of Open Access Journals (Sweden)

Marcos Arêas Marques

2010-12-01

Full Text Available CONTEXTO: A relação entre trombose venosa profunda e trombofilia tem sido pouco estudada em indivíduos portadores de compressão da veia ilíaca comum esquerda, conhecida clinicamente como síndrome de May-Thurner. OBJETIVO: Avaliar a prevalência de marcadores de trombofilia nos pacientes portadores de síndrome de May-Thurner e trombose de veia ilíaca comum esquerda. MÉTODOS: Entre março de 1999 e dezembro de 2008, 20 pacientes com síndrome de May-Thurner e trombose de veia ilíaca comum esquerda foram avaliados retrospectivamente quanto à presença de marcadores de trombofilia. RESULTADOS: Foi detectada a associação entre síndrome de May-Thurner e marcadores de trombofilia em 8 pacientes (40%. CONCLUSÃO: A presença de marcadores de trombofilia em pacientes com trombose de veia ilíaca comum esquerda e síndrome de May-Thurner é frequente, porém não difere da prevalência encontrada em pacientes portadores de trombose venosa profunda sem a síndrome associada.BACKGROUND: The relationship between deep venous thrombosis and thrombophilia has been little studied in patients with left common iliac vein compression, clinically known as May-Thurner syndrome. OBJECTIVE: To evaluate the prevalence of thrombophilia markers in patients with May-Thurner syndrome and left common iliac vein thrombosis. METHODS: From March 1999 to December 2008, 20 patients with May-Thurner syndrome and left common iliac vein thrombosis were retrospectively investigated for the presence of thrombophilia markers. RESULTS: The association between May-Thurner syndrome and thrombophilia markers was found in 8 patients (40%. CONCLUSION: There is a high prevalence of thrombophilia markers in patients with May-Thurner syndrome and left common iliac vein thrombosis. The prevalence, however, is not different from that found in patients with deep venous thrombosis without May-Thurner syndrome.

Characteristic adaptations of the extracellular matrix in dilated cardiomyopathy

NARCIS (Netherlands)

Louzao-Martinez, Laura; Vink, Aryan; Harakalova, Magdalena; Asselbergs, Folkert W; Verhaar, Marianne C; Cheng, Caroline

2016-01-01

Dilated cardiomyopathy (DCM) is a relatively common heart muscle disease characterized by the dilation and thinning of the left ventricle accompanied with left ventricular systolic dysfunction. Myocardial fibrosis is a major feature in DCM and therefore it is inevitable that corresponding

Esophageal dilatation using the Eder Puestow dilators.

Science.gov (United States)

Royston, C M; Dowling, B L; Gear, M W

1976-06-01

We have performed fifty-one dilatations in twenty-six patients using an end-viewing fiberoptic endoscope and Eder Puestow dilators. All (except two) were performed using intravenous diazepam, the majority on an outpatient basis. The only complication has been a single case of aspiration pneumonia. We have found this method of esophageal dilatation particularly useful in the preoperative dilatation of benign strictures, and in those elderly frail patients who are unsuitable for surgery. Transthoracic resection of the stricture is avoided and thus transabdominal repair of the hiatus hernia may be undertaken.

A predictive model for canine dilated cardiomyopathy: a meta-analysis of Doberman Pinscher data

OpenAIRE

Simpson, Siobhan; Edwards, Jennifer; Emes, Richard D.; Cobb, Malcolm A.; Mongan, Nigel P.; Rutland, Catrin S.

2015-01-01

Dilated cardiomyopathy is a prevalent and often fatal disease in humans and dogs. Indeed dilated cardiomyopathy is the third most common form of cardiac disease in humans, reported to affect approximately 36 individuals per 100,000 individuals. In dogs, dilated cardiomyopathy is the second most common cardiac disease and is most prevalent in the Irish Wolfhound, Doberman Pinscher and Newfoundland breeds. Dilated cardiomyopathy is characterised by ventricular chamber enlargement and systolic d...

Relationship between width of greater trochanters and width of iliac wings in tronchanteric bursitis.

Science.gov (United States)

Viradia, Neal K; Berger, Alex A; Dahners, Laurence E

2011-09-01

Trochanteric bursitis is a common disorder that is characterized by inflammation of the bursa, superficial to the greater trochanter of the femur, leading to pain in the lateral hip, and often occurs because of acute trauma or repetitive friction involving the iliotibial band, the greater trochanter, and the bursa. In the study reported here, we hypothesized that the increased incidence of bursitis may be the result of the increased prominence of the trochanter in relation to the wings of the iliac crest. Distances between the outermost edges of trochanters and iliac wings were measured in 202 patients from the University of North Carolina Health Care System-101 without a known diagnosis and 101 with a clinical diagnosis of trochanteric bursitis. To determine significance, t tests for nonpaired data were used. Mean (SD) difference between trochanter and iliac wing widths was 28 (20) mm in the group diagnosed with trochanteric bursitis and 17 (18) mm in the control group. The difference between the groups in this regard was significant (Pbursitis group and 1.05 (.06) in the control group. The difference between these groups was significant (Pbursitis.

Computed tomography of hepatocellular carcinoma. Dilatation of intrahepatic bile duct

Energy Technology Data Exchange (ETDEWEB)

Choi, Soomi; Nakamura, Hitonobu; Tanaka, Ken; Hori, Shinichi; Tokunaga, Kou [Osaka Univ. (Japan). Faculty of Medicine

1983-10-01

Based on a series of CT of the liver in 125 patients with hepatoma and 45 patients with metastatic hepatic tumors, the mode of dilatation of the intrahepatic bile duct was examined. In patients with hepatoma, partia dilatations of intrahepatic bile duct were more commonly seen than general dilatations. On the other hand, there was no case of partial dilatation of the intrahepatic bile duct in patients with metastatic hepatic tumors. It could be concluded that partial dilatation of the intrahepatic bile duct is an useful CT finding to make a diagnosis of hepatoma, particularly to differentiate hepatoma from metastatic hepatic tumor.

Embolization of the Internal Iliac Artery: Cost-Effectiveness of Two Different Techniques

International Nuclear Information System (INIS)

Pellerin, Olivier; Caruba, Thibaud; Kandounakis, Yanis; Novelli, Luigi; Pineau, Judith; Prognon, Patrice; Sapoval, Marc

2008-01-01

The purpose of this study was to compare the cost-effectiveness of coils versus the Amplatzer Vascular Plug (AVP) for occlusion of the internal iliac artery (IAA). Between 2002 and January 2006, 13 patients (mean age 73 ± 13 years) were referred for stent-grafting of abdominal aortic aneurysm (n = 6); type I distal endoleak (n = 3), isolated iliac aneurysm (n = 3), or rupture of a common iliac aneurysm (n = 1). In all patients, extension of the stent-graft was needed because the distal neck was absent. Two different techniques were used to occlude the IIA: AVP in seven patients (group A) and coil embolization in six patients (group C). Immediate results and direct material costs were assessed retrospectively. Immediate success was achieved in all patients, and simultaneous stent-grafting was successfully performed in two of six patients in group C versus five of seven patients in group A. In all group A patients, a single AVP was sufficient to achieve occlusion of the IIA, accounting for a mean cost of 485 Euro , whereas in group C patients, an average of 7 ± 3 coils were used, accounting for a mean cost of 1,745 Euro . Mean average cost savings using the AVP was 1,239 Euro . When IIA occlusion is needed, the AVP allows a single-step procedure at significant cost savings.

Metallic stent for the treatment of iliac arterial stenosis

Energy Technology Data Exchange (ETDEWEB)

Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Suh, Chul Soo; Yoo, Jae Wook; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of); Song, Chi Sung [Seoul City Boramae Hospital, Seoul (Korea, Republic of)

1993-07-15

In order to study the clinical efficacy of the metallic stent of the treatment of iliac arterial stenosis, the clinical and arteriographic findings of the 8 patients were retrospectively reviewed. All 8 patients were males with an age of 51 to 79. The Fontaine class for the functional status of lower extremities was II in 4 patients, III in 3 patents and IV in 1 patient. Self expandable Gianturco stent was inserted of in 7 iliac arteries and balloon expandable Palmaz stent was inserted in 2 iliac arteries in the 8 patients. The indications for the metallic stent application were localized dissection with significant residual stenosis in 6 sites, recoiling due to calcification in one case and eccentricity of the stenosislesionin 2 sites. The deployment of the metallic stent was successful in all the cases to maintain the patency of iliac arteries with residual stenosis less than 30%. The Fontaine class was improved to 1 in 6 patients, IIa in 1 patient and IIb in another one. During the follow up period of 3 to 14 month, none except one developed recurrence of the symptom. On the basis of our experience, we believe that metallic stent is safe and effective for the treatment of iliac arterial stenosis. However, we think that it is a complementary measure to the percutaneous transluminal angioplasty. The comparative study between different types of metallic stent and the long term effect should be investigated further.

Screening for aortoiliac lesions by visual interpretation of the common femoral Doppler waveform

DEFF Research Database (Denmark)

Eiberg, J P; Jensen, F; Grønvall Rasmussen, J B

2001-01-01

to study the accuracy of simple visual interpretation of the common femoral artery Doppler waveform for screening the aorto-iliac segment for significant occlusive disease.......to study the accuracy of simple visual interpretation of the common femoral artery Doppler waveform for screening the aorto-iliac segment for significant occlusive disease....

Arteriovenous fistula complicating iliac artery pseudo aneurysm: diagnosis by CT angiography.

Science.gov (United States)

Huawei, L; Bei, D; Huan, Z; Zilai, P; Aorong, T; Kemin, C

2002-01-01

Fistula formation to the inferior vena cava is a rare complication of aortic aneurysm which is often misdiagnosed clinically. In one hundred of reported arteriocaval fistulae, none was originating from the right common iliac artery. We report a case of ileo-caval fistula due to a iatrogenic pseudoaneurysm. High resolution 3D imaging using breath-hold CT angiography is highly specific in identifying the location, extent of the aortocaval fistula as well as the neighbouring anatomic structures.

Ruptured internal iliac artery aneurysm presenting as Cullen’s sign

OpenAIRE

Choon K. Gan; Srinivasan Ravi; Rachel Archibald; David Hodgson; Fung J. Foo; William Wong

2010-01-01

Cullen?s sign or periumbilical ecchymosis, is classically considered as an indicator of acute hemorrhagic pancreatitis or ruptured ectopic pregnancy. Internal iliac artery aneurysms are rare and are usually asymptomatic. We present a case of a contained rupture of the internal iliac artery aneurysm presenting with Cullen?s sign.

Bovine aortic arch: A novel association with thoracic aortic dilation

International Nuclear Information System (INIS)

Malone, C.D.; Urbania, T.H.; Crook, S.E.S.; Hope, M.D.

2012-01-01

Aim: To investigate whether there is a link between bovine arch and thoracic aortic aneurysm. Materials and methods: Computed tomography (CT) and magnetic resonance imaging (MRI) images of the thorax of 191 patients with dilated thoracic aortas and 391 consecutive, unselected patients as controls were retrospectively reviewed. Bovine arch was considered present if either a shared origin of the left common carotid and innominate arteries or an origin of the left common carotid from the innominate artery was identified. A chi-square test was used to evaluate the significance of differences between subgroups. Results: A trend towards increased prevalence of bovine arch was seen in patients with dilated aortas (26.2%) compared to controls (20.5%, p = 0.12). The association was statistically significant in patients over 70 years old (31.9%, p = 0.019) and when dilation involved the aortic arch (47.6%, p = 0.003). Conclusions: An association between bovine arch and aortic dilation is seen in older patients, and when dilation involves the aortic arch. Bovine arch should be considered a potential risk factor for thoracic aortic aneurysm.

Providers' Experiences with Vaginal Dilator Training for Patients with Vaginal Agenesis.

Science.gov (United States)

Patel, Vrunda; Hakim, Julie; Gomez-Lobo, Veronica; Amies Oelschlager, Anne-Marie

2018-02-01

To examine providers' experiences with vaginal dilator training for patients with vaginal agenesis. Anonymous electronic survey. Members of the North American Society for Pediatric and Adolescent Gynecology. How providers learn about vaginal dilator training, common techniques, and methods used for patient training, assessment of patient readiness, common patient complaints, issues leading to early discontinuation. There were a total of 55 completed survey responses of which 31 respondents (56%) had been in practice for more than 10 years. Forty-nine were gynecologists (89%), 20 had completed a fellowship in pediatric and adolescent gynecology (36%), and 6 were reproductive endocrinologists (11%). Thirty-one respondents had first learned about vaginal dilator training through lectures (56%) whereas only 9 through mentorship and fellowship (16%). According to respondents, the most common issue leading to early discontinuation was lack of patient motivation and readiness (n = 42; 76%). The most common complication was pain or discomfort (n = 45; 82%). More than half of respondents determined dilator therapy was successful when patients reported comfortable sexual intercourse (n = 30; 55%) and 65% (n = 35) did not delineate any restrictions to initiation of sexual intercourse. Most respondents (87%) requested further vaginal dilator training at either a clinical meeting (n = 26; 47%) or with a training video (n = 22; 40%). Our study in an experienced cohort of pediatric gynecology providers highlights the need for further research and training on vaginal dilation education. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Roentgenoendovascular dilatation and recanalization of vessels of lower extremities

International Nuclear Information System (INIS)

Rabkin, I.Kh.; Matevosov, A.L.; Gotman, L.N.

1987-01-01

Advantages and disadvantages of using roentgenoendovascular dilatation (RED) of vessels of lower extremities are presented. RED is recommended in treating patients with short segmented stenoses of common and external illiac arteries and also with the similar damages of surficial femoral arteries. Dilatation is a success when there is permeability in at least one of the three central crus arteries. Success of delayed results of vessel dilatation is to a certain degree in inverse proportion to time and length of occlusion

OP-1 compared with iliac crest autograft in instrumented posterolateral fusion a randomized, multicenter non-inferiority trial

NARCIS (Netherlands)

Delawi, Diyar; Jacobs, Wilco; Van Susante, Job L C; Rillardon, Ludovic; Prestamburgo, Domenico; Specchia, Nicola; Gay, Emmanuel; Verschoor, Nico; Garcia-Fernandez, Carlos; Guerado, Enrique; Van Ufford, Henriette Quarles; Kruyt, Moyo C.; Dhert, Wouter J A; Cumhur Oner, F.

2016-01-01

Background: Spinal fusion with the use of autograft is a commonly performed procedure. However, harvesting of bone from the iliac crest is associated with complications. Bone morphogenetic proteins (BMPs) are extensively used as alternatives, often without sufficient evidence of safety and efficacy.

Ruptured internal iliac artery aneurysm presenting as Cullen’s sign

Directory of Open Access Journals (Sweden)

Choon K. Gan

2010-11-01

Full Text Available Cullen’s sign or periumbilical ecchymosis, is classically considered as an indicator of acute hemorrhagic pancreatitis or ruptured ectopic pregnancy. Internal iliac artery aneurysms are rare and are usually asymptomatic. We present a case of a contained rupture of the internal iliac artery aneurysm presenting with Cullen’s sign.

Anatomic differences of the distal aorta with dilatation or aneurysm between patients from Asia and Europe as seen on CT imaging

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Mladenovic, Ana S., E-mail: ancicak@yahoo.com [Institute of Radilogy, Clinical Centre of Serbia, Visegradska 26, DP 237, 11 000 Belgrade (Serbia); Markovic, Zeljko Z., E-mail: dr.zmarkovic@gmail.com [Clinical Center of Serbia, Center of Radiology, Belgrade (Serbia); Institute of Radilogy, Clinical Centre of Serbia, Visegradska 26, DP 237, 11 000 Belgrade (Serbia); Hyodoh, Hideki H., E-mail: hyodoh@sapmed.ac.jp [Department of Radiology, Sapporo Medical University, S1W17, Chuo-ku, Sapporo 060-8556 (Japan)

2012-09-15

Aim: The hypothesis of this research is that there are differences in morphology of dilated and aneurysm changed infrarenal aorta between the patients from Europe and Asia that are important for endovascular treatment. Authors analyzed the morphologic differences of the infra-renal segment of abdominal aorta (a.a.) and the iliac arteries, common iliac artery (c.i.a.) between the Asians and Europeans examined by computed tomography (64 MD CT) from the point of the clinical use of the endovascular stent-graft. Materials and methods: The research was conducted simultaneously in Europe and in Asia and 60 patients with distal aorta aneurysm were included (30 of each ethnic origin). The examinations were conducted at the identical types of 64 MD CT equipment, and under same conditions of examination technique and post-processing. Results: There were statistically significant differences in regard to important morphology criteria for a.a. and c.i.a. between patients with the aneurysm from Asia and the Europe. Analysis was preformed referring to the gender, age, body weight (BW), height, body mass index (BMI), body surface (SA index), and various diameters of a.a. and c.i.a. at several linear and transversal levels, angle and volume of the aneurysm. The biggest differences relate to the width of the central part of aneurysm of a.a. and the length and volume of c.i.a. Conclusion: There were statistically significant differences in regard to important morphology criteria for a.a. and c.i.a. between patients with the aneurysm from Asia and the Europe.

Gout in the spine and sacri-iliac joints: radiological manifestations

International Nuclear Information System (INIS)

Jajic, I.

1982-01-01

It is well known that deposits of urates in soft tissues occur commonly in gout, particularly in para-articular areas and in articular cartilages of the limbs. Involvement of the spine and sacro-iliac joints by such deposits, however, has been regarded as being relatively unusual and has attracted little attention in the literature. As we were impressed by the frequency of episodes of acute back pain in our patients with gouty arthritis, established definitely on clinical and biochemical grounds, we undertook a radiological investigation of the spine and sacro-iliac joints in a series of 54 subjects. It was suspected that their episodes of pain were clinical manifestations of gout, and 12 of the group had suffered one or more attacks. Of these 12 subjects, eight were found to have radiological abnormalities. In six subjects, evidence of sacro-iliitis was demonstrated, which is comparable to the report of Resnick and Reinke [8], and in two patients vertebral lesions corresponded to those described by Jaffe [5]. Hyperostotic spondylosis was present in no fewer than 29 of the series. Although lacking histological confirmation of the lesions demonstrated radiologically, we believe that our suspicions have been confirmed

Gout in the spine and sacri-iliac joints: Radiological manifestations

International Nuclear Information System (INIS)

Jajic, I.

1982-01-01

It is well known that deposits of urates in soft tissues occur commonly in gout, particularly in para-articular areas and in articular cartilages of the limbs. Involvement of the spine and sacro-iliac joints by such deposits, however, has been regarded as being relatively unusual and has attracted little attention in the literature. As we were impressed by the frequency of episodes of acute back pain in our patients with gouty arthritis, established definitely on clinical and biochemical grounds, we undertook a radiological investigation of the spine and sacro-iliac joints in a series of 54 subjects. It was suspected that their episodes of pain were clinical manifestations of gout, and 12 of the group had suffered one or more attacks. Of these 12 subjects, eight were found to have radiological abnormalities. In six subjects, evidence of sacro-iliitis was demonstrated, which is comparable to the report of Resnick and Reinke [8], and in two patients vertebral lesions corresponded to those described by Jaffe [5]. Hyperostotic spondylosis was present in no fewer than 29 of the series. Although lacking histological confirmation of the lesions demonstrated radiologically, we believe that our suspicions have been confirmed. (orig.)

Predictors for adverse outcome after iliac angioplasty and stenting for limb-threatening ischemia.

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Timaran, Carlos H; Stevens, Scott L; Freeman, Michael B; Goldman, Mitchell H

2002-09-01

The role of iliac artery angioplasty and stenting (IAS) for the treatment of limb-threatening ischemia is not defined. IAS has been used primarily for patients with disabling claudication. Because poorer results have been shown in patients with critical ischemia after iliac artery angioplasty, the purpose of this study was to estimate the influence of risk factors on the outcome of iliac angioplasty and stent placement in patients with limb-threatening ischemia. During a 5-year period (from 1996 to 2001), 85 iliac angioplasty and stent placement procedures (107 stents) were performed in 31 women and 43 men with limb-threatening ischemia. Patients with claudication were specifically excluded. The criteria prepared by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery) were followed to define the variables. The TransAtlantic InterSociety Consensus classification was used to characterize the type of iliac lesions. Both univariate (Kaplan-Meier [KM]) and multivariate analyses (Cox proportional hazards model) were used to determine the association between variables, cumulative patency, limb salvage, and survival. Indications for iliac angioplasty with stenting were ischemic rest pain (56%) and tissue loss (44%). Primary stenting was performed in 36 patients (42%). Stents were placed selectively after iliac angioplasty mainly for residual stenosis or pressure gradient (43%). Overall, primary stent patency rate was 90% at 1 year, 74% at 3 years, and 69% at 5 years. Primary stent patency rate was significantly reduced in women compared with men (KM, log-rank test, P 1.6 mg/dL; KM, log-rank test, P IAS. Limb salvage, as shown in this study, is not affected by previous iliac stent failure.

Sacro-iliac joint arthrography in low back pain: feasibility of MRI guidance

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Ojala, Risto; Klemola, Rauli; Karppinen, Jaro; Sequeiros, Roberto Blanco; Tervonen, Osmo

2001-01-01

Objective: Evaluation of the feasibility of MR-guidance in sacro-iliac joint arthrography in patients whose low back pain is suspected to arise from the sacro-iliac joint (SIJ). Methods and patients: Twenty patients with low back pain underwent MR-guided sacro-iliac joint arthrography. Needles made from titanium (size 20 G, MDTech, USA) were used. For image guidance a 0.23T open-configuration C arm magnet (Proview, Marconi Medical Systems, USA) with special interventional hardware and software package (I-Path 200, Marconi Medical Systems) containing an MR compatible in-room console, large-screen (36'') display, optical navigator and accompanying software with dedicated sequences was used. No other image guidance modalities were used. Results: MR-guided SIJ arthrography was successfully performed in all twenty patients without complications. The optimal imaging sequence both for preoperative and intraoperative images was 3D-Gradient Echo sequence. The dispersal of the injected saline and anaesthetic could be determined inside the joint in all cases with heavily T2-weighted fast spin echo sequence. In the present study, 60% of the patients had significant reduction of pain after sacro-iliac joint arthrography and sacro-iliac joint was considered to be the source of patients low back pain in these patients. Conclusion: The present study shows that MR guidance with open configuration low field scanner is an accurate guiding method for sacro-iliac joint arthrography

Blood pressure shifts resulting from a concealed arteriovenous fistula associated with an iliac aneurysm: a case report.

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Doi, Shintaro; Motoyama, Yoshiaki; Ito, Hiromi

2016-01-01

A solitary iliac aneurysm (SIA) is more uncommon than an abdominal aortic aneurysm. The aneurysm is located in the deep pelvis and is diagnosed when it reaches a large size with symptoms of compression around adjacent structures and organs or when it ruptures. A definite diagnosis of an arteriovenous fistula (AVF) associated with a SIA is difficult preoperatively because there might not be enough symptoms and time for diagnosis. Here, we present a patient with asymptomatic rupture of SIA into the common iliac vein with characteristic blood pressure shifts. A 41-year-old man with a huge SIA underwent aortobifemoral graft replacement. Preoperatively, his blood pressure showed characteristic shifts for one or two heartbeats out of five beats, indicating that an AVF was present and that the shunt was about to having a high flow. During surgery, an AVF associated with the SIA was found to be concealed owing to compression from the huge iliac artery aneurysm, and the shunt showed a high flow, resulting in shock during the surgery. No complications were noted after aortobifemoral graft replacement. Postoperatively, we noted an enhanced paravertebral vein on computed tomography (CT), which indicated the presence of an AVF. Definite diagnosis of an AVF offers advantages in surgical and anesthetic management. We emphasize that a large SIA can push the iliac vein and occlude an AVF laceration, concealing the enhancement of the veins in the arterial phase on CT. Blood pressure shifts might predict the existence of a concealed AVF that has a large shunt. Even if the vena cava and the iliac veins are not enhanced on CT, anesthesiologists should carefully determine whether their distal branches are enhanced.

Cryoplasty for the treatment of iliac artery stenosis in canine model

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Wu Zhengzhong; Yang Weizhu; Jiang Na; Zheng Qubin; Huang Keyao; Huang Ning; Shen Quan

2013-01-01

Objective To evaluate the treatment effect of balloon angioplasty and cryoplasty on iliac artery stenosis in canine model. Methods: Canine models of iliac artery stenosis were established with surgical ligation and transfixion. Models were randomly divided into two groups: iliac artery stenosis treated by cryoplasty (n = 8) and by balloon angioplasty (n = 8). The degree of iliac artery stenosis of two model groups was assessed by digital subtraction angiography (DSA) immediately and two weeks after the angioplasties. Then all the dogs were executed for pathological observation of the target vessels. Results: Sixteen canine models of iliac artery stenosis were established by surgical ligation and transfixion method with 100% success rate. DSA showed there was (45 ± 12)% of residual artery stenosis in the cryoplasty group immediately after surgery, while it was (39-12)% in the balloon angioplasty group, and there was no significant difference between them (t = 3.183, P > 0.05). The artery stenosis of cryoplasty group was (48 ± 17)% after two weeks and not significantly different from that after surgery immediately (t = -1.271, P > 0.05). The artery stenosis of balloon angioplasty group was (67 ± 13)% after two weeks, and it was significantly higher compared with at after surgery immediately (t = -6.666, P < 0.01). The degree of vascular stenosis in balloon angioplasty group was severer than that in cryoplasty group two weeks after angiography (P = 0.041). The pathological examination showed artery intimal hyperplasia in cryoplasty group was milder than that in balloon angioplasty group and neointimal content of collagen in cryoplasty group was less than that in balloon angioplasty group. Conclusions: The animal models of iliac artery stenosis were established successfully with surgical ligation and transfixion by damaging the intima and media of arterial wall. Compared with balloon angioplasty, the cryoplasty was able to inhibit proliferation of intimal and reduce

Costo-iliac distance: a physical sign of understated importance.

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Barry, P J; O'Mahony, D

2012-03-01

Osteoporosis is a common condition, especially affecting the older female population. The ability to predict loss of lumbar height using simple anatomical measurements would be a useful tool. Forty subjects were recruited. Mean age was 72 years. Arm span (AS) and the costo-iliac distance (CID) were measured. The CID/AS ratio was calculated. The L(1)-L(4) vertebral height of each patient was obtained from dual-energy X-ray absorptiometry (DEXA). There was a statistically significant correlation between the lumbar height and CID/AS ratio (R (2) = 0.79, p < 0.001). The CID/AS ratio may be a useful bedside test in identifying loss of lumbar vertebral height.

Vena Cava Filter Retrieval with Aorto-Iliac Arterial Strut Penetration.

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Holly, Brian P; Gaba, Ron C; Lessne, Mark L; Lewandowski, Robert J; Ryu, Robert K; Desai, Kush R; Sing, Ronald F

2018-05-03

To evaluate the safety and technical success of inferior vena cava (IVC) filter retrieval in the setting of aorto-iliac arterial strut penetration. IVC filter registries from six large United States IVC filter retrieval practices were retrospectively reviewed to identify patients who underwent IVC filter retrieval in the setting of filter strut penetration into the adjacent aorta or iliac artery. Patient demographics, implant duration, indication for placement, IVC filter type, retrieval technique and technical success, adverse events, and post procedural clinical outcomes were identified. Arterial penetration was determined based on pre-procedure CT imaging in all cases. The IVC filter retrieval technique used was at the discretion of the operating physician. Seventeen patients from six US centers who underwent retrieval of an IVC filter with at least one strut penetrating either the aorta or iliac artery were identified. Retrieval technical success rate was 100% (17/17), without any major adverse events. Post-retrieval follow-up ranging from 10 days to 2 years (mean 4.6 months) was available in 12/17 (71%) patients; no delayed adverse events were encountered. Findings from this series suggest that chronically indwelling IVC filters with aorto-iliac arterial strut penetration may be safely retrieved.

Vascular type Ehlers-Danlos Syndrome with fatal spontaneous rupture of a right common iliac artery dissection: case report and review of literature

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Abayazeed, Aly; Hayman, Emily; Moghadamfalahi, Mana; Cain, Darren

2014-01-01

Vascular Ehlers-Danlos Syndrome (previously Ehlers-Danlos IV) is a rare autosomal dominant collagen vascular disorder caused by a 2q31 COL3A1 gene mutation encoding pro-alpha1 chain of type III collagen (in contrast to classic Ehlers-Danlos, caused by a COL5A1 mutation). The vascular type accounts for less than 4% of all Ehlers-Danlos cases and usually has a poor prognosis due to life threatening vascular ruptures and difficult, frequently unsuccessful surgical and vascular interventions. In 70% of cases, vascular rupture or dissection, gastrointestinal perforation, or organ rupture is a presenting sign. We present a case of genetically proven vascular Ehlers-Danlos with fatal recurrent retroperitoneal hemorrhages secondary to a ruptured right common iliac artery dissection in a 30-year-old male. This case highlights the need to suspect collagen vascular disorders when a young adult presents with unexplained retroperitoneal hemorrhage, even without family history of such diseases. PMID:24967021

Ipsilateral common iliac artery plus femoral artery clamping for inducing sciatic nerve ischemia/reperfusion injury in rats: a reliable and simple method

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Barzegar-Fallah Anita

2008-12-01

Full Text Available Abstract The aim of this study was to develop a practical model of sciatic ischemia reperfusion (I/R injury producing serious neurologic deficits and being technically feasible compared with the current time consuming or ineffective models. Thirty rats were divided into 6 groups (n = 5. Animal were anesthetized by using ketamine (50 mg/kg and xylazine (4 mg/kg. Experimental groups included a sham-operated group and five I/R groups with different reperfusion time intervals (0 h, 3 h, 1 d, 4 d, 7 d. In I/R groups, the right common iliac artery and the right femoral artery were clamped for 3 hrs. Sham-operated animals underwent only laparotomy without induction of ischemia. Just before euthanasia, behavioral scores (based on gait, grasp, paw position, and pinch sensitivity were obtained and then sciatic nerves were removed for light-microscopy studies (for ischemic fiber degeneration (IFD and edema. Behavioral score deteriorated among the ischemic groups compared with the control group (p

A case of double inferior vena cava with renal, ovarian and iliac vein variation.

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Ito, Taro; Ikeda, Yayoi

2018-01-01

We encountered a rare case of an anatomic variant of inferior vena cava (IVC) duplication with renal, ovarian and iliac vein variation in an 81-year-old Japanese female cadaver during a student dissection course of anatomy at Aichi Gakuin University School of Dentistry. The two IVCs ran upwards bilaterally to the abdominal aorta. The left IVC joined with the left renal vein (RV) to form a common trunk that crossed anterior to the aorta and ended at the right IVC. We detected a vein [interiliac vein (IiV)] connecting the two IVCs at the level of the aortic bifurcation. The IiV was formed by the union of two tributaries from the left IVC and a tributary from the left internal iliac vein (IIV) and ran obliquely upwards from left to right. Two right ovarian veins, arising separately from the ipsilateral pampiniform plexus, ran vertically in parallel to each other, and each one independently terminated at the right IVC and the right RV. Two right IIVs, connecting each other with small branches, ascended and separately joined the right external iliac vein. The right and left IIVs were connected to each other. These variations cause abnormal drainage, which could lead to clinical symptoms associated with the dysfunction of the vascular and urogenital systems. Here we describe the detailed anatomical features of the area and discuss the related anatomical and developmental aspects.

Iliac hyperdense line: a new radiographic sign of gluteal muscle contracture

International Nuclear Information System (INIS)

Cai, Jin-Hua; Gan, Lan-Feng; Zheng, He-Lin; Li, Hao

2005-01-01

A hyperdense line on the ilium that runs roughly parallel to the sacroiliac joint (we called it ''iliac hyperdense line sign'') was frequently observed on pelvic radiographs of patients with gluteal muscle contracture (GMC). A literature search revealed no description of this sign. To determine the relationship between the iliac hyperdense line sign and GMC and to explore how this sign is formed. Pelvic plain films of 103 cases of GMC and those of 200 control individuals were reviewed for the presence or absence of the iliac hyperdense line sign. Pelvic CT scans in 8 of 103 cases and 13 of 200 controls were analyzed with relation to the plain films. The iliac hyperdense line sign was visualized in 85 of 103 (82.5%) cases of GMC and none of the 200 controls. In the GMC group, pelvic CT scans showed a deformity of the posterior ilium. The lateral cortex of the posterior ilium took on a partly or completely anteroposterior course, while in the control group the course appeared as an oblique orientation from posteromedial to anterolateral. The iliac hyperdense line on pelvic plain film can be used as a radiographic sign to suggest a diagnosis of GMC. This sign might be a result of the long and persistent pulling effect of the contracted gluteus maximus muscle, which deforms the lateral cortex of the posterior ilium from an oblique course to an anteroposterior course tangential to the X-ray beam. (orig.)

Iliac hyperdense line: a new radiographic sign of gluteal muscle contracture

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Cai, Jin-Hua; Gan, Lan-Feng; Zheng, He-Lin; Li, Hao [Chongqing Medical University, Department of Radiology, Children' s Hospital, Chongqing (China)

2005-10-01

A hyperdense line on the ilium that runs roughly parallel to the sacroiliac joint (we called it ''iliac hyperdense line sign'') was frequently observed on pelvic radiographs of patients with gluteal muscle contracture (GMC). A literature search revealed no description of this sign. To determine the relationship between the iliac hyperdense line sign and GMC and to explore how this sign is formed. Pelvic plain films of 103 cases of GMC and those of 200 control individuals were reviewed for the presence or absence of the iliac hyperdense line sign. Pelvic CT scans in 8 of 103 cases and 13 of 200 controls were analyzed with relation to the plain films. The iliac hyperdense line sign was visualized in 85 of 103 (82.5%) cases of GMC and none of the 200 controls. In the GMC group, pelvic CT scans showed a deformity of the posterior ilium. The lateral cortex of the posterior ilium took on a partly or completely anteroposterior course, while in the control group the course appeared as an oblique orientation from posteromedial to anterolateral. The iliac hyperdense line on pelvic plain film can be used as a radiographic sign to suggest a diagnosis of GMC. This sign might be a result of the long and persistent pulling effect of the contracted gluteus maximus muscle, which deforms the lateral cortex of the posterior ilium from an oblique course to an anteroposterior course tangential to the X-ray beam. (orig.)

Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population

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Abhinav Goyal

2017-07-01

Full Text Available Background/Aims Esophageal stricture is usually managed with outpatient endoscopic dilation. However, patients with food impaction or failure to thrive undergo inpatient dilation. Esophageal perforation is the most feared complication, and its risk in inpatient setting is unknown. Methods We used National Inpatient Sample (NIS database for 2007–2013. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM codes were used to identify patients with esophageal strictures. Logistic regression was used to assess association between hospital/patient characteristics and utilization of esophageal dilation. Results There were 591,187 hospitalizations involving esophageal stricture; 4.2% were malignant. Endoscopic dilation was performed in 28.7% cases. Dilation was more frequently utilized (odds ratio [OR], 1.36; p<0.001, had higher in-hospital mortality (3.1% vs. 1.4%, p<0.001, and resulted in longer hospital stays (5 days vs. 4 days, p=0.01, among cases of malignant strictures. Esophageal perforation was more common in the malignant group (0.9% vs. 0.5%, p=0.007. Patients with malignant compared to benign strictures undergoing dilation were more likely to require percutaneous endoscopic gastrostomy or jejunostomy (PEG/J tube (14.1% vs. 4.5%, p<0.001. Palliative care services were utilized more frequently in malignant stricture cases not treated with dilation compared to those that were dilated. Conclusions Inpatient endoscopic dilation was utilized in 29% cases of esophageal stricture. Esophageal perforation, although infrequent, is more common in malignant strictures.

Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population

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Goyal, Abhinav; Chatterjee, Kshitij; Yadlapati, Sujani; Singh, Shailender

2017-01-01

Background/Aims Esophageal stricture is usually managed with outpatient endoscopic dilation. However, patients with food impaction or failure to thrive undergo inpatient dilation. Esophageal perforation is the most feared complication, and its risk in inpatient setting is unknown. Methods We used National Inpatient Sample (NIS) database for 2007–2013. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes were used to identify patients with esophageal strictures. Logistic regression was used to assess association between hospital/patient characteristics and utilization of esophageal dilation. Results There were 591,187 hospitalizations involving esophageal stricture; 4.2% were malignant. Endoscopic dilation was performed in 28.7% cases. Dilation was more frequently utilized (odds ratio [OR], 1.36; p<0.001), had higher in-hospital mortality (3.1% vs. 1.4%, p<0.001), and resulted in longer hospital stays (5 days vs. 4 days, p=0.01), among cases of malignant strictures. Esophageal perforation was more common in the malignant group (0.9% vs. 0.5%, p=0.007). Patients with malignant compared to benign strictures undergoing dilation were more likely to require percutaneous endoscopic gastrostomy or jejunostomy (PEG/J) tube (14.1% vs. 4.5%, p<0.001). Palliative care services were utilized more frequently in malignant stricture cases not treated with dilation compared to those that were dilated. Conclusions Inpatient endoscopic dilation was utilized in 29% cases of esophageal stricture. Esophageal perforation, although infrequent, is more common in malignant strictures. PMID:28301921

Dilated Cardiomyopathy

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... Family history of dilated cardiomyopathy Inflammation of heart muscle from immune system disorders, such as lupus Neuromuscular disorders, such as muscular dystrophy Complications Complications from dilated cardiomyopathy include: Heart ...

The Eyes Have It: Sex and Sexual Orientation Differences in Pupil Dilation Patterns

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Rieger, Gerulf; Savin-Williams, Ritch C.

2012-01-01

Recent research suggests profound sex and sexual orientation differences in sexual response. These results, however, are based on measures of genital arousal, which have potential limitations such as volunteer bias and differential measures for the sexes. The present study introduces a measure less affected by these limitations. We assessed the pupil dilation of 325 men and women of various sexual orientations to male and female erotic stimuli. Results supported hypotheses. In general, self-reported sexual orientation corresponded with pupil dilation to men and women. Among men, substantial dilation to both sexes was most common in bisexual-identified men. In contrast, among women, substantial dilation to both sexes was most common in heterosexual-identified women. Possible reasons for these differences are discussed. Because the measure of pupil dilation is less invasive than previous measures of sexual response, it allows for studying diverse age and cultural populations, usually not included in sexuality research. PMID:22870196

Dilations and interaction

International Nuclear Information System (INIS)

Buchholz, D.; Fredenhagen, K.

1976-07-01

As a consequence of the geometrical features of dilations massless particles do not interact in a local, dilationally invariant quantum theory. This result also holds in models in which dilations are only an asymptotically visible symmetry of the S-matrix. (orig.) [de

Percutaneous aspiration thrombectomy with adjunctive venoplasty for iliac vein compression syndrome with lower extremity deep venous thrombosis

International Nuclear Information System (INIS)

Wang Yiping; Zhang Xiquan; Sun Yequan

2013-01-01

Objective: To investigate the clinical effect of mechanical aspiration thrombectomy with adjunctive PTA and stenting for iliac vein compression syndrome with lower extremity deep venous thrombosis. Materials and Methods: The clinical data of 184 patients who had iliac vein compression syndrome with lower extremity DVT were analyzed retrospectively. The healthy femoral vein was accessed, then a 12-14 F sheath was introduced via a guide wire to aspirate thrombus in the iliofemoral; For the cases with femoropopliteal thrombus, the thrombus was macerated and pulled by Fogarty balloon catheter, then performing mechanical aspiration thrombectomy. After thrombus removal, PTA and stenting were performed on stenosis or occlusion of common iliac vein that displayed on venography. Results: The thrombus removal rate: Grade Ⅲ 80.89% and Grade Ⅱ 19.02%. The circumference of affected limbs at 15 cm above and below knee joints were (43.9±4.7) cm and (31.5±4.1) cm, respectively, after being discharged from hospital, the differences were statistical significance (t=6.43, t=-5.79, both P=0.000)compared to be hospitalized. The follow -up result: the treatment efficiency was 97.75%. The stent patency rate of postoperation at 6, 12, and 24 months were 97.19%, 94.94%, 92.13%, respectively, on sonography or digital subtract angiography. Conclusion: Mechanical aspiration thrombectomy with adjunctive venoplasty for iliac vein compression syndrome with lower extremity deep venous thrombosis is an effective and safe therapy having notable therapeutic effect in short l middle-term follow-up and shorter hospitalization time. (authors)

Age-related changes in vertebral and iliac crest 3D bone microstructure--differences and similarities.

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Thomsen, J S; Jensen, M V; Niklassen, A S; Ebbesen, E N; Brüel, A

2015-01-01

Age-related changes of vertebra and iliac crest 3D microstructure were investigated, and we showed that they were in general similar. The 95th percentile of vertebral trabecular thickness distribution increased with age for women. Surprisingly, vertebral and iliac crest bone microstructure was only weakly correlated (r = 0.38 to 0.75), despite the overall similar age-related changes. The purposes of the study were to determine the age-related changes in iliac and vertebral bone microstructure for women and men over a large age range and to investigate the relationship between the bone microstructure at these skeletal sites. Matched sets of transiliac crest bone biopsies and lumbar vertebral body (L2) specimens from 41 women (19-96 years) and 39 men (23-95 years) were micro-computed tomography (μCT) scanned, and the 3D microstructure was quantified. For both women and men, bone volume per total volume (BV/TV), connectivity density (CD), and trabecular number (Tb.N) decreased significantly, while structure model index (SMI) and trabecular separation (Tb.Sp) increased significantly with age at either skeletal site. Vertebral trabecular thickness (Tb.Th) was independent of age for both women and men, while iliac Tb.Th decreased significantly with age for men, but not for women. In general, the vertebral and iliac age-related changes were similar. The 95th percentile of the Tb.Th distribution increased significantly with age for women but was independent of age for men at the vertebral body, while it was independent of age for either sex at the iliac crest. The Tb.Th probability density functions at the two skeletal sites became significantly more similar with age for women, but not for men. The microstructural parameters at the iliac crest and the vertebral bodies were only moderately correlated from r = 0.38 for SMI in women to r = 0.75 for Tb.Sp in men. Age-related changes in vertebral and iliac bone microstructure were in general similar. The iliac

Perioperative Internal Iliac Artery Balloon Occlusion, In the Setting of Placenta Accreta and Its Variants: The Role of the Interventional Radiologist.

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Petrov, David A; Karlberg, Benjamin; Singh, Kamalpreet; Hartman, Matthew; Mittal, Pardeep K

2017-11-10

Placenta accreta and its variants (increta and percreta) are conditions of abnormal placentation that are encountered with increasing frequency. The spectrum of placenta accreta (including placenta increta and percreta) involves an abnormal attachment of the placental chorionic villi to the uterine myometrium. This abnormal attachment leads to increased adherence of the placenta to the uterus and abnormal placental-uterine separation at the time of delivery. Placental invasion into, or through the myometrium is associated with increased postpartum morbidity and mortality as a result of uterine hemorrhage during and following cesarean section. A multidisciplinary clinical approach to the treatment of patients with placenta accreta is recommended by the American College of Obstetricians and Gynecologists. As potential members of an interdisciplinary team, interventional radiologists can perform prophylactic internal iliac arterial balloon occlusion as an adjunctive therapy for reducing potentially life-threatening postpartum hemorrhage. The procedure involves placement of a balloon catheter into the internal iliac or common iliac arteries bilaterally prior to cesarean section. Following delivery, and prior to placental separation, the catheter balloons are inflated with a pre-determined volume of saline leading to transient occlusion of the internal iliac arteries and reduced uterine blood flow. Copyright © 2017 Elsevier Inc. All rights reserved.

Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department

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Shiloni Bhambani

2017-04-01

Full Text Available Introduction: A dislodged gastrostomy tube (GT is a common complaint that requires evaluation in the pediatric emergency department (ED and, on occasion, will require stoma dilation to successfully replace the GT. The objective of this study was to describe the frequency that stoma dilation is required, the success rate of replacement, complications encountered, and the techniques used to confirm placement of the GT after dilation. Methods: We conducted a retrospective medical record review of children 0–18 years who presented to the pediatric ED from February 2013 through February 2015 with a dislodged GT that required stoma dilation by pediatric emergency physicians with serially increasing Foley catheter sizes prior to successful placement of the GT. Results: We reviewed a total of 302 encounters in 215 patients, with 97 (32% of the encounters requiring stoma dilation prior to replacing a GT. The median amount of dilation was 2 French between the initial Foley catheter size and the final GT size. There was a single complication of a mal-positioned balloon that was identified at the index visit. No delayed complications were encountered. We performed confirmation of placement in all patients. The two most common forms of confirmation were aspiration of gastric contents (56/97 [58%] followed by contrast radiograph in 39 (40%. Conclusion: The practice of serial dilation of a gastrostomy stoma site to allow successful replacement of a gastrostomy tube in pediatric patients who present to the ED with a dislodged gastrostomy tube is generally successful and without increased complication. All patients received at least one form of confirmation for appropriate GT placement with the most common being aspiration of gastric contents.

Iliac hyperdense line: a new X-ray sign of gluteal muscle contracture

International Nuclear Information System (INIS)

Cai Jinhua; Gan Lanfeng; Zheng Helin; He Ling; Yu Guorong

2003-01-01

Objective: To elucidate the relationship between gluteal muscle contracture (GMC) and the iliac hyperdense line on pelvic plain film, and to explore how the iliac hyperdense line is formed. Methods: The pelvic plain films of 103 cases with GMC confirmed by operation and those of 200 individuals as control were analyzed. Pelvic CT scanning was performed in 8 cases GMC and 13 cases of normal controls. Results: The iliac hyperdense line at the side of sacroiliac joint was found on the pelvic plain film in 85 of 103 cases with GMC and 5 of 200 in control group. In 103 cases of GMC, the iliac hyperdense line was detected in 81 of 88 patients beyond 5 years, and 83 of 94 was mostly the gluteus maximus contracture. In control group, pelvic CT showed that the outer cortex of posterior ilium at the level of sacroiliac joint appeared as an oblique plane, oriented from posteromedial side to anterolateral side, while in GMC group, the oblique plane became steeper and almost oriented posteroanteriorly. In addition, the posterior part of the ilium which gave the attachment of contracted gluteus maximus muscle deformed and widened. Conclusion: The iliac hyperdense line on the pelvic plain film is resulted from the long and persistent pulling effect of contracted gluteus maximus muscle, which causes the change the oblique plane of posterior ilium into a posteroanterior course parallel to the X-ray beam

Postoperative internal iliac artery embolisation as salvage therapy ...

African Journals Online (AJOL)

Postoperative internal iliac artery embolisation as salvage therapy for ... of blood products. Damage control surgery was performed, and bleeding was ultimately only ... abdomen was packed with adrenalin-soaked swabs. Coagulation.

Treatment of urethral strictures with balloon dilation: A forgotten tale

Directory of Open Access Journals (Sweden)

Konstantinos Stamatiou

2015-09-01

Full Text Available Urethral stricture is a common condition that can lead to serious complications such as urinary infections and renal insufficiency secondary to urinary retention. Treatment options include catheterization and dilation, urethroplasty and endoscopic internal urethrotomy as well. Although treatment option depends on the type, length and aetiology of stricture, the choice can be influenced to varying degrees by the simplicity of the method, the preferences of the patient the available accoutrements and the patient health condition. Both urethroplasty and endoscopic internal urethrotomy require anaesthesia and thus are not suitable for many elder and unfit for surgical treatment patients. On the other hand, dilations are easy to perform in every day clinical practice however they have been associated with iatrogenic urethral trauma. In contrast, balloon dilation under vision dilates by radial application of forces against the stricture, avoiding the potentially shearing forces associated with sequential rigid dilation. Since it reduces the possibility of an iatrogenic urethral trauma and the subsequent spongiofibrosis may lead into improved therapeutic outcomes. In this report we describe a technique for the treatment of urethral strictures with balloon dilation in elder and unfit for surgical treatment patients.

An unusual triad: Bilateral dilated odontoma, hypodontia and peg laterals

Directory of Open Access Journals (Sweden)

Alphy Alphonsa Sebastian

2013-01-01

The aim of this case report is to present a rare case of bilateral dilated odontoma affecting a microdontic permanent lateral incisor in a 30 year old female patient with hypodontia and peglateral teeth with its clinical, radiological and histological features, which has yet been not reported. Bilateral presence of dilated odontoma is not a common occurrence, although a single tooth involvement in each case has been reported in the literature.

Placement of hemoparin-coated stents in the iliac arteries: Early experience and midterm results in 28 patients

Energy Technology Data Exchange (ETDEWEB)

Kalmar, Peter I., E-mail: peter.kalmar@medunigraz.at; Portugaller, Rupert H., E-mail: rupert.portugaller@medunigraz.at; Schedlbauer, Peter, E-mail: peter.schedlbauer@klinikum-graz.at; Bohlsen, Dennis, E-mail: dennis.bohlsen@medunigraz.at; Deutschmann, Hannes A., E-mail: hannes.deutschmann@medunigraz.at

2014-07-15

Purpose: Aim was to determine immediate results and mid-term outcome of the hemoparin-coated (HC) stainless-steel stent (camouflage coating) in the treatment of occlusive lesions of the iliac arteries. Materials and methods: Twenty-eight patients were prospectively treated with the use of a HC stent between January 2007 and March 2010. Clinical examination and color-doppler ultrasound were performed at 1, 3, 6 and 12 months, CT angiography (CTA) or MR angiography (MRA) at 12 months. Indication for treatment was a high-grade stenosis of the common iliac and/or external iliac artery. Results: Successful placement was achieved in all patients. Significant decrease in translesional pressure gradient (>10 mmHg) was measured in 27 patients (96%). In one patient, proximal dissection occurred without flow limitation. A minor complication (small access site hematoma) occurred in one patient (4%). Two patients (7%) were lost to follow-up. After 12 months, stent patency in CTA, MRA and ultrasound was 100%. 20 patients (77%) experienced an initial improvement of at least one clinical stage. In one patient (4%), mild intimal hyperplasia without significant stenosis was observed. In three patients (12%), proximal or distal stenosis occurred. A non-significant increase of mean ankle-brachial index (ABI) after treatment was measured (0.85 ± 0.27 vs. 0.75 ± 0.22, respectively; p = 0.328). Conclusions: The use of HC stents in patients with iliac artery occlusive disease may lead to a lower rate of intimal hyperplasia and thus to increased patency rates even in heavily calcified vessels. However, large-scale prospective trials have to be performed to evaluate the long-term patency rates of the HC coated stents.

Placement of hemoparin-coated stents in the iliac arteries: Early experience and midterm results in 28 patients

International Nuclear Information System (INIS)

Kalmar, Peter I.; Portugaller, Rupert H.; Schedlbauer, Peter; Bohlsen, Dennis; Deutschmann, Hannes A.

2014-01-01

Purpose: Aim was to determine immediate results and mid-term outcome of the hemoparin-coated (HC) stainless-steel stent (camouflage coating) in the treatment of occlusive lesions of the iliac arteries. Materials and methods: Twenty-eight patients were prospectively treated with the use of a HC stent between January 2007 and March 2010. Clinical examination and color-doppler ultrasound were performed at 1, 3, 6 and 12 months, CT angiography (CTA) or MR angiography (MRA) at 12 months. Indication for treatment was a high-grade stenosis of the common iliac and/or external iliac artery. Results: Successful placement was achieved in all patients. Significant decrease in translesional pressure gradient (>10 mmHg) was measured in 27 patients (96%). In one patient, proximal dissection occurred without flow limitation. A minor complication (small access site hematoma) occurred in one patient (4%). Two patients (7%) were lost to follow-up. After 12 months, stent patency in CTA, MRA and ultrasound was 100%. 20 patients (77%) experienced an initial improvement of at least one clinical stage. In one patient (4%), mild intimal hyperplasia without significant stenosis was observed. In three patients (12%), proximal or distal stenosis occurred. A non-significant increase of mean ankle-brachial index (ABI) after treatment was measured (0.85 ± 0.27 vs. 0.75 ± 0.22, respectively; p = 0.328). Conclusions: The use of HC stents in patients with iliac artery occlusive disease may lead to a lower rate of intimal hyperplasia and thus to increased patency rates even in heavily calcified vessels. However, large-scale prospective trials have to be performed to evaluate the long-term patency rates of the HC coated stents

Iliac vein stenosis is an underdiagnosed cause of pelvic venous insufficiency.

Science.gov (United States)

Santoshi, Ratnam K N; Lakhanpal, Sanjiv; Satwah, Vinay; Lakhanpal, Gaurav; Malone, Michael; Pappas, Peter J

2018-03-01

Reflux in the ovarian veins, with or without an obstructive venous outflow component, is reported to be the primary cause of pelvic venous insufficiency (PVI). The degree to which venous outflow obstruction plays a role in PVI is currently ill-defined. We retrospectively reviewed the charts of 227 women with PVI who presented to the Center for Vascular Medicine from January 2012 to September 2015. Assessments and interventions consisted of an evaluation for other causes of chronic pelvic pain by a gynecologist; preintervention and postintervention visual analog scale (VAS) pain score; complete venous duplex ultrasound examination; and Clinical, Etiology, Anatomy, and Pathophysiology classification. All patients underwent diagnostic venography of their pelvic and left ovarian veins as well as intravascular ultrasound of their iliac veins. Patients were treated in one of six ways: ovarian vein embolization (OVE) alone (chemical ± coils), OVE with staged iliac vein stenting, OVE with simultaneous iliac vein stenting, iliac vein stenting alone, OVE with venoplasty, and venoplasty alone. Of the 227 women treated, the average age and number of pregnancies was 46.4 ± 10.4 years and 3.36 ± 1.99, respectively. Treatment distribution was the following: OVE, n = 39; OVE with staged stenting, n = 94; OVE with simultaneous stenting, n = 33; stenting alone, n = 50; OVE with venoplasty, n = 8; and venoplasty alone, n = 3. Seven patients in the OVE and stenting groups (staged) and one patient in the OVE + venoplasty group required a second embolization of the left ovarian vein. Eighty percent (181/227) of patients demonstrated an iliac stenosis >50% by intravascular ultrasound. Average VAS scores for the entire cohort before and after intervention were 8.45 ± 1.11 and 1.86 ± 1.61 (P ≤ .001). In the staged group, only 9 of 94 patients reported a decrease in the VAS score with OVE alone. VAS score decreased from 8.6 ± 0.89 before OVE to 7.97 ± 2.10 after OVE

The effect of pneumatic dilation in management of postfundoplication dysphagia.

Science.gov (United States)

Sunjaya, D; Podboy, A; Blackmon, S H; Katzka, D; Halland, M

2017-06-01

Fundoplication surgery is a commonly performed procedure for gastro-esophageal reflux disease or hiatal hernia repair. Up to 10% of patients develop persistent postoperative dysphagia after surgery. Data on the effectiveness of pneumatic dilation for treatment are limited. The aim of this study was to evaluate clinical outcomes and identify clinical factors associated with successful response to pneumatic dilation among patients with persistent postfundoplication dysphagia (PPFD). We retrospectively evaluated patients who had undergone pneumatic dilation for PPFD between 1999 and 2016. Patients with dysphagia or achalasia prior to fundoplication were excluded. Demographic information, surgical history, severity of dysphagia, and clinical outcomes were collected. Data pertaining to esophagram, manometry, endoscopy, and pneumatic dilation were also collected. We identified 38 patients (82% female, 95% Caucasian, and median age 59 years) with PPFD who completed pneumatic dilation. The median postfundoplication dysphagia score was 2. Eleven patients had abnormal peristalsis on manometry. Seventeen patients reported response (seven complete) with an average decrease of 1 in their dysphagia score. Fifteen patients underwent reoperation due to PPFD. Hiatal hernia repair was the only factor that predicts a higher response rate to pneumatic dilation. Only one patient in our study developed complication (pneumoperitoneum) from pneumatic dilation. We found that pneumatic dilation to be a safe treatment option for PPFD with moderate efficacy. Patients who developed PPFD after a hiatal hernia repair may gain the greatest benefit after pneumatic dilation. We were not able to identify additional clinical, radiological, endoscopic, or manometric parameters that were predictive of response. © 2017 John Wiley & Sons Ltd.

Radiological features of superomedial iliac insufficiency fractures: a possible mimicker of metastatic disease

International Nuclear Information System (INIS)

Donovan, Andrea; Schweitzer, Mark E.; Rafii, Mahvash; Lax, Allison

2009-01-01

Pelvic insufficiency fractures are common in elderly patients. Because both osteoporosis and metastatic disease occur in similar patient populations, insufficiency fractures may be mistaken for metastatic foci. Although the ilium is not an uncommon location for metastases, insufficiency fractures rarely involve the ilium. The radiological features of insufficiency fractures adjacent to the sacroiliac joint (superomedial ilium) have not been well described. We describe the computed tomography (CT), magnetic resonance (MR), and positron emission tomography (PET) imaging findings of these rare fractures. Six patients (five female, one male; mean age 66 years, age range 47-83 years) with iliac insufficiency fractures adjacent to the sacroiliac joint were identified following retrospective review of a clinical database. Imaging studies, including CT (n = 4), MR (n = 3), and PET (n = 2) were reviewed by two radiologists. Tissue biopsy result was available in one patient. CT demonstrated subtle fracture lucency (n = 2) or linear sclerosis (n = 3) adjacent to the sacroiliac joint; MR marrow changes adjacent to the sacroiliac joint demonstrated a low T1, high T2 signal intensity line (n = 2), or a low T1 and low T2 signal intensity line (n = 1). Fractures were fluorodeoxyglucose avid (n = 2) with average SUV max 2.2. Iliac fractures were bilateral in three patients; additional pelvic insufficiency fractures were present in one patient. In one patient, CT-guided biopsy showed no evidence of malignancy. Recognition of the radiological characteristics of iliac insufficiency fractures is important in order to distinguish them from malignancy. The presence of additional pelvic fractures in characteristic locations in the setting of osteoporosis may help to confirm the diagnosis. (orig.)

Radiological features of superomedial iliac insufficiency fractures: a possible mimicker of metastatic disease

Energy Technology Data Exchange (ETDEWEB)

Donovan, Andrea; Schweitzer, Mark E. [NYU Hospital for Joint Diseases, New York, NY (United States); Rafii, Mahvash [New York, NY (United States); Lax, Allison [Georgetown University Hospital, Washington, DC (United States)

2009-01-15

Pelvic insufficiency fractures are common in elderly patients. Because both osteoporosis and metastatic disease occur in similar patient populations, insufficiency fractures may be mistaken for metastatic foci. Although the ilium is not an uncommon location for metastases, insufficiency fractures rarely involve the ilium. The radiological features of insufficiency fractures adjacent to the sacroiliac joint (superomedial ilium) have not been well described. We describe the computed tomography (CT), magnetic resonance (MR), and positron emission tomography (PET) imaging findings of these rare fractures. Six patients (five female, one male; mean age 66 years, age range 47-83 years) with iliac insufficiency fractures adjacent to the sacroiliac joint were identified following retrospective review of a clinical database. Imaging studies, including CT (n = 4), MR (n = 3), and PET (n = 2) were reviewed by two radiologists. Tissue biopsy result was available in one patient. CT demonstrated subtle fracture lucency (n = 2) or linear sclerosis (n = 3) adjacent to the sacroiliac joint; MR marrow changes adjacent to the sacroiliac joint demonstrated a low T1, high T2 signal intensity line (n = 2), or a low T1 and low T2 signal intensity line (n = 1). Fractures were fluorodeoxyglucose avid (n = 2) with average SUV{sub max} 2.2. Iliac fractures were bilateral in three patients; additional pelvic insufficiency fractures were present in one patient. In one patient, CT-guided biopsy showed no evidence of malignancy. Recognition of the radiological characteristics of iliac insufficiency fractures is important in order to distinguish them from malignancy. The presence of additional pelvic fractures in characteristic locations in the setting of osteoporosis may help to confirm the diagnosis. (orig.)

The Effect of Iliac Crest Autograft on the Outcome of Fusion in the Setting of Degenerative Spondylolisthesis

Science.gov (United States)

Radcliff, Kristen; Hwang, Raymond; Hilibrand, Alan; Smith, Harvey E.; Gruskay, Jordan; Lurie, Jon D.; Zhao, Wenyan; Albert, Todd; Weinstein, James

2012-01-01

Background: There is considerable controversy about the long-term morbidity associated with the use of posterior autologous iliac crest bone graft for lumbar spine fusion procedures compared with the use of bone-graft substitutes. The hypothesis of this study was that there is no long-term difference in outcome for patients who had posterior lumbar fusion with or without iliac crest autograft. Methods: The study population includes patients enrolled in the degenerative spondylolisthesis cohort of the Spine Patient Outcomes Research Trial who underwent lumbar spinal fusion. Patients were divided according to whether they had or had not received posterior autologous iliac crest bone graft. Results: There were 108 patients who had fusion with iliac crest autograft and 246 who had fusion without iliac crest autograft. There were no baseline differences between groups in demographic characteristics, comorbidities, or baseline clinical scores. At baseline, the group that received iliac crest bone graft had an increased percentage of patients who had multilevel fusions (32% versus 21%; p = 0.033) and L5-S1 surgery (37% versus 26%; p = 0.031) compared with the group without iliac crest autograft. Operative time was higher in the iliac crest bone-graft group (233.4 versus 200.9 minutes; p case-by-case basis for lumbar spinal fusion. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:22878599

Dilation and Curettage (D&C)

Science.gov (United States)

... For Patients About ACOG Dilation and Curettage (D&C) Home For Patients Search FAQs Dilation and Curettage ( ... February 2016 PDF Format Dilation and Curettage (D&C) Special Procedures What is dilation and curettage (D& ...

Shape of the dilated aorta in children with bicuspid aortic valve

International Nuclear Information System (INIS)

Mart, Christopher R; McNerny, Bryn E

2013-01-01

The dilated aorta in adults with bicuspid aortic valve has been shown to have different shapes, but it is not known if this occurs in children. This observational study was performed to determine if there are different shapes of the dilated aorta in children with bicuspid aortic valve and their association with age, gender, hemodynamic alterations, and degree of aortic enlargement. One hundred and eighty-seven echocardiograms done on pediatric patients (0 – 18 years) for bicuspid aortic valve, during 2008, were reviewed. Aortic valve morphology, shape/size of the aorta, and pertinent hemodynamic alterations were documented. Aortic dilation was felt to be present when at least one aortic segment had a z-score > 2.0; global aortic enlargement was determined by summing the aortic segment z-scores. The aortic shape was assessed by age, gender, valve morphology, and hemodynamic alterations. Aortic dilation was present in 104/187 patients. The aorta had six different shapes designated from S1 through S6. There was no association between the aortic shape and gender, aortic valve morphology, or hemodynamic abnormalities. S3 was the most common after the age of six years and was associated with the most significant degree of global aortic enlargement. The shape of the dilated aorta in children with bicuspid aortic valve does not occur in a uniform manner and multiple shapes are seen. S2 and S3 are most commonly seen. As aortic dilation becomes more significant, a single shape (S3) becomes the dominant pattern

Can FDG-PET/CT replace blind bone marrow biopsy of the posterior iliac crest in Ewing sarcoma?

International Nuclear Information System (INIS)

Kasalak, Oemer; Glaudemans, Andor W.J.M.; Overbosch, Jelle; Kwee, Thomas C.; Jutte, Paul C.

2018-01-01

To determine and compare the value of 18 F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) to blind bone marrow biopsy (BMB) of the posterior iliac crest in detecting metastatic bone marrow involvement in newly diagnosed Ewing sarcoma. This retrospective study included 20 patients with newly diagnosed Ewing sarcoma who underwent pretreatment FDG-PET/CT and a total of 38 blind BMBs (two unilateral and 18 bilateral) of the posterior iliac crest. FDG-PET/CT scans were evaluated for bone marrow involvement, both in the posterior iliac crest and other sites, and compared to blind BMB results. FDG-PET/CT was positive for bone marrow involvement in 7/38 posterior iliac crests, whereas BMB was positive in 5/38 posterior iliac crests. FDG-PET/CT and BMB results in the posterior iliac crest agreed in 36/38 cases (94.7%, 95% confidence interval [CI]: 82.7-98.5%). On a patient level, FDG-PET/CT was positive for bone marrow involvement in 4/20 patients, whereas BMB of the posterior iliac crest was positive in 3/20 patients. On a patient level, FDG-PET/CT and BMB results agreed in 19/20 patients (95.0%, 95% CI: 76.4-99.1%). The only discrepancies between FDG-PET/CT and BMB were observed in two BMBs of one patient. Both BMBs in this patient were negative, whereas FDG-PET/CT indicated bilateral posterior iliac crest involvement and also extensive bone marrow involvement elsewhere. FDG-PET/CT appears to be a valuable method for metastatic bone marrow assessment in newly diagnosed Ewing sarcoma. The routine use of blind BMB of the posterior iliac crest should be reconsidered when FDG-PET/CT is available. (orig.)

Can FDG-PET/CT replace blind bone marrow biopsy of the posterior iliac crest in Ewing sarcoma?

Energy Technology Data Exchange (ETDEWEB)

Kasalak, Oemer; Glaudemans, Andor W.J.M.; Overbosch, Jelle; Kwee, Thomas C. [University of Groningen, Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen (Netherlands); Jutte, Paul C. [University of Groningen, Department of Orthopedics, University Medical Center Groningen (Netherlands)

2018-03-15

To determine and compare the value of {sup 18}F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) to blind bone marrow biopsy (BMB) of the posterior iliac crest in detecting metastatic bone marrow involvement in newly diagnosed Ewing sarcoma. This retrospective study included 20 patients with newly diagnosed Ewing sarcoma who underwent pretreatment FDG-PET/CT and a total of 38 blind BMBs (two unilateral and 18 bilateral) of the posterior iliac crest. FDG-PET/CT scans were evaluated for bone marrow involvement, both in the posterior iliac crest and other sites, and compared to blind BMB results. FDG-PET/CT was positive for bone marrow involvement in 7/38 posterior iliac crests, whereas BMB was positive in 5/38 posterior iliac crests. FDG-PET/CT and BMB results in the posterior iliac crest agreed in 36/38 cases (94.7%, 95% confidence interval [CI]: 82.7-98.5%). On a patient level, FDG-PET/CT was positive for bone marrow involvement in 4/20 patients, whereas BMB of the posterior iliac crest was positive in 3/20 patients. On a patient level, FDG-PET/CT and BMB results agreed in 19/20 patients (95.0%, 95% CI: 76.4-99.1%). The only discrepancies between FDG-PET/CT and BMB were observed in two BMBs of one patient. Both BMBs in this patient were negative, whereas FDG-PET/CT indicated bilateral posterior iliac crest involvement and also extensive bone marrow involvement elsewhere. FDG-PET/CT appears to be a valuable method for metastatic bone marrow assessment in newly diagnosed Ewing sarcoma. The routine use of blind BMB of the posterior iliac crest should be reconsidered when FDG-PET/CT is available. (orig.)

Reconstruction of iliac crest with rib to prevent donor site complications: A prospective study of 26 cases

Directory of Open Access Journals (Sweden)

Dave B

2007-01-01

Full Text Available Background: The tricortical bone graft from the iliac crest are used to reconstruct the post corpectomy spinal defects. The donor iliac area defect is large and may give rise to pain at donor site, instability of pelvis, fracture of ilium, donor site muscle herniation or abdominal content herniation. Rib removed during thoracotomy was used by us to reconstruct the iliac crest defect. Materials and Methods: Twenty-six patients who underwent thoracotomy for dorsal spine corpectomy or curettage for various spinal pathologies from June 2002 to May 2004 were included in the study. After adequate decompression the spine was reconstructed by tricortical bone graft from iliac crest and reconstruction of the iliac crest was done with the rib removed for exposure during thoracotomy. Results: The mean follow up was 15 months. All patients had good graft incorporation which was evaluated on the basis of local tenderness and radiographs. One patient had graft displacement. Conclusion: The reconstruction of iliac crest by rib is a simple and effective procedure to prevent donor site complications.

Titin gene mutations are common in families with both peripartum cardiomyopathy and dilated cardiomyopathy

NARCIS (Netherlands)

van Spaendonck-Zwarts, Karin Y.; Posafalvi, Anna; van den Berg, Maarten P.; Hilfiker-Kleiner, Denise; Bollen, Ilse A. E.; Sliwa, Karen; Alders, Mariëlle; Almomani, Rowida; van Langen, Irene M.; van der Meer, Peter; Sinke, Richard J.; van der Velden, Jolanda; van Veldhuisen, Dirk J.; van Tintelen, J. Peter; Jongbloed, Jan D. H.

2014-01-01

Peripartum cardiomyopathy (PPCM) can be an initial manifestation of familial dilated cardiomyopathy (DCM). We aimed to identify mutations in families that could underlie their PPCM and DCM. We collected 18 families with PPCM and DCM cases from various countries. We studied the clinical

Evaluation of aorto-iliac disease with Doppler ultrasound and isotope clearance techniques

International Nuclear Information System (INIS)

Appleberg, M.; Lewis, J.D.

1975-01-01

The clearance of 99 mTc from the hamstring muscle compartment of patients with aorto-iliac or iliac disease was examined with the patients at rest and after exercise. The values were compared with those obtained in a group of controls and another group with superficial femoral, or femoropopliteal arterial occlusion. A statistically significant difference in the rate of 99 mTc clearance was found in patients with proximal vascular disease

Dilatation of aortic grafts over time: what to expect and when to be concerned

DEFF Research Database (Denmark)

Schroeder, Torben V; Eldrup, Nikolaj; Just, Sven

2009-01-01

Dilatation of aortic prosthetic grafts is commonly reported, but most reports are anecdotal, with little objective data in the literature. We performed a prospective trial of 303 patients who underwent prosthetic graft repair for aortic aneurysm or occlusive disease, randomizing patients between...... insertion of a woven polyester or expanded polytetrafluoroethylene (ePTFE) graft. Patients were followed with computed tomography and ultrasonography for up to 5 years in order to assess the frequency and magnitude of postoperative dilatation. Graft dilatation was documented in patients with polyester...... grafts at 12 months. Thereafter and up to 60 months, polyester grafts did not dilate further. After 5 years, polyester prostheses had dilated by 25% and ePTFE by 12.5%, as determined by computed tomography imaging. These observations suggest that dilatation of prosthetic grafts is more frequent...

Titin gene mutations are common in families with both peripartum cardiomyopathy and dilated cardiomyopathy

NARCIS (Netherlands)

van Spaendonck-Zwarts, Karin Y.; Posafalvi, Anna; van den Berg, Maarten P.; Hilfiker-Kleiner, Denise; Bollen, Ilse A. E.; Sliwa, Karen; Alders, Marielle; AlMomani, Rowida; van Langen, Irene M.; van der Meer, Peter; Sinke, Richard J.; van der Velden, Jolanda; Van Veldhuisen, Dirk J.; van Tintelen, J. Peter; Jongbloed, Jan D. H.

2014-01-01

Aim Peripartum cardiomyopathy (PPCM) can be an initial manifestation of familial dilated cardiomyopathy (DCM). We aimed to identify mutations in families that could underlie their PPCM and DCM. Methods and results We collected 18 families with PPCM and DCM cases from various countries. We studied

Advantages and disadvantages of magnetic resonance cholangiography for patients with cholelithiasis with reference to those patients associated with dilatation of the common bile duct

International Nuclear Information System (INIS)

Higuchi, Takuya; Morimoto, Yoshikazu; Sumimura, Junichi; Miyazaki, Minoru

2000-01-01

Magnetic resonance cholangiography (MRC) was performed on patients with cholelithiasis with dilatation of the common bile duct (more than 10 mm in diameter) before surgery, and the advantages and disadvantages were investigated based on laparotomy findings. Subjects were 27 patients with cholelithiasis associated with common bile duct dilatation who were operated on at the department since June 1996. There were 13 men and 14 women. A mean age of them was 68.2±11.2 years, ranging from 43 to 90 years. As preoperative imagings, abdominal ultrasonography (US) and abdominal CT scan were performed in all cases; either of intravenous cholangiography (IVC), endoscopic retrograde cholangiography (ERCP), or percutaneous transhepatic cholangiography (PTC) was conducted in them; and MRC was performed in 22 cases except incompatible cases. Patients were imaged in the coronal planes by 0.5-T MR scanner employing a body surface coil at 10 second catch at a single breath-hold without injection of contrast medium. Twenty-one (21) out of 27 patients were proven to have common bile duct stones. The overall diagnostic accuracies in US, CT, IVC, and MRC were 40.7%, 62.9%, 68.4% and 86.3%, respectively. The diameters of common bile duct were ranged from 10 mm to 45 mm (mean 15.9±7.9 mm). MRC allows to assess microstones in the common bile duct, and moreover it is useful for postoperative or allergic patients. However, MRC can necessarily reveal peripapillary diverticulum, and it may overestimate the gallbladder in case of negative cholecystogram. MRC can noninvasively and rapidly reveal the presence of stones in the common bile duct, but further studies are required for a better evaluation of the potential disadvantages of this technique. (author)

Is Internal Iliac Artery Embolization Essential Prior to Endovascular Repair of Aortoiliac Aneurysms?

International Nuclear Information System (INIS)

Bharwani, N.; Raja, J.; Choke, E.; Belli, A. M.; Thompson, M. M.; Morgan, R. A.; Munneke, G.

2008-01-01

Patients who undergo endovascular repair of aorto-iliac aneurysms (EVAR) require internal iliac artery (IIA) embolization (IIAE) to prevent type II endoleaks after extending the endografts into the external iliac artery. However, IIAE may not be possible in some patients due to technical factors or adverse anatomy. The aim of this study was to assess retrospectively whether patients with aorto-iliac aneurysms who fail IIAE have an increase in type II endoleak after EVAR compared with similar patients who undergo successful embolization. We retrospectively analyzed the records of 148 patients who underwent EVAR from December 1997 to June 2005. Sixty-one patients had aorto-iliac aneurysms which required IIAE before EVAR. Fifty patients had successful IIAE and 11 patients had unsuccessful IIAE prior to EVAR. The clinical and imaging follow-up was reviewed before and after EVAR. The endoleak rate of the embolized group was compared with that of the group in whom embolization failed. After a mean follow-up of 19.7 months in the study group and 25 months in the control group, there were no statistically significant differences in outcome measures between the two groups. Specifically, there were no type II endoleaks related to the IIA in patients where IIAE had failed. We conclude that failure to embolize the IIA prior to EVAR should not necessarily preclude patients from treatment. In patients where there is difficulty in achieving coil embolization, it is recommended that EVAR should proceed, as clinical sequelae are unlikely

Case Report Percutaneous Dilational Tracheostomy A bed side ...

African Journals Online (AJOL)

Introduction: Tracheostomy is one of the most commonly performed procedures in critically ill patients. Percutaneous dilatational tracheostomy (PDT), according to ciaglias technique described in 1985, has become the most popular technique for percutaneous tracheostomy and is demonstrably as safe as surgical.

Constipation following bilateral of internal iliac artery aneurysms

Directory of Open Access Journals (Sweden)

S Morita

2012-09-01

Full Text Available A 72-year-old man presented with constipation. He was hypertensive and suffered from chronic constipation. On arrival, the patient was fully conscious, and his vital signs were stable. He requested an enema because this treatment had proved effective in the past. On physical examination, a hard palpable mass was detected in the lower abdomen. Computed tomography was performed with contrast media. It revealed an abdominal aortic aneurysm (AAA and bilateral internal iliac artery aneurysms (IIAAs; the latter obstructing the sigmoid colon. We believe that this obstruction was the cause of constipation. The patient underwent Y-graft replacement for the treatment of the AAA and bilateral IIAAs. The surgery was successful, and constipation has not recurred since. As constipation is the most common digestive disorder in the general population, all physicians should be aware that chronic constipation can be caused by bilateral IIAAs.

Bone formation in cranial, mandibular, tibial and iliac bone grafts in rats

DEFF Research Database (Denmark)

Solheim, E; Pinholt, E M; Talsnes, O

1995-01-01

Several studies have suggested that grafts from membranous derived bone (e.g., calvarial grafts) retain their volume better than those from endochondral derived bone (e.g., iliac bone grafts). Increased osteogenesis in grafts of the former type has been offered as the explanation. However, simple...... volume measurements of the recovered grafts do not differentiate between viable and dead bone. We studied fresh syngeneic full-thickness bone grafts from calvaria, mandibula, tibia diaphysis, and iliac bone implanted in the back muscles of young Lewis rats. Bone formation in grafts recovered 3 weeks...... that the anatomical area of harvest is important regarding new bone formation in syngeneic bone grafts. However, the results do not support the contention that better maintenance of volume of calvarial grafts compared with iliac bone grafts is due to enhanced osteogenesis in the former....

The risk of endoleak following stent covering of the internal iliac artery during endovascular aneurysm repair

International Nuclear Information System (INIS)

Rajesparan, K.; Partridge, W.; Refson, J.; Abidia, A.; Aldin, Z.

2014-01-01

Aim: To investigate the risk of endoleak during endovascular aneurysm repair (EVAR) involving the distal common iliac artery (CIA) when the internal iliac artery (IIA) is covered without prior coil embolization. Materials and methods: Retrospective analysis of 145 (125 men, 20 women) consecutive EVAR cases. Clinical notes and radiological images were reviewed, and data collected on patient demographics, aneurysm morphology, covering of the IIA with or without embolization, presence of endoleaks, and patient symptoms relating to IIA ischaemia. Results: A total of 29 IIAs (10%) were covered in a total of 25 patients. Seven IIAs (24%) were embolized before stent covering (Embolization group), and 22 IIAs (76%) were covered only without embolization (Cover group). There was no statistically significant difference in the mean size of the abdominal aortic aneurysm diameter or CIA diameter between each group. No endoleaks from IIA retrograde filling were found in either group. Conclusion: The results of the present study do not support the traditional view that coverage of the IIA without prior embolization carries a high risk of endoleak, with no endoleaks seen in all 22 cases. Large-scale trials are required. However, the advent of branched-stenting techniques and the emergence of their success in long-term follow-up may preclude the former. - Highlights: • No EVAR endoleaks due to retrograde filling of the internal iliac artery (IIA). • No increased risk of endoleak with stent coverage of the IIA without embolisation. • Current evidence does not support traditional views

Evaluation of aorto-iliac disease with Doppler ultrasound and isotope clearance techniques

Energy Technology Data Exchange (ETDEWEB)

Appleberg, M [University of the Witwatersrand, Johannesburg (South Africa). Dept. of Surgery; Lewis, J D

1975-10-04

The clearance of /sup 99/mTc from the hamstring muscle compartment of patients with aorto-iliac or iliac disease was examined with the patients at rest and after exercise. The values were compared with those obtained in a group of controls and another group with superficial femoral, or femoropopliteal arterial occlusion. A statistically significant difference in the rate of /sup 99/mTc clearance was found in patients with proximal vascular disease.

Directional Atherectomy in Iliac Stent Failure: Clinical Technique and Histopathologic Correlation

International Nuclear Information System (INIS)

Ettles, Duncan F.; MacDonald, Alastair W.; Burgess, Paul A.; Nicholson, Anthony A.; Dyet, John F.

1998-01-01

Purpose: To assess the feasibility and efficacy of directional atherectomy in the treatment of iliac stent stenosis or occlusion and to evaluate the histologic composition of excised atherectomy specimens. Methods: Directional atherectomy of six occluded and 10 severely stenosed iliac stents was undertaken in 12 patients at a mean interval of 28 months (range 3-69 months) after stent insertion for occlusive aortoiliac disease. In cases of stent occlusion, atherectomy was preceded by low-dose thrombolysis. In all patients stent clearance with return of femoral pulses was achieved within 24 hr and there were no significant complications. All excised specimens were sent for histologic examination. Results: Eleven patients (92%) remain symptom free with unlimited walking distance at a mean follow-up interval of 11.5 months (range 3-31 months) after treatment. Histologic examination revealed typical myointimal hyperplasia at three excision sites, intimal fibrosis at three sites, atheroma at four sites and organized thrombus at six sites. Conclusion: Atherectomy offers an effective treatment in iliac stent occlusion and restenosis with no significant adverse effects. Debulking of these lesions seems to offer a more logical approach than simple balloon angioplasty. Clinical and duplex follow-up confirms satisfactory outcome within the first year but longer-term results are not yet known. The histologic data obtained demonstrate that stent restenosis and occlusion are likely to be multifactorial, and challenge the assumption that myointimal hyperplasia is the sole cause of iliac stent occlusion

Non-vascularized iliac bone grafting for scaphoid nonunion with avascular necrosis.

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Kim, Jihyeung; Park, Jin Woo; Chung, Jeehyeok; Jeong Bae, Kee; Gong, Hyun Sik; Baek, Goo Hyun

2018-01-01

We present the surgical outcomes of non-vascularized bone grafting taken from the iliac crest in 24 patients with scaphoid nonunion and avascular necrosis. The Fisk-Fernandez technique was used in 11 patients, and cancellous bone grafting was used in 13 patients. Bony union was achieved in 22 of the 24 patients. Non-vascularized iliac bone grafting can be used for the surgical management of scaphoid nonunion with avascular necrosis. Although revascularization of the proximal fragment after surgery was not evaluated, bony union was confirmed in nearly all patients. IV.

Internal thoracic artery collateral to the external iliac artery in chronic aortoiliac occlusive disease

International Nuclear Information System (INIS)

Kim, Jinna; Won, Jong Yun; Park, Sung Il; Lee, Do Yun

2003-01-01

To evaluate the incidence and angiographic findings of the collateral pathway involving the internal thoracic artery in patients with chronic aortoiliac occlusive disease. Between March 2000 and Februrary 2001, 124 patients at our hospital underwent angiographic evaluation of chronic aortoiliac occlusive disease, and in 15 of these complete obstruction or severe stenosis of the aortoiliac artery was identified. The aortograms and collateral arteriograms obtained, including internal thoracic arteriograms, as well as the medical records of the patients involved, were evaluated. In nine patients there was complete occlusion of the infrarenal aorta, or diffuse stenosis of 75% or more in the descending thoracic aorta, and in the other six, a patent aorta but complete occlusion or stenosis of 75% or more of the common iliac artery was demonstrated. Collateral perfusion via hypertrophied internal thoracic arteries and rich anastomoses between the superior and inferior epigastric arteries, reconstituting the external iliac artery, were noted in all fifteen patients, regardless of symptom duration, which ranged from six months to twelve years. In patients with chronic aortoiliac occlusive disease, the internal thoracic artery, along with visceral collaterals and those from the contralateral side, is one of the major parietal collateral pathways

Assessment of a Polyester-Covered Nitinol Stent in the Canine Aorta and Iliac Arteries

International Nuclear Information System (INIS)

Castaneda, Flavio; Ball-Kell, Susan M.; Young, Kate; Li Ruizong

2000-01-01

Purpose: To evaluate the patency and healing characteristics of a woven polyester fabric-covered stent in the canine model.Methods: Twenty-four self-expanding covered stents were placed in the infrarenal aorta and bilateral common iliac arteries of eight dogs and evaluated at 1 (n = 2), 3 (n = 2), and 6 (n = 4) months. Stent assessment was done using angiography prior to euthanasia, and light and scanning electron microscopy.Results: Angiographically, just prior to euthanasia, 8 of 8 aortic and 14 of 16 iliac endovascular covered stents were patent. Histologically, the stented regions showed complete endothelialization 6 months after graft implantation. A neointima had formed inside the stented vessel regions resulting in complete encasement of the fabric-covered stent by 3 months after graft implantation. Medial compression with smooth muscle cell atrophy was present in all stented regions. Explanted stent wires, examined by scanning electron microscopy, showed pitting but no cracks or breakage.Conclusion: The covered stent demonstrated predictable healing and is effective in preventing stenosis in vessels 10.0 mm or greater in diameter but does not completely preclude stenosis in vessels 6.0 mm or less in diameter

Percutaneous dilatational tracheostomy following total artificial heart implantation.

Science.gov (United States)

Spiliopoulos, Sotirios; Dimitriou, Alexandros Merkourios; Serrano, Maria Rosario; Guersoy, Dilek; Autschbach, Ruediger; Goetzenich, Andreas; Koerfer, Reiner; Tenderich, Gero

2015-07-01

Coagulation disorders and an immune-altered state are common among total artificial heart patients. In this context, we sought to evaluate the safety of percutaneous dilatational tracheostomy in cases of prolonged need for mechanical ventilatory support. We retrospectively analysed the charts of 11 total artificial heart patients who received percutaneous dilatational tracheostomy. We focused on early and late complications. We observed no major complications and no procedure-related deaths. Early minor complications included venous oozing (45.4%) and one case of local infection. Late complications, including subglottic stenosis, stomal infection or infections of the lower respiratory tract, were not observed. In conclusion, percutaneous dilatational tracheostomy in total artificial heart patients is safe. Considering the well-known benefits of early tracheotomy over prolonged translaryngeal intubation, we advocate early timing of therapy in cases of prolonged mechanical ventilation. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Avulsion fractures of the anterior inferior iliac spine: spectrum of imaging findings

International Nuclear Information System (INIS)

Fernandes, Joao Luiz; Viana, Sergio Lopes; Mendonca, Jose Luiz Furtado de; Freitas, Flavia Mendes Oliveira; Lima, Gylse-Anne de Souza; Vila, Ana Fabiola da; Ribeiro, Nelmar

2005-01-01

Avulsive injuries of the pelvic aphophyses are relatively common among 13-18 year old athletes, particularly among soccer players in Brazil. Diagnosis is made upon clinical and imaging findings. These lesions show three distinct phases: acute, repair and consolidation phases. Although acute and consolidation phases usually represent no diagnostic challenge, the repair phase may appear as an aggressive process on diagnostic images simulating neoplasic lesions. In this paper, the authors present the imaging findings of patients with avulsion of the anterior inferior iliac spine on plain radiographs, computerized tomography and magnetic resonance imaging, emphasizing the typical features of the three evolutive phases of these lesions. (author)

Percutaneous Iliac Screws for Minimally Invasive Spinal Deformity Surgery

Directory of Open Access Journals (Sweden)

Michael Y. Wang

2012-01-01

Full Text Available Introduction. Adult spinal deformity (ASD surgeries carry significant morbidity, and this has led many surgeons to apply minimally invasive surgery (MIS techniques to reduce the blood loss, infections, and other peri-operative complications. A spectrum of techniques for MIS correction of ASD has thus evolved, most recently the application of percutaneous iliac screws. Methods. Over an 18 months 10 patients with thoracolumbar scoliosis underwent MIS surgery. The mean age was 73 years (70% females. Patients were treated with multi-level facet osteotomies and interbody fusion using expandable cages followed by percutaneous screw fixation. Percutaneous iliac screws were placed bilaterally using the obturator outlet view to target the ischial body. Results. All patients were successfully instrumented without conversion to an open technique. Mean operative time was 302 minutes and the mean blood loss was 480 cc, with no intraoperative complications. A total of 20 screws were placed successfully as judged by CT scanning to confirm no bony violations. Complications included: two asymptomatic medial breaches at T10 and L5, and one patient requiring delayed epidural hematoma evacuation. Conclusions. Percutaneous iliac screws can be placed safely in patients with ASD. This MIS technique allows for successful caudal anchoring to stress-shield the sacrum and L5-S1 fusion site in long-segment constructs.

Iliac artery myointimal hyperplasia in rabbits submitted to angioplasty and treated with Moringa oleifera.

Science.gov (United States)

Rolim, Jânio Cipriano; Nogueira, Manoel Ricardo Sena; Lima, Paulo Roberto da Silva; Bandeira, Francisco Chavier Vieira; Pordeus, Mizael Armando Abrantes; Castro, Aldemar Araújo; Pitta, Guilherme Benjamin; Diniz, Margareth de Fátima Formiga Melo; Pereira, Adamastor Humberto

2016-02-01

to assess post-angioplasty myointimal hyperplasia in iliac artery of rabbits treated with extract of Moringa oleifera leaves. we conducted a randomized trial in laboratory animals for five weeks of follow-up, developed in the Vivarium of Pharmaceutical Technology Laboratory of the Universidade Federal da Paraíba. We used rabbits from the New Zealand breed, subjected to a hypercholesterolemic diet and angioplasty of the external iliac artery, randomized into two groups: M200 Group (n=10) - rabbits treated with 200mg/kg/day of Moringa oleifera leaves extract orally; SF group (n=10) - rabbits treated with 0.9% saline orally. After five weeks, the animals were euthanized and the iliac arteries prepared for histology. Histological sections were analyzed by digital morphometry. Statistical analysis was performed using the Student's t test. The significance level was 0.05. there was no significant difference in myointimal hyperplasia between M200 and SF groups when comparing the iliac arteries submitted to angioplasty. there was no difference of myointimal hyperplasia between groups treated with saline and Moringa oleifera after angioplasty.

Iliac artery myointimal hyperplasia in rabbits submitted to angioplasty and treated with Moringa oleifera

Directory of Open Access Journals (Sweden)

Jânio Cipriano Rolim

Full Text Available Objective: to assess post-angioplasty myointimal hyperplasia in iliac artery of rabbits treated with extract of Moringa oleifera leaves. Methods : we conducted a randomized trial in laboratory animals for five weeks of follow-up, developed in the Vivarium of Pharmaceutical Technology Laboratory of the Universidade Federal da Paraíba. We used rabbits from the New Zealand breed, subjected to a hypercholesterolemic diet and angioplasty of the external iliac artery, randomized into two groups: M200 Group (n=10 - rabbits treated with 200mg/kg/day of Moringa oleifera leaves extract orally; SF group (n=10 - rabbits treated with 0.9% saline orally. After five weeks, the animals were euthanized and the iliac arteries prepared for histology. Histological sections were analyzed by digital morphometry. Statistical analysis was performed using the Student's t test. The significance level was 0.05. Results : there was no significant difference in myointimal hyperplasia between M200 and SF groups when comparing the iliac arteries submitted to angioplasty. Conclusion : there was no difference of myointimal hyperplasia between groups treated with saline and Moringa oleifera after angioplasty.

Remote Iliac Artery Endarterectomy: A Case Series and Systematic Review.

Science.gov (United States)

Bekken, Joost A; de Boer, Sanne W; van der Sluijs, Rogier; Jongsma, Hidde; de Vries, Jean-Paul P M; Fioole, Bram

2018-02-01

To evaluate the long-term results of remote iliac artery endarterectomy (RIAE) in 2 vascular referral centers and review existing literature. A retrospective analysis was conducted of 109 consecutive patients (mean age 64.2±10.7 years; 72 men) who underwent 113 RIAE procedures for lower limb ischemia from January 2004 to August 2015 at 2 vascular centers. The majority of limbs (82, 72.6%) had TASC II D lesions (31 TASC II C). Primary outcome measures were primary, assisted primary, and secondary patency. A comprehensive literature search was performed in the PubMed and EMBASE databases to identify all English-language studies published after 1990 reporting the results of RIAE. Technical success was achieved in 95 (84.1%) of the 113 procedures. The complication rate was 13.7%, and 30-day mortality was 0%. At 5 years, primary patency was 78.2%, assisted primary patency was 83.4%, and secondary patency was 86.7%. Hemodynamic success was obtained in 91.7% of patients, and clinical improvement was observed in 95.2%. Freedom from major amputation was 94.7% at 5 years. The systematic review comprised 6 studies including 419 RIAEs, and pooled data showed results similar to the current study. For external iliac artery occlusions extending into the common femoral artery, RIAE appears to be a valuable hybrid treatment option. It combines acceptable morbidity and low mortality with good long-term patency. It has some advantages over an open surgical iliofemoral bypass or complete endovascular revascularization and could be the best treatment option in selected cases.

Complete resection of locally advanced ovarian carcinoma fixed to the pelvic sidewall and involving external and internal iliac vessels.

Science.gov (United States)

Nishikimi, Kyoko; Tate, Shinichi; Matsuoka, Ayumu; Shozu, Makio

2017-08-01

Locally advanced ovarian carcinomas may be fixed to the pelvic sidewall, and although these often involve the internal iliac vessels, they rarely involve the external iliac vessels. Such tumors are mostly considered inoperable. We present a surgical technique for complete resection of locally advanced ovarian carcinoma fixed to the pelvic sidewall and involving external and internal iliac vessels. A 69-year-old woman presented with ovarian carcinoma fixed to the right pelvic sidewall, which involved the right external and internal iliac arteries and veins and the right lower ureter, rectum, and vagina. We cut the external iliac artery and vein at the bifurcation and at the inguinal ligament to resect the external artery and vein. Then, we reconstructed the arterial and venous supplies of the right external artery and vein with grafts. After creating a wide space immediately inside of the sacral plexus to allow the tumor fixed to pelvic sidewall with the internal iliac vessels to move medially, we performed total internal iliac vessel resection. We achieved complete en bloc tumor resection with the right external and internal artery and vein, right ureter, vagina, and rectum adhering to the tumor. There were no intra- or postoperative complications, such as bleeding, graft occlusion, infection, or limb edema. Exfoliation from the sacral plexus and total resection with external and internal iliac vessels enables complete resection of the tumor fixed to the pelvic sidewall. Copyright © 2017 Elsevier Inc. All rights reserved.

Case report of deep vein thrombosis caused by artificial urinary sphincter reservoir compressing right external iliac vein

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Marcus J Yip

2015-01-01

Full Text Available Artificial urinary sphincters (AUSs are commonly used after radical prostatectomy for those who are incontinent of urine. However, they are associated with complications, the most common being reservoir uprising or migration. We present a unique case of occlusive external iliac and femoral vein obstruction by the AUS reservoir causing thrombosis. Deflation of the reservoir and anticoagulation has, thus far, not been successful at decreasing thrombus burden. We present this case as a rare, but significant surgical complication; explore the risk factors that may have contributed, and other potential endovascular therapies to address this previously unreported AUS complication.

Primary extraskeletal mesenchymal chondrosarcoma arising from the iliac vein

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Hua Zhang

2017-10-01

Full Text Available The iliac vein is an extremely rare site for mesenchymal chondrosarcoma, and patients with primary extraskeletal mesenchymal chondrosarcoma arising from a vein always suffer a very poor prognosis. We report a case of a 45-year-old female who presented with a 5-month history of left leg edema in 2015. Contrast-enhanced computed tomography showed a large mass in the left iliac vein with scattered calcifications. Wide-margin resection was performed, and histopathologic and immunohistochemical analyses confirmed the presence of intraluminal mesenchymal chondrosarcoma with local invasion out of the vein wall. Due to poor patient compliance, postoperative neoadjuvant chemotherapy and radiotherapy were not started, and a bone scan performed 16 weeks postoperatively showed multiple bone metastases. The patient died on the twenty-fourth postoperative week.

The establishment of bilateral external iliac artery stenosis model in experimental canines and its angiographic evaluation

International Nuclear Information System (INIS)

Xia Yonghui; Li Weixiao; Bi Yonghua; Xu Ke

2011-01-01

Objective: To establish an experimental canine model of bilateral external iliac artery stenosis by surgical method with absorbable suture. Methods: Under general anesthesia bilateral external iliac arteries were partly obstructed (about 50%) with absorbable suture in ten dogs. Three months later angiography was performed to evaluate the arterial stricture degree. Results: Bilateral external iliac artery stenosis model was successfully established in eight dogs and the other two dogs died within two weeks after the procedure. Angiography performed three months after the procedure showed that the stricture degree of arterial lumen was (60.6±12.5)%. Conclusion: Satisfactory experimental canine model of bilateral external iliac artery stenosis can be established by surgical method with absorbable suture. This method can be used for reference when peripheral artery stenosis model is to be prepared in larger animals. (authors)

Intravascular ultrasound for iliac artery imaging. Clinical review

DEFF Research Database (Denmark)

Vogt, K G; Schroeder, T V

2001-01-01

IVUS is able to produce trans-sectional images of the iliac arteries at a high resolution. The three layered appearance of the arterial wall can be visualized. In the atherosclerotic diseased artery calcified plaques can be discerned from non-calcified plaques, and the distribution of the plaque...

Cryoplasty for Canine Iliac Artery Stenosis and its Impact on Expression of TIMP-2 and MMP-2.

Science.gov (United States)

Wu, Zhengzhong; Zang, Shengbing; Liu, Wenwen; Jiang, Na; Yang, Weizhu

2015-01-01

This study was performed to observe the effects of cryoplasty on canine iliac artery stenosis and the expression of tissue inhibition of matrix metalloproteinase 2 (TIMP-2) and matrix metalloproteinase 2 (MMP-2). We produced a reliable canine model to mimic the atherosclerotic stenosis in the iliac artery by suturing the artery followed by vessel ligation to create an injury to intimal and medial walls. Sixteen mongrel dogs with iliac artery stenosis were randomized to conventional balloon angioplasty (n = 8) or cryoplasty (n = 8). Four weeks posttreatment, the cryoplasty group with less collagen fibers and smooth muscle demonstrated significantly larger luminal diameter of iliac artery compared to the balloon angioplasty group (P < .001). Expression of TIMP-2 significantly increased and expression of MMP-2 significantly reduced in iliac artery of the cryoplasty group compared to conventional balloon angioplasty. Our study suggests cryoplasty might increase the expression of TIMP-2 and decrease the expression of MMP-2, thereby inhibiting vascular hyperplasia and collagen fibers synthesis of the stenotic vessels. © The Author(s) 2015.

Subperiosteal hematoma of the iliac bone: imaging features of acute and chronic stages with emphasis on pathophysiology

Energy Technology Data Exchange (ETDEWEB)

Guillin, Raphael [Rennes University Hospital, Department of Musculoskeletal Imaging, Rennes Cedex 2 (France); Moser, Thomas [Montreal University Hospital, Department of Musculoskeletal Imaging, Montreal (Canada); Koob, Meriam [Strasbourg University Hospital, Department of Pediatric Imaging, Strasbourg (France); Khoury, Viviane [Mc Gill University Health center, Department of Radiology, Montreal (Canada); Chapuis, Madeleine [Rennes University Hospital, Department of Pediatric Orthopedic Surgery, Rennes (France); Ropars, Mickael [Rennes University Hospital, Department of orthopedic surgery, Rennes (France); Cardinal, Etienne [Radiologie Laennec, Montreal (Canada)

2012-06-15

The goal of this work is to describe the radiological appearance and clinical presentation of subperiosteal iliac hematoma and present a review of the literature. We retrospectively reviewed the radiological and clinical files of 19 patients (age range: 12-75; mean: 47) who presented with acute or chronic subperiosteal iliac hematomas. Imaging findings and relevant clinical information were recorded. A thorough literature search was performed to find additional cases of this rare condition. Three young patients presented with acute subperiosteal iliac hematoma following a fall. Clinical presentation was characterized by pain and gait disturbance presumed to result from crural nerve compression. Unilateral or bilateral lenticular hematomas deep in the iliacus muscle were demonstrated by CT for all patients while MRI was also available for two of them. In 16 asymptomatic patients, chronic ossified subperiosteal iliac hematomas were incidentally detected by CT. Progressive ossification of acute hematoma was demonstrated at follow-up in two patients. Subperiosteal iliac hematoma is rare but has typical imaging findings that may present acutely in adolescents or chronically in asymptomatic adults. (orig.)

[Common types of massive intraoperative haemorrhage, treatment philosophy and operating skills in pelvic cancer surgery].

Science.gov (United States)

Wang, Gang-cheng; Han, Guang-sen; Ren, Ying-kun; Xu, Yong-chao; Zhang, Jian; Lu, Chao-min; Zhao, Yu-zhou; Li, Jian; Gu, Yan-hui

2013-10-01

To explore the common types of massive intraoperative bleeding, clinical characteristics, treatment philosophy and operating skills in pelvic cancer surgery. We treated massive intraoperative bleeding in 19 patients with pelvic cancer in our department from January 2003 to March 2012. Their clinical data were retrospectively analyzed. The clinical features of massive intraoperative bleeding were analyzed, the treatment experience and lessons were summed up, and the operating skills to manage this serious issue were analyzed. In this group of 19 patients, 7 cases were of presacral venous plexus bleeding, 5 cases of internal iliac vein bleeding, 6 cases of anterior sacral venous plexus and internal iliac vein bleeding, and one cases of internal and external iliac vein bleeding. Six cases of anterior sacral plexus bleeding and 4 cases of internal iliac vein bleeding were treated with suture ligation to stop the bleeding. Six cases of anterior sacral and internal iliac vein bleeding, one cases of anterior sacral vein bleeding, and one case of internal iliac vein bleeding were managed with transabdominal perineal incision or transabdominal cotton pad compression hemostasis. One case of internal and external iliac vein bleeding was treated with direct ligation of the external iliac vein and compression hemostasis of the internal iliac vein. Among the 19 patients, 18 cases had effective hemostasis. Their blood loss was 400-1500 ml, and they had a fair postoperative recovery. One patient died due to massive intraoperative bleeding of ca. 4500 ml. Most of the massive intraoperative bleeding during pelvic cancer surgery is from the presacral venous plexus and internal iliac vein. The operator should go along with the treatment philosophy to save the life of the patient above all, and to properly perform suture ligation or compression hemostasis according to the actual situation, and with mastered crucial operating hemostatic skills.

Sonography of gallstones and biliary dilatation without a visible aetiology: The infrequency of obstructing choledocholithiasis

International Nuclear Information System (INIS)

Cabrera, O.; Van Sonnenberg, E.; Wittich, G.R.; Leopold, G.R.; Gosink, U.B.; Bowen, J.S.; California Univ., San Diego, La Jolla

1988-01-01

This paper describes 50 consecutive patients who sonographically had gallbladder stones and dilated bile ducts, but no visible aetiology for the dilatation. We reviewed these cases to determine the frequency of choledocholithiasis in this setting. Common duct stones caused obstruction in only 36% of these patients. Other aetiologies included strictures due to chronic pancreatitis or prior stone passage in 24% of the patients, and malignant obstruction in 16%. In 24% of the patients, no cause was found for biliary dilatation: common duct stones or obstructing tumours were excluded in the group. Since aetiologies other than stones are likely in a majority of cases, further preoperative workup (CT, percutaneous transhepatic cholangiography, ERCP) or intraoperative cholangiography (if the patient requires urgent cholecystectomy) is indicated. The additional studies should provide a diagnosis, help determine whether or not the common duct should be explored, or avoid unnecessary operation in case of incurable malignancy. (orig.)

Genetics of Human and Canine Dilated Cardiomyopathy

OpenAIRE

Siobhan Simpson; Jennifer Edwards; Thomas F. N. Ferguson-Mignan; Malcolm Cobb; Nigel P. Mongan; Catrin S. Rutland

2015-01-01

Cardiovascular disease is a leading cause of death in both humans and dogs. Dilated cardiomyopathy (DCM) accounts for a large number of these cases, reported to be the third most common form of cardiac disease in humans and the second most common in dogs. In human studies of DCM there are more than 50 genetic loci associated with the disease. Despite canine DCM having similar disease progression to human DCM studies into the genetic basis of canine DCM lag far behind those of human DCM. In th...

Topological Origin of the Network Dilation Anomaly in Ion-Exchanged Glasses

Science.gov (United States)

Wang, Mengyi; Smedskjaer, Morten M.; Mauro, John C.; Sant, Gaurav; Bauchy, Mathieu

2017-11-01

Ion exchange is commonly used to strengthen oxide glasses. However, the resulting stuffed glasses usually do not reach the molar volume of as-melted glasses of similar composition—a phenomenon known as the network dilation anomaly. This behavior seriously limits the potential for the chemical strengthening of glasses and its origin remains one of the mysteries of glass science. Here, based on molecular dynamics simulations of sodium silicate glasses coupled with topological constraint theory, we show that the topology of the atomic network controls the extent of ion-exchange-induced dilation. We demonstrate that isostatic glasses do not show any network dilation anomaly. This is found to arise from the combined absence of floppy modes of deformation and internal eigenstress in isostatic atomic networks.

Aorto-iliac angioplasty

International Nuclear Information System (INIS)

Kotb, M.; Bennett, J.; Kadir, S.

1990-01-01

This paper reports on the results and complications of aortoiliac balloon percutaneous transluminal angioplasty (PTA) and Simpson atherectomy that are compared to determine the role of the latter procedure in the management of aortoiliac disease. In 1984--1988, 92 patients underwent 126 angioplasties of the aortoiliac region. In 1986--1989, 21 patients underwent iliac artery atherectomy. Both groups had similar symptoms, risk factors, and age ranges. The overall technical success rate was 97.6or PTA and 100% for atherectomy. The initial clinical success was 92.8% for PTA and 100% for atherectomy. The 2-year clinical patency rate was 60% for PTA and 64% for artherectomy. Complications requiring surgery occurred in four of 126 (3%) PTA patients and one of 21 (5%) atherectomy patients. Groin hematomas were observed in 16% of PTA patients and 19% of atherectomy patients

Aberrant Ovarian Collateral Originating from External Iliac Artery During Uterine Artery Embolization

Energy Technology Data Exchange (ETDEWEB)

Kwon, Joon Ho; Kim, Man Deuk, E-mail: mdkim@yuhs.ac; Lee, Kwang-hun; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Park, Sung Il; Lee, Do Yun [Yonsei University College of Medicine, Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Korea, Republic of)

2013-02-15

We report a case of a 35-year-old woman who underwent uterine artery embolization (UAE) for symptomatic multiple uterine fibroids with collateral aberrant right ovarian artery that originated from the right external iliac artery. We believe that this is the first reported case in the literature of this collateral uterine flow by the right ovarian artery originated from the right external iliac artery. We briefly present the details of the case and review the literature on variations of ovarian artery origin that might be encountered during UAE.

Aberrant Ovarian Collateral Originating from External Iliac Artery During Uterine Artery Embolization

International Nuclear Information System (INIS)

Kwon, Joon Ho; Kim, Man Deuk; Lee, Kwang-hun; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Park, Sung Il; Lee, Do Yun

2013-01-01

We report a case of a 35-year-old woman who underwent uterine artery embolization (UAE) for symptomatic multiple uterine fibroids with collateral aberrant right ovarian artery that originated from the right external iliac artery. We believe that this is the first reported case in the literature of this collateral uterine flow by the right ovarian artery originated from the right external iliac artery. We briefly present the details of the case and review the literature on variations of ovarian artery origin that might be encountered during UAE.

Subintimal stent placement in patients with long segment occlusion of the iliac artery

Energy Technology Data Exchange (ETDEWEB)

Yu, Ho Jung; Kim, Young Hwan; Kim, Si Hyung; Ko, Sung Min; Choi, Jin Soo; Lee, Hyun Jin; Kim, Hyung Tae; Jo, Won Hyun [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of)

2008-01-15

We evaluated the technical feasibility and clinical efficacy of subintimal stent placement for long segment occlusion of the iliac artery. From March 2003 to February 2007, subintimal stent placement for long segment occlusion of the iliac artery of 24 limbs in 22 patients was analyzed retrospectively. Endovascular access was performed via the ipsilateral femoral artery in 7 cases, via the contralateral femoral artery in 6 cases, via both femoral arteries in 10 cases and via the brachial artery in one case. The SAFARI (subintimal arterial flossing with antegrade-retrograde intervention) technique using a microcatheter was performed to recannalize iliac artery occlusion in three cases. Medical records were reviewed for the collection of follow-up data. The stent patency rate was analyzed by use of the Kaplan-Meier method. Subintimal stent placement was technically successful in 23 of 24 procedures (95.8%). The mean ankle-brachial index (ABI) increased form 0.26 to 0.82. The Fontaine classification was improved after stent placement in all patients. Major complications occurred in four procedures: three distal embolizations and one arterial rupture. All of the complications were successfully treated by endovascular intervention. The primary stent patency rates at 6-months, 1-, 2-and 3-years were 95%, 88%, 88% and 88%, respectively. Subintimal stent placement is a safe and effective treatment for long segment occlusion of the iliac artery.

Predictors of Reintervention After Endovascular Repair of Isolated Iliac Artery Aneurysm

International Nuclear Information System (INIS)

Zayed, Hany A.; Attia, Rizwan; Modarai, Bijan; Clough, Rachel E.; Bell, Rachel E.; Carrell, Tom; Sabharwal, Tarun; Reidy, John; Taylor, Peter R.

2011-01-01

The objective of this study was to identify factors predicting the need for reintervention after endovascular repair of isolated iliac artery aneurysm (IIAA). We reviewed prospectively collected database records of all patients who underwent endovascular repair of IIAA between 1999 and 2008. Detailed assessment of the aneurysms was performed using computed tomography angiography (CTA). Follow-up protocol included CTA at 3 months. If this showed no complication, then annual duplex scan was arranged. Multivariate analysis and analysis of patient survival and freedom from reintervention were performed using Kaplan–Meier life tables. Forty IIAAs (median diameter 44 mm) in 38 patients were treated (all men; median age 75 years), and median follow-up was 27 months. Endovascular repair of IIAA was required in 14 of 40 aneurysms (35%). The rate of type I endoleak was significantly higher with proximal landing zone (PLZ) diameter >30 mm in the aorta or >24 mm in the common iliac artery or distal landing zone (DLZ) diameter >24 mm (P = 0.03, 0.03, and 0.0014, respectively). Reintervention rate (RR) increased significantly with increased diameter or decreased length of PLZ; increased DLZ diameter; and endovascular IIAA repair (P = 0.005, 0.005, 0.02, and 0.02 respectively); however, RR was not significantly affected by length of PLZ or DLZ. Freedom-from-reintervention was 97, 93, and 86% at 12, 24, and 108 months. There was no in-hospital or aneurysm-related mortality. Endovascular IIAA repair is a safe treatment option. Proper patient selection is essential to decrease the RR.

Histologic characterization of canine dilated cardiomyopathy.

Science.gov (United States)

Tidholm, A; Jönsson, L

2005-01-01

Dilated cardiomyopathy (DCM), characterized by chamber dilatation and myocardial systolic and diastolic dysfunction, is one of the most common heart diseases in dogs. The clinical diagnosis is based on findings on echocardiographic and Doppler examinations, with the active exclusion of other acquired or congenital heart diseases. However, the echocardiographic criteria for the diagnosis of DCM are not wholly specific for the disease, and histologic examination may be necessary for final diagnosis. Review of reports on histologic findings in dogs with clinically diagnosed DCM reveals two histologically distinct forms of DCM: 1) cardiomyopathy of Boxers and Doberman Pinschers, corresponding to the "fatty infiltration-degenerative" type and 2) the form seen in many giant, large-, and medium-sized breeds, including some Boxers and Doberman Pinschers, classified as the "attenuated wavy fiber" type of DCM. The histologic changes of the attenuated wavy fiber type of DCM may precede clinical and echocardiographic signs of heart disease, thus indicating an early stage of DCM.

Balloon dilation of congenital supravalvular pulmonic stenosis in a dog.

Science.gov (United States)

Treseder, Julia R; Jung, SeungWoo

2017-03-30

Percutaneous balloon valvuloplasty is considered the standard of care for treatment of valvular pulmonic stenosis, a common congenital defect in dogs. Supravalvular pulmonic stenosis is a rare form of pulmonic stenosis in dogs and standard treatment has not been established. Although, there have been reports of successful treatment of supravalvular pulmonic stenosis with surgical and stenting techniques, there have been no reports of balloon dilation to treat dogs with this condition. Here, a case of supravalvular pulmonic stenosis diagnosed echocardiographically and angiographically in which a significant reduction in pressure gradient was achieved with balloon dilation alone is presented.

Percutaneous balloon dilation of pulmonary stenosis

International Nuclear Information System (INIS)

Hua Yangde; Huang Ming; Li Jinkang; Qian Jinqing; Chen Xiuyu; Yang Siyuan

2003-01-01

Objective: Review our experience of balloon dilation of valvular pulmonary stenosis in 32 cases. Methods: Totally 32 cases of pulmonary stenosis admitted from 1995-2001 with age of 1.5-13 yrs mean 6.8. Diagnosis was made by clinical manifestations, EKG, ECHO and angiocardiography. Results: Before dilation, the mean systolic pressure of right ventricle was (93.5 ± 28.5) mmHg, after the procedure it reduced to (42 ± 9.0) mmHg. The pressure gradient between right ventricle and pulmonary artery before dilation was (76 ± 30) mmHg and become (24.5 ± 8.5) mmHg after dilation. The gradient pressure after dilation was less than 25 mmHg in 90.6% cases. A case of Noonan syndrome showed no response to balloon dilation and died during valvulectomy from accompanying left ventricular cardiomyopathy. Conclusions: Balloon dilation of valvular pulmonary stenosis is effective and safe. The selection of proper diameter of pulmonary valvular rings and sized of the balloon are the major factors

Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

Energy Technology Data Exchange (ETDEWEB)

Mehta, Vimal, E-mail: drvimalmehta@yahoo.co.in; Pandit, Bhagya Narayan; Mehra, Pratishtha; Nigam, Arima; Vyas, Aniruddha; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay [G.B. Pant Institute of Postgraduate Medical Education and Research (India)

2016-01-15

We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory.

Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

International Nuclear Information System (INIS)

Mehta, Vimal; Pandit, Bhagya Narayan; Mehra, Pratishtha; Nigam, Arima; Vyas, Aniruddha; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay

2016-01-01

We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory

The Timing and Frequency of Complications After Peripheral Percutaneous Transluminal Angioplasty and Iliac Stenting: Is a Change from Inpatient to Outpatient Therapy Feasible?

International Nuclear Information System (INIS)

Burns, Briony J.; Phillips, Andrea J.; Fox, Anthony; Boardman, Phillip; Phillips-Hughes, Jane

2000-01-01

Purpose: A prospective study was performed to assess the frequency and timing of complications after transluminal angioplasty and stent placement with a view to changing our practice and performing these procedures on an outpatient basis.Method: A total of 266 angioplasties and 51 stent deployments were attempted on 240 consecutive patients. Immediate complications were documented by the radiologists. The timing and nature of any complications during and beyond the first 24 hr were reported by the vascular surgeons.Results: There were 14 complications in 240 patients, giving a complication rate of 4.8% per vessel segment dilated. There were five major and nine minor complications. Eighty-six percent of complications were evident before the patient had left the angiography suite. All complications were evident within 4.5 hr of the procedure.Conclusion: The timing of complications suggests it would be reasonable to perform percutaneous transluminal angioplasties and iliac stenting on an outpatient basis in suitable patients

Aorto-iliac occlusive disease in the different population groups ...

African Journals Online (AJOL)

Background. It has previously been accepted that atherosclerotic disease is uncommon among blacks worldv.ride; however, recent studies have increasingly reported atherosclerotic disease in this group. Study design. Prospective study of hospital patients with aorta-iliac occlusive disease presenting to the vascUlar ...

Randomized controlled trial comparing esophageal dilation to no dilation among adults with esophageal eosinophilia and dysphagia.

Science.gov (United States)

Kavitt, R T; Ates, F; Slaughter, J C; Higginbotham, T; Shepherd, B D; Sumner, E L; Vaezi, M F

2016-11-01

The role of esophageal dilation in patients with esophageal eosinophilia with dysphagia remains unknown. The practice of dilation is currently based on center preferences and expert opinion. The aim of this study is to determine if, and to what extent, dysphagia improves in response to initial esophageal dilation followed by standard medical therapies. We conducted a randomized, blinded, controlled trial evaluating adult patients with dysphagia and newly diagnosed esophageal eosinophilia from 2008 to 2013. Patients were randomized to dilation or no dilation at time of endoscopy and blinded to dilation status. Endoscopic features were graded as major and minor. Subsequent to randomization and endoscopy, all patients received fluticasone and dexlansoprazole for 2 months. The primary study outcome was reduction in overall dysphagia score, assessed at 30 and 60 days post-intervention. Patients with severe strictures (less than 7-mm esophageal diameter) were excluded from the study. Thirty-one patients were randomized and completed the protocol: 17 randomized to dilation and 14 to no dilation. Both groups were similar with regard to gender, age, eosinophil density, endoscopic score, and baseline dysphagia score. The population exhibited moderate to severe dysphagia and moderate esophageal stricturing at baseline. Overall, there was a significant (P dysphagia score at 30 and 60 days post-randomization compared with baseline in both groups. No significant difference in dysphagia scores between treatment groups after 30 (P = 0.93) or 60 (P = 0.21) days post-intervention was observed. Esophageal dilation did not result in additional improvement in dysphagia score compared with treatment with proton pump inhibitor and fluticasone alone. In patients with symptomatic esophageal eosinophilia without severe stricture, dilation does not appear to be a necessary initial treatment strategy. © 2015 International Society for Diseases of the Esophagus.

RECONSTRUCTION OF ATROPHIC MAXILLA BY ANTERIOR ILIAC CREST BONE GRAFTING VIA NEUROAXIAL BLOCKADE TECHNIQUE: A CASE REPORT

Directory of Open Access Journals (Sweden)

Erol CANSIZ

2017-01-01

Full Text Available Anterior iliac crest bone grafting is a well-established modality in the treatment of alveolar bone deficiencies. However, this procedure may also have considerable postoperative morbidity which is mostly related to general anesthesia. Postoperative pain-related complications can be managed by neuroaxial blockade techniques which provide adequate surgical analgesia and reduce postoperative pain. This clinical report describes the reconstruction of a severely atrophic maxilla with anterior iliac crest bone grafting using combined spinal epidural anesthesia. Neuroaxial blockade techniques may be a useful alternative to eliminate general anesthesia related challenges of anterior iliac crest bone grafting procedures.

Balloon dilatation for the treatment of stricture of gastrojejunostomy

Energy Technology Data Exchange (ETDEWEB)

Choi, Yeon Hwa [Lee Rha Hospital, Chungju (Korea, Republic of); Song, Ho Young [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Han, Young Min; Chon, Su Bin; Chung, Gyung Ho; Kim, Chong Soo; Choi, Ki Chul [Chonbuk National University College of Medicine, Chungju (Korea, Republic of)

1993-07-15

Enteroenteric anastomotic strictures of UGI tract are common and require treatment if significant obstruction occurs. We performed fluoroscopic guided balloon dilatation in 6 patients who had symptomatic stricture of gastrojejunostomy. The stricture was successfully resolved in 4 patients with benign stricture. But 2 patients with malignant stricture had recurrence of obstructive symptoms 2 weeks later, and they required a stent. Asymptomatic balloon rupture was seen in one patients, but other procedural complications did not occur. We found that fluoroscopic guided balloon dilatation is an effective and safe method in the treatment of anastomotic stricture of gastrojejunostomy. We also found transient effect in malignant gastrojejunal anastomotic strictures, which required an interventional procedure, such as placement of a stent.

Kikuchi Disease Presented with External Iliac Lymphadenitis in a 7-year-old Girl: A Case Report

International Nuclear Information System (INIS)

Kim, Young Tong; Yoo, Kyung Hee; Cho, Hyun Deuk; Oh, Mee Hye; Shin, Hyeong Cheol

2010-01-01

Kikuchi disease of the iliac lymph node is rare, and even more rare is lymphadenitis with abdominal pain caused by Kikuchi disease. We report the US and CT findings of Kikuchi disease of the external iliac node in a 7 year-old-girl who complained of fever and abdominal pain in the left lower quadrant

Brain Abscess after Esophageal Dilatation

DEFF Research Database (Denmark)

Gaïni, S; Grand, M; Michelsen, J

2007-01-01

Brain abscess formation is a serious disease often seen as a complication to other diseases and to procedures. A rare predisposing condition is dilatation therapy of esophageal strictures. A case of brain abscess formation after esophageal dilatations is presented. A 59-year-old woman was admitted...... with malaise, progressive lethargy, fever, aphasia and hemiparesis. Six days before she had been treated with esophageal dilatation for a stricture caused by accidental ingestion of caustic soda. The brain abscess was treated with surgery and antibiotics. She recovered completely. This clinical case...... illustrates the possible association between therapeutic esophageal dilatation and the risk of brain abscess formation....

Esophageal achalasia : results of balloon dilation

Energy Technology Data Exchange (ETDEWEB)

Ki, Won Woo; Kang, Sung Gwon; Yoon, Kwon Ha; Kim, Nam Hyeon; Lee, Hyo Jeong; Yoon, Hyun Ki; Sung, Kyu Bo; Song, Ho Young [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

1996-08-01

To evaluate the clinical effectiveness of fluoroscopically guided balloon dilation in the treatment of esophageal achalasia. Under fluoroscopic guidance, 21 balloon dilation procedures were performed in 14 patients with achalasia. A balloon with a diameter of 20 mm was used for the initial attempt.If the patient tolerated this well, the procedure was repeated with a 10-20 mm balloon, placed alongside at the same session. If, however the patient complained of severe chest pain and/or a postprocedural esophagogram showed an improvement,the additional balloon was not used. For patients whose results were unsatisfactory, the dilation procedure was repeated at sessions three to seven days apart. Succesful dilation was achieved in 13 of 14 patients(92.9%), who needed a total of 20 sessions of balloon dilation, ranging from one to three sessions per patient(mean, 1.54 sessions). Esophageal rupture occured in one of 14 patients(7.1%) ; of the 13 patients who underwent a successful dilation procedure, 12(92.3%) were free of recurrent symptoms during the follow-up period of 1-56(mean, 18.5) months. The remaning patient(7.7%) had a recurrence seven months after dilation. Fluoroscopically guided balloon dilation seems to be safe and effective in the treatment of esophageal achalasia.

Esophageal achalasia : results of balloon dilation

International Nuclear Information System (INIS)

Ki, Won Woo; Kang, Sung Gwon; Yoon, Kwon Ha; Kim, Nam Hyeon; Lee, Hyo Jeong; Yoon, Hyun Ki; Sung, Kyu Bo; Song, Ho Young

1996-01-01

To evaluate the clinical effectiveness of fluoroscopically guided balloon dilation in the treatment of esophageal achalasia. Under fluoroscopic guidance, 21 balloon dilation procedures were performed in 14 patients with achalasia. A balloon with a diameter of 20 mm was used for the initial attempt.If the patient tolerated this well, the procedure was repeated with a 10-20 mm balloon, placed alongside at the same session. If, however the patient complained of severe chest pain and/or a postprocedural esophagogram showed an improvement,the additional balloon was not used. For patients whose results were unsatisfactory, the dilation procedure was repeated at sessions three to seven days apart. Succesful dilation was achieved in 13 of 14 patients(92.9%), who needed a total of 20 sessions of balloon dilation, ranging from one to three sessions per patient(mean, 1.54 sessions). Esophageal rupture occured in one of 14 patients(7.1%) ; of the 13 patients who underwent a successful dilation procedure, 12(92.3%) were free of recurrent symptoms during the follow-up period of 1-56(mean, 18.5) months. The remaning patient(7.7%) had a recurrence seven months after dilation. Fluoroscopically guided balloon dilation seems to be safe and effective in the treatment of esophageal achalasia

Proposal for a new classification of variations in the iliac venous system based on internal iliac veins: a case series and a review of double and left inferior vena cava.

Science.gov (United States)

Hayashi, Shogo; Naito, Munekazu; Hirai, Shuichi; Terayama, Hayato; Miyaki, Takayoshi; Itoh, Masahiro; Fukuzawa, Yoshitaka; Nakano, Takashi

2013-09-01

There are many reports on variations in the inferior vena cava (IVC), particularly double IVC (DIVC) and left IVC (LIVC). However, no systematic report has recorded iliac vein (IV) flow patterns in the DIVC and LIVC. In this study, we examined IV flow patterns in both DIVC and LIVC observed during gross anatomy courses conducted for medical students and in previously reported cases. During the gross anatomy courses, three cases of DIVC and one case of LIVC were found in 618 cadavers. The IV flow pattern from these four cases and all other previously reported cases can be classified into one of the following three types according to the vein into which the internal iliac vein drained: the ipsilateral external IV; confluence of the ipsilateral external IV and IVC; and the communicating vein, which connects the IVC and the contralateral IVC or its iliac branch. This classification, which is based on the internal IV course, is considered to be useful because IV variations have the potential to cause clinical problems during related retroperitoneal surgery, venous interventional radiology, and diagnostic procedures for pelvic cancer.

Sacroiliac joint injection using the posterior superior iliac spines as ...

African Journals Online (AJOL)

Limitations in the availability of such image guided techniques in health ... School of Medical Sciences, University of Science and Technology between 2006 and ... The needle position from the posterior superior iliac spine and its angle of ...

Iliac artery stenting in patients with poor distal runoff: Influence of concomitant infrainguinal arterial reconstruction.

Science.gov (United States)

Timaran, Carlos H; Ohki, Takao; Gargiulo, Nicholas J; Veith, Frank J; Stevens, Scott L; Freeman, Michael B; Goldman, Mitchell H

2003-09-01

Inadequate infrainguinal runoff is considered an important risk factor for iliac stent failure. However, the influence of concomitant infrainguinal arterial reconstruction (CIAR) on iliac stent patency is unknown. This study evaluated the influence of CIAR on outcome of iliac angioplasty and stenting (IAS) in patients with poor distal runoff. Over 5 years (1996 to 2001), 68 IAS procedures (78 stents) were performed in 62 patients with poor distal runoff (angiographic runoff score >or=5). The SVS/AAVS reporting standards were followed to define outcome variables and risk factors. Data were analyzed with both univariate analysis (Kaplan-Meier method [K-M]) and regression analysis (Cox proportional hazards model). Indications for iliac artery stenting were disabling claudication (59%) and limb salvage (41%). Of the 68 procedures, IAS with CIAR was performed in 31 patients (46%), and IAS alone was performed in 37 patients (54%). Patients undergoing IAS with CIAR were older (P =.03) and had more extensive and multifocal iliac artery occlusive disease, with more TASC (TransAtlantic Inter-Society Consensus) type C lesions (P =.03), compared with patients undergoing IAS alone. No other significant differences in risk factors were noted. Runoff scores between patients undergoing IAS with CIAR and those undergoing IAS alone were not significantly different (median runoff scores, 6 [range, 5-8] and 7 [range, 5-9], respectively; P =.77). Primary stent patency rate at 1, 3, and 5 years was 87%, 54%, and 42%, respectively, for patients undergoing IAS with CIAR, and was 76%, 66%, and 55%, respectively, for patients undergoing IAS. Univariate analysis revealed that primary stent patency rate was not significantly different between the 2 groups (K-M, log-rank test, P =.81). Primary graft patency rate for CIAR was 81%, 52%, and 46% at 1, 3, and 5 years, respectively. Performing CIAR did not affect primary iliac stent patency (relative risk, 1.1; 95% confidence interval, 0.49-2.47; P

New treatment of iliac artery disease: focus on the Absolute Pro® Vascular Self-Expanding Stent System

Directory of Open Access Journals (Sweden)

Gates L

2013-09-01

Full Text Available Lindsay Gates, Jeffrey Indes Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT, USA Abstract: Management of iliac artery disease has evolved over the years, from a surgical-only approach to a primarily endovascular-only approach as the first line treatment option. This has been continuously improved upon with the advent of new devices and applied technologies. Most recently in particular, the literature has shown good, reliable outcomes with the use of self-expandable stents in iliac artery atherosclerotic lesions. Nevertheless, no device is without its limitations, and the Absolute Pro® Vascular Self-Expanding Stent System was designed with the intent of overcoming some of the shortcomings of other available stents while maintaining acceptable postprocedural outcomes. Based on preliminary industry-acquired data, it has achieved these goals and appears to be an emergent competitor for the treatment of both focal and complex iliac artery lesions. Keywords: Absolute-Pro®, iliac stent, self-expanding stents, atherosclerotic disease

Contralateral Deep Vein Thrombosis after Iliac Vein Stent Placement in Patients with May-Thurner Syndrome.

Science.gov (United States)

Le, Trong Binh; Lee, Taeg Ki; Park, Keun-Myoung; Jeon, Yong Sun; Hong, Kee Chun; Cho, Soon Gu

2018-04-25

To investigate the incidence and potential causes of contralateral deep vein thrombosis (DVT) after common iliac vein (CIV) stent placement in patients with May-Thurner syndrome (MTS). Data of 111 patients (women: 73%) who had CIV stent implantation for symptomatic MTS at a single center were retrospectively analyzed. Mean patient age was 63.1 ± 15.2 years. Median follow-up was 36 months (range, 1-142 months). Stent location was determined by venogram and classified as extended to the inferior vena cava (IVC), covered the confluence, or confined to the iliac vein. Potential causes of contralateral DVT were presumed based on venographic findings. The relationship between stent location and contralateral DVT was analyzed. Ten patients (9%, men/women: 4/6) exhibited contralateral DVT at a median timing of 40 months (range, 6-98 months). Median age was 69 years (range, 42-85 years). Median follow-up was 73.5 months (range, 20-134 months). Potential causes were venous intimal hyperplasia (VIH) (n = 7), "jailing" (n = 2), and indeterminate (n = 1). All patients with VIH had previous CIV stents overextended to the IVC. Overextension of CIV stent was associated with contralateral DVT (P VIH should be considered a potential cause. Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.

Bypass iliac-mesenteric-cava inpatients under two years of age. Case report and literature review

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Villanueva López Noé

2014-07-01

Full Text Available Introduction: In the treatment of portal hypertension in pediatric patients, some type of porto-systemic shunt is indicated, which is an unusual surgical procedure in patients under two years of age, due to the low incidence of this disease at this age and the increase in the number of complications. Objective: We present our experience and results with this procedure in patients under two years of age seen in the Hepatobiliopancreatic general surgery service at Instituto Nacional de PediatríaDiscussion: The causes of portal hypertension in children are varied. Among the extrahepatic causes, the most common is cavernomatous portal degeneration. Children with portal hypertension under two years have severe symptoms such as recurrent gastrointestinal bleeding or anemia; others have hypersplenism data. In many cases medical management is useless and a surgical procedure require such as a portosystemic shunt in order to decrease the size of varicose esophageal veins and prevent bleeding that threatens the patient’s life. Conclusion: The iliac-mesenteric-caval shunt in patients under two years is a feasible alternative that improves the clinical status of the patient, reducing the risk of bleeding. However long-term studies are needed to determine the outcome of these patients. Keywords: Iliac-mesenteric-caval shunt, portal hypertension.

Pelvic instability after bone graft harvesting from posterior iliac crest: report of nine patients

Energy Technology Data Exchange (ETDEWEB)

Chan, K.; Pathria, M.; Jacobson, J. [Dept. of Radiology, Univ. of California, San Diego, CA (United States); Resnick, D. [Dept. of Radiology, Veterans Affairs Medical Center, San Diego, CA (United States)

2001-05-01

Objective. To report the imaging findings in nine patients who developed pelvic instability after bone graft harvest from the posterior aspect of the iliac crest.Design and patients. A retrospective study was performed of the imaging studies of nine patients who developed pelvic pain after autologous bone graft was harvested from the posterior aspect of the ilium for spinal arthrodesis. Plain films, bone scans, and CT and MR examinations of the pelvis were reviewed. Pertinent aspects of the clinical history of these patients were noted, including age, gender and clinical symptoms.Results. The age of the patients ranged from 52 to 77 years (average 69 years) and all were women. The bone graft had been derived from the posterior aspect of the iliac crest about the sacroiliac joint. All patients subsequently developed subluxation of the pubic symphysis. Eight patients had additional insufficiency fractures of the iliac crest adjacent to the bone graft donor site, and five patients also revealed subluxation of the sacroiliac joint. Two had insufficiency fractures of the sacrum and one had an additional fracture of the pubic ramus.Conclusions. Pelvic instability is a potential complication of bone graft harvesting from the posterior aspect of the iliac crest. The pelvic instability is manifested by insufficiency fractures of the ilium and subluxation of the sacroiliac joints and pubic symphysis. (orig.)

Pelvic instability after bone graft harvesting from posterior iliac crest: report of nine patients

International Nuclear Information System (INIS)

Chan, K.; Pathria, M.; Jacobson, J.; Resnick, D.

2001-01-01

Objective. To report the imaging findings in nine patients who developed pelvic instability after bone graft harvest from the posterior aspect of the iliac crest.Design and patients. A retrospective study was performed of the imaging studies of nine patients who developed pelvic pain after autologous bone graft was harvested from the posterior aspect of the ilium for spinal arthrodesis. Plain films, bone scans, and CT and MR examinations of the pelvis were reviewed. Pertinent aspects of the clinical history of these patients were noted, including age, gender and clinical symptoms.Results. The age of the patients ranged from 52 to 77 years (average 69 years) and all were women. The bone graft had been derived from the posterior aspect of the iliac crest about the sacroiliac joint. All patients subsequently developed subluxation of the pubic symphysis. Eight patients had additional insufficiency fractures of the iliac crest adjacent to the bone graft donor site, and five patients also revealed subluxation of the sacroiliac joint. Two had insufficiency fractures of the sacrum and one had an additional fracture of the pubic ramus.Conclusions. Pelvic instability is a potential complication of bone graft harvesting from the posterior aspect of the iliac crest. The pelvic instability is manifested by insufficiency fractures of the ilium and subluxation of the sacroiliac joints and pubic symphysis. (orig.)

Isolated aneurysms of the iliac arteries

International Nuclear Information System (INIS)

Eckmann, A.; Schild, H.; Schmiedt, W.; Groenninger, J.

1988-01-01

Isolated aneurysms of the iliac arteries are rare. They must be considered as a disease pattern of their own as against aneurysms of the abdominal aorta because of the specific anatomical conditions in the pelvis. The clinical symptomatology is determinated by their localisation and topographical relationships within teh pelvis; this can give rise to problems in differential diagnosis primary urological, neurological or gastrointestinal diseases. The prognosis is decisively determined early and correct diagnosis because of the danger of rupture. Sonography, computed tomography and angiography are indispensable aids in preoperative planning. (orig.) [de

Internal iliac artery embolotherapy for primary postpartum hemorrhage

International Nuclear Information System (INIS)

Chen Weijun; Mei Haibing; He Zhongwei; Li Meimei

2001-01-01

Objective: To evaluate the effectiveness of internal iliac artery embolotherapy (IIAE) for primary postpartum hemorrhage (PPH). Methods: 9 cases of PPH were treated with IIAE. Results: Selective catheterization and embolotherapy were successful in 9 cases of PPH, with only one case of left lower extremity arterial thrombosis. No serious complications occurred in others. Conclusions: IIAE is a quick, safe, effective technique for PPH

Excellent long-term results with iliac stenting in local anesthesia for post-thrombotic syndrome

DEFF Research Database (Denmark)

Klitfod, Lotte; Just, Sven; Foegh, Pia

2015-01-01

BACKGROUND: Only 20% of iliac veins will recanalize on anticoagulation (AC) treatment alone and may, therefore, develop venous obstruction after iliofemoral deep venous thrombosis (DVT). A considerable number of these patients will suffer from post-thrombotic syndrome (PTS) leading to impaired qu...... stent was 89% (17/19) and 16 patients (84 %) had almost or total symptom relief at follow-up. CONCLUSION: Endovascular stenting of iliac obstruction in local anesthesia is minimally invasive and shows excellent long-term outcomes for patients suffering from PTS....

Office-based esophageal dilation in head and neck cancer: Safety, feasibility, and cost analysis.

Science.gov (United States)

Howell, Rebecca J; Schopper, Melissa A; Giliberto, John Paul; Collar, Ryan M; Khosla, Sid M

2018-02-08

To review experience, safety, and cost of office-based esophageal dilation in patients with history of head and neck cancer (HNCA). The medical records of patients undergoing esophageal dilation in the office were retrospectively reviewed between August 2015 and May 2017. Patients were given nasal topical anesthesia. Next, a transnasal esophagoscopy (TNE) was performed. If the patient tolerated TNE, we proceeded with esophageal dilation using Seldinger technique with the CRE™ Boston Scientific (Boston Scientific Corp., Marlborough, MA) balloon system. Patients were discharged directly from the outpatient clinic. Forty-seven dilations were performed in 22 patients with an average of 2.1 dilations/patient (range 1-10, standard deviation [SD] ± 2.2). Seventeen patients (77%) were male. The average age was 67 years (range 35-78 years, SD ± 8.5). The most common primary site of cancer was oral cavity/oropharynx (n = 10), followed by larynx (n = 6). All patients (100%) had history of radiation treatment. Four patients were postlaryngectomy. The indication for esophageal dilation was esophageal stricture and progressive dysphagia. All dilations occurred in the proximal esophagus. There were no major complications. Three focal, superficial lacerations occurred. Two patients experienced mild, self-limited epistaxis. One dilation was poorly tolerated due to discomfort. One patient required pain medication postprocedure. Office-based esophageal dilation generated $15,000 less in health system charges compared to traditional operating room dilation on average per episode of care. In patients with history of HNCA and radiation, office-based TNE with esophageal dilation appears safe, well-tolerated, and cost-effective. In a small cohort, the technique has low complication rate and is feasible in an otolaryngology outpatient office setting. 4. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

Characterization of dilation-analytic operators

Energy Technology Data Exchange (ETDEWEB)

Balslev, E; Grossmann, A; Paul, T

1986-01-01

Dilation analytic vectors and operators are characterized in a new representation of quantum mechanical states through functions analytic on the upper half-plane. In this space H/sub o/-bounded operators are integral operators and criteria for dilation analyticity are given in terms of analytic continuation outside of the half-plane for functions and for kernels. A sufficient condition is given for an integral operator in momentum space to be dilation-analytic.

Percutaneous dilatation of biliary benign strictures

Energy Technology Data Exchange (ETDEWEB)

Park, Jae Hyung; Choi, Byung Ihn; Sung, Kyu Bo; Han, Man Chung; Park, Yong Hyun; Yoon, Yong Bum [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1986-06-15

Percutaneous biliary dilation was done in 3 patients with benign strictures. The first case was 50-year-old male who had multiple intrahepatic stones with biliary stricture. The second 46-year-old female and the third 25-year-old male suffered from recurrent cholangitis with benign stricture of anastomotic site after choledocho-jejunostomy. In the first case, a 6mm diameter Grunzing dilatation balloon catheter was introduced through the T-tube tract. In the second case, the stricture was dilated with two balloons of 5mm and 8mm in each diameter sequentially through the U-loop tract formed by surgically made jejunostomy and percutaneous transhepatic puncture. In the third case, the dilatation catheter was introduced through the percutaneous transhepatic tract. Dilatation was made with a pressure of 5 to 10 atmospheres for 1 to 3 minutes duration for 3 times. In all 3 cases, the strictures were successfully dilated and in second and third cases internal stent was left across the lesion for prevention of restenosis.

Study design and rationale of the 'Balloon-Expandable Cobalt Chromium SCUBA Stent versus Self-Expandable COMPLETE-SE Nitinol Stent for the Atherosclerotic ILIAC Arterial Disease (SENS-ILIAC Trial) Trial': study protocol for a randomized controlled trial.

Science.gov (United States)

Choi, Woong Gil; Rha, Seung Woon; Choi, Cheol Ung; Kim, Eung Ju; Oh, Dong Joo; Cho, Yoon Hyung; Park, Sang Ho; Lee, Seung Jin; Hur, Ae Yong; Ko, Young Guk; Park, Sang Min; Kim, Ki Chang; Kim, Joo Han; Kim, Min Woong; Kim, Sang Min; Bae, Jang Ho; Bong, Jung Min; Kang, Won Yu; Seo, Jae Bin; Jung, Woo Yong; Cho, Jang Hyun; Kim, Do Hoi; Ahn, Ji Hoon; Kim, Soo Hyun; Jang, Ji Yong

2016-06-25

The self-expandable COMPLETE™ stent (Medtronic) has greater elasticity, allowing it to regain its shape after the compression force reduces, and has higher trackability, thus is easier to maneuver through tortuous vessels, whereas the balloon-expandable SCUBA™ stent (Medtronic) has higher radial stiffness and can afford more accurate placement without geographic miss, which is important in aortoiliac bifurcation lesions. To date, there have been no randomized control trials comparing efficacy and safety between the self-expanding stent and balloon-expandable stent in advanced atherosclerotic iliac artery disease. The purpose of our study is to examine primary patency (efficacy) and incidence of stent fracture and geographic miss (safety) between two different major representative stents, the self-expanding nitinol stent (COMPLETE-SE™) and the balloon-expanding cobalt-chromium stent (SCUBA™), in stenotic or occlusive iliac arterial lesions. This trial is designed as a prospective, randomized, multicenter trial to demonstrate a noninferiority of SCUBA™ stent to COMPLETE-SE™ stent following balloon angioplasty in iliac arterial lesions, and a total of 280 patients will be enrolled. The primary end point of this study is the rate of primary patency in the treated segment at 12 months after intervention as determined by catheter angiography, computed tomography angiography, or duplex ultrasound. The SENS-ILIAC trial will give powerful insight into whether the stent choice according to deployment mechanics would impact stent patency, geographic miss, or stent fracture in patients undergoing stent implantation in iliac artery lesions. National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier: NCT01834495 ), registration date: May 8, 2012.

Cell therapy in dilated cardiomyopathy: from animal models to clinical trials

Directory of Open Access Journals (Sweden)

C. del Corsso

2011-05-01

Full Text Available Dilated cardiomyopathy can be the end-stage form and common denominator of several cardiac disorders of known cause, such as hypertensive, ischemic, diabetic and Chagasic diseases. However, some individuals have clinical findings, such as an increase in ventricular chamber size and impaired contractility (classical manifestations of dilated cardiomyopathy even in the absence of a diagnosed primary disease. In these patients, dilated cardiomyopathy is classified as idiopathic since its etiology is obscure. Nevertheless, regardless of all of the advances in medical, pharmacological and surgical procedures, the fate of patients with dilated cardiomyopathy (of idiopathic or of any other known cause is linked to arrhythmic episodes, severe congestive heart failure and an increased risk of sudden cardiac death. In this review, we will summarize present data on the use of cell therapies in animal models of dilated cardiomyopathies and will discuss the few clinical trials that have been published so far involving patients affected by this disease. The animal models discussed here include those in which the cardiomyopathy is produced by genetic manipulation and those in which disease is induced by chemical or infectious agents. The specific model used clearly creates restrictions to translation of the proposed cell therapy to clinical practice, insofar as most of the clinical trials performed to date with cell therapy have used autologous cells. Thus, translation of genetic models of dilated cardiomyopathy may have to wait until the use of allogeneic cells becomes more widespread in clinical trials of cell therapies for cardiac diseases.

Tetralogy of Fallot and aortic root dilation: a long-term outlook.

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Nagy, Christian D; Alejo, Diane E; Corretti, Mary C; Ravekes, William J; Crosson, Jane E; Spevak, Philip J; Ringel, Richard; Carson, Kathryn A; Khalil, Sara; Dietz, Harry C; Cameron, Duke E; Vricella, Luca A; Traill, Thomas A; Holmes, Kathryn W

2013-04-01

Dilation of the sinus of Valsalva (SoV) has been increasingly observed after repaired tetralogy of Fallot (TOF). We estimate the prevalence of SoV dilation in adults with repaired TOF and analyze possible factors related to aortic disease. Adults with TOF [n = 109, median age 33.2 years (range 18.1 to 69.5)] evaluated at Johns Hopkins Hospital from 2001 to 2009 were reviewed in an observational retrospective cohort study. Median follow-up was 27.3 (range 0.1-48.8) years. SoV dilation was defined as >95 % confidence interval adjusted for age and body surface area (z-score > 2). The prevalence of SoV dilation was 51 % compared with that of a normal population with a mean z-score of 2.03. Maximal aortic diameters were ≥ 4 cm in 39 % (42 of 109), ≥ 4.5 cm in 21 % (23 of 109), ≥ 5 cm in 8 % (9 of 109), and ≥ 5.5 cm in 2 % (2 of 109). There was no aortic dissection or death due contributable to aortic disease. Aortic valve replacement was performed in 1.8 % and aortic root or ascending aorta (AA) replacement surgery in 2.8 % of patients. By multivariate logistic regression analysis, aortic regurgitation (AR) [odds ratio (OR) = 3.09, p = 0.005], residual ventricular septal defect (VSD) (OR = 4.14, p < 0.02), and TOF with pulmonary atresia (TOF/PA) (OR = 6.75, p = 0.03) were associated with increased odds of dilated aortic root. SoV dilation after TOF repair is common and persists with aging. AR, residual VSD, and TOF/PA are associated with increased odds of dilation. AA evaluation beyond the SoV is important. Indexed values are imperative to avoid bias on the basis of age and body surface area.

Characterization and Long-Term Prognosis of Postmyocarditic Dilated Cardiomyopathy Compared With Idiopathic Dilated Cardiomyopathy.

Science.gov (United States)

Merlo, Marco; Anzini, Marco; Bussani, Rossana; Artico, Jessica; Barbati, Giulia; Stolfo, Davide; Gigli, Marta; Muça, Matilda; Naso, Paola; Ramani, Federica; Di Lenarda, Andrea; Pinamonti, Bruno; Sinagra, Gianfranco

2016-09-15

Dilated cardiomyopathy (DC) is the final common pathway of different pathogenetic processes and presents a significant prognostic heterogeneity, possibly related to its etiologic variety. The characterization and long-term prognosis of postmyocarditic dilated cardiomyopathy (PM-DC) remain unknown. This study assesses the clinical-instrumental evolution and long-term prognosis of a large cohort of patients with PM-DC. We analyzed 175 patients affected with DC consecutively enrolled from 1993 to 2008 with endomyocardial biopsy (EMB) data available. PM-DC was defined in the presence of borderline myocarditis at EMB or persistent left ventricular dysfunction 1 year after diagnosis of active myocarditis at EMB. Other patients were defined as affected by idiopathic dilated cardiomyopathy (IDC). Analysis of follow-up evaluations was performed at 24, 60, and 120 months. We found 72 PM-DC of 175 enrolled patients (41%). Compared with IDC, patients with PM-DC were more frequently females and less frequently presented a familial history of DC. No other baseline significant differences were found. During the long-term follow-up (median 154, first to third interquartile range 78 to 220 months), patients with PM-DC showed a trend toward slower disease progression. Globally, 18 patients with PM-DC (25%) versus 49 with IDC (48%) experienced death/heart transplantation (p = 0.045). The prognostic advantage for patients with PM-DC became significant beyond 40 months of follow-up. At multivariable time-dependent Cox analysis, PM-DC was confirmed to have a global independent protective role (hazard ratio 0.53, 95% confidence interval 0.28 to 0.97, p = 0.04). In conclusion, PM-DC is characterized by better long-term prognosis compared with IDC. An exhaustive etiologic characterization appears relevant in the prognostic assessment of DC. Copyright © 2016 Elsevier Inc. All rights reserved.

Repair of abdominal aortic aneurysms with aortouni- iliac stentgraft ...

African Journals Online (AJOL)

The aorto-uni-iliac (AUI) graft configuration with femoro-femoral bypass (FFBP) is a promising alternative which may extend the scope of EVAR for AAAs. The aim of ... Open surgery posed an unacceptably high risk to all patients owing to advanced age and/or American Society of Anesthesiologists (ASA) classification 3/4.

Connect the dot: Computing feed-links with minimum dilation

NARCIS (Netherlands)

Aronov, B.; Buchin, K.; Buchin, M.; Kreveld, van M.J.; Löffler, M.; Luo, J.; Silveira, R.I.; Speckmann, B.; Dehne, F.; Gavrilova, M.; Sack, J.-R.; Tóth, C.D.

2009-01-01

A feed-link is an artificial connection from a given location p to a real-world network. It is most commonly added to an incomplete network to improve the results of network analysis, by making p part of the network. The feed-link has to be "reasonable", hence we use the concept of dilation to

An Unusual Endovascular Therapeutic Approach for a Rare Case of May-Thurner Syndrome.

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DaSilva-DeAbreu, Adrian; Masha, Luke; Peerbhai, Shareez

2017-03-06

BACKGROUND The etiology of deep venous thrombosis (DVT) may pose a significant diagnostic challenge because truly reversible causes of DVT are rare. In this regard, known pelvic anatomic abnormalities such as aortic and iliac aneurysms should be seriously considered as a complicating factor in patients presenting with acute DVT so as not to miss a potentially curable etiology of May-Thurner syndrome (MTS). CASE REPORT We report the case of a 69-year-old man with a known abdominal aortic aneurysm and bilateral iliac artery aneurysms who presented with an acute DVT. A computed tomography scan of the abdomen and pelvis showed increased dilation of his aneurysmal disease with new resultant compression of the left iliac vein representing acquired MTS. The patient underwent endovascular aneurysm repair of the infra-renal abdominal aortic aneurysm and right common iliac artery aneurysm with a Gore Excluder endoprosthesis in lieu of venous stenting, with resolution of symptoms. CONCLUSIONS Infra-renal aortic and iliac aneurysms causing MTS are extremely rare, and patients at risk for MTS through these mechanisms do not fit the classical demographics associated with this syndrome. Furthermore, this is the first case described in which MTS was treated by addressing the aneurysm through an endoprosthetic approach instead of venous stenting, which is the conventional intervention for MTS.

Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation

Science.gov (United States)

Takuma, Kensuke; Kamisawa, Terumi; Tabata, Taku; Hara, Seiichi; Kuruma, Sawako; Inaba, Yoshihiko; Kurata, Masanao; Honda, Goro; Tsuruta, Koji; Horiguchi, Shin-ichiro; Igarashi, Yoshinori

2012-01-01

AIM: To clarify the strategy for early diagnosis of pancreaticobiliary maljunction (PBM) without biliary dilatation and to pathologically examine gallbladder before cancer develops. METHODS: The anatomy of the union of the pancreatic and bile ducts was assessed by using endoscopic retrograde cholangiopancreatography (ERCP). Patients with a long common channel in which communication between the pancreatic and bile ducts was maintained even during sphincter contraction were diagnosed as having PBM. Of these, patients in which the maximal diameter of the bile duct was less than 10 mm were diagnosed with PBM without biliary dilatation. The process of diagnosing 54 patients with PBM without biliary dilatation was retrospectively investigated. Histopathological analysis of resected gallbladder specimens from 8 patients with PBM without biliary dilatation or cancer was conducted. RESULTS: Thirty-six PBM patients without biliary dilatation were diagnosed with gallbladder cancer after showing clinical symptoms such as abdominal or back pain (n = 16) or jaundice (n = 12). Radical surgery for gallbladder cancer was only possible in 11 patients (31%) and only 4 patients (11%) survived for 5 years. Eight patients were suspected as having PBM without biliary dilatation from the finding of gallbladder wall thickening on ultrasound and the diagnosis was confirmed by ERCP and/or magnetic resonance cholangiopancreatography (MRCP). The median age of these 8 patients was younger by a decade than PBM patients with gallbladder cancer. All 8 patients underwent prophylactic cholecystectomy and bile duct cancer has not occurred. Wall thickness and mucosal height of the 8 resected gallbladders were significantly greater than controls, and hyperplastic changes, hypertrophic muscular layer, subserosal fibrosis, and adenomyomatosis were detected in 7 (88%), 5 (63%), 7 (88%) and 5 (63%) patients, respectively. Ki-67 labeling index was high and K-ras mutation was detected in 3 of 6 patients

Mechanical Thrombectomy of Iliac Vein Thrombosis in a Pig Model Using the Rotarex and Aspirex Catheters

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Minko, P., E-mail: peterminko@yahoo.com; Bücker, A. [University Hospital Homburg/Saar, Department of Diagnostic and Interventional Radiology (Germany); Laschke, M.; Menger, M. [University Hospital Homburg/Saar, Institute of Clinical and Experimental Surgery (Germany); Bohle, R. [University Hospital Homburg/Saar, Department of Pathology (Germany); Katoh, M. [University Hospital Homburg/Saar, Department of Diagnostic and Interventional Radiology (Germany)

2013-06-08

PurposeTo investigate the efficacy and safety of mechanical thrombectomy for iliac vein thrombosis using Rotarex and Aspirex catheters in a pig model.Materials and MethodsIliac vein thrombosis was induced in six pigs by means of an occlusion-balloon catheter and thrombin injection. The presence of thrombi was verified by digital subtraction angiography (DSA) and computed tomography (CT). Thrombectomy was performed using 6F and 8F Rotarex and 6F, 8F, and 10F Aspirex catheters (Straub Medical AG, Wangs, Switzerland). After intervention, DSA and CT were repeated to evaluate the efficacy of mechanical thrombectomy and to exclude local complications. In addition, pulmonary CT was performed to rule out pulmonary embolism. Finally, all pigs were killed, and iliac veins were dissected to perform macroscopic and histological examination.ResultsThrombus induction was successfully achieved in all animals as verified by DSA and CT. Subsequent thrombectomy lead to incomplete recanalization of the iliac veins with residual thrombi in all cases. However, the use of the 6F and 8F Rotarex catheters caused vessel perforation and retroperitoneal hemorrhage in all cases. Application of the Aspirex device caused one small transmural perforation in a vessel treated with a 10F Aspirex catheter, and this was only seen microscopically. Pulmonary embolism was detected in one animal treated with the Rotarex catheters, whereas no pulmonary emboli were seen in animals treated with the Aspirex catheters.ConclusionThe Aspirex catheter allowed subtotal and safe recanalization of iliac vein thrombosis. In contrast, the use of the Rotarex catheter caused macroscopically obvious vessel perforations in all cases.

A Comparison of Over-the-Counter Mechanical Nasal Dilators: A Systematic Review.

Science.gov (United States)

Kiyohara, Nicole; Badger, Christopher; Tjoa, Tjoson; Wong, Brian

2016-09-01

The internal nasal valve is the narrowest part of the nasal airway and a common site of inspiratory collapse and obstruction of nasal airflow. Over-the-counter mechanical nasal dilators are an alternative to surgical intervention that attempts to improve airflow through the internal nasal valve. To determine the efficacy of over-the-counter mechanical nasal dilators and classify these products by mechanism. A database of 33 available over-the-counter mechanical nasal dilators was generated via a PubMed search as well as an internet search via Amazon.com and Google, conducted from April 1, 2013, through December 31, 2015. Products determined to be unavailable or discontinued were excluded from the database. Of the devices examined in published literature, efficacy was based on objective measures, such as measured airflow, the cross-sectional area of the nasal valve, and changes in resistance. Measures of reported sleep quality or patient perception were excluded. An analysis of each product's mechanism revealed 4 broad classes: external nasal dilator strips, nasal stents, nasal clips, and septal stimulators. A review demonstrated 5 studies supporting the use of external nasal dilator strips, 4 studies supporting the use of nasal clips, 1 study supporting the use of nasal stents, and no studies supporting the use of septal stimulators. Our findings suggest that external nasal dilator strips and nasal clips effectively relieve obstruction of the internal nasal valve and may be an alternative to surgical intervention in some patients.

Danish Guidelines 2015 for percutaneous Dilatational Tracheostomy in the Intensive Care Unit

DEFF Research Database (Denmark)

Madsen, Kristian Rørbæk; Guldager, Henrik; Rewers, Mikael

2015-01-01

Percutaneous dilatational tracheostomy is a common procedure in intensive care. This updated Danish national guideline describes indications, contraindications and complications, and gives recommendations for timing, anaesthesia, and technique, use of fibre bronchoscopy and ultrasound guidance...

Balloon dilatation of ureteric strictures.

Directory of Open Access Journals (Sweden)

Punekar S

2000-01-01

Full Text Available AIMS: Evaluation of dilatation as a minimally invasive technique for the treatment of ureteric strictures. MATERIAL AND METHODS: We evaluated this technique in 16 patients with ureteric and secondary pelviureteric junction strictures from June 1998. Of these, 7 were men and 9 were women. The age range was from 14 to 40 years. RESULTS: Balloon dilatation was successful in 69% of patients. Strictures secondary to previous surgery had nearly 100% success. Of the 8 cases diagnosed as genitourinary tuberculosis, success rate was 50%. CONCLUSIONS: Factors affecting success of balloon dilatation are: a age of the stricture b length of the stricture and c etiology of the stricture. In a select group of patients with fresh post-operative or post-inflammatory strictures, balloon dilatation may be an attractive alternative to surgery.

Segmental colonic dilation is associated with premature termination of high-amplitude propagating contractions in children with intractable functional constipation

NARCIS (Netherlands)

Koppen, I. J. N.; Thompson, B. P.; Ambeba, E. J.; Lane, V. A.; Bates, D. G.; Minneci, P. C.; Deans, K. J.; Levitt, M. A.; Wood, R. J.; Benninga, M. A.; Di Lorenzo, C.; Yacob, D.

2017-01-01

Background: Colonic dilation is common in children with intractable functional constipation (FC). Our aim was to describe the association between segmental colonic dilation and colonic dysmotility in children with FC. Methods: We performed a retrospective study on 30 children with intractable FC

Infrainguinal arterial reconstructions in patients with aortoiliac occlusive disease: the influence of iliac stenting.

Science.gov (United States)

Timaran, C H; Stevens, S L; Freeman, M B; Goldman, M H

2001-12-01

Iliac artery angioplasty (IAA) is an effective adjunct when combined with infrainguinal arterial reconstructions (IARs) in appropriate patients with multilevel occlusive disease. However, the effect of iliac artery stenting (IAS) on the outcome of patients undergoing distal bypass procedures is not defined. The purpose of this study was to estimate the influence of previous IAS for iliac occlusive disease on the outcome of IARs, compared with those after IAA alone or aortofemoral bypass grafting procedures (AFBs). During a 5-year period (1995-2000), 105 patients with previous intervention for iliac occlusive disease underwent 120 IARs. The criteria prepared by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery) were followed to define the variables. The TransAtlantic Inter-Society Consensus classification was used to characterize the type of iliac lesions. Univariate (Kaplan-Meier) and multivariate analyses (Cox proportional hazards model) were used to determine the association between preoperative variables and cumulative primary patency. Forty-five IARs were performed in patients with an earlier IAS repair, 33 in patients with an earlier IAA repair, and 42 in patients with an earlier AFB repair. There were not significant differences between patients in the IAS and IAA groups, except for a more frequent use of polytetrafluoroethylene grafts for IARs in the IAS group (40% vs 15%; chi(2) test, P = .03). The 5-year primary patency rate for IARs was 68% in the IAS group, 46% in the IAA group, and 61% in the AFB group. Univariate analyses revealed that primary patency rates for IARs in patients with previous IAS were significantly higher than those in the IAA group (Kaplan-Meier, log-rank test, P = .02). Previous IAA repair was associated with a two-fold increased risk of IAR graft failure (relative risk, 2.2; 95% CI, 1.1-4.8; P = .04). IARs in patients with previous IAS have significantly

An improved method for sacro-iliac joint imaging: a study of normal subjects, patients with sacro-iliitis and patients with low back pain

International Nuclear Information System (INIS)

Ayres, J.; Hilson, A.J.W.; Maisey, M.N.; Laurent, R.; Panayi, G.S.; Saunders, A.J.

1981-01-01

A new method is described for quantitative measurement of the uptake of sup(99m)Tc-methylene diphosphonate (MDP) by the sacro-iliac joints. The method uses 'regions of interest' providing advantages over the previously described 'slice' method; the two methods are compared in normal subjects, patients with known sacro-iliitis and patients with low back pain. Sacro-iliac activity, as calculated by the sacro-iliac index (SII) in normal patients, was shown to decrease with age in females but not in males. The SII was compared with radiographs of the sacro-iliac joints in the patients with known sacro-iliac joint disease and in those with low back pain. The method is useful for the exclusion of sacro-iliitis as a specific cause of back pain. (author)

Iliac artery pseudoaneurysm after lumbar disc hernia operation

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Mehmet Atay

2016-03-01

Full Text Available Lumbar disc herniation surgery is usually performed through a posterior approach. Vascular injuries can be counted among the complications. 39 years old male patient had lower extremity pain which has started after lumbar disc herniation surgery and continued for a month. Iliac arterial pseudoaneurysm has been detected in computerized tomography. It was successfully treated with vascular surgery [Cukurova Med J 2016; 41(0.100: 5-7

Balloon dilatation of iatrogenic urethral strictures

International Nuclear Information System (INIS)

Acunas, B.; Acunas, G.; Gokmen, E.; Celik, L.

1988-01-01

Balloon dilatation of the urethra was performed in five patients with iatrogenic urethral strictures. The urethral strictures were successfully negotiated and dilated in all patients. Redilatation became necessary in a period ranging from 3 to 10 months. The authors believe that balloon dilatation of the urethra can be safely and successfully performed; the procedure produces minimal trauma and immediate relief of symptoms. (orig.)

Percutaneous Transhepatic Cutting Balloon Papillotomy for Removal of Common Bile Duct Stones

International Nuclear Information System (INIS)

Oguzkurt, Levent; Ozkan, Ugur; Gumus, Burcak

2009-01-01

We report the case of a 66-year-old female who presented with jaundice secondary to recurrent adenocarcinoma of the gallbladder and several common bile duct stones. Percutaneous papillary dilatation was planned to remove the common bile duct stones. Papilla was dilated through the percutaneous approach with an 8-mm peripheral cutting balloon instead of a standard balloon. All the stones were pushed successfully into the duodenum with a saline flush. No complications were encountered. Use of a peripheral cutting balloon for dilatation of the papilla seems to be safe and effective because it has the advantage of controlled incision and dilatation of the target at low pressures.

Primary Infrarenal Aortic Stenting With or Without Iliac Stenting for Isolated and Aortoiliac Stenoses: Single-Centre Experience With Long-Term Follow-Up

Energy Technology Data Exchange (ETDEWEB)

Tapping, C. R.; Ahmed, M.; Scott, P. M.; Lakshminarayan, R.; Robinson, G. J.; Ettles, D. F.; Shrivastava, V., E-mail: vivek.shrivastava@hey.nhs.uk [Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Department of Radiology (United Kingdom)

2013-02-15

The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 {+-} 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included paired Student t test and Kaplan-Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non-flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60-132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 {+-} -0.15 (right) and 0.61 {+-} -0.16 (left). After the procedure they were 0.86 {+-} -0.07 (right) and 0.90 {+-} -0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year. Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic stenotic

Vessel dilatation in coronary angiograms

International Nuclear Information System (INIS)

Hinterauer, L.; Goebel, N.

1983-01-01

Amongst 166 patients with aneurysms, ectasia or megaloarteries shown on coronary angiograms, 86.1% had dilated vessels as part of generalised coronary sclerosis (usually in patients with three-vessel disease). In 9%, dilatation was of iatrogenic origin and in 4.8% it was idiopathic. One patient had Marfan's syndrome. Amongst 9 000 patients, there were eight with megalo-arteries without stenosis; six of these had atypical angina and three suffered an infarct. Patients with definite dilatation of the coronary artery and stagnation of contrast flow required treatment. (orig.) [de

Vessel dilatation in coronary angiograms

Energy Technology Data Exchange (ETDEWEB)

Hinterauer, L.; Goebel, N.

1983-11-01

Amongst 166 patients with aneurysms, ectasia or megaloarteries shown on coronary angiograms, 86.1% had dilated vessels as part of generalised coronary sclerosis (usually in patients with three-vessel disease). In 9%, dilatation was of iatrogenic origin and in 4.8% it was idiopathic. One patient had Marfan's syndrome. Amongst 9 000 patients, there were eight with megalo-arteries without stenosis; six of these had atypical angina and three suffered an infarct. Patients with definite dilatation of the coronary artery and stagnation of contrast flow required treatment.

Acute appendicitis: most common clinical presentation and causative microorganism

International Nuclear Information System (INIS)

Awan, M.Y.; Shukr, I.; Mahmood, M.A.; Qasmi, S.A.

2013-01-01

Objective: To determine the most common clinical presentation and causative microorganism for acute appendicitis. Study Design: Descriptive. Place and duration of study: Department of Surgery, Combined Military Hospital Multan, from June 2002 to May 2004. Patients and Methods: Clinical features of all the patients, older than 5 years of age diagnosed with acute appendicitis were recorded. Patients presented with other pathology which mimic acute appendicitis were excluded from the study. Surgery was done under general anaesthesia. Appendices of all the patient as well as pus swabs from abdominal cavity were sent to the laboratory for histopathology and microbiological cultures to confirm the diagnoses of acute appendicitis and causative organism. Results: The mean age of 75 subjects was 32.56 +- 11.93 years. The most common symptom was pain in right iliac fossa (80 % cases) and the most common physical sign was tenderness (92% cases). Some of the patients(9.3%) had a histologically normal appendix. Maximum isolates on culture were E. coli. Conclusion: The most common presentation of acute appendicitis was pain in right iliac fossa while the most sensitive sign was tenderness. Proper history and sharp clinical examination is the key to diagnosis. The most frequent organism of appendicitis was Escherichia Coli. (author)

Reproducibility and genital sparing with a vaginal dilator used for female anal cancer patients

International Nuclear Information System (INIS)

Briere, Tina Marie; Crane, Christopher H.; Beddar, Sam; Bhosale, Priya; Mok, Henry; Delclos, Marc E.; Krishnan, Sunil; Das, Prajnan

2012-01-01

Purpose: Acute vulvitis, acute urethritis, and permanent sexual dysfunction are common among patients treated with chemoradiation for squamous cell carcinoma of the anal canal. Avoidance of the genitalia may reduce sexual dysfunction. A vaginal dilator may help delineate and displace the vulva and lower vagina away from the primary tumor. The goal of this study was to evaluate the positional reproducibility and vaginal sparing with the use of a vaginal dilator. Materials and methods: Ten female patients treated with IMRT for anal cancer were included in this study. A silicone vaginal dilator measuring 29 mm in diameter and 114 mm in length was inserted into the vagina before simulation and each treatment. The reproducibility of dilator placement was investigated with antero-posterior and lateral images acquired daily. Weekly cone beam CT (CBCT) imaging was used to confirm coverage of the GTV, which was typically posterior and inferior to the dilator apex. Finally, a planning study was performed to compare the vaginal doses for these 10 patients to a comparable group of 10 female patients who were treated for anal cancer with IMRT without vaginal dilators. Results: The absolute values of the location of the dilator apex were 7.0 ± 7.8 mm in the supero-inferior direction, 7.5 ± 5.5 mm in the antero-posterior, and 3.8 ± 3.1 mm in the lateral direction. Coverage of the GTV and CTV was confirmed from CBCT images. The mean dose to the vagina was lower by 5.5 Gy, on average, for the vaginal dilator patients, compared to patients treated without vaginal dilators. Conclusion: The vaginal dilator tended to be inserted more inferiorly during treatment than during simulation. For these ten patients, this did not compromise tumor coverage. Combined with IMRT treatment planning, use of a vaginal dilator could allow for maximum sparing of female genitalia for patients undergoing radiation therapy for anal cancer.

Aneurisma de artéria ilíaca interna roto: relato de caso Ruptured internal iliac artery aneurysm: case report

Directory of Open Access Journals (Sweden)

Cristina Toledo Afonso

2009-03-01

Full Text Available Aneurismas isolados da artéria ilíaca interna são raros, acometem 0,1% da população e correspondem a 1% dos aneurismas aorto-ilíacos. Na maioria das vezes, os pacientes são assintomáticos, mas podem apresentar dor abdominal, massa pulsátil no hipogástrio ou na fossa ilíaca, sintomas compressivos urinários, gastrointestinais ou neurológicos. Podem ocasionar quadro de abdome agudo, principalmente quando há ruptura. O diagnóstico precoce dos aneurismas isolados de artéria ilíaca interna é incomum, sendo identificados quando mais volumosos ou rotos, o que aumenta significativamente sua morbimortalidade e torna seu prognóstico mais reservado. Dessa forma, representam um desafio terapêutico. A ligadura cirúrgica tem sido o tratamento mais comum, entretanto a cirurgia endovascular tem mostrado bons resultados, inclusive nos aneurismas rotos. É relatado caso de aneurisma de artéria ilíaca interna isolado roto diagnosticado durante laparotomia para abordagem de abdome agudo.Isolated internal iliac artery aneurysms are rare. They affect 0.1% of the population, and account for 1% of aortoiliac aneurysms. Patients are mostly asymptomatic, yet they can have abdominal pain, pulsatile mass in the hypogastrium or iliac fossa, or urinary, gastrointestinal or neurological compressive symptoms. Such aneurysms are likely to course with an acute abdomen, especially when ruptured. Early diagnosis of isolated internal iliac artery aneurysms is difficult, as they are more easily detected when larger or ruptured, which significantly raises their morbidity and mortality rate and determines a poor prognosis. Therefore, they are a therapeutic challenge. Surgical ligation has been the most common treatment; however, the endovascular approach has presented good outcomes, even in the event of ruptured aneurysms. A case of ruptured isolated iliac artery aneurysm diagnosed during a laparotomy (acute abdomen approach is reported.

Revascularization of calvarial, mandibular, tibial, and iliac bone grafts in rats

DEFF Research Database (Denmark)

Pinholt, E M; Solheim, E; Talsnes, O

1994-01-01

Some studies have suggested that membranous bone grafts undergo less resorption than endochondral grafts, and faster revascularization of the former has been proposed as the explanation. We studied fresh syngeneic full-thickness bone grafts from calvaria, mandibula, tibia diaphysis, and iliac bone...... implanted in the back muscles of young Lewis rats. As a measure of the quantity of cancellous bone in grafts before implantation, the ratio of the total area of soft-tissue spaces to the total area of the graft was measured histomorphometrically. Revascularization in grafts 3 weeks postoperatively...... was evaluated by deposit of 141Ce-labeled microspheres. Both the quantity of cancellous bone (before implantation) and the revascularization (3 weeks postoperatively) were greater in the mandibular and iliac bone grafts than in the calvarial and tibia diaphyseal grafts. The results suggest that the anatomical...

Age-related changes in vertebral and iliac crest 3D bone microstructure-differences and similarities

DEFF Research Database (Denmark)

Thomsen, Jesper Skovhus; Jensen, Michael Vinkel; Niklassen, Andreas Steenholt

2015-01-01

Summary Age-related changes of vertebra and iliac crest 3D microstructure were investigated, and we showed that they were in general similar. The 95th percentile of vertebral trabecular thickness distribution increased with age for women. Surprisingly, vertebral and iliac crest bone microstructure...... was only weakly correlated (r = 0.38 to 0.75), despite the overall similar age-related changes.Introduction The purposes of the study were to determine the age-related changes in iliac and vertebral bone microstructure for women and men over a large age range and to investigate the relationship between...... the bone microstructure at these skeletal sites.Methods Matched sets of transiliac crest bone biopsies and lumbar vertebral body (L2) specimens from 41 women (19–96 years) and 39 men (23–95 years) were micro-computed tomography (μCT) scanned, and the 3D microstructure was quantified.Results For both women...

Canine dilated cardiomyopathy: a retrospective study of signalment, presentation and clinical findings in 369 cases.

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Martin, M W S; Stafford Johnson, M J; Celona, B

2009-01-01

To review the clinical and diagnostic findings and survival of dilated cardiomyopathy from a large population of dogs in England. A retrospective study of the case records of dogs with dilated cardiomyopathy collected between January 1993 and May 2006. There were 369 dogs with dilated cardiomyopathy of which all were pure-bred dogs except for four. The most commonly affected breeds were dobermanns and boxers. Over 95 per cent of dogs weighed more than 15 kg and 73 per cent were male. The median duration of signs before referral was three weeks with 65 per cent presenting in stage 3 heart failure. The most common signs were breathlessness (67 per cent) and coughing (64 per cent). The majority of dogs (89 per cent) had an arrhythmia at presentation and 74 per cent of dogs had radiographic signs of pulmonary oedema or pleural effusion. The median survival time was 19 weeks. Dilated cardiomyopathy occurs primarily in medium to large breed pure-bred dogs, and males are more frequently affected than females. The duration of clinical signs before referral is often short and the survival times are poor. Greater awareness of affected breeds, clinical signs and diagnostic findings may help in early recognition of this disease which often has a short clinical phase.

Dilation of non-quasifree dissipative evolution

Energy Technology Data Exchange (ETDEWEB)

Varilly, J C [Costa Rica Univ., San Jose. Escuela de Matematica

1981-03-01

A semigroup evolution for the 1/2-spin which admits a conservative dilation is known to be governed by a Bloch equation in a standard form. Here we construct a conservative dilation directly from the Bloch equation, thus yielding an example of a dilation scheme for an evolution which is not quasifree. Moreover, we show that this conservative evolution is never ergodic in the non-quasifree case.

Clinical review: Percutaneous dilatational tracheostomy

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Al-Ansari, Mariam A; Hijazi, Mohammed H

2006-01-01

As the number of critically ill patients requiring tracheotomy for prolonged ventilation has increased, the demand for a procedural alternative to the surgical tracheostomy (ST) has also emerged. Since its introduction, percutaneous dilatational tracheostomies (PDT) have gained increasing popularity. The most commonly cited advantages are the ease of the familiar technique and the ability to perform the procedure at the bedside. It is now considered a viable alternative to (ST) in the intensive care unit. Evaluation of PDT procedural modifications will require evaluation in randomized clinical trials. Regardless of the PDT technique, meticulous preoperative and postoperative management are necessary to maintain the excellent safety record of PDT. PMID:16356203

A characterization of dilation-analytic operators

International Nuclear Information System (INIS)

Balslev, E.; Grossmann, A.; Paul, T.

1986-01-01

Dilation analytic vectors and operators are characterized in a new representation of quantum mechanical states through functions analytic on the upper half-plane. In this space H o -bounded operators are integral operators and criteria for dilation analyticity are given in terms of analytic continuation outside of the half-plane for functions and for kernels. A sufficient condition is given for an integral operator in momentum space to be dilation-analytic

Segmental dilatation of the ileum

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Tune-Yie Shih

2017-01-01

Full Text Available A 2-year-old boy was sent to the emergency department with the chief problem of abdominal pain for 1 day. He was just discharged from the pediatric ward with the diagnosis of mycoplasmal pneumonia and paralytic ileus. After initial examinations and radiographic investigations, midgut volvulus was impressed. An emergency laparotomy was performed. Segmental dilatation of the ileum with volvulus was found. The operative procedure was resection of the dilated ileal segment with anastomosis. The postoperative recovery was uneventful. The unique abnormality of gastrointestinal tract – segmental dilatation of the ileum, is described in details and the literature is reviewed.

Application of Electrocautery Needle Knife Combined with Balloon Dilatation versus Balloon Dilatation in the Treatment of Tracheal Fibrotic Scar Stenosis.

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Bo, Liyan; Li, Congcong; Chen, Min; Mu, Deguang; Jin, Faguang

Electrocautery needle knives can largely reduce scar and granulation tissue hyperplasia and play an important role in treating patients with benign stricture. The aim of this retrospective study was to evaluate the efficacy and safety of electrocautery needle knife combined with balloon dilatation versus balloon dilatation alone in the treatment of tracheal stenosis caused by tracheal intubation or tracheotomy. We retrospectively analysed the clinical data of 43 patients with tracheal stenosis caused by tracheotomy or tracheal intubation in our department from January 2013 to January 2016. Among these 43 patients, 23 had simple web-like stenosis and 20 had complex steno sis. All patients were treated under general anaesthesia, and the treatment methods were (1) balloon dilatation alone, (2) needle knife excision of fibrotic tissue combined with balloon dilatation, and (3) needle knife radial incision of fibrotic tissue combined with balloon dilatation. After treatment the symptoms, such as shortness of breath, were markedly improved immediately in all cases. The stenosis degree of patients who were treated with the elec-trocautery needle knife combined with balloon dilatation had better improvement compared with that of those treated with balloon dilatation treatment alone after 3 months (0.45 ± 0.04 vs. 0.67 ± 0.05, p knife combined with balloon dilatation is an effective and safe treatment for tracheal fibrotic stenosis compared with balloon dilatation alone. © 2017 S. Karger AG, Basel.

Accuracy of S2 Alar-Iliac Screw Placement Under Robotic Guidance.

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Laratta, Joseph L; Shillingford, Jamal N; Lombardi, Joseph M; Alrabaa, Rami G; Benkli, Barlas; Fischer, Charla; Lenke, Lawrence G; Lehman, Ronald A

Case series. To determine the safety and feasibility of S2 alar-iliac (S2AI) screw placement under robotic guidance. Similar to standard iliac fixation, S2AI screws aid in achieving fixation across the sacropelvic junction and decreasing S1 screw strain. Fortunately, the S2AI technique minimizes prominent instrumentation and the need for offset connectors to the fusion construct. Herein, we present an analysis of the largest series of robotic-guided S2AI screws in the literature without any significant author conflicts of interest with the robotics industry. Twenty-three consecutive patients who underwent spinopelvic fixation with 46 S2AI screws under robotic guidance were analyzed from 2015 to 2016. Screws were placed by two senior spine surgeons, along with various fellow or resident surgical assistants, using a proprietary robotic guidance system (Renaissance; Mazor Robotics Ltd., Caesara, Israel). Screw position and accuracy was assessed on intraoperative CT O-arm scans and analyzed using three-dimensional interactive viewing and manipulation of the images. The average caudal angle in the sagittal plane was 31.0° ± 10.0°. The average horizontal angle in the axial plane using the posterior superior iliac spine as a reference was 42.8° ± 6.6°. The average S1 screw to S2AI screw angle was 11.3° ± 9.9°. Two violations of the iliac cortex were noted, with an average breach distance of 7.9 ± 4.8 mm. One breach was posterior (2.2%) and one was anterior (2.2%). The overall robotic S2AI screw accuracy rate was 95.7%. There were no intraoperative neurologic, vascular, or visceral complications related to the placement of the S2AI screws. Spinopelvic fixation achieved using a bone-mounted miniature robotic-guided S2AI screw insertion technique is safe and reliable. Despite two breaches, no complications related to the placement of the S2AI screws occurred in this series. Level IV, therapeutic. Copyright © 2017 Scoliosis Research Society. Published by Elsevier

Comparison of Pneumatic Dilation with Pneumatic Dilation Plus Botulinum Toxin for Treatment of Achalasia

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Alireza Bakhshipour

2010-03-01

Full Text Available Among the therapeutic options for achalasia are pneumatic dilatation (PD, an appropriate long-term therapy, and botulinum toxin injection (BT that is a relatively short-term therapy. This study aimed to compare therapeutic effect of repetitive pneumatic dilation with a combined method (botulinum toxin injection and pneumatic dilation in a group of achalasia patients who are low responder to two initial pneumatic dilations. Thirty- four patients with documented primary achalasia that had low response to two times PD (<50% decrease in symptom score and barium height at 5 minute in timed esophagogram after 3month of late PD were randomized to receive pneumatic dilation (n=18 or botulinum toxin injection and pneumatic dilation by four weeks interval (n=16, PD and BT+PD groups respectively. Symptom scores were evaluated before and at 1, 6 and 12 months after treatment. Clinical remission was defined as a decrease in symptom score ≥ 50% of baseline. There were no significant differences between the two groups in gender, age and achalasia type. Remission rate of patients in BT-PD group in comparison with PD group were 87.5% vs. 67.1% (P = 0.7, 87.5% vs. 61.1% (P = 0.59 and 87.5% vs. 55.5% (P = 0.53 at 1, 6 and 12 months respectively .There were no major complications in either group. The mean symptom score decreased by 62.71% in the BT-PD group (P < 0.002 and 50.77% in the PD group (P < 0.01 at the end of the first year. Despite a better response rate in BT+PD group, a difference was not statistically significant. A difference may be meaningful if a large numbers of patients are included in the study.

Scintigraphy of cysts of the common bile duct in children

International Nuclear Information System (INIS)

Mironov, S.P.; Akopyan, V.G.; Murieva, Z.D.; Tumanyan, G.T.; Mironova, E.S.

1984-01-01

Cyst of the common bile duct, the most frequent variant of cystic dilatation of the extrahepatic biliary tract, represents a serious diagnostic problem. 13 children with cysts of the common bile duct were studied by the method of dynamic scintigraphy with sup(99m)Tc-HIDA. The scintigraphic picture was characterized by the following signs: sacculated or spheroidal dilatation of the common bile duct, dilatation of the left or both lobular bile ducts, absence of the gall bladder visualization. Change of indicators of the hepatic function and the time of interstinal visualization reflects both the disorder of distal parts permeability and the degree of cyst drainage. An experience of radioisotropic cholegraphy application reveals, that the efficiency of preoperational diagnosis of cysts of the common bile duct increases as a result of the more accurate evaluation of the dynamic of improvement of absorptive-excretory hepatic function after different variants of operations

Anatomical Location of the Common Iliac Veins at the Level of the Sacrum: Relationship between Perforation Risk and the Trajectory Angle of the Screw

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Javid Akhgar

2016-01-01

Full Text Available Purpose. To determine the safety of transarticular surface screw (TASS insertion and the anatomical location of the common iliac veins (CIVs at the level of the promontorium. Materials and Methods. The locations of the CIVs on 1 mm computed tomography-myelography slices of 50 patients at the level of the promontorium and 20 human cadavers were investigated. Results. Among the patients, the left CIV was closer to the S1 anterior wall than the right CIV (mean distance: 5.0 ± 3.0 and 7.0 ± 4.2 mm, resp.. The level of the inferior vena cava (IVC formation varied among the cadavers. The mean distance between the IVC formation and promontorium tip was 30.2 ± 12.8 mm. The height of the IVC formation and distance between the right and the left CIVs at the level of the promontorium were significantly correlated (P<0.001. Conclusion. The TASS trajectory is safe as long as the screw does not penetrate the anterior cortex of S1. The level of the IVC formation can help to predict the distance between the right and the left CIVs at the level of the promontorium. The CIVs do not have a uniform anatomical location; therefore, preoperative computed tomography is necessary to confirm their location.

Vaginal dilator therapy for women receiving pelvic radiotherapy.

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Miles, Tracie; Johnson, Nick

2014-09-08

Vaginal dilation therapy is advocated after pelvic radiotherapy to prevent stenosis (abnormal narrowing of the vagina), but can be uncomfortable and psychologically distressing. To assess the benefits and harms of different types of vaginal dilation methods offered to women treated by pelvic radiotherapy for cancer. Searches included the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 5), MEDLINE (1950 to June week 2, 2013), EMBASE (1980 to 2013 week 24) and CINAHL (1982 to 2013). Comparative data of any type, which evaluated dilation or penetration of the vagina after pelvic radiotherapy treatment for cancer. Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We found no trials and therefore analysed no data. We identified no studies for inclusion in the original review or for this update. However, we felt that some studies that were excluded warranted discussion. These included one randomised trial (RCT), which showed no improvement in sexual scores associated with encouraging women to practise dilation therapy; a recent small RCT that did not show any advantage to dilation over vibration therapy during radiotherapy; two non-randomised comparative studies; and five correlation studies. One of these showed that objective measurements of vaginal elasticity and length were not linked to dilation during radiotherapy, but the study lacked power. One study showed that women who dilated tolerated a larger dilator, but the risk of objectivity and bias with historical controls was high. Another study showed that the vaginal measurements increased in length by a mean of 3 cm after dilation was introduced 6 to 10 weeks after radiotherapy, but there was no control group; another case series showed the opposite. Three recent studies showed less stenosis associated with prophylactic dilation after radiotherapy. One small case series suggested that dilation years after radiotherapy might restore the

Diagnosis and assessment of dilated cardiomyopathy: a guideline protocol from the British Society of Echocardiography

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Thomas Mathew

2017-06-01

Full Text Available Heart failure (HF is a debilitating and life-threatening condition, with 5-year survival rate lower than breast or prostate cancer. It is the leading cause of hospital admission in over 65s, and these admissions are projected to rise by more than 50% over the next 25 years. Transthoracic echocardiography (TTE is the first-line step in diagnosis in acute and chronic HF and provides immediate information on chamber volumes, ventricular systolic and diastolic function, wall thickness, valve function and the presence of pericardial effusion, while contributing to information on aetiology. Dilated cardiomyopathy (DCM is the third most common cause of HF and is the most common cardiomyopathy. It is defined by the presence of left ventricular dilatation and left ventricular systolic dysfunction in the absence of abnormal loading conditions (hypertension and valve disease or coronary artery disease sufficient to cause global systolic impairment. This document provides a practical approach to diagnosis and assessment of dilated cardiomyopathy that is aimed at the practising sonographer.

A rare case of large isolated internal iliac artery aneurysm with ureteral obstruction and hydronephrosis: Compression symptoms are limitation for endovascular procedures.

Science.gov (United States)

Nenezic, Dragoslav; Tanaskovic, Slobodan; Gajin, Predrag; Ilijevski, Nenad; Novakovic, Aleksandra; Radak, Djordje

2015-04-01

In this report, we aim to present a rare case of isolated internal iliac artery aneurysm with associated left ureteric obstruction and consequent hydronephrosis. A 66-year-old male patient was admitted for occasional pain in the lower back that appeared one month earlier. CT arteriography revealed isolated internal iliac artery (diameter 99 mm) with ureteral obstruction, hydroureter and left kidney hydronephrosis occurrence. Aneurysm was resected, after six months the patient was doing well. Bearing in mind that 77% of the patients with isolated internal iliac artery have symptoms caused by aneurysmal compression on adjacent organs, we wanted to highlight that despite the amazing expansion of endovascular procedures in the last decades, its therapeutic effect in isolated internal iliac artery's treatment is to a great extent limited since compression symptoms cannot be solved. Open surgery remains the gold standard for isolated internal iliac artery's treatment considering significant limitations of endovascular procedures due to the inability to eliminate problems caused by compression. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Evidence for shear stress-mediated dilation of the internal carotid artery in humans

DEFF Research Database (Denmark)

Carter, Howard Henry; Atkinson, Ceri L; Heinonen, Ilkka H A

2016-01-01

-mediated dilation of larger conduit arteries in humans. There was a strong association between change in shear and diameter of the internal carotid (r=0.68; Ptime in humans, that shear stress is an important stimulus for hypercapnic vasodilation of the internal carotid...... increases carotid shear stress, a known stimulus to vasodilation in other conduit arteries. To explore the hypothesis that shear stress contributes to hypercapnic internal carotid dilation in humans, temporal changes in internal and common carotid shear rate and diameter, along with changes in middle.......01) carotids. Diameter also increased (Ptime course is associated with shear...

Break dance hip: chronic avulsion of the anterior superior iliac spine.

Science.gov (United States)

Winkler, A R; Barnes, J C; Ogden, J A

1987-01-01

A case of chronic, progressive avulsion of the anterior superior iliac spine leading to the formation of a long, attenuated spur of bone in an 18-year-old black male break dancer is described. The mechanism of formation appeared to be repetitive avulsion from break dancing.

Break dance hip: Chronic avulsion of the anterior superior iliac spine

International Nuclear Information System (INIS)

Winkler, A.R.; Barnes, J.C.

1987-01-01

A case of chronic, progressive avulsion of the anterior iliac spine leading to the formation of a long, attenuated spur of bone in an 18-year-old black male break dancer is described. The mechanism of formation appeared to be repetitive avulsion from break dancing. (orig.)

A Case Report of Reversible Dilated Cardiomyopathy

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Abhishek Singhai

2014-01-01

Full Text Available Dilated cardiomyopathy (DCM is mostly an idiopathic disease with a progressive and irreversible course. It carries poor prognosis and outcome. Rarely, a reversible metabolic etiology that is amenable to specific therapy is identified. Alteration in thyroid status can lead to changes in systolic and diastolic function of left ventricle. Heart is sensitive to thyroid hormone changes, and cardiac disorders are commonly associated with both hyper and hypothyroidism. Diastolic dysfunction is the most common abnormality reported in hypothyroidism. In systolic function, prolonged systolic time interval or normal cardiac function has been reported by most workers. DCM is a rare presentation of hypothyroidism. Here, we report a case of 40-year-old female diagnosed with DCM due to hypothyroidism

Combined Radial and Femoral Access Strategy and Radial-Femoral Rendezvous in Patients With Long and Complex Iliac Occlusions.

Science.gov (United States)

Hanna, Elias B; Mogabgab, Owen N; Baydoun, Hassan

2018-01-01

We present cases of complex, calcified iliac occlusive disease revascularized via a combined radial-femoral access strategy. Through a 6-French, 125-cm transradial guiding catheter, antegrade guidewires and catheters are advanced into the iliac occlusion, while retrograde devices are advanced transfemorally. The transradial and transfemoral channels communicate, allowing the devices to cross the occlusion into the true lumen (radial-femoral antegrade-retrograde rendezvous).

Roentgenoendovascular dilatation of brachycephalic arteries

International Nuclear Information System (INIS)

Rabkin, I.Kh.; Kachel, R.; Glazer, F.; Matevosov, A.L.; Dzhoraev, I.G.; Medizinische Akademie, Erfurt

1988-01-01

The authors reported the technique, methods of and indications for roentgenoendovascular dilation in stenotic and occlusive lesions of the brachycephalic branches of the aorta. A total of 102 vascular dilations were perfomed in 76 patients resulting in a good angiographic and clinical effect. In 2 patients the first world prosthetics was performed using an original coiled nitinol prosthesis

Iliac Vein Interrogation Augments Venous Ulcer Healing in Patients Who Have Failed Standard Compression Therapy along with Pathological Venous Closure.

Science.gov (United States)

Mousa, Albeir Y; Broce, Mike; Yacoub, Michael; AbuRahma, Ali F

2016-07-01

Treatment of venous ulcers is demanding for patients, as well as clinicians, and the investigation of underlying venous hypertension is the cornerstone of therapy. We propose that occult iliac vein stenosis should be ruled out by iliac vein interrogation (IVI) in patients with advanced venous stasis. We conducted a systematic retrospective analysis of a consecutive series of patients who presented with CEAP (clinical, etiological, anatomical, and pathophysiological) 6 venous disease. All patients had great saphenous vein ablation, compressive treatment, wound care (including Unna boot compression), and perforator closure using ablation therapy. Iliac vein stenosis was defined as ≥50% stenosis in cross-sectional surface area on intravascular ultrasound. Primary outcomes include time of venous ulcer healing and/or measurable change in the Venous Clinical Severity Score. Twenty-two patients with CEAP 6 venous disease met the inclusion criteria (active ulcers >1.5 cm in diameter). The average age and body mass index were 62.2 ± 9.2 years and 41.7 ± 16.7, respectively. The majority were female (72.7%) with common comorbidities, such as hyperlipidemia (54.5%), hypertension (36.4%), and diabetes mellitus (27.3%). Twenty-nine ulcers with an average diameter of 3.4 ± 1.9 cm and a depth of 2.2 ± 0.5 mm were treated. The majority of the ulcers occurred on the left limb (n = 17, 58.6%). Average perforator venous reflux was 3.6 ± 0.8 sec, while common femoral reflux was 1.8 ± 1.6. The majority (n = 19, 64.5%) of the perforator veins were located at the base of the ulcer, while the remainder (n = 10, 34.5%) were within 2 cm from the base. Of the 13 patients who underwent IVI, 8 patients (61.5%) had stenosis >50% that was corrected with iliac vein angioplasty and stenting (IVAS). There was a strong trend toward shorter healing time in the IVI group (7.9 ± 9.5 weeks) than for patients in the no iliac vein interrogation (NIVI) group (20.2 ± 15

A negative screen for mutations in calstabin 1 and 2 genes in patients with dilated cardiomyopathy

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Biagi Diogo G

2012-01-01

Full Text Available Abstract Background Calstabins 1 and 2 bind to Ryanodine receptors regulating muscle excitation-contraction coupling. Mutations in Ryanodine receptors affecting their interaction with calstabins lead to different cardiac pathologies. Animal studies suggest the involvement of calstabins with dilated cardiomyopathy. Results We tested the hypothesis that calstabins mutations may cause dilated cardiomyopathy in humans screening 186 patients with idiopathic dilated cardiomyopathy for genetic alterations in calstabins 1 and 2 genes (FKBP12 and FKBP12.6. No missense variant was found. Five no-coding variations were found but not related to the disease. Conclusions These data corroborate other studies suggesting that mutations in FKBP12 and FKBP12.6 genes are not commonly related to cardiac diseases.

Upper gastrointestinal strictures: The results of balloon dilatation

Energy Technology Data Exchange (ETDEWEB)

Lee, Kil Woo; Lim, Hyo Keun; Choo, In Wook; Bae, Sang Hoon; Yoon, Jong Sup [Hallym University College of Medicine, Seoul (Korea, Republic of); Yoo, Hyung Sik [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1990-12-15

Balloon catheter dilatation of upper gastrointestinal strictures is an accepted mode of therapy. The authors report the balloon dilatation in 11 consecutive patients. The lesions treated included 10 benign strictures, and 1 esophageal cancer. Esophageal balloon were ranged from 2 mm in diameter, 4 cm in length, to 30 mm in diameter, 8 cm in length. Inflation was held for from 30 to 60 seconds and then repeated two or three times during each session. The balloons were inflated to pressure of from 2 to 12 atmospheres. There were from 1 to 13 dilatations. Two esophageal perforations were occurred in one esophagitis patient and other lye stricture patient. Two perforations were not required any surgical repair. All dilatation were performed without anesthesia. All strictures were responded immediately to dilatation. Prolonged course of treatment were needed with chronic severe esophagitis, lye stricture, gastrojejunostomy with chemotherapy, as a result, all patients, except esophageal cancer, could take regular diet after balloon catheter dilatation. Balloon catheter dilatation of upper gastrointestinal stenosis was effective and safe. It should be considered before other methods of treatment applicable.

Time-dependent dilatancy for brittle rocks

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Jie Li

2017-12-01

Full Text Available This paper presents a theoretical study on time-dependent dilatancy behaviors for brittle rocks. The theory employs a well-accepted postulation that macroscopically observed dilatancy originates from the expansion of microcracks. The mechanism and dynamic process that microcracks initiate from local stress concentration and grow due to localized tensile stress are analyzed. Then, by generalizing the results from the analysis of single cracks, a parameter and associated equations for its evolution are developed to describe the behaviors of the microcracks. In this circumstance, the relationship between microcracking and dilatancy can be established, and the theoretical equations for characterizing the process of rock dilatancy behaviors are derived. Triaxial compression and creep tests are conducted to validate the developed theory. With properly chosen model parameters, the theory yields a satisfactory accuracy in comparison with the experimental results.

Hepatopulmonary syndrome induced by common bile duct ligation in a rabbit model: correlation between pulmonary vascular dilatation on thin-section CT and angiography and serum nitrite concentration or endothelial nitric oxide synthase (eNOS)1 expression

International Nuclear Information System (INIS)

Lee, Ki Nam; Yoon, Seong Kuk; Lee, Jin Wha; Kim, Ki Nam; Park, Byung Ho; Kwak, Jong Young; Jeong, Jin Sook; Kim, Young Hoon

2004-01-01

To investigate the correlation between radiologic vascular dilatation and serum nitrite concentration and eNOS expression in the endothelial cell and pneumocyte in a rabbit model of hepatopulmonary syndrome induced by common bile duct ligation (CBDL). Thin-section CT scans of the lung and pulmonary angiography were obtained 3 weeks after CBDL (n=6), or a sham operation (n=4), and intrapulmonary vasodilatation was assessed. The diameter and tortuosity of peripheral vessels in the right lower lobe by thin-section CT and angiography at the same level of the right lower lobe in all subjects were correlated to serum nitrite concentration and eNOS (endothelial nitric oxide synthase) expression as determined by immunostaining. The diameters of pulmonary vessels on thin-section CT were well correlated with nitrite concentrations in serum (r=0.92, ρ < 0.001). Dilated pulmonary vessels were significantly correlated with an increased eNOS expression (r=0.94, ρ < 0.0001), and the severity of pulmonary vessel tortuosity was found to be well correlated with serum nitrite concentration (r=0.90, ρ < 0.001). The peripheral pulmonary vasculature in hepatopulmonary syndrome induced by CBLD was dilated on thin-section CT and on angiographs. Our findings suggest that peripheral pulmonary vascular dilatations are correlated with serum nitrite concentrations and pulmonary eNOS expression

Comparison of fracture site callus with iliac crest bone marrow as the source of plastic-adherent cells

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Achmad Zaki

2013-05-01

Full Text Available Background: Red marrow has been described as the main source of mesenchymal stem cells although its aspiration and isolation from bone marrow was reported to have significant donor site morbidity. Since secondary bone healing occurs through formation of callus as the result of proliferation and differentiation of mesenchymal stem cells, callus may become alternative source for mesenchymal stem cells. In this study, we compared the number of plastic-adherent cells from fracture site callus and bone marrow of iliac crest after two and four weeks of culture.Methods: Sixteen New Zealand rabbits were fracturized at the femoral shaft. Then, these rabbits were taken care. After two weeks of fracturization, 3 mL iliac crest bone marrow aspiration and callus extraction of eight rabbits were cultured (group I. The other eight rabbits were treated equally after four weeks of fracturization (group II. Simultaneously, the cultures were observed after one and two weeks. Four weeks later, they were harvested. Cells were counted using Neubauer hemocytometer. The average number of cells between the sources and groups were statistically analyzed using the unpaired t-test. Results: In group I, there were 2.6 ± 0.1 x 104 cells in the culture of iliac crest bone marrow aspirate and 2.5 ± 0.1 x 104 cells in culture of callus extract from fracture site (p = 0.34. In group II, there were 2.7 ± 0.1 x 104 cells and 2.1 ± 0.1 x 104 cells, respectively (p < 0.001.Conclusion: Fracture site callus at the second week post-fracturization may be potential as source of plastic-adherent cells compared with iliac crest bone marrow. (Med J Indones. 2013;22:70-5Keywords: Bone marrow, fracture site callus, iliac crest, long bone, mesenchymal stem cell, plastic-adherent cells

Midterm results of endovascular treatment of iliac artery lesions: analysis of 59 cases

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Leonardo Ghizoni Bez

2013-06-01

Full Text Available BACKGROUND: Endovascular treatment of peripheral arterial occlusive disease has become increasingly frequent in the past few years. Because it is a less invasive procedure, lower morbidity and mortality rates are associated with this form of treatment. OBJECTIVES: To describe the endovascular procedures performed in iliac arteries for the treatment of peripheral arterial occlusive disease. METHODS: This retrospective study assesses 59 cases of iliac artery angioplasty performed according to a specific protocol from January 2004 to February 2010. RESULTS: Mean age of patients was 62 years (minimum: 42, maximum: 89. Thirty seven were male (62.72% and 22 female (37.28%. The main indications for treatment were moderate to severe intermittent claudication in 30 cases (50.84% and rest pain or trophic lesions (critical ischemia in 29 cases (49.15%. Postoperative follow-up included ankle-brachial index measurements and a duplex ultrasound at 30 days, 3 months, 6 months, 12 months, and every 6 months thereafter. Minimum follow-up time was 3 months, and maximum, 72 months (6 years, with primary and secondary patency rates of 91.37 and 94.82%, respectively. CONCLUSIONS: The results of this case series, combined with literature review results, allow to conclude that the endovascular approach is an effective and safe option to treat peripheral arterial occlusive disease in iliac arteries.

An Extensive Stanford Type A Aortic Dissection Involving Bilateral Carotid and Iliac Arteries

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E. W. Lee

2013-01-01

Full Text Available We present a rare case of continuous, extensive aortic dissection (AD involving the bilateral common carotid arteries, the ascending, thoracic, and abdominal aorta, and bifurcation of the right common iliac artery. A 61-year-old man with history of chronic hypertension presented with a one-day history of chest pain, vertigo, left facial drooping, and left hemiparesis. Despite the presence of bilateral carotid bruits, doppler ultrasound of the neck was postponed, and the patient was treated with thrombolytic therapy for a presumed ischemic stroke. The patient's symptoms began to resolve within an hour of treatment, at which time treatment was withheld. Ultrasound performed the following day showed dissection of bilateral common carotid arteries, and CT angiography demonstrated extensive AD as described earlier. The patient subsequently underwent cardiovascular surgery and has been doing clinically well since then. AD has a myriad of manifestations depending on the involvement of aortic branches. Our paper illustrates the importance of having a high index of suspicion for AD when a patient presents with a picture of ischemic stroke, since overlapping signs and symptoms exist between AD and stroke. Differentiating between the two conditions is central to patient care as thrombolytic therapy can be helpful in stroke, but detrimental in AD.

Intraoperative intermittent blocking of the common iliac arteries in cases of placenta percreta without the use of fluoroscopy; Intraoperative intermittierende Blockung der Arteriae iliacae communes bei Placenta percreta unter Vermeidung von Roentgenstrahlung

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Heinze, S. [Frankfurt Univ. (Germany). Inst. of Forensic Medicine; Klinikum Oldenburg (Germany). Inst. of Diagnostic and Interventional Radiology; Filsinger, B. [St. Marienkrankenhaus, Ludwigshafen (Germany). Maternity Clinic; Kastenholz, G.; Schroeder, R.J. [St. Marienkrankenhaus, Ludwigshafen (Germany). Dept. of Radiology

2016-12-15

The number of patients with placenta accreta, percreta and increta is increasing. The morbidity and mortality are higher mostly due to hemorrhage. Therefore, new methods to reduce the risk of severe bleeding are necessary. Three patients were treated in collaboration by obstetricians, urologists, anesthesiologists, and radiologists. An MRI of the pelvis was performed and the diameters and lengths of the iliac arteries were measured to avoid fluoroscopy during the preoperative placement of catheter balloons into the iliac arteries. During the operational procedure the balloons were inflated and deflated depending on the operative site and the occurrence of bleeding. In comparison to the literature, severe bleeding was clearly reduced. No complications of the intervention were observed. The presented method to reduce severe bleeding might represent significant progress in the management of abnormal placenta implantation. Nevertheless, further controlled studies are needed in order to establish evidence-based recommendations.

Dilatation effect of ''quantum clocks''

International Nuclear Information System (INIS)

Chylinski, Z.

1981-01-01

The relativistic dilatation effect of the life-time of unstable microparticles combined with quantum symmetry of their description results in the ''quantum-dilatation'' dilemma. It is due to the classical character of the relativity theory which here reveals itself in the classical world-line of the clock necessary in order to deduce the dilatation effect from the Lorentz transformation. It is shown how to solve this dilemma, basing on the relation continuum C 4 . Two types of measurements of time intervals, the direct and indirect one, are analyzed. The former type corresponds to the external space-time continuum, where any direct measurement takes place, and the latter, to the internal relation continuum C 4 , where the internal structures of isolated micro-systems are sunk. (author)

[Comparison of the Latissimus dorsi insertions on the iliac crest in chimpanzee (Pan troglodytes) and in man].

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Vacher, C; Ben Hadj Yahia, S; Braun, M; Journeau, P

2014-03-01

Comparing to other primates, one of the most important specificities of the human anatomy are consequences of bipedalism. Although bone consequences are well known (lumbar lordosis, horizontal position of the foramen magnum, lengthening of the lower limbs, reduction of the pelvis, specialization of the foot), consequences of our locomotion on the Latissimus dorsi are still unclear. One dissection of a chimpanzee Latissimus dorsi (Pan troglodytes) has been performed and compared to 30 human Latissimus dorsi dissections (10 fresh cadavers and 20 formoled cadavers). In each dissection, the existence of direct muscular insertions on the iliac crest has been investigated and the constitution of the thoracolumbar fascia has been described. In chimpanzee dissection, a muscular direct insertion of the Latissimus dorsi was present on the iliac crest of 9 cm long. The TLF was made of the superficial and the deep fascias of the Latissimus dorsi and the superficial fascia of the erector spinae muscles which was deeper. In man, there was no direct muscular insertion of the Latissimus dorsi in 90 % of cases, the TLF was constituted the same way. This study suggests that the Latissimus dorsi has been separated from the iliac crest in man during the evolution because of the permanent bipedalism and that it stayed inserted on the iliac crest in chimpanzee because of the brachiation. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Correlation of Peripheral Vein Tumour Marker Levels, Internal Iliac Vein Tumour Marker Levels and Radical Prostatectomy Specimens in Patients with Prostate Cancer and Borderline High Prostate-Specific Antigen: A Pilot Study.

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Farrelly, Cormac; Lal, Priti; Trerotola, Scott O; Nadolski, Gregory J; Watts, Micah M; Gorrian, Catherine Mc; Guzzo, Thomas J

2016-05-01

To correlate prostate-specific antigen (PSA), free to total PSA percentage (fPSA%) and prostatic acid phosphatase (PAP) levels from peripheral and pelvic venous samples with prostatectomy specimens in patients with prostate adenocarcinoma and borderline elevation of PSA. In this prospective institutional review board approved study, 7 patients with biopsy proven prostate cancer had a venous sampling procedure prior to prostatectomy (mean 3.2 days, range 1-7). Venous samples were taken from a peripheral vein (PVS), the right internal iliac vein, a deep right internal iliac vein branch, left internal iliac vein and a deep left internal iliac vein branch. Venous sampling results were compared to tumour volume, laterality, stage and grade in prostatectomy surgical specimens. Mean PVS PSA was 4.29, range 2.3-6 ng/ml. PSA and PAP values in PVS did not differ significantly from internal iliac or deep internal iliac vein samples (p > 0.05). fPSA% was significantly higher in internal iliac (p = 0.004) and deep internal iliac (p = 0.003) vein samples compared to PVS. One of 7 patients had unilateral tumour only. This patient, with left-sided tumour, had a fPSA% of 6, 6, 6, 14 and 12 in his peripheral, right internal iliac, deep right internal iliac branch, left internal iliac and deep left internal iliac branch samples respectively. There were no adverse events. fPSA%, unlike total PSA or PAP, is significantly higher in pelvic vein compared to peripheral vein samples when prostate cancer is present. Larger studies including patients with higher PSA values are warranted to further investigate this counterintuitive finding.

Primary Infrarenal Aortic Stenting With or Without Iliac Stenting for Isolated and Aortoiliac Stenoses: Single-Centre Experience With Long-Term Follow-Up

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Tapping, C. R.; Ahmed, M.; Scott, P. M.; Lakshminarayan, R.; Robinson, G. J.; Ettles, D. F.; Shrivastava, V.

2013-01-01

The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 ± 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included paired Student t test and Kaplan–Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non–flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60–132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 ± −0.15 (right) and 0.61 ± −0.16 (left). After the procedure they were 0.86 ± −0.07 (right) and 0.90 ± −0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year. Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic

Dynamical and hamiltonian dilations of stochastic processes

International Nuclear Information System (INIS)

Baumgartner, B.; Gruemm, H.-R.

1982-01-01

This is a study of the problem, which stochastic processes could arise from dynamical systems by loss of information. The notions of ''dilation'' and ''approximate dilation'' of a stochastic process are introduced to give exact definitions of this particular relationship. It is shown that every generalized stochastic process is approximately dilatable by a sequence of dynamical systems, but for stochastic processes in full generality one needs nets. (Author)

Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: Pros, cons, and costs

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Epstein, Nancy E.

2012-01-01

Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The “gold standard”, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers. Methods: Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the “value-added” of these various constructs (e.g. safety/efficacy, risks/complications, costs). Results: The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent “post hoc analysis of data from a prospective multicenter trial” (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%. Conclusion: Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the “value added” of these increasingly expensive graft constructs. PMID:22905321

Treatment strategy for sacroiliac joint-related pain at or around the posterior superior iliac spine.

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Murakami, Eiichi; Kurosawa, Daisuke; Aizawa, Toshimi

2018-02-01

Pain at or around the posterior superior iliac spine (PSIS) is characteristic of sacroiliac joint (SIJ) -related pain. This pain can be treated by either a peri- or intra-articular injection into the joint, with the former being much easier to perform. We investigated whether peri- or intra-articular injections were more frequently effective in patients with SIJ-related pain, and aimed to create an efficient treatment strategy for SIJ-related pain at or around the PSIS. Prospective case-control study. We evaluated 85 patients with pain at or around the posterior superior iliac spine as indicated by the one finger test. First, we performed a peri-articular sacroiliac joint injection. If it was ineffective, an intra-articular injection was later given. Groin pain, sitting pain, sacroiliac joint shear test results, and posterior superior iliac spine and sacro-tuberous ligament tenderness were also compared between patients for whom a peri- or intra-articular injection was effective. Seventy-two (85%) of 85 patients had an effective injection. Out of these 72 patients, 58 (81%) had a positive peri-articular injection and 14 (19%) had a positive intra-articular injection. Four items, excluding tenderness of the sacro-tuberous ligament had no significant difference between these two injection types. To treat sacroiliac joint-related pain at or around the posterior superior iliac spine, a peri-articular injection should be performed first, and only if it is not effective should an intra-articular injection be administered. Using this strategy, we expect that most patients with sacroiliac joint-related pain will be efficiently diagnosed and treated. Copyright © 2017 Elsevier B.V. All rights reserved.

Anatomical reconstruction of the fourth brachymetatarsia with one-stage iliac bone and cartilage cap grafting.

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Woo, Sang Hyun; Bang, Chi Young; Ahn, Hee-Chan; Kim, Sung-Jung; Choi, Jun-Young

2017-05-01

We present a one-stage procedure for lengthening the fourth brachymetatarsia with autogenous iliac bone and cartilage cap grafting for the anatomical reconstruction of the metatarsophalangeal (MTP) joint METHODS: During the last 8 years, 56 feet in 41 patients with congenital brachymetatarsia of the fourth toe were corrected with a one-stage operation to reposition the articular cartilage cap to the distal part of interpositional iliac bone graft at the metatarsal epiphysis. The length of the harvested iliac bone graft was 22.9 mm on average. The mean fixation period was 58.5 days, and the mean gain in length and percentage increase was 20.9 mm and 39%, respectively. MRI showed a stable MTP joint over viable cartilage cap in 83.3% of the cases. Mean postoperative American Orthopedic Foot and Ankle Society lesser MTP-interphalangeal score was 82.0. Neither neurovascular impairment nor recurrence of brachymetatarsia occurred in the mean follow-up period of 43.6 months. All patients were satisfied with the postoperative cosmetic results. Thirteen patients (23.2%) complained of limited active dorsiflexion of the fourth toe, and extensor adhesion was released by extensor tenolysis in only one patient. In a single case of nonunion at the bone graft site, additional surgery was not necessary. Anatomical reconstruction of the fourth brachymetatarsia with one-stage interpositional iliac bone and cartilage cap grafting resulted in excellent cosmetic results and a physiologic MTP joint, providing the benefits of one-stage lengthening with a low complication rate. Therapeutic, IV. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Donor site complications in bone grafting: comparison of iliac crest, calvarial, and mandibular ramus bone.

Science.gov (United States)

Scheerlinck, Laura M E; Muradin, Marvick S M; van der Bilt, Andries; Meijer, Gert J; Koole, Ronald; Van Cann, Ellen M

2013-01-01

To compare the donor site complication rate and length of hospital stay following the harvest of bone from the iliac crest, calvarium, or mandibular ramus. Ninety-nine consecutively treated patients were included in this retrospective observational single-center study. Iliac crest bone was harvested in 55 patients, calvarial bone in 26 patients, and mandibular ramus bone in 18 patients. Harvesting of mandibular ramus bone was associated with the lowest percentages of major complications (5.6%), minor complications (22.2%), and total complications (27.8%). Harvesting of iliac crest bone was related to the highest percentages of minor complications (56.4%) and total complications (63.6%), whereas harvesting of calvarial bone induced the highest percentage of major complications (19.2%). The length of the hospital stay was significantly influenced by the choice of donor site (P = .003) and age (P = .009); young patients with the mandibular ramus as the donor site had the shortest hospital stay. Harvesting of mandibular ramus bone was associated with the lowest percentage of complications and the shortest hospital stay. When the amount of bone to be obtained is deemed sufficient, mandibular ramus bone should be the first choice for the reconstruction of maxillofacial defects.

Balloon catheter dilatation of esophageal strictures

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Kim, Jeung Sook; Yoon, Yup; Sung, Dong Yook; Choi, Woo Suk; Nam, Kyung Jin; Lim, Jae Hoon [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

1990-07-15

The authors performed 27 fluoroscopically guided balloon dilatation in 12 patients of esophageal stricture during recent 3 years. The causes of esophageal stricture were corrosive esophagitis (N=2) and congenital narrowing (N=1), including postoperative narrowing in achalasia (N=3), esophageal varix (N=3), lye stricture (N=2) and esophageal cancer (N=1). Successful dilatation of the stricture was achieved during the procedure in 10 patients(83%). Major complication such as esophageal rupture was not found. The authors conclude that fluoroscopically guided esophageal balloon dilatation is a safe and effective method for treatment of symptomatic esophageal strictures.

Balloon catheter dilatation of esophageal strictures

International Nuclear Information System (INIS)

Kim, Jeung Sook; Yoon, Yup; Sung, Dong Yook; Choi, Woo Suk; Nam, Kyung Jin; Lim, Jae Hoon

1990-01-01

The authors performed 27 fluoroscopically guided balloon dilatation in 12 patients of esophageal stricture during recent 3 years. The causes of esophageal stricture were corrosive esophagitis (N=2) and congenital narrowing (N=1), including postoperative narrowing in achalasia (N=3), esophageal varix (N=3), lye stricture (N=2) and esophageal cancer (N=1). Successful dilatation of the stricture was achieved during the procedure in 10 patients(83%). Major complication such as esophageal rupture was not found. The authors conclude that fluoroscopically guided esophageal balloon dilatation is a safe and effective method for treatment of symptomatic esophageal strictures

Clinical evaluation of internal iliac artery anticancer drug infusion for the treatment of androgen-independent prostate cancer

International Nuclear Information System (INIS)

Cao Ye; Wang Jin; Nie Yong; Chen Hua; Huang Xinjie

2008-01-01

Objective: To evaluate the clinical efficacy of bilateral internal iliac artery chemotherapy infusion for the treatment of androgen-independent prostate cancer (ALPC). Methods: Thirty eight eases of confirmed AIPC were randomly divided into treatment group and control group. The patients in treatment group (23 cases) were treated with androgen deprivation therapy and regular internal iliac artery chemotherapy, while patients in control group (15 cases) were only received androgen deprivation therapy. The therapeutic efficacies of the two groups were compared and analyzed after completion of the treatment. Results: The clinical symptoms and maximum urine flow rates of' treatment group were improved rapidly 6 months later. After 2 years follow-up, the total efficacies of treatment group and control group were 65.2% and 26.7% respectively, showing a significant statistical difference (P<0.05). Conclusions: The treatment of AlPC with bilateral internal iliac artery chemotherapy is effective, providing melioration the quality of life and alleviation of the symptoms. (authors)

Paschke Dilations

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Abraham Westerbaan

2017-01-01

Full Text Available In 1973 Paschke defined a factorization for completely positive maps between C*-algebras. In this paper we show that for normal maps between von Neumann algebras, this factorization has a universal property, and coincides with Stinespring's dilation for normal maps into B(H.

Correlation of Peripheral Vein Tumour Marker Levels, Internal Iliac Vein Tumour Marker Levels and Radical Prostatectomy Specimens in Patients with Prostate Cancer and Borderline High Prostate-Specific Antigen: A Pilot Study

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Farrelly, Cormac, E-mail: farrellycormac@gmail.com [Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Division of Interventional Radiology, Department of Radiology (United States); Lal, Priti [University of Pennsylvania Perelman School of Medicine, Department of Pathology and Laboratory Medicine (United States); Trerotola, Scott O.; Nadolski, Gregory J.; Watts, Micah M. [Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Division of Interventional Radiology, Department of Radiology (United States); Gorrian, Catherine Mc. [Mater Misericordiae University Hospital, University College Dublin School of Medicine & Medical Science (Ireland); Guzzo, Thomas J. [University of Pennsylvania Perelman School of Medicine, Department of Urology and Surgery (United States)

2016-05-15

PurposeTo correlate prostate-specific antigen (PSA), free to total PSA percentage (fPSA%) and prostatic acid phosphatase (PAP) levels from peripheral and pelvic venous samples with prostatectomy specimens in patients with prostate adenocarcinoma and borderline elevation of PSA.Materials and MethodsIn this prospective institutional review board approved study, 7 patients with biopsy proven prostate cancer had a venous sampling procedure prior to prostatectomy (mean 3.2 days, range 1–7). Venous samples were taken from a peripheral vein (PVS), the right internal iliac vein, a deep right internal iliac vein branch, left internal iliac vein and a deep left internal iliac vein branch. Venous sampling results were compared to tumour volume, laterality, stage and grade in prostatectomy surgical specimens.ResultsMean PVS PSA was 4.29, range 2.3–6 ng/ml. PSA and PAP values in PVS did not differ significantly from internal iliac or deep internal iliac vein samples (p > 0.05). fPSA% was significantly higher in internal iliac (p = 0.004) and deep internal iliac (p = 0.003) vein samples compared to PVS. One of 7 patients had unilateral tumour only. This patient, with left–sided tumour, had a fPSA% of 6, 6, 6, 14 and 12 in his peripheral, right internal iliac, deep right internal iliac branch, left internal iliac and deep left internal iliac branch samples respectively. There were no adverse events.ConclusionfPSA%, unlike total PSA or PAP, is significantly higher in pelvic vein compared to peripheral vein samples when prostate cancer is present. Larger studies including patients with higher PSA values are warranted to further investigate this counterintuitive finding.

Correlation of Peripheral Vein Tumour Marker Levels, Internal Iliac Vein Tumour Marker Levels and Radical Prostatectomy Specimens in Patients with Prostate Cancer and Borderline High Prostate-Specific Antigen: A Pilot Study

International Nuclear Information System (INIS)

Farrelly, Cormac; Lal, Priti; Trerotola, Scott O.; Nadolski, Gregory J.; Watts, Micah M.; Gorrian, Catherine Mc.; Guzzo, Thomas J.

2016-01-01

PurposeTo correlate prostate-specific antigen (PSA), free to total PSA percentage (fPSA%) and prostatic acid phosphatase (PAP) levels from peripheral and pelvic venous samples with prostatectomy specimens in patients with prostate adenocarcinoma and borderline elevation of PSA.Materials and MethodsIn this prospective institutional review board approved study, 7 patients with biopsy proven prostate cancer had a venous sampling procedure prior to prostatectomy (mean 3.2 days, range 1–7). Venous samples were taken from a peripheral vein (PVS), the right internal iliac vein, a deep right internal iliac vein branch, left internal iliac vein and a deep left internal iliac vein branch. Venous sampling results were compared to tumour volume, laterality, stage and grade in prostatectomy surgical specimens.ResultsMean PVS PSA was 4.29, range 2.3–6 ng/ml. PSA and PAP values in PVS did not differ significantly from internal iliac or deep internal iliac vein samples (p > 0.05). fPSA% was significantly higher in internal iliac (p = 0.004) and deep internal iliac (p = 0.003) vein samples compared to PVS. One of 7 patients had unilateral tumour only. This patient, with left–sided tumour, had a fPSA% of 6, 6, 6, 14 and 12 in his peripheral, right internal iliac, deep right internal iliac branch, left internal iliac and deep left internal iliac branch samples respectively. There were no adverse events.ConclusionfPSA%, unlike total PSA or PAP, is significantly higher in pelvic vein compared to peripheral vein samples when prostate cancer is present. Larger studies including patients with higher PSA values are warranted to further investigate this counterintuitive finding.

Balloon dilatation of nasopharyngeal stenosis in a dog.

Science.gov (United States)

Berent, Allyson C; Kinns, Jennifer; Weisse, Chick

2006-08-01

A dog was examined because of a 6-month history of upper airway stridor that began after postoperative regurgitation of gastric contents. Constant stridor was evident during inspiration and expiration, although it was worse during inspiration. The stridor was no longer evident when the dog's mouth was manually held open. Computed tomography, rhinoscopy, and fluoroscopy were used to confirm a diagnosis of nasopharyngeal stenosis. The dog was anesthetized, and balloon dilatation of the stenosis was performed. Prednisone was prescribed for 4 weeks after the procedure to decrease fibrous tissue formation. Although the dog was initially improved, signs recurred 3.5 weeks later, and balloon dilatation was repeated. This time, however, triamcinolone was injected into the area of stenosis at the end of the dilatation procedure. Two months later, although the dog did not have clinical signs of stridor, a third dilatation procedure was performed because mild stenosis was seen on follow-up computed tomographic images; again, triamcinolone was injected into the area of stenosis at the end of the dilatation procedure. Three and 6 months after the third dilatation procedure, the dog reportedly was clinically normal. Findings suggest that balloon dilatation may be an effective treatment for nasopharyngeal stenosis in dogs.

Achalasia: pneumatic Dilation. Experience in a reference hospital

International Nuclear Information System (INIS)

Garzon, Martin; Farfan, Yezid; Molano, Juan; Rey, Mario; Martinez, Julian; Marulanda, Juan

2005-01-01

Chalasia has an incidence of 1:100.000. The therapy for achalasia, focus on reducing the pressure gradient across the LES, which can be achieved by forceful pneumatic dilation of the gastroesophageal junction, surgical myotomy or by pharmacological agents, injected endoscopically or taken orally. Pneumatic balloon dilation is regarded as the first-Line treatment, with an initial success rate of 85% to 90%. The objective of this study is to show our experience with pneumatic balloon dilation in the patients with diagnosis of achalasia from the hospital La Samaritana during a period from February 2002 to February 2005. Patients diagnosed with achalasia from the department of gastroenterology and endoscopy of the Hospital La Samaritana during period of February 2002 to February 2005 was included. Procedures were made in fluoroscopy room. The patients received intravenous sedation and analgesia. We used a Regiflex balloon, 3.5 cm diameter. Balloons were inflated with saline water and water-soluble contrast during one minute. We diagnosed 19 patients with achalasia during period from February 2002 to February 2005, 14 were females and 5 males (26%); we made pneumatic dilation in 11 patients (60%), 9 were females (82%) with mean age 38.9 years (ranged from 16 to 13 years). Three patients (21%) underwent once pneumatic dilation and the rest (8 patients) underwent twice (73%). We don't report any perforation. So far we have followed the patients ambulatory during period from 6 months to 2 years. We find recurrence one year after of the pneumatic dilation in a female patient 22 years old (9%). The pneumatic dilation as cost-effective therapy, with a good initial success, but in the longer the follow-up lower the success rate and low morbidity (4). We suggest making only two pneumatic dilations. Today, there isn't consensus on the optimal endoscopic dilation technique and we believe that the sedation must be included in this procedure. In the future, we need more comparative

Congenital segmental dilatation of the colon

African Journals Online (AJOL)

Congenital segmental dilatation of the colon is a rare cause of intestinal obstruction in neonates. We report a case of congenital segmental dilatation of the colon and highlight the clinical, radiological, and histopathological features of this entity. Proper surgical treatment was initiated on the basis of preoperative radiological ...

Endovascular Management of Aorta-Iliac Stenosis and Occlusive Disease by Kissing-Stent Technique

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Meng Liu

2016-01-01

Full Text Available Kissing-stenting treatment has been used to treat patients with peripheral artery disease (PAD. However, the long term efficacy of the stenting therapy is not well defined in Chinese PAD patients. To investigate the question, sixty-three PAD patients (37 males and 26 females, aged 66±7.3 years, were analysed in the study. They were featured as claudication (n=45, 71.4%, rest pain (n=18, 28.6%, or gangrene (n=8, 12.7%. In total, 161 stents were applied in aorta-iliac lesions with 2.6 stents for each patient, including 55 self-expanding stents, 98 balloon expandable stents, and 8 covered stents. The success rate of implanting Kissing-stents was 100%. Catheter-directed thrombolysis (CDT with urokinase was performed in 8 cases (12.7%. The severity of peripheral ischemia was significantly improved, as evidenced by 3.3-fold increase of ankle-brachial pressure index (ABI after the surgery (P=0.008. One, three, five, and seven years after surgery, the primary patency rate was 87.3%, 77.4%, 71.1%, and 65.0%, whereas the secondary patency rate was 95.2%, 92.5%, 89.5%, and 85.0%, respectively. No in-hospital mortality was recorded. In conclusion, Kissing-stenting technique for aorta-iliac lesions is safe and effective with lower complications. It is beneficial for aorta-iliac occlusions that are longer than 60 mm.

Boston's balloon dilatation for treatment of cardiac achalasia

International Nuclear Information System (INIS)

Yin Jianguo; Song Jinwen; Yang Yan; Liu Xiaohong; Fu Zhiming; Zhang Yaqin

2001-01-01

Objective: To review and summarize effectiveness and method of the Boston's balloon dilation in cardiac achalasia. Methods: The intensified guide wire was inserted into stomach through mouth cavity under TV control. The Boston's balloon was inserted to the cardiac stricture through the guide wire and dilatated with 15% contrast medium with to a maximum diameter for five minutes and then the balloon was dilatated again for 3-5 minutes, all together for 3-4 times. The severe stricture must be pre-dilatated with 20-25 mm diameter balloon. Results: The balloon insertion was technically successful in all 26 patients. The once success of balloon dilation was achieved in 24 patients and twice in other 2. Follow-up time was from 2 weeks to 31 months (mean 10.6 months). Recurrent stenosis had not occurred in all patients. Remission rate of dysphagia was 100%. Esophageal reflux occurred in 3 patients. Conclusions: The Boston's balloon dilatation is simple and effective for treatment of cardiac achalasia. The method sometimes may replace surgical procedure

Clinical outcome of pneumatic dilatation in patients with achalasia cardia: A single-center prospective study

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Amit Hanmant Shejal

2017-01-01

Full Text Available Background and Aim: Pneumatic balloon dilation is one of the most commonly used and effective methods for treating patients with achalasia cardia. This study was performed to assess immediate and long-term response of pneumatic dilatation (PD in these patients. Materials and Methods: Forty-four achalasia cardia patients, who underwent PD in our center from January 2013 to December 2015, were prospectively studied. Data from these patients were analyzed for clinical improvement in symptoms after dilatation procedure over this period as per Eckardt score. Patients who required repeated procedure and factors influencing remission of symptoms were analyzed. Results: A total of 44 patients underwent PD, among which three lost to follow up. Of the 41 patients, 21 were male (51.22% and 20 were females (48.78%. Mean age was 38.68 (13–64 years. Median symptom duration before first dilatation was 18 months (2–240. Major symptoms at presentation were dysphagia (n = 41, 100%, regurgitation (n = 38 92.68%, chest pain (n = 31, 75.6%, and weight loss (n = 20, 48.78%. Mean follow-up period was 22.22 months (9–38. Forty (97.56% patients had immediate clinical improvement after 1 dilatation, of which 38 (92.68% patients did not require any further treatment. Mean Eckardt score was 6.82 (4–11 at the time of first dilatation which improved to 0.66 during follow-up. Two patients required second dilatation (one 5 months and other 18 months after the first procedure. Conclusion: PD is a safe and effective long-term therapy for achalasia cardia and has a good long-term clinical remission.

Right-sided duplication of the inferior vena cava and the common iliac vein: hidden hinds in spiral-computed tomography; Rechtsseitige Dopplung der Vena cava inferior und Vena iliaca communis: Bildgebung mit der Spiral-Computertomographie

Energy Technology Data Exchange (ETDEWEB)

Meyer, D.R.; Friedrich, M. [Krankenhaus am Urban (Germany). Abt. fuer Roentgendiagnostik und Nuklearmedizin; Andresen, R. [Staedtisches Krankenhaus Zehlendorf, Behring (Germany). Abt. fuer Roentgendiagnostik und Nuklearmedizin

1998-05-01

Duplications of the inferior vena cava (IVC) are rare variants of the abdominal vessels and are normally located on both sides of the abdominal aorta. The rare case of a rightsided infrarenal duplication of the IVC with involvement of the common iliac vein is reported. Details of the embryology are presented for the understanding of this IVC variant. The spiral CT with multiplanar reconstructions makes it possible to define the vascular morphology and to differentiate it from lymphoma. (orig.) [Deutsch] Duplikaturen der Vena cava inferior (VCI) sind seltene meist bilateral der Aorta abdominalis gelegene abdominelle Gefaessvarianten. Der ungewoehnliche Fall einer rechtsseitigen infrarenalen Dopplung der VCI mit Beteiligung der Vena iliaca communis wird dargestellt. Auf der Embryologie wird, soweit fuer das Verstaendnis der vorliegenden VCI-Variante notwendig, eingegangen. Die Spiral-CT mit multiplanaren Rekonstruktionen erlaubt die morphologische Beschreibung der Gefaesssituation und die Differenzierung gegenueber Lymphomen. (orig.)

Esophageal dilations in eosinophilic esophagitis: A single center experience

OpenAIRE

Ukleja, Andrew; Shiroky, Jennifer; Agarwal, Amitesh; Allende, Daniela

2014-01-01

AIM: To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications; examine the safety of dilation in patients with eosinophilic esophagitis (EoE).

Pelvic injuries in combination with vascular lesions of branches from the iliac artery: Outcome - Incidence - Treatment strategy

DEFF Research Database (Denmark)

Schmal, H.; Klemt, C.; Uhrmeister, P.

2002-01-01

The acute haemorrhagic shock is one of the leading causes for death following severe pelvic injuries. Typical bleeding sources are fractured spongiosa surfaces, lesions of the major venous plexus or ruptures of branches originating from the iliac artery. This study characterizes the population...... from active hemorrhage because of vascular lacerations of iliac artery branches. Average of ISS, PTS, part of multiple injured patients, prevalence of rotary and vertical unstable fractures as well as mortality of patients with accompanying arterial injury was found to be much higher when compared...

Experimental study of the preventive effect of 1'03Pd stent on in-stent restenosis in rabbit iliac artery

International Nuclear Information System (INIS)

Luo Quanyong; Chen Libo; Yuan Zhibin; Lu Hankui; Zhu Ruisen

2003-01-01

Objective: To investigate the ability of γ-emitting 103 Pd radioactive stent implantation for preventing in-stent restenosis in iliac artery of rabbits. Methods: Twenty New Zealand white rabbits were divided into six groups on the basis of radioactivity loading [2.22 (n=3), 5.55 (n=4), 9.25 (n=4), 14.8 (n=3), 22.2 (n=3), 33.3 MBq (n=3)]. 103 Pd stent was implanted in one of the two iliac arteries of each rabbit and nonradioactive stent in the contralateral artery. The rabbits were fed with high fat diet. Treatment efficiency was assessed by angiography and quantitative histomorphometry of the stented iliac segments 28 d after the implantation. Results: Quantitative histomorphometry analysis indicated that 103 Pd stents induced a significant reduction in neointimal area and the percentage of stenosis within radioactive stents was lower compared with that in the control stents. Nevertheless, the suppression of neointima formation by 103 Pd stent implantation was not in a dose-dependent manner. Conclusions: Low-dose intravascular brachytherapy via a γ-particle-emitting 103 Pd radioactive stent potently inhibits neointimal hyperplasia and prevents the in-stent restenosis in rabbit iliac artery. 103 Pd stent implantation probably can be employed as a novel means to prevent in-stent restenosis

Ligation of internal iliac arteries for control of pelvic haemorrhage.

Directory of Open Access Journals (Sweden)

Nandanwar Y

1993-10-01

Full Text Available This is a retrospective review of the internal iliac ligations (IAL done over a period of 3 years. Both gynaecological and obstetric cases were considered. A total of 46 ligations were performed. The additional treatment required was hysterectomy to control haemorrhage. Intra-and post-operative complications were noted. A comparative review of the effectiveness of IAL in different situations is done and alternative modalities of treatment are considered.

Salivary gland enlargement during oesophageal stricture dilatation.

OpenAIRE

Martin, D.

1980-01-01

A case of recurrent salivary gland enlargement occurring during fibreoptic oesophagoscopy and oesophageal stricture dilatation with Eder-Puestow dilators is described. The genesis of this condition is discussed and its transient and usually benign nature emphasized.

Computed tomography of localized dilatation of the intrahepatic bile ducts

International Nuclear Information System (INIS)

Araki, T.; Itai, Y.; Tasaka, A.

1981-01-01

Twenty-nine patients showed localized dilatation of the intrahepatic bile ducts on computed tomography, usually unaccompanied by jaundice. Congenital dilatation was diagnosed when associated with a choledochal cyst, while cholangiographic contrast material was helpful in differentiating such dilatation from a simple cyst by showing its communication with the biliary tract when no choledochal cyst was present. Obstructive dilatation was associated with intrahepatic calculi in 4 cases, hepatoma in 9, cholangioma in 5, metastatic tumor in 5, and polycystic disease in 2. Cholangioma and intrahepatic calculi had a greater tendency to accompany such localized dilatation; in 2 cases, the dilatation was the only clue to the underlying disorder

Dilatation and Dysfunction of the Neo-aortic Root and in 76 Patients After the Ross Procedure.

Science.gov (United States)

Zimmermann, Corina A; Weber, Roland; Greutmann, Matthias; Dave, Hitendu; Müller, Christoph; Prêtre, René; Seifert, Burkhardt; Buechel, Emanuela Valsangiacomo; Kretschmar, Oliver; Attenhofer Jost, Christine H

2016-08-01

Pulmonary autograft replacement (Ross procedure) is used as an alternative to prosthetic aortic valve replacement patients with aortic valve disease. There are limited data on incidence and risk factors for dilatation and dysfunction of the neo-aortic after the Ross procedure. Ross procedure was performed in 100 patients at our institution between 1993 and 2011. In 76 patients, complete follow-up data were available. Their median age at surgery was 16 (0.4-58) years (76 % males; 95 % with congenital aortic valve disease). Median follow-up duration was 5.2 years (0.3-16.0 years). We analyzed their clinical and echocardiographic follow-up to identify possible risk factors for neo-aortic root dilatation and dysfunction. Ross procedure included reduction plasty of the native ascending aorta in 25 % of patients. During follow-up, 21 patients (28 %) developed neo-aortic root dilatation, 38 patients (50 %) dilatation oft the native ascending aorta and 7 patients (9 %) at least moderate neo-aortic regurgitation. Univariate risk factors for neo-aortic root dilatation were preoperative aortic regurgitation (p = 0.04), concomitant reduction plasty of the ascending aorta (p = 0.009) and a longer duration of follow-up (p = 0.005). Younger age at surgery was associated with dilatation of the ascending aorta (p = 0.03). Reoperation on the neo-aortic root because of severe dilatation was necessary in 6 patients (8 %), where 2 patients had at least moderate neo-aortic root regurgitation. Neo-aortic root and aortic dilatation are common after the Ross procedure. This is often combined with neo-aortic valve dysfunction. Close follow-up of these patients is mandatory.

Hepatorenal bypass using autogenous, free internal iliac artery graft: An attractive alternative to revascularize the right kidney in Takayasu's disease.

Science.gov (United States)

Khattar, Nikhil; Guleria, Sandeep; Sharma, Sanjeev

2012-04-01

Nonspecific aortoarteritis or Takayasu's disease (TD) is a chronic pan endarteritis of unknown origin involving the aorta and its major branches affecting young adults especially women. The disease is more common in eastern Asian countries. Hypertension in these patients generally reflects as renal artery stenosis, which is seen in 28-75% of patients. Surgical revascularization is occasionally needed in patients with failed medical management or endovascular interventions. We report two cases of Takayasu's arteritis in young women where renal revascularization was done using free internal iliac artery hepatorenal bypass graft with excellent control of hypertension in the postoperative period.

Congenital absence of infrarenal IVC and iliac venous system : Unusual collateral Pathways

International Nuclear Information System (INIS)

Lee, Jin Joo; Lee, Byung Hee; Kim, Kie Hwan; Do, Young Soo; Chin, Soo Yil

1994-01-01

We present a case with congenital absence of the infrarenal portion of inferior vena cava and iliac venous system, showing unusual venous collaterals including the left ovarian venous collateral via parametrial venous complex, and a mesenteric-periureteric venous connection. The venous collateral pathways were demonstrated by computed tomography and venography

An Erupted Dilated Odontoma: A Rare Presentation

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Gaurav Sharma

2016-01-01

Full Text Available A dilated odontoma is an extremely rare developmental anomaly represented as a dilatation of the crown and root as a consequence of a deep, enamel-lined invagination and is considered a severe variant of dens invaginatus. An oval shape of the tooth lacking morphological characteristics of a crown or root implies that the invagination happened in the initial stages of morphodifferentiation. Spontaneous eruption of an odontoma is a rare occurrence and the occurrence of a dilated odontoma in a supernumerary tooth is even rarer with only a few case reports documented in the English literature. We present an extremely rare case of erupted dilated odontoma occurring in the supernumerary tooth in anterior maxillary region in an 18-year-old male, which, to the best of our knowledge, is the first ever case reported in English literature.

Microsurgical Bypass Training Rat Model, Part 1: Technical Nuances of Exposure of the Aorta and Iliac Arteries.

Science.gov (United States)

Tayebi Meybodi, Ali; Lawton, Michael T; Mokhtari, Pooneh; Yousef, Sonia; Gandhi, Sirin; Benet, Arnau

2017-11-01

Animal models using rodents are frequently used for practicing microvascular anastomosis-an essential technique in cerebrovascular surgery. However, safely and efficiently exposing rat's target vessels is technically difficult. Such difficulty may lead to excessive hemorrhage and shorten animal survival. This limits the ability to perform multiple anastomoses on a single animal and may increase the overall training time and costs. We report our model for microsurgical bypass training in rodents in 2 consecutive articles. In part 1, we describe the technical nuances for a safe and efficient exposure of the rat abdominal aorta and common iliac arteries (CIAs) for bypass. Over a 2-year period, 50 Sprague-Dawley rats underwent inhalant anesthesia for practicing microvascular anastomosis on the abdominal aorta and CIAs. Lessons learned regarding the technical nuances of vessel exposure were recorded. Several technical nuances were important for avoiding intraoperative bleeding and preventing animal demise while preparing an adequate length of vessels for bypass. The most relevant technical nuances include (1) generous subcutaneous dissection; (2) use of cotton swabs for the blunt dissection of the retroperitoneal fat; (3) combination of sharp and blunt dissection to isolate the aorta and iliac arteries from the accompanying veins; (4) proper control of the posterior branches of the aorta; and (5) efficient division and mobilization of the left renal pedicle. Applying the aforementioned technical nuances enables safe and efficient preparation of the rat abdominal aorta and CIAs for microvascular anastomosis. Copyright © 2017 Elsevier Inc. All rights reserved.

Salivary gland enlargement during oesophageal stricture dilatation.

Science.gov (United States)

Martin, D.

1980-01-01

A case of recurrent salivary gland enlargement occurring during fibreoptic oesophagoscopy and oesophageal stricture dilatation with Eder-Puestow dilators is described. The genesis of this condition is discussed and its transient and usually benign nature emphasized. Images Fig. 1 PMID:7393809

Traumatic tracheobronchial stricture treated with the Eder-Puestow dilator.

Science.gov (United States)

Erichsen, H G

1980-09-01

A case of tracheobronchial stenosis secondary to trauma is presented. Primary reconstruction resulted in stricture in the distal part of the trachea. Resection and anastomosis was followed by restenosis, which had to be treated endoscopically. Endobronchial resections and forceful dilatations with stiff bronchoscopes were done weekly for about 11 months without lasting benefit. After changing to Eder-Puestow dilators, the dilatations could be done at steadily increasing intervals. This method of dilatation was found to be safe, effective and less traumatic.

Repair of articular cartilage defects in the knee with autologous iliac crest cartilage in a rabbit model.

Science.gov (United States)

Jing, Lizhong; Zhang, Jiying; Leng, Huijie; Guo, Qinwei; Hu, Yuelin

2015-04-01

To demonstrate that iliac crest cartilage may be used to repair articular cartilage defects in the knees of rabbits. Full-thickness cartilage defects were created in the medial femoral condyle on both knees of 36 New Zealand white rabbits. The 72 defects were randomly assigned to be repaired with ipsilateral iliac crest cartilage (Group I), osteochondral tissues removed at defect creation (Group II), or no treatment (negative control, Group III). Animals were killed at 6, 12, and 24 weeks post-operatively. The repaired tissues were harvested for magnetic resonance imaging (MRI), histological studies (haematoxylin and eosin and immunohistochemical staining), and mechanical testing. At 6 weeks, the iliac crest cartilage graft was not yet well integrated with the surrounding articular cartilage, but at 12 weeks, the graft deep zone had partial ossification. By 24 weeks, the hyaline cartilage-like tissue was completely integrated with the surrounding articular cartilage. Osteochondral autografts showed more rapid healing than Group I at 6 weeks and complete healing at 12 weeks. Untreated defects were concave or partly filled with fibrous tissue throughout the study. MRI showed that Group I had slower integration with surrounding normal cartilage compared with Group II. The mechanical properties of Group I were significantly lower than those of Group II at 12 weeks, but this difference was not significant at 24 weeks. Iliac crest cartilage autografts were able to repair knee cartilage defects with hyaline cartilage and showed comparable results with osteochondral autografts in the rabbit model.

Balloon dilation of congenital supravalvular pulmonic stenosis in a dog

OpenAIRE

Treseder, Julia R.; Jung, SeungWoo

2017-01-01

Percutaneous balloon valvuloplasty is considered the standard of care for treatment of valvular pulmonic stenosis, a common congenital defect in dogs. Supravalvular pulmonic stenosis is a rare form of pulmonic stenosis in dogs and standard treatment has not been established. Although, there have been reports of successful treatment of supravalvular pulmonic stenosis with surgical and stenting techniques, there have been no reports of balloon dilation to treat dogs with this condition. Here, a...

Iliac Crest Donor Site for Children With Cleft Lip and Palate Undergoing Alveolar Bone Grafting: A Long-term Assessment.

Science.gov (United States)

Wheeler, Jonathan; Sanders, Megan; Loo, Stanley; Moaveni, Zac; Bartlett, Glenn; Keall, Heather; Pinkerton, Mark

2016-05-01

The authors aimed to accurately assess the donor site morbidity from iliac crest bone grafts for secondary bone grafting in patients with cleft lip and palate alveolar defects. Fifty patients between 3 months and 10 years following alveolar bone grafting for cleft lip and palate were entered into the study. Two-thirds of patients had no significant concerns about the donor site. The remaining third had some concerns about the appearance of their hips and less than 10% of patients expressing strong agreement with statements about concerns with shape, appearance, and self-consciousness about the iliac crest donor site. Examination findings showed the average length of scar being 5.4 cm and a third of patients having some minor palpable boney irregularities of the iliac crest. The authors found that the alveolar crest donor site is well tolerated by patients long term but has a measurable morbidity long term.

Gastric Necrosis due to Acute Massive Gastric Dilatation

Directory of Open Access Journals (Sweden)

Ibrahim Aydin

2013-01-01

Full Text Available Gastric necrosis due to acute massive gastric dilatation is relatively rare. Vascular reasons, herniation, volvulus, acute gastric dilatation, anorexia, and bulimia nervosa play a role in the etiology of the disease. Early diagnosis and treatment are highly important as the associated morbidity and mortality rates are high. In this case report, we present a case of gastric necrosis due to acute gastric dilatation accompanied with the relevant literature.

Gastric Necrosis due to Acute Massive Gastric Dilatation.

Science.gov (United States)

Aydin, Ibrahim; Pergel, Ahmet; Yucel, Ahmet Fikret; Sahin, Dursun Ali; Ozer, Ender

2013-01-01

Gastric necrosis due to acute massive gastric dilatation is relatively rare. Vascular reasons, herniation, volvulus, acute gastric dilatation, anorexia, and bulimia nervosa play a role in the etiology of the disease. Early diagnosis and treatment are highly important as the associated morbidity and mortality rates are high. In this case report, we present a case of gastric necrosis due to acute gastric dilatation accompanied with the relevant literature.

Multielement analysis of iliac crest bone by neutron activation

International Nuclear Information System (INIS)

Aras, N.K.; Yilmaz, G.; Korkusuz, F.; Olmez, I.; Sepici, B.; Eksioglu, F.; Bode, P.

2000-01-01

Bone samples from iliac crest were obtained from apparently healthy female (n = 4) and male (n = 8) subjects with ages between 15-50. Cortical and trabecular parts were separated and soft tissues like fat, muscle and blood were removed. Calcium, Mg, Na, Cl, Fe, Zn, Br, Sr, and Cs were determined by instrumental neutron activation analysis and other techniques, and their relations were discussed. Fairly good agreement was obtained with literature data. These values may serve as reference values for subjects from a Turkish population. (author)

On $rho$-dilations of commuting operators

Czech Academy of Sciences Publication Activity Database

Müller, Vladimír

2017-01-01

Roč. 78, č. 1 (2017), s. 3-20 ISSN 0379-4024 R&D Projects: GA ČR(CZ) GA14-07880S Institutional support: RVO:67985840 Keywords : regular unitary dilation * rho-dilation Subject RIV: BA - General Mathematics OBOR OECD: Pure mathematics Impact factor: 0.524, year: 2016 http://www.mathjournals.org/jot/2017-078-001/2017-078-001-001. html

Multiple Genetic Associations with Irish Wolfhound Dilated Cardiomyopathy.

Science.gov (United States)

Simpson, Siobhan; Dunning, Mark D; Brownlie, Serena; Patel, Janika; Godden, Megan; Cobb, Malcolm; Mongan, Nigel P; Rutland, Catrin S

2016-01-01

Cardiac disease is a leading cause of morbidity and mortality in dogs and humans, with dilated cardiomyopathy being a large contributor to this. The Irish Wolfhound (IWH) is one of the most commonly affected breeds and one of the few breeds with genetic loci associated with the disease. Mutations in more than 50 genes are associated with human dilated cardiomyopathy (DCM), yet very few are also associated with canine DCM. Furthermore, none of the identified canine loci explain many cases of the disease and previous work has indicated that genotypes at multiple loci may act together to influence disease development. In this study, loci previously associated with DCM in IWH were tested for associations in a new cohort both individually and in combination. We have identified loci significantly associated with the disease individually, but no genotypes individually or in pairs conferred a significantly greater risk of developing DCM than the population risk. However combining three loci together did result in the identification of a genotype which conferred a greater risk of disease than the overall population risk. This study suggests multiple rather than individual genetic factors, cooperating to influence DCM risk in IWH.

Multiple Genetic Associations with Irish Wolfhound Dilated Cardiomyopathy

Directory of Open Access Journals (Sweden)

Siobhan Simpson

2016-01-01

Full Text Available Cardiac disease is a leading cause of morbidity and mortality in dogs and humans, with dilated cardiomyopathy being a large contributor to this. The Irish Wolfhound (IWH is one of the most commonly affected breeds and one of the few breeds with genetic loci associated with the disease. Mutations in more than 50 genes are associated with human dilated cardiomyopathy (DCM, yet very few are also associated with canine DCM. Furthermore, none of the identified canine loci explain many cases of the disease and previous work has indicated that genotypes at multiple loci may act together to influence disease development. In this study, loci previously associated with DCM in IWH were tested for associations in a new cohort both individually and in combination. We have identified loci significantly associated with the disease individually, but no genotypes individually or in pairs conferred a significantly greater risk of developing DCM than the population risk. However combining three loci together did result in the identification of a genotype which conferred a greater risk of disease than the overall population risk. This study suggests multiple rather than individual genetic factors, cooperating to influence DCM risk in IWH.

Dilatation of the intrahepatic bile ducts associated with benign liver lesions: an unusual finding

International Nuclear Information System (INIS)

Lapeyre, Matthieu; Mathieu, Didier; Rahmouni, Alain; Kobeiter, Hicham; Tailboux, Laurent

2002-01-01

In three patients presenting different types of liver lesions, including isolated cyst, focal nodular hyperplasia (FNH), and hemangioma, intrahepatic bile duct dilatation was observed on US and CT. Final diagnosis was obtained by surgery in two cases (cyst and FNH) and by 1-year follow-up in one patient presenting an isolated hemangioma. The only common characteristic in our three cases was that lesions were present in segment four according to Couinaud's classification, at the level of the transverse fissure, suggesting that a space-occupying lesion at this site may cause compression of the common hepatic duct and right or left intrahepatic bile ducts. Our report indicates that compression may occur even with lesion of moderate size (35-40 mm in diameter). A benign liver lesion may cause a bile duct dilatation, particularly if located in segment 4, close to the hilum. Awareness of this possibility is important to avoid unnecessary invasive diagnostic procedures, particularly when all imaging criteria are consistent with a benign lesion. (orig.)

Pouch dilatation following laparoscopic adjustable gastric banding: psychobehavioral factors (can psychiatrists predict pouch dilatation?).

Science.gov (United States)

Poole, Norman; Al Atar, Ashraf; Bidlake, Louise; Fienness, Alberic; McCluskey, Sara; Nussey, S; Bano, Gal; Morgan, John

2004-01-01

Laparoscopic adjustable gastric banding is increasingly being performed in morbidly obese individuals for weight loss. Some patients develop pouch dilatation as a postoperative complication that limits the utility of the procedure. Surgical variables are poor predictors of this complication. 5 patients from a series of 157 who underwent LAGB at a single center developed the condition. Psychiatric and surgical case-notes were analyzed retrospectively for the presence of operationally defined psychiatric disorders and compared to 10 controls from the same population. Cases were significantly more likely to have past or current binge eating, emotionally triggered eating with reduced awareness of the link, a history of affective disorder, reduced sexual functioning and successful preoperative weight loss. No difference between groups was observed for compliance with orlistat, childhood sexual abuse, relationships with parents, history of bulimia nervosa, rate of band inflation or preoperative BMI. Psychological factors may be better predictors of pouch dilatation than biomedical variables. Disordered eating can be an attempt to modulate negative emotions. Pouch dilatation may be a consequence of this eating behavior.

Isolated Main Pancreatic Duct Dilatation: CT Differentiation Between Benign and Malignant Causes.

Science.gov (United States)

Kim, Se Woo; Kim, Se Hyung; Lee, Dong Ho; Lee, Sang Min; Kim, Yeon Soo; Jang, Jin Young; Han, Joon Koo

2017-11-01

The purpose of this study is to retrospectively evaluate the differential CT features of isolated benign and malignant main pancreatic duct (MPD) dilatation and to investigate whether the diagnostic performance of radiologists can be improved with knowledge of these differential CT features. Forty-one patients who had isolated MPD dilatation without any visible mass on CT from January 2000 to October 2016 were retrospectively enrolled in the study. Two radiologists reviewed CT images in consensus for the location, shape (smooth vs abrupt), length of transition, dilated pancreatic duct (PD) diameter, presence of duct penetrating sign, parenchymal atrophy, attenuation difference, associated pancreatitis, calcification, PD or common bile duct (CBD) enhancement, and perilesional cyst. The chi-square test, Fisher exact test, and t test were used to find the differential CT features of benign and malignant MPD dilatation. Two successive review sessions for differentiation between the two disease entities were then independently performed by three other reviewers with differing expertise, with the use of a 5-point confidence scale. The first session provided no information for differentiation; however, reviewers were aware of the results of univariate analyses in the second session. The diagnostic performance of the radiologists was evaluated using a pairwise comparison of ROC curves. A total of 19 benign and 22 malignant MPD dilatations were identified. In patients with benign MPD dilatation, transition areas were frequently located in the head (57.9% [11/19] vs 13.6% [3/22], p = 0.003) and showed significantly shorter (< 6.1 mm) (78.9% [15/19] vs 9.1% [2/22], p < 0.0001) and smooth transition (89.5% [17/19] vs 9.1% [2/22], p < 0.0001). Duct penetrating sign was exclusively observed in patients with benign MPD dilatation (73.7% [14/19] vs 0% [0/22], p < 0.0001). In contrast, malignant MPD dilatation frequently was accompanied by attenuation difference (63.6% [14/22] vs

Results of Eder-Puestow dilatation in the management of esophageal peptic strictures.

Science.gov (United States)

Rago, E; Boesby, S; Spencer, J

1983-01-01

Eder-Puestow dilatation of esophageal strictures is a safe procedure. The treatment is followed by symptomatic improvement, but the effect of dilatation on the patients' nutritional state has so far not been reported. We have reviewed 33 patients with benign esophageal stricture with special regard to the effect of dilatation on body weight. A total of 152 dilatations was carried out. All patients had dysphagia, 32 patients had heartburn and 20 had regurgitation. Hiatus hernia was present in 29 patients. Thirteen patients had antireflux surgery; 10 operations were performed before, and four during the dilatation period. One patient required no further dilatations after operation. Dilators greater than 35 FG were passed in 85% of the dilatations. No serious complications occurred. Patients were followed for up to 5 yr (mean follow-up: 27 months). The mean interval between dilatations was 7 months. Body weight was recorded before and one month after dilatation on 78 occasions. There was a significant overall weight increase of 0.78 kg 1 month after dilatation. The mean weight increase was greater after the first dilatation (1.06 kg) than after subsequent ones (0.6 kg). We found that Eder-Puestow dilatation in patients with benign esophageal stricture led to symptomatic improvement and was followed by an increase in body weight.

Iliac artery reconstruction secondary to incidental injury in open hernia repair: A case report and literature review

Directory of Open Access Journals (Sweden)

R. Doña-Jaimes

2018-04-01

Full Text Available Introduction: Inguinal hernia repair is one of the most common surgeries performed worldwide by general surgeons. More than 750,000 inguinal hernia repairs are performed each year in the United States. Complications of inguinal or femoral hernia are relatively rare, depending on the clinical circumstances in which the patient is admitted to the operating room and the type of hernia. The complications are classified as: intraoperative, short term and long term. Arterial lesions are the rarest but most dangerous. Objective: To describe surgical techniques used to repair injuries to the external iliac artery during an inguinal hernia repair that is reproducible by general surgeons. Materials and methods: A case report of an intraoperative external iliac artery injury is presented in which is a polytetrafluoroethylene (PTFE graft was used over the length of the lesion. Different techniques may be used for revascularisation: autogenous vein graft, synthetic grafts, revascularisation with ipsilateral or contralateral internal iliac artery and femoro-femoral crossover graft. Conclusion: The surgical technique using PTFE grafts is effective for repairing arterial injuries and it results in timely revascularisation that promotes satisfactory progress. Resumen: Introducción: La plastia inguinal es una de las cirugías más frecuente realizadas a nivel mundial por cirujanos generales. En Estados Unidos más de 750,000 hernioplastias inguinales se realizan por año. Las complicaciones de una hernia inguinal o femoral son relativamente infrecuentes, depende de las circunstancias clínicas en las que se ingresa a quirófano y el tipo de la hernia. Las complicaciones se clasifican en: intraoperatoría, a corto plazo y a largo plazo. Las lesiones arteriales son las más raras pero más graves. Objetivo: Describir técnicas quirúrgicas para reparación de lesiones de la arteria iliaca durante una plastia inguinal y reproducible por cirujanos generales

Genetics of Human and Canine Dilated Cardiomyopathy.

Science.gov (United States)

Simpson, Siobhan; Edwards, Jennifer; Ferguson-Mignan, Thomas F N; Cobb, Malcolm; Mongan, Nigel P; Rutland, Catrin S

2015-01-01

Cardiovascular disease is a leading cause of death in both humans and dogs. Dilated cardiomyopathy (DCM) accounts for a large number of these cases, reported to be the third most common form of cardiac disease in humans and the second most common in dogs. In human studies of DCM there are more than 50 genetic loci associated with the disease. Despite canine DCM having similar disease progression to human DCM studies into the genetic basis of canine DCM lag far behind those of human DCM. In this review the aetiology, epidemiology, and clinical characteristics of canine DCM are examined, along with highlighting possible different subtypes of canine DCM and their potential relevance to human DCM. Finally the current position of genetic research into canine and human DCM, including the genetic loci, is identified and the reasons many studies may have failed to find a genetic association with canine DCM are reviewed.

Evolution of the ischio-iliac lordosis during natural growth and its relation with the pelvic incidence.

Science.gov (United States)

Schlösser, Tom P C; Janssen, Michiel M A; Vrtovec, Tomaž; Pernuš, Franjo; Oner, F Cumhur; Viergever, Max A; Vincken, Koen L; Castelein, René M

2014-07-01

Human fully upright ambulation, with fully extended hips and knees, and the body's center of gravity directly above the hips, is unique in nature, and distinguishes humans from all other mammalians. This bipedalism is made possible by the development of a lordosis between the ischium and ilium; it allows to ambulate in this unique bipedal manner, without sacrificing forceful extension of the legs. This configuration in space introduces unique biomechanical forces with relevance for a number of spinal conditions. The aim of this study was to quantify the development of this lordosis between ischium and ilium in the normal growing and adult spine and to evaluate its correlation with the well-known clinical parameter, pelvic incidence. Consecutive series of three-dimensional computed tomography scans of the abdomen of 189 children and 310 adults without spino-pelvic pathologies were used. Scan indications were trauma screening or acute abdominal pathology. Using previously validated image processing techniques, femoral heads, center of the sacral endplate and the axes of the ischial bones were semi-automatically identified. A true sagittal view of the pelvis was automatically reconstructed, on which ischio-iliac angulation and pelvic incidence were calculated. The ischio-iliac angle was defined as the angle between the axes of the ischial bones and the line from the midpoint of the sacral endplate to the center of the femoral heads. A wide natural variation of the ischio-iliac angle (3°-46°) and pelvic incidence (14°-77°) was observed. Pearson's analysis demonstrated a significant correlation between the ischio-iliac angle and pelvic incidence (r = 0.558, P lordosis is unique in nature, is in harmonious continuity with the highly individual lumbar lordosis and defines the way the human spine is biomechanically loaded. The practical parameter that reflects this is the pelvic incidence; both values increase during growth and remain stable in adulthood.

Percutaneous transluminal angioplasty of iliac and femoral arteries in severe lower-limb ischaemia

DEFF Research Database (Denmark)

Jørgensen, B; Henriksen, L O; Karle, A

1988-01-01

angioplasty) or persistent greater than or equal to 0.15 rise in arm/ankle blood pressure index (femoropopliteal angioplasty). The respective technical success rates were 82% and 64%. The complication rate was 10.9%, including 5.4% distal embolization. Patency rates were higher in iliac than...

Bilateral avulsion fractures of the anterior superior iliac spines in sprinters

International Nuclear Information System (INIS)

Khoury, M.B.; Kirks, D.R.; Martinez, S.; Apple, J.

1985-01-01

Three cases of bilateral pelvic avulsion fractures in adolescent sprinters are reviewed. An acute avulsion fracture of the anterior superior iliac spine (ASIS) occurred during active running in three teenaged sprinters. Radiography confirmed a healed fracture of the contralateral ASIS. The clinical features and radiologic appearances are characteristic. The pathophysiology of this type of unique pediatric fracture is discussed. Conservative treatment is successful. (orig.)

Cushing’s Disease Presented by Reversible Dilated Cardiomyopathy

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Berna İmge Aydoğan

2015-01-01

Full Text Available Introduction. Dilated cardiomyopathy is rarely reported among CS patients especially without hypertension and left ventricular hypertrophy. Materials and Methods. We hereby report a Cushing’s syndrome case presenting with dilated cardiomyopathy. Results. A 48-year-old female patient was admitted to our clinic with severe proximal myopathy and dilated cardiomyopathy without ventricular hypertrophy. Cushing’s disease was diagnosed and magnetic-resonance imaging of the pituitary gland revealed a microadenoma. Under diuretic and ketoconazole treatments, she underwent a successful transnasal/transsphenoidal adenomectomy procedure. Full recovery of symptoms and echocardiographic features was achieved after six months of surgery. Conclusion. Cushing’s syndrome must be kept in mind as a reversible cause of dilated cardiomyopathy. Recovery of cardiomyopathy is achieved with successful surgery.

Cardiovascular effects of oesophageal dilation under general anaesthesia

DEFF Research Database (Denmark)

Jakobsen, C H; Rasmussen, V; Rosenberg, J

1999-01-01

, but was not associated with the actual time of oesophageal distension. Thus, all cases of myocardial ischaemia were related to the time of extubation. No lasting complications were seen, and all patients could be discharged a maximum of 24 hours after the procedure. Pneumatic dilation of the oesophagus under general......Myocardial ischaemia and cardiac arrhythmias may occur during oesophageal dilation under conscious sedation, but no prospective data exist regarding dilation under general anaesthesia. We have studied the haemodynamic and electrocardiographic changes during routine oesophageal balloon dilation...... the procedure. Four patients developed significant hypotension at the time of balloon inflation with two patients requiring medical intervention to re-establish sufficient cardiovascular function. Tachycardia and ST-deviation occurred in four and three patients, respectively, during the general anaesthesia...

Treatments for pediatric achalasia: Heller myotomy or pneumatic dilatation?

Science.gov (United States)

Jung, C; Michaud, L; Mougenot, J-F; Lamblin, M-D; Philippe-Chomette, P; Cargill, G; Bonnevalle, M; Boige, N; Bellaïche, M; Viala, J; Hugot, J-P; Gottrand, F; Cezard, J-P

2010-03-01

The treatment of achalasia consists of reducing distal esophageal obstruction by either Heller myotomy surgery or endoscopic pneumatic dilatation. The aim of the present study was to evaluate the short- and middle-term results of these procedures in children. For technical reasons, children under six years old (n=8) were treated by surgery only, whereas patients over six years old (n=14) were treated by either Heller myotomy or pneumatic dilatation. Of the children aged under six years, 75% were symptom-free at six months and 83% at 24 months of follow-up. Of the patients aged over six years, complete remission was achieved by Heller myotomy in 44.5% vs. 55.5% by pneumatic dilatation after six months, and in 40% vs. 65%, respectively, after 24 months. Both pneumatic dilatation and Heller myotomy showed significant rates of failure. These results suggest that pneumatic dilatation may be considered a primary treatment in children over six years old. Also, where necessary, Heller myotomy and pneumatic dilatation may be used as complementary treatments.

Dilator Use After Vaginal Brachytherapy for Endometrial Cancer: A Randomized Feasibility and Adherence Study.

Science.gov (United States)

Hanlon, Alexandra; Small, William; Strauss, Jonathan; Lin, Lilie L; Hanisch, Laura; Huang, Liming; Bai, Jinbing; Wells, Jessica; Bruner, Deborah Watkins

Vaginal brachytherapy, a common treatment of endometrial cancer, is associated with high rates of vaginal stenosis. Recommendations for vaginal dilator use to minimize stenosis generally include 3 times per week for approximately 10 minutes per use. However, adherence rates range widely and are generally well less than 50%. The aims of this study were to assess feasibility of recruitment to a study of dilator use and test a theoretically driven enhanced educational program (EEP) to increase adherence. Eligibility included women treated with postoperative vaginal brachytherapy for stage I to IIIc endometrial cancer. Patients were randomized to either nurse-delivered standard institutional instruction or EEP. Of eligible patients, 76% consented, 42 were randomized, and 69% completed the 6-month assessment. Mean age was 58.2 years; 48% were sexually active. There was no difference in adherence between arms. Overall, 20% and 8.3% were adherent to the prescribed use of 3 times per week, and 64% and 16% were adherent to use at least once per week at 6 weeks and 6 months, respectively. Adherence was greater among those motivated by vaginal health and having lower body mass index. Nonadherence was significantly higher among those who are college educated, in the EEP group, and with higher weight. Feasibility of recruitment into a study of vaginal dilator use was high. Adherence was low, and there was no difference between groups. Adherence to vaginal dilator use requires novel interventions to test. Nursing education that includes how dilators may maintain vaginal health may improve use because it was a motivator for adherence in this study.

Percutaneous Dilatational Tracheostomy via Griggs Technique.

Science.gov (United States)

Karimpour, Hasan Ali; Vafaii, Kamran; Chalechale, Maryam; Mohammadi, Saeed; Kaviannezhad, Rasool

2017-01-01

Tracheostomy is considered the airway management of choice for patients who need prolonged mechanical ventilation support. Percutaneous Dilatational Tracheotomy (PDT) is a technique that can be performed easily and rapidly at bedside and is particularly useful in the intensive care setting. The Griggs percutaneous tracheotomy is unique in its utilization of a guide wire dilator forceps. We aimed to describe the early perioperative and late postoperative complications of PDT using the Griggs technique in patients in the intensive care unit (ICU). This cross-sectional study was conducted on all patients who underwent tracheostomy in the ICU of the Imam Reza Hospital of Kermanshah, Iran, from June 2011 to June 2015. PDT was performed in 184 patients with the Griggs technique. Demographic variables, as well as perioperative and late postoperative complications were recorded. The mean age of patients was 57.3 ± 15.37 years. The most common primary causes of tracheostomy were hypoxic brain damage disorders (43.2%) and pneumonia (14.8%). Perioperative and early complications occurred in 16.7 % of procedures, of which 9.3% were bleedings (minor, significant and major). Furthermore, the incidence of late complications was 8.6%, including: stomal infection, difficult replace tracheostomy tube, tracheoesophageal fistula, tracheal stenosis, and tracheomalacia. PDT via Griggs technique is a safe, quick, and effective method. The low incidence of complications indicates that bedside percutaneous tracheostomy can be performed safely as a routine procedure for daily care implemented in the ICU.

Static Histomorphometry of the iliac crest after 360 days of antiorthostatic bed rest with and without countermeasures

Science.gov (United States)

Thomsen, J. S.; Morukov, B. V.; Vico, L.; Saparin, P. I.; Gowin, W.

The loss of bone during immobilization is well-known and investigated, whereas the structural changes human cancellous bone undergoes during disuse is less well examined. The aim of the study was to examine the influence of hypokinesia on the static histomorphometric measures of the iliac crest using a 360-day-long bed rest experiment, simulating exposure to microgravity. Eight healthy males underwent 360 days of 5° head-down tilt bed rest. Three subjects were treated with the bisphosphonate Xidifon (900 mg/day) combined with a treadmill and ergonometer exercise regimen (1--2 hours/day) for the entire study period. Five subjects underwent 120 days of bed rest without countermeasures followed by 240 days of bed rest with the treadmill and ergonometer exercise regimen. Transiliac bone biopsies were obtained either at day 0 and 360 or at day 0, 120, and 360 at alternating sides of the ileum. The biopsies were embedded in methylmethacrylate, cut in 7-μm-thick sections, stained with Goldner trichrome, and static histomorphometry was performed. 120 days of bed rest without countermeasures resulted in decreased trabecular bone volume (-6.3%, p = 0.046) and trabecular number (-10.2%, p = 0.080) and increased trabecular separation (14.7%, p = 0.020), whereas 240 days of subsequent bed rest with exercise treatment prevented further significant deterioration of the histomorphometric measures. 360 days of bed rest with bisphosphonate and exercise treatment did not induce any significant changes in any of the histomorphometric measures. The study showed that 120 days of antiorthostatic bed rest without countermeasures induced significant deterioration of iliac crest trabecular bone histomorphometric properties. There are indications that the immobilization induced changes involve a loss of trabeculae rather than a general thinning of the trabeculae. On average, the countermeasures consisting of either bisphosphonate and exercise or exercise alone were able to either prevent

Thoracic Stent Graft Implantation for Aortic Coarctation with Patent Ductus Arteriosus via Retroperitoneal Iliac Approach in the Presence of Small Sized Femoral Artery

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Ozge Korkmaz

2016-01-01

Full Text Available Endovascular stent graft implantation is a favorable method for complex aortic coarctation accompanied by patent ductus arteriosus. Herein, an 18-year-old woman with complex aortic coarctation and patent ductus arteriosus was successfully treated by endovascular thoracic stent graft via retroperitoneal approach. The reason for retroperitoneal iliac approach was small sized common femoral arteries which were not suitable for stent graft passage. This case is the first aortic coarctation plus patent ductus arteriosus case described in the literature which is treated by endovascular thoracic stent graft via retroperitoneal approach.

Cardiovascular and systemic effects of gastric dilatation and volvulus in dogs.

Science.gov (United States)

Sharp, Claire R; Rozanski, Elizabeth A

2014-09-01

Gastric dilatation and volvulus (GDV) is a common emergency condition in large and giant breed dogs that is associated with high morbidity and mortality. Dogs with GDV classically fulfill the criteria for the systemic inflammatory response syndrome (SIRS) and can go on to develop multiple organ dysfunction syndrome (MODS). Previously reported organ dysfunctions in dogs with GDV include cardiovascular, respiratory, gastrointestinal, coagulation and renal dysfunction. Cardiovascular manifestations of GDV include shock, cardiac arrhythmias and myocardial dysfunction. Respiratory dysfunction is also multifactorial, with contributory factors including decreased respiratory excursion due to gastric dilatation, decreased pulmonary perfusion and aspiration pneumonia. Gastrointestinal dysfunction includes gastric necrosis and post-operative gastrointestinal upset such as regurgitation, vomiting, and ileus. Coagulation dysfunction is another common feature of MODS in dogs with GDV. Disseminated intravascular coagulation can occur, putting them at risk of complications associated with thrombosis in the early hypercoagulable state and hemorrhage in the subsequent hypocoagulable state. Acute kidney injury, acid-base and electrolyte disturbances are also reported in dogs with GDV. Understanding the potential for systemic effects of GDV allows the clinician to monitor patients astutely and detect such complications early, facilitating early intervention to maximize the chance of successful management. Copyright © 2014 Elsevier Inc. All rights reserved.

Balloon dilatation of the prostatic urethra

International Nuclear Information System (INIS)

Lee, Yeon Soo; Shim, Hyung Jin; Cha, Kyung Soo; Hong, Ju Hee; Lim, Myung Ah; Kim, Cheol Soo

1991-01-01

We analyzed the result of transurethral balloon dilatation in 11 patients with benign prostatic hypertrophy. The procedures were performed under intravenous sedation and local anesthesia with double lumen balloon catheter at 4 atmosphere for 10 minutes. After dilatation, the prostatism symptom scores improved in 10 out of 11 patients and the mean diameter of the prostatic urethra significantly increased form 4.3 mm to 10.2 mm (ρ < 0.005). The procedures were successful not only in lateral lobe hypertrophy but also in median lobe hypertrophy of the prostate. Postdilatation MRI of 1 patient showed an intact prostatic capsule and no periprostatic hematoma. Complications did not develop except in 1 patient with mild hematuria and incontinence. These preliminary results suggest that transurethral balloon dilatation can be an effective and safe treatment modality for benign prostatic hypertrophy

Endovascular treatment of external iliac vein stenosis caused by graft compression after kidney transplantation

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Willamax Oliveira de Sousa

2013-06-01

Full Text Available A 57-year old patient presented with approximately 80% stenosis of the left external iliac vein due to compression by the renal graft after kidney transplantation. The initial clinical manifestation of this vascular complication was progressive edema of the left lower limb, starting in the foot during the immediate postoperative period and reaching the thigh. Renal function also deteriorated during the first four months after transplantation. Venous Doppler ultrasound findings were suggestive of a diagnosis of extrinsic compression by the kidney graft and so phlebography was ordered, confirming stenosis of the left external iliac vein. The patient was initially treated with balloon angioplasty, but there was still residual stenosis so a stent was inserted, eliminating the stenosis. The edema reduced over time and the patient's renal function improved. While vascular complications are rare, and potentially severe, events, success rates are good if treatment is started early.

Balloon dilatations of esophageal strictures

International Nuclear Information System (INIS)

Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De

1990-01-01

Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used

Balloon dilatations of esophageal strictures

Energy Technology Data Exchange (ETDEWEB)

Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De [Chonnam National University College of Medicine, Seoul (Korea, Republic of)

1990-04-15

Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used.

Genetics of Human and Canine Dilated Cardiomyopathy

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Siobhan Simpson

2015-01-01

Full Text Available Cardiovascular disease is a leading cause of death in both humans and dogs. Dilated cardiomyopathy (DCM accounts for a large number of these cases, reported to be the third most common form of cardiac disease in humans and the second most common in dogs. In human studies of DCM there are more than 50 genetic loci associated with the disease. Despite canine DCM having similar disease progression to human DCM studies into the genetic basis of canine DCM lag far behind those of human DCM. In this review the aetiology, epidemiology, and clinical characteristics of canine DCM are examined, along with highlighting possible different subtypes of canine DCM and their potential relevance to human DCM. Finally the current position of genetic research into canine and human DCM, including the genetic loci, is identified and the reasons many studies may have failed to find a genetic association with canine DCM are reviewed.

Percutaneous coil embolization of massive pelvic pseudoaneurysm in an infant.

Science.gov (United States)

Lillis, Anna P; Shaikh, Raja; Alomari, Ahmad I; Chaudry, Gulraiz

2015-06-01

Iatrogenic pseudoaneurysm formation is an uncommon but potentially serious complication of cardiac catheterization. This case report describes diagnosis and treatment of a large left external iliac artery pseudoaneurysm in a 3-month-old boy following cardiac catheterization and aortic balloon dilatation for aortic coarctation. A 4-cm pulsatile mass in the left hemipelvis was discovered on MRI performed 6 weeks later for possible tethered spinal cord. Sonography and angiography showed a large pseudoaneurysm of the left external iliac artery just distal to the iliac bifurcation with no flow in the external iliac artery distal to the pseudoaneurysm. Percutaneous US-guided thrombin injection was performed twice, with partial recanalization after each treatment. The residual portion of the pseudoaneurysm was then successfully embolized with percutaneous coils deployed under US and fluoroscopic guidance.

Total plasma proANP increases with atrial dilatation in horses

DEFF Research Database (Denmark)

Van Der Vekens, N; Hunter, I; Timm, A

2015-01-01

ANP product in plasma has proven to be successful in human medicine, but has never been used in horses. The aims were to establish an equine proANP reference interval by measurement of the total proANP product using PIA and to examine the proANP concentrations in horses with atrial dilatation. Sample...... stability was studied by comparison of storage at -80°C and -20°C. Plasma samples were obtained from 23 healthy horses, 12 horses with moderate or severe valvular regurgitation without atrial dilatation and 42 horses with valvular regurgitation and atrial dilatation. The proANP concentration...... was significantly (Phorses with atrial dilatation (761.4 (442.1-1859.1) pmol/l) than in healthy horses (491.6 (429.5-765.9) pmol/l; Phorses with cardiac disease but without atrial dilatation (544.4 (457.0-677.6) pmol/l). A cut-off value (573.8 pmol/l) for detection of atrial dilatation...

Magnetic resonance imaging of dilated cardiomyopathy; MRT bei dilatativen Kardiomyopathien

Energy Technology Data Exchange (ETDEWEB)

D' Anastasi, M. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Greif, M. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Medizinische Klinik und Poliklinik I, Muenchen (Germany); Reiser, M.F.; Theisen, D. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Deutsches Zentrum fuer Herzkreislaufforschung (DZHK), Muenchen (Germany)

2013-01-15

Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy with a prevalence of 1 out of 2,500 in adults. Due to mild clinical symptoms in the early phase of the disease, the true prevalence is probably even much higher. Patients present with variable clinical symptoms ranging from mild systolic impairment of left ventricular function to congestive heart failure. Even sudden cardiac death may be the first clinical symptom of DCM. The severity of the disease is defined by the degree of impairment of global left ventricular function. Arrhythmias, such as ventricular or supraventricular tachycardia, atrioventricular (AV) block, ventricular extrasystole and atrial fibrillation are common cardiac manifestations of DCM. Magnetic resonance imaging (MRI) plays an important role in the exact quantification of functional impairment of both ventricles and in the evaluation of regional wall motion abnormalities. With its excellent ability for the assessment of myocardial structure, it is becoming increasingly more important for risk stratification and therapy guidance. (orig.) [German] Die dilatative Kardiomyopathie (DCM) ist die haeufigste Form der Kardiomyopathie mit einer Praevalenz von 1/2500 Erwachsenen. Aufgrund der zunaechst milden klinischen Symptomatik ist jedoch von einer relativ hohen Dunkelziffer auszugehen. Die klinische Praesentation ist variabel, die Schwere der Erkrankung wird vom Ausmass der systolischen Funktionseinschraenkung bestimmt. Herzrhythmusstoerungen, wie ventrikulaere oder supraventrikulaere Tachykardien, AV-Blockierungen, ventrikulaere Extrasystolen und Vorhofflimmern sind moegliche klinische Manifestationen. Bei manchen Patienten ist der ploetzliche Herztod die erste klinische Manifestation der Erkrankung. Die kardiale MRT spielt eine bedeutende Rolle fuer die Beurteilung des Ausmasses der ventrikulaeren Dilatation, Dysfunktion und fuer die Beurteilung regionaler Wandbewegungsstoerungen. Darueber hinaus kann sie zur Anwendung kommen

The neural substrates of subjective time dilation

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Marc Wittmann

2010-02-01

Full Text Available An object moving towards an observer is subjectively perceived as longer in duration than the same object that is static or moving away. This 'time dilation effect' has been shown for a number of stimuli that differ from standard events along different feature dimensions (e.g. color, size, and dynamics. We performed an event-related functional magnetic resonance imaging (fMRI, while subjects viewed a stream of five visual events, all of which were static and of identical duration except the fourth one, which was a deviant target consisting of either a looming or a receding disc. The duration of the target was systematically varied and participants judged whether the target was shorter or longer than all other events. A time dilation effect was observed only for looming targets. Relative to the static standards, the looming as well as the receding targets induced increased activation of the anterior insula and anterior cingulate cortices (the “core control network”. The decisive contrast between looming and receding targets representing the time dilation effect showed strong asymmetric activation and, specifically, activation of cortical midline structures (the “default network”. These results provide the first evidence that the illusion of temporal dilation is due to activation of areas that are important for cognitive control and subjective awareness. The involvement of midline structures in the temporal dilation illusion is interpreted as evidence that time perception is related to self-referential processing.

Eosinophilic esophagitis: dilate or medicate? A cost analysis model of the choice of initial therapy.

Science.gov (United States)

Kavitt, R T; Penson, D F; Vaezi, M F

2014-07-01

Eosinophilic esophagitis (EoE) is an increasingly recognized clinical entity. The optimal initial treatment strategy in adults with EoE remains controversial. The aim of this study was to employ a decision analysis model to determine the less costly option between the two most commonly employed treatment strategies in EoE. We constructed a model for an index case of a patient with biopsy-proven EoE who continues to be symptomatic despite proton-pump inhibitor therapy. The following treatment strategies were included: (i) swallowed fluticasone inhaler (followed by esophagogastroduodenoscopy [EGD] with dilation if ineffective); and (ii) EGD with dilation (followed by swallowed fluticasone inhaler if ineffective). The time horizon was 1 year. The model focused on cost analysis of initial treatment strategies. The perspective of the healthcare payer was used. Sensitivity analyses were performed to assess the robustness of the model. For every patient whose symptoms improved or resolved with the strategy of fluticasone first followed by EGD, if necessary, it cost an average of $1078. Similarly, it cost an average of $1171 per patient if EGD with dilation was employed first. Sensitivity analyses indicated that initial treatment with fluticasone was the less costly strategy to improve dysphagia symptoms as long as the effectiveness of fluticasone remains at or above 0.62. Swallowed fluticasone inhaler (followed by EGD with dilation if necessary) is the more economical initial strategy when compared with EGD with dilation first. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

Endoscopic electrocautery dilation of benign anastomotic colonic strictures: a single-center experience.

Science.gov (United States)

Bravi, Ivana; Ravizza, Davide; Fiori, Giancarla; Tamayo, Darina; Trovato, Cristina; De Roberto, Giuseppe; Genco, Chiara; Crosta, Cristiano

2016-01-01

Benign anastomotic colonic stenosis sometimes occur after surgery and usually require surgical or endoscopic dilation. Endoscopic dilation of anastomotic colonic strictures by using balloon or bougie-type dilators has been demonstrated to be safe and effective in multiple uncontrolled series. However, few data are available on safety and efficacy of endoscopic electrocautery dilation. The aim of our study was to retrospectively investigate safety and efficacy of endoscopic electrocautery dilation of postsurgical benign anastomotic colonic strictures. Sixty patients (37 women; median age 63.6 years, range 22.6-81.7) with benign anastomotic colonic or rectal strictures treated with endoscopic electrocautery dilation between June 2001 and February 2013 were included in the study. Anastomotic stricture was defined as a narrowed anastomosis through which a standard colonoscope could not be passed. Only annular anastomotic strictures were considered suitable for electrocautery dilation which consisted of radial incisions performed with a precut sphincterotome. Treatment was considered successful if the colonic anastomosis could be passed by a standard colonoscope immediately after dilation. Recurrence was defined as anastomotic stricture reappearance during follow-up. The time interval between colorectal surgery and the first endoscopic evaluation or symptoms development was 7.3 months (1.3-60.7). Electrocautery dilation was successful in all the patients. There were no procedure-related complications. Median follow-up was 35.5 months (2.0-144.0). Anastomotic stricture recurrence was observed in three patients who were successfully treated with electrocautery dilation and Savary dilation. Endoscopic electrocautery dilation is a safe and effective treatment for annular benign anastomotic postsurgical colonic strictures.

Arteriovenous fistula of the superior gluteal artery as a complication of posterior iliac crest bone graft harvesting: 3D-CT angiography and arterial embolization

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Kong, Chae-Gwan; Park, Jong-Beom; Won, Yoo-Dong; Riew, K. Daniel

2009-01-01

Superior gluteal artery injuries are rare, but potentially serious complications that occur during posterior iliac crest bone graft harvesting. The authors reported an arteriovenous fistula of the superior gluteal artery, which occurred as a complication during posterior iliac crest bone graft harvesting and was diagnosed with 3D-CT angiography, then treated with arterial embolization.

Transient Occlusion of Bilateral Internal Iliac Arteries Facilitates Bloodless Operative Field in Subcapsular Prostatectomy

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Takumi Takeuchi

2012-01-01

Full Text Available Transurethral resection of the prostate is the gold standard of surgical treatment for benign prostatic hyperplasia (BPH. Nevertheless, open subcapsular prostatectomy is still performed for large BPH. While enucleation of prostatic adenoma is being performed, unneglectable bleeding can occur and surgeons need to rush to remove adenomas, often using fingers and in a blinded fashion. The blood supply to the prostatic capsule and adenoma can be reduced to a marked extent in subcapsular prostatectomy if the bilateral internal iliac arteries are transiently occluded. Thus, a bloodless operative field is reasonably acquired during enucleation of adenoma, which would, otherwise, be a cause for concern to surgeons due to bleeding. It is not always applicable, but it could be an option if the estimated volume of BPH is more than 100 mL. In two cases, bilateral internal iliac arteries were occluded with Bulldog clamps, and then adenomas of 159 and 97 g were enucleated.

Late effects of low-energy gamma-emitting stents in a rabbit iliac artery model

International Nuclear Information System (INIS)

Strauss, Bradley H.; Li, Chris; Whittingham, Heather A.; Tio, Fermin O.; Kutryk, Michael J.B.; Janicki, Christian; Sparkes, John D.; Turnlund, Todd; Sweet, William L.

2002-01-01

Purpose: To determine the long-term dose response of novel low-dose γ-emitting stents in a rabbit iliac artery model. Methods and Materials: Control stents (n=24) and 103 Pd stents 1.0 to 4.0 mCi (n=36) were implanted in the iliac arteries of 30 New Zealand rabbits. Stents were evaluated by intravascular ultrasound (immediately post procedure and before killing) and by histomorphometry. Results: At 26 weeks, 28 rabbits were killed, with no evidence of stent thrombosis. In the body of the stent there was a dose-response relationship with 50% inhibition of intimal hyperplasia at the highest activity compared to control stents (p=0.07) and a significant increase in intimal hyperplasia at the lowest activity (p 103 Pd stents is feasible with reduction of in-stent hyperplasia in a dose-related manner. However, significant narrowing at the stent edges, increased in-stent hyperplasia at lower activities, and incomplete vascular healing with persistence of immature neointima at higher activities are significant limitations

Clinical effectiveness of 99mTc-diphosphonate scintigraphy of revascularized iliac crest flaps

International Nuclear Information System (INIS)

Smeele, L.E.; Hoekstra, O.S.; Winters, H.A.H.; Leemans, C.R.

1996-01-01

Clinical assessment of the perfusion of the musculocutaneous portion of composite iliac crest free flaps was compared to 99m Tc-diphosphonate (HDP) uptake in 14 patients who underwent primary oromandibular reconstruction after ablative cancer surgery. Bone scanning was performed on average at the 9-10th postoperative day (range 4-48) 3 h after intravenous injection of 550 MBq 99m Tc-HDP. Eleven patients showed complete concordance between 99m Tc-HDP uptake and soft-tissue status. Two patients showed uptake and viable muscle in spite of necrotic skin. One patient had a viable musculocutaneous flap but a photopenic defect in the bone graft; 6 months later, a small corresponding part of the bone was sequestrated. In this study, bone scanning and clinical assessment of muscle perfusion were 100% accurate in predicting viability of bone graft. Skin viability was a less reliable parameter. It is concluded that bone scanning is not indicated as routine investigation for revascularized iliac crest flaps and that clinical assessment of muscle perfusion is a reliable monitor of the early function of such flaps. (au) 8 refs

Hepatorenal bypass using autogenous, free internal iliac artery graft: An attractive alternative to revascularize the right kidney in Takayasu′s disease

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Nikhil Khattar

2012-01-01

Full Text Available Nonspecific aortoarteritis or Takayasu′s disease (TD is a chronic pan endarteritis of unknown origin involving the aorta and its major branches affecting young adults especially women. The disease is more common in eastern Asian countries. Hypertension in these patients generally reflects as renal artery stenosis, which is seen in 28-75% of patients. Surgical revascularization is occasionally needed in patients with failed medical management or endovascular interventions. We report two cases of Takayasu′s arteritis in young women where renal revascularization was done using free internal iliac artery hepatorenal bypass graft with excellent control of hypertension in the postoperative period.

Safety and efficacy of stenting nonthrombotic iliac vein lesions in octogenarians and nonagenarians in an office setting.

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Kibrik, Pavel; Eisenberg, Justin; Alsheekh, Ahmad; Rizvi, Syed Ali; Aurshina, Afsha; Marks, Natalie; Hingorani, Anil; Ascher, Enrico

2018-02-01

Objectives Treatment options for venous insufficiency are rapidly evolving in the office setting and include venography, intravascular ultrasound, and venous stenting. Non-thrombotic iliac vein lesions assessment and treatment in an office setting is currently an area of interest. The purpose of this study is to demonstrate the safety and efficacy of evaluating non-thrombotic iliac vein lesion with this office-based procedure in octogenarians and nonagenarians. Methods From January 2012 through December 2013, 300 non-thrombotic iliac vein lesion limbs in 192 patients with venous insufficiency ≥80 years old were evaluated for non-thrombotic iliac vein lesion. Patients were evaluated and treated with venography, intravascular ultrasound, and stent placement for significant lesions demonstrated by greater than 50% diameter or cross-sectional area reduction. Group 1: 168 of these patients were octogenarians; female/male ratio was 1.75:1, bilateral in 89/168 patients (53%), left sided in 131/259 limbs (51%), right sided in 128 limbs (49%), average age 83.5 ± 2.6 years (range 80-89) compared to Group 2: 24 nonagenarians; female/male was 3:1, bilateral in 17/24 patients (70%), left sided in 20/41 limbs (49%), right sided in 21/41 limbs (51%), average age 92.9 ± 2.2 years (range 90-99). Stent related outcomes were evaluated with communication to the patient within 24 h to assess post-procedure pain followed by serial iliocaval ultrasonography. Results Out of the 300 limbs evaluated, in Group 1, 86% of limbs had stents placed compared to 90% in Group 2 and 11% of both groups had two stents placed. Overall improvement in pain, edema, and ulcers was reported in 147 (59%) of octogenarians and 24 (65%) of nonagenarians. There were no surgical site infections, pseudo-aneurysms, arteriovenous fistulas, or femoral artery injuries. No patients required transfusion within three days post-operatively and there were no 30-day mortalities in both sets of patients

Relationships between age and microarchitectural descriptors of iliac trabecular bone determined by microCT.

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Deguette, C; Ramond-Roquin, A; Rougé-Maillart, C

2017-06-01

Estimation of age at death is a major issue in anthropology. The main anthropological histological methods propose studying the architecture of cortical bone. In bone histomorphometry, researches on metabolic bone diseases have provided normative tables for trabecular bone volume (BV/TV) according to age and gender of individuals on trans-iliac bone biopsies. We have used microCT, a non-destructive tool for measuring bone volume and trabecular descriptors to compare the French tables to a series of forensic anthropological population and if the two iliac bones could be used interchangeably. Coxal bone of a personal forensic collection whose age and gender were known (DNA identification) were used. Bone samples, centered on the same area than bone biopsy. MicroCT (pixel size: 36μm) was used to measure BV/TV and morphometric trabecular parameters of microarchitecture. An adjusted Z-score was calculated for BV/TV to compare with normative tables and a right/left comparison of trabecular parameters was provided. Twenty-seven iliac bones, which 20 forming 10 complete pelvises, aged between 24 and 73y.o. (average of 47.7 y.o.) were used. All adjusted Z-score were within normal values. There was a strong positive correlation between right and left sides for Tb.Th, Tb.N and Tb.Sp, but an insignificant correlation was obtained for BV/TV. Normative tables between age and BV/TV are valid and therefore usable in anthropology. They may represent an alternative to determine the age at death. Nevertheless, it requires a precise technique that could be a drawback in current practice. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Exploring full cervical dilatation caesarean sections-A retrospective cohort study.

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Corry, Edward M A; Ramphul, Meenakshi; Rowan, Ann M; Segurado, Ricardo; Mahony, Rhona M; Keane, Declan P

2018-05-01

The rate of caesarean sections at full cervical dilatation with their high risk of morbidity continues to rise mirroring the overall increase in caesarean section rates internationally. The objectives of this study were to determine the rate of full dilatation caesarean section in a tertiary referral unit and evaluate key labour, maternal and fetal factors potentially linked to those deliveries. We also assessed maternal and fetal morbidity at full dilatation sections. Where possible, these were compared with successful operative vaginal deliveries carried out in theatre to determine key differences. Retrospective cohort study. We reviewed the rate of full dilatation caesarean section over a 10-year period. We analysed deliveries (caesarean sections or operative vaginal deliveries) in single cephalic pregnancies ≥34 weeks with contemporaneously collected data from our unit's electronic database for 2015. The rate of full dilatation caesarean section increased by over a third in the ten-year period (56/6947 (0.80%) vs 92/7378 (1.24%), p = 0.01). Of 84 full dilatation caesarean sections who met the inclusion criteria, 63 (75%) were nulliparous and the mean maternal age was 33 (±5) years. Oxytocin was used in the second stage in less than half of second stage caesarean sections (22 out of a recorded 57, 38.6%). There were more fetal head malposition (occipito-posterior, or occipito-transverse) at full dilatation caesarean section compared to successful operative vaginal deliveries (41/46 (89.1%) vs 2/21 (9.5), p < 0.001). The rate of significant postpartum haemorrhage (defined as estimated blood loss ≥1000 ml) was similar in both full dilatation caesarean section and operative vaginal deliveries. There was no difference in the mean birthweight at full dilatation caesarean sections compared to operative vaginal delivery (3.88 kg (2.80-5.33 kg) vs 3.48 kg (1.53-4.40 kg)). There was no difference in neonatal morbidity. Fetal head malposition is

Canine gastric dilatation/volvulus syndrome in a veterinary critical care unit: 295 cases (1986-1992).

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Brockman, D J; Washabau, R J; Drobatz, K J

1995-08-15

Two hundred ninety-five case records were included in an analysis of dogs treated by a standardized protocol for gastric dilatation/volvulus syndrome between 1986 and 1992. A breed predisposition was demonstrated for Great Danes, German Shepherd Dogs, large mixed-breed dogs, and Standard Poodles. One hundred and ninety-three dogs had gastric dilatation and volvulus (GDV) confirmed at surgery, 66 had simple gastric dilatation (GD), and 36 others had gastric dilatation but volvulus could not be proved or disproved (GD +/- V). Among dogs with GDV, the fatality rate was 15% (29/193). Twenty-six (13.5%) dogs with GDV underwent partial gastrectomy, and 8 (31%) died or were subsequently euthanatized. In comparing the group of dogs with GDV that survived to those that died, there were no statistical differences in the age of dog, time between onset of clinical signs and admission, time from admission to surgery, or duration of anesthesia. Cardiac arrhythmias were detected in 40% (78/193) of the dogs with GDV. There also was no statistical correlation between development of a cardiac arrhythmia and outcome in dogs with GDV. The causes of death in dogs with GDV were multiple and varied; presumed gastric necrosis was a common reason for intraoperative euthanasia (11 dogs). Among dogs with GD or GD +/- V, the fatality rate was 0.9% (1/102).

Interventional management of complete long iliac artery occlusions. Interventionell-radiologisches Vorgehen bei laengerstreckigen kompletten Beckenarterienverschluessen

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Rominger, M B; Rauber, K; Rau, S [Giessen Univ. (Germany, F.R.). Zentrum fuer Radiologie; Matthes, B [Giessen Univ. (Germany, F.R.). Zentrum fuer Innere Medizin; Schulz, A [Giessen Univ. (Germany, F.R.). Zentrum fuer Pathologie

1991-03-01

15 completely occluded iliac arteries (five cases over 10 cm, 8 cases between 5 and 10 cm and two cases below 5 cm) were reviewed for their interventional management, technical results and complications. The procedure was successful in 14 of 15 cases (93%). In six cases we performed local thrombolysis before PTA. In the patient group with 'only PTA' the treatment had to be abandoned in one case because of the risk of embolism. Two patients suffered from a distal embolism of the same side and one patient from an ipsi- and contralateral embolism. A stent implantation was necessary in one patient. In the group of patients with prior local thrombolysis there was no complication nor was there an indication for a stent-implantation. Hence, we conclude that a primary local lysis with a consecutive PTA is an appropriate treatment of complete long occlusions of the iliac artery. (orig.).

Gastric dilatation and volvulus in brown bear (Ursus arctos)

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Marinković, Darko; Özvegy, Jòzsef; Aničić, Milan; Vučićević, Ivana; Nešić, Slađan; Kukolj, Vladimir

2016-01-01

Gastric dilatation and volvulus is a life-threatening condition characterized by rapid accumulation of food and gases that cause displacement and distension of the stomach. The large and giant, deep-chested breeds of dogs are at higher risk for developing the gastric dilatation and volvulus. Uncommonly, it can also develop in cats, but it is also described in free-range polar bears. A case of gastric dilatation and volvulus in a brown bear (Ursus arctos) is described in this paper. This case ...

The bicuspid aortic valve and its relation to aortic dilation

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Shi-Min Yuan

2010-01-01

Full Text Available BACKGROUND: A bicuspid aortic valve (BAV is a common congenital heart disease, which affects 1-2% of the population. However, the relationship between BAVs and aortic dilation has not been sufficiently elucidated. METHODS: A total of 241 BAV patients who were referred to this hospital for cardiac surgey over a 4.75-year period were included in this study. In addition to the clinical characteristics of the included patients, the morphological features of the aortic valve and aorta, the length of the left main coronary artery, and the laboratory findings (the coagulation and hematological parameters as well as the total cholesterol concentration were determined and compared with those of the tricuspid aortic valve (TAV patients. RESULTS: The BAV patients were younger than the TAV patients for a valve surgery in the last 3 months of the study period. The BAV patients were predominantly male. Most of the BAVs that were surgically treated were stenotic, regurgitant, or combined, and only 19 (7.88% were normally functioning valves. According to echocardiography or operative records, 148 (78.31% were type A, 31 (16.40% were type B, and 10 (5.29% were type C. The left main coronary artery was much shorter in the BAV patients than it was in the TAV patients. There was no significant difference between BAV and TAV patients in the total cholesterol concentrations; whereas differences were noted between patients receiving lipid-lowering therapy and those not receiving lipid-lowering therapy. The dimensions of the aortic root, sinotubular junction, and ascending aorta were beyond normal limits, while they were significantly smaller in the BAV patients than in the TAV patients. They were also much smaller in patients receiving statin therapy than those not receiving statin therapy in both groups. Moreover, the aortic dilation in the BAV group was found to be significantly associated with patient age. CONCLUSIONS: The BAV patients developed aortic wall and

Activated Braf induces esophageal dilation and gastric epithelial hyperplasia in mice.

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Inoue, Shin-Ichi; Takahara, Shingo; Yoshikawa, Takeo; Niihori, Tetsuya; Yanai, Kazuhiko; Matsubara, Yoichi; Aoki, Yoko

2017-12-01

Germline mutations in BRAF are a major cause of cardio-facio-cutaneous (CFC) syndrome, which is characterized by heart defects, characteristic craniofacial dysmorphology and dermatologic abnormalities. Patients with CFC syndrome also commonly show gastrointestinal dysfunction, including feeding and swallowing difficulties and gastroesophageal reflux. We have previously found that knock-in mice expressing a Braf Q241R mutation exhibit CFC syndrome-related phenotypes, such as growth retardation, craniofacial dysmorphisms, congenital heart defects and learning deficits. However, it remains unclear whether BrafQ241R/+ mice exhibit gastrointestinal dysfunction. Here, we report that BrafQ241R/+ mice have neonatal feeding difficulties and esophageal dilation. The esophagus tissues from BrafQ241R/+ mice displayed incomplete replacement of smooth muscle with skeletal muscle and decreased contraction. Furthermore, the BrafQ241R/+ mice showed hyperkeratosis and a thickened muscle layer in the forestomach. Treatment with MEK inhibitors ameliorated the growth retardation, esophageal dilation, hyperkeratosis and thickened muscle layer in the forestomach in BrafQ241R/+ mice. The esophageal dilation with aberrant skeletal-smooth muscle boundary in BrafQ241R/+ mice were recovered after treatment with the histone H3K27 demethylase inhibitor GSK-J4. Our results provide clues to elucidate the pathogenesis and possible treatment of gastrointestinal dysfunction and failure to thrive in patients with CFC syndrome. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Balloon catheter dilation of benign esophageal stenosis in children

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Fan Guoping; Yu Juming; Zhong Weixing; Zhu Ming; Wu Yeming; Shi Chengren

2001-01-01

Objective: To evaluate the methods and effect of balloon catheter dilation of benign esophageal stenosis in children. Methods: 9 cases had an anastomotic stenosis after surgical correction of esophageal atresia; 11 cases of esophageal stenosis due to ingestion of caustics; one case had an lower esophageal stenosis after Nissen surgery and one case after gastro-esophagoplasty. Age ranged from 17 days to 7 years. Each case had a barium esophagram before balloon dilation. The balloon size varied from 3 to 10 mm in diameter. Results: 21 cases were successful after dilation of balloon catheter. There were no esophageal perforation and complications. The satisfactory results maintained from six months to thirty months. Conclusions: Balloon catheter dilation is a simple, safe and reliable method for the treatment of benign esophageal strictures in children as the first choice

Dilated odontoma: A report of two cases from a radiological perspective

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S Jayachandran

2016-01-01

Full Text Available Dilated odontoma is the most extreme form of dens invaginatus. The lesion appears as a roughly spherical mass that does not resemble a tooth but in a way appears tooth - like on radiographs due to somewhat similar radiodensity. The lesion is mostly spherical in appearance and hence the term “dilated.” Occasionally, we come across cases of simultaneous pathologies. Here, we report two cases of a dilated odontoma one of which is associated with dentigerous cyst and in other case dilated odontoma pushing the maxillary sinus superiorly. Histologically, the mass was composed of dentinal tubules. These morphological and histological features are compatible with those of a dilated odontoma.

The Efficacy of Endoscopic Papillary Balloon Dilation for Patients with Acute Biliary Pancreatitis

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Wei-Chih Sun

2015-01-01

Full Text Available Background. No study investigated the efficacy and safety of endoscopic papillary balloon dilation (EPBD for the treatment of acute biliary pancreatitis (ABP. Method. We retrospectively reviewed the effects of EPBD on patients with ABP from February 2003 to December 2012. The general data, findings of image studies, details of the procedure, and outcomes after EPBD were analyzed. Result. Total 183 patients (male/female: 110/73 were enrolled. The mean age was 65.9 years. Among them, 155 patients had mild pancreatitis. The meantime from admission to EPBD was 3.3 days. Cholangiogram revealed filling defects inside the common bile duct (CBD in 149 patients. The mean dilating balloon size was 10.5 mm and mean duration of the dilating procedure was 4.3 minutes. Overall, 124 patients had gross stones retrieved from CBD. Four (2.2% adverse events and 2 (1.1% intraprocedure bleeding incidents but no procedure-related mortality were noted. Bilirubin and amylase levels significantly decreased after EPBD. On average, patients resumed oral intake within 1.4 days. The clinical parameters and outcomes were similar in patients with different severity of pancreatitis. Conclusion. EPBD can be effective and safe for the treatment of ABP, even in patients presenting with severe disease.

Pupil dilation during recognition memory: Isolating unexpected recognition from judgment uncertainty.

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Mill, Ravi D; O'Connor, Akira R; Dobbins, Ian G

2016-09-01

Optimally discriminating familiar from novel stimuli demands a decision-making process informed by prior expectations. Here we demonstrate that pupillary dilation (PD) responses during recognition memory decisions are modulated by expectations, and more specifically, that pupil dilation increases for unexpected compared to expected recognition. Furthermore, multi-level modeling demonstrated that the time course of the dilation during each individual trial contains separable early and late dilation components, with the early amplitude capturing unexpected recognition, and the later trailing slope reflecting general judgment uncertainty or effort. This is the first demonstration that the early dilation response during recognition is dependent upon observer expectations and that separate recognition expectation and judgment uncertainty components are present in the dilation time course of every trial. The findings provide novel insights into adaptive memory-linked orienting mechanisms as well as the general cognitive underpinnings of the pupillary index of autonomic nervous system activity. Copyright © 2016 Elsevier B.V. All rights reserved.

Internal Iliac Artery Embolization for the Control of Severe Bladder Hemorrhage Secondary to Carcinoma: Long-Term Follow-Up

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Ahmed El-Assmy

2007-01-01

Full Text Available The purpose of this study was to evaluate the efficacy and long-term complications of internal iliac artery embolization as a palliative measure in the control of intractable hemorrhage from advanced bladder malignancy. From January 1998 through December 2005, seven patients underwent transcatheter arterial embolization (TAE of anterior division of internal iliac artery bilaterally for intractable bladder hemorrhage. After embolization, patients were followed for the efficacy of the procedure in controlling hematuria and complications. TAE was successful in immediate control of severe hemorrhage in all seven patients after a mean period of 4 days. At a mean (range follow-up of 10 (6–12 months, the hemorrhage was permanently controlled in four (57% patients. Three patients developed hematuria and required emergency admissions; two had mild hematuria and were managed conservatively, and the remaining one required a second attempt of embolization after 2 months from the first one. During the whole period of follow-up, there were no significant complications related to embolization. Internal iliac artery embolization is an effective and minimally invasive option when managing advanced bladder malignancies presenting with intractable bleeding. The long-term follow-up showed control of bleeding in the majority of such patients with no serious complications.

Cancellous bone structure of iliac crest biopsies following 370 days of head-down bed rest

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Thomsen, Jesper Skovhus; Morukov, Boris V.; Vico, Laurence

2005-01-01

INTRODUCTION: Static bone histomorphometry was applied to existing iliac bone sections originating from a 370-d 5 degrees head-down bed rest experiment. This bed rest experiment is the longest ever to have been conducted. We hypothesized that bed rest would decrease cancellous bone volume fractio...

Safety and outcome using endoscopic dilation for benign esophageal stricture without fluoroscopy

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E R Siddeshi

2015-01-01

Full Text Available Aim : The aim was to investigate the use of Savary-Gilliard marked dilators in tight esophageal strictures without fluoroscopy. Materials and Methods: Four hundred and six patients with significant dysphagia from benign strictures due to a variety of causes were dilated endoscopically. Patients with achalasia, malignant lesions, and external compression were excluded. The procedure consisted of two parts. First, Savary-Gilliard or zebra guide wire was placed through video endoscopy and then dilatation was performed without fluoroscopy. In general, "the rule of three" was followed. Effective treatment was defined as the ability of patients, with or without repeated dilatations, to maintain a solid or semisolid diet for more than 12 months. Results: One thousand and twenty-four dilatations sessions in a total of 408 patients were carried out. The success rate for placement of a guide wire was 100% and for dilatation 97% without the use of fluoroscopy, after 6 months-24 years of follow-up. The number of sessions per patient was between one and seven, with an average of three sessions. The ability of patients, after one or more sessions of dilatations to maintain a solid or semisolid diet for more than 12 months was obtained in 386 patients (95.8%. All patients improved clinically without complications after the endoscopic procedure without fluoroscopy, but we noted 22 failures. Conclusions: Dilatation (dilation using Savary-Gilliard dilators without fluoroscopy are safe and effective in the treatment of very tight esophageal strictures if performed with care.

Endoscopic Dilation of Pharyngoesophageal Strictures: There Are More Dimensions than a Diameter

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Diana Martins

2018-02-01

Full Text Available Background/Aims: Dysphagia due to benign pharyngoesophageal strictures (PES often requires repeated dilations; however, a uniform definition for the therapeutic efficacy of this technique has not been yet established. We aimed to assess the overall efficacy of endoscopic dilation of pharyngoesophageal anastomotic or post-radiotherapy (post-RT strictures. Methods: The data of 48 patients with post-RT (n = 29 or anastomotic PES (n = 19 submitted to endoscopic dilation during a 3-year period were retrospectively assessed. The Kochman criteria were used to determine refractoriness and recurrence. Patients were asked to answer a questionnaire determining prospectively the dilation program efficacy as (a dysphagia improvement, (b dysphagia resolution, (c need for further dilations, or (d percutaneous endoscopic gastrostomy (PEG during the previous 6 months. Need for additional therapy was considered an inefficacy criterion. Results: The median number of dilations per patient was 4 (total of 296 dilations with a median follow-up of 29 months. The mean predilation dysphagia Mellow-Pinkas score was 3 and the initial stenosis diameter was 7 mm. Fifteen and 29% of patients presented with the Kochman criteria for refractory and recurrent strictures, respectively. Moreover, 96 and 60% showed dysphagia improvement and resolution, respectively. Seventy-five-percent did not require dilations during 6 months, and 89% did not require PEG. From the patients’ perspective, overall efficacy was achieved in 58% of cases. Nine additional therapies were required. Number of dilations (OR 0.7, stricture diameter (OR 2.2, and nonrecurrence criteria (OR 14.2 appeared as significant predictors of overall efficacy, whereas refractory stenosis criteria did not. Conclusions: Endoscopic dilation seems to be effective for patients with dysphagia after RT or surgery, especially when assessed as patient perception of improvement. Narrow strictures, recurrent ones, and strictures

Endovascular Treatment of Anastomotic Pseudoaneurysms after Aorto-iliac Surgical Reconstruction

International Nuclear Information System (INIS)

Lagana, Domenico; Carrafiello, Gianpaolo; Mangini, Monica; Recaldini, Chiara; Lumia, Domenico; Cuffari, Salvatore; Caronno, Roberto; Castelli, Patrizio; Fugazzola, Carlo

2007-01-01

Purpose. To assess the effectiveness of endovascular treatment of anastomotic pseudoaneurysms (APAs) following aorto-iliac surgical reconstruction. Materials. We retrospectively evaluated 21 men who, between July 2000 and March 2006, were observed with 30 APAs, 13 to the proximal anastomosis and 17 to the distal anastomosis. The patients had had previous aorto-iliac reconstructive surgery with a bypass due to aneurysm (15/21) or obstructive disease (6/21). The following devices were used: 12 bifurcated endoprostheses, 2 aorto-monoiliac, 4 aortic extenders, 1 stent-graft leg, and 2 covered stents. Follow-up was performed with CT angiography at 1, 3, and 6 months after the procedure and yearly thereafter. Results. Immediate technical success was 100%. No periprocedural complications occurred. Four patients died during follow-up from causes not related to APA, and 1 (treated for prosthetic-enteric fistula) from sepsis 3 months after the procedure. During a mean follow-up of 19.7 months (range 1-72 months), 2 of 21 occlusions of stent-graft legs occurred 3 and 24 months after the procedure (treated with thrombolysis and percutaneous transluminal angioplasty and femorofemoral bypass, respectively) and 1 type I endoleak. Primary clinical success rate was 81% and secondary clinical success was 91%. Conclusion. Endovascular treatment is a valid alternative to open surgery and can be proposed as the treatment of choice for APAs, especially in patients who are a high surgical risk. Further studies with larger series and longer follow-up are necessary to confirm the long-term effectiveness of this approach

Balloon catheter dilatation of esophageal strictures in children and an infant

International Nuclear Information System (INIS)

Yeon, Kyung Mo; Choe, Yeon Hyeon; Kim, In One

1986-01-01

Severe postoperative strictures in two children and an infant and mild postoperative stricture in a child were treated with balloon catheter. A child with post-fundoplication stricture showed symptomatic improvement. Anastomotic strictures after esophageal atresia repair in an infant and a child were successfully dilated with improved luminal diameter and symptoms. In a child with mild postoperative stricture, balloon dilatation was performed to prevent stricture of the anastomotic site. Radiological esophageal dilatation using balloon catheters is a safe effective method for dilating symptomatic esophageal strictures which obviates surgery and allows subsequent standard bougienage.

Laparoscopic Heller Myotomy for Non-Dilated Esophageal Achalasia in Children with Intraoperative Stepped Dilation Under Image Guidance: Attempting Complete Myotomy.

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Miyano, Go; Miyake, Hiromu; Koyama, Mariko; Morita, Keiichi; Kaneshiro, Masakatsu; Nouso, Hiroshi; Yamoto, Masaya; Fukumoto, Koji; Urushihara, Naoto

2016-05-01

This study presents a modified surgical approach to laparoscopic myotomy for achalasia using stepped dilation with a Rigiflex balloon and contrast medium under image guidance. A 10-year-old boy with persistent dysphagia and vomiting had ingested only liquids for 3 months, losing >10 kg in body weight. Barium swallow and esophageal manometry diagnosed esophageal achalasia with mild esophageal dilatation. After failed pneumatic dilatation, laparoscopic Heller myotomy with Dor fundoplication was performed. Prior to surgery, a Rigiflex balloon dilator was placed within the esophagus near the diaphragmatic hiatus. A four-port technique was used, and mobilization of the esophagus was limited to the anterior aspect. A 5-cm Heller myotomy was performed, extending another 2 cm onto the anterior gastric wall. During myotomy, the Rigiflex balloon was serially dilated from 30 to 50 mL, and filled with contrast medium under fluoroscopic image guidance in order to maintain appropriate tension on the esophagus to facilitate myotomy, and to confirm adequate myotomy with sufficient release of lower esophageal sphincter by resecting residual circular muscle fibers. Residual circular muscle fibers can be simultaneously visualized under both fluoroscopic image guidance and direct observation through the laparoscope, and they were cut precisely until the residual notch fully disappeared. Dor fundoplication was completed. The operative time was 180 minutes, and oral intake was started after esophagography on postoperative day 1. As of the 12-month follow-up, the patient has not shown any symptoms, and his postoperative course appeared satisfactory.

Percutaneous dilatation of benign ureteral stricture -a case report-

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Sung, Kyu Bo; Ahn, Jung Sook; Ham, So Hie; Woo, Won Hyung [Koryo General Hospital, Seoul (Korea, Republic of)

1987-06-15

Percutaneous ureteral dilatation was done with balloon catheter and ureteral stent. A 40 year old woman had a pelvic surgery due to inflammatory cyst and this surgery was complicated by incidental cutting of right ureter and ureteroureteral anastomosis was done. After 1 month, she was suffered from severe right flank pain, nausea and vomiting, and showed delayed visualization of pelvocalyceal system with dilatation in intravenous pyelography. Percutaneous nephrostomy was done and complete obstruction at lower ureter was seen in antegrade pyelography. 4 mm balloon catheter was introduced through the nephrostomy tract and dilatation was done with a pressure of 5 atm for 1 minute duration for 4 times and no. 7 double J ureteral stent was left across the lesion for prevention of restenosis. Ureteral stent was removed after 2 months, and successful dilatation was seen and no evidence of restenosis in 5 weeks follow up.

Pneumatic dilatation in achalasia cardia results and follow-up.

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Supe A

1990-10-01

Full Text Available Pneumatic dilatation is one of the more recent methods in the management of achalasia cardia. Fifty dilatations were done in 42 patients with achalasia cardia over 5 years. There was a significant decrease in the maximum diameter of the oesophagus and a significant increase in diameter in the narrowed lower oesophageal segment in all the patients. Of the patients studied, 95.23% were relieved of their symptoms after only one to two sessions. There were no immediate complications. Out of the 38 patients on long term follow up, 8 (21.05% had recurrence of symptoms. On repeat dilatations, 4 (50% of them had good response. Late complication like reflux oesophagitis was observed in only 1 patient over a median follow up period of 22 months. It was thus concluded that pneumatic dilatation is a safe, simple and effective procedure in managing patients with achalasia cardia.

Self-dilation for therapy-resistant benign esophageal strictures: towards a systematic approach

NARCIS (Netherlands)

van Halsema, Emo E.; 't Hoen, Chantal A.; de Koning, Patricia S.; Rosmolen, Wilda D.; van Hooft, Jeanin E.; Bergman, Jacques J.

2018-01-01

Patients with therapy-resistant benign esophageal strictures (TRBES) suffer from chronic dysphagia and generally require repeated endoscopic dilations. For selected patients, esophageal self-dilation may improve patient's autonomy and reduce the number of endoscopic dilations. We evaluated the

Molecular genetics of dilated cardiomyopathy in the Dobermann dog

NARCIS (Netherlands)

Stabej, Polona

2005-01-01

Canine dilated cardiomyopathy (DCM) is a disease of the myocardium associated with dilatation and impaired contraction of the ventricles. It primarily affects large and giant breed dogs with Dobermanns being one of the most frequently affected. The high prevalence of DCM in specific breeds suggests

Balloon catheter dilatation in esophageal achalasia: long term follow-up

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Shin, Cheol Yong; Park, Hyun Mee; Kim, So Eun; Lee, Shin Hyung; Kim, Seung Hyeon; Lee, Chang Joon [National Medical Center, Seoul (Korea, Republic of)

1994-12-15

To evaluate the clinical efficacy of balloon catheter dilatation in the treatment of esophageal achalasia. Seven patients(three males and four females) with esopha-geal achalasia were treated with balloon catheter dilatation. Balloon catheters of variable sizes were used depending on patient's conditions. The patients were followed up over a period of 12-39 months. Balloon catheter dilatation in esophageal achalasia was successful in all patients without esophageal perforation. All patients were relieved from dysphagia. Recurrence was not found in 5 patients on long term follow-up study, but was seen in 2 patients after 18 and 21 months, respectively. Balloon catheter dilatation was a safe and effective method in the treatment of esophageal achalasia with low recurrence rate of 29% on follow-up study.

Balloon catheter dilatation in esophageal achalasia: long term follow-up

International Nuclear Information System (INIS)

Shin, Cheol Yong; Park, Hyun Mee; Kim, So Eun; Lee, Shin Hyung; Kim, Seung Hyeon; Lee, Chang Joon

1994-01-01

To evaluate the clinical efficacy of balloon catheter dilatation in the treatment of esophageal achalasia. Seven patients(three males and four females) with esopha-geal achalasia were treated with balloon catheter dilatation. Balloon catheters of variable sizes were used depending on patient's conditions. The patients were followed up over a period of 12-39 months. Balloon catheter dilatation in esophageal achalasia was successful in all patients without esophageal perforation. All patients were relieved from dysphagia. Recurrence was not found in 5 patients on long term follow-up study, but was seen in 2 patients after 18 and 21 months, respectively. Balloon catheter dilatation was a safe and effective method in the treatment of esophageal achalasia with low recurrence rate of 29% on follow-up study

Avulsion fractures of the anterior inferior iliac spine: spectrum of imaging findings; Avulsao da espinha iliaca antero-inferior: espectro dos achados de imagem

Energy Technology Data Exchange (ETDEWEB)

Fernandes, Joao Luiz [Hospital Santa Lucia, Brasilia, DF (Brazil). Dept. de Ressonancia Magnetica; Viana, Sergio Lopes; Mendonca, Jose Luiz Furtado de; Freitas, Flavia Mendes Oliveira; Lima, Gylse-Anne de Souza; Vila, Ana Fabiola da; Ribeiro, Nelmar [Clinica Radiologica Vila Rica, Brasilia, DF (Brazil). Dept. de Ressonancia Magnetica]. E-mail: radiolog@uol.com.br

2005-07-15

Avulsive injuries of the pelvic aphophyses are relatively common among 13-18 year old athletes, particularly among soccer players in Brazil. Diagnosis is made upon clinical and imaging findings. These lesions show three distinct phases: acute, repair and consolidation phases. Although acute and consolidation phases usually represent no diagnostic challenge, the repair phase may appear as an aggressive process on diagnostic images simulating neoplasic lesions. In this paper, the authors present the imaging findings of patients with avulsion of the anterior inferior iliac spine on plain radiographs, computerized tomography and magnetic resonance imaging, emphasizing the typical features of the three evolutive phases of these lesions. (author)

Radionuclide esophageal emptying study before and after pneumatic dilatation in achalasia

Energy Technology Data Exchange (ETDEWEB)

Ujiie, Hiroaki; Hongo, Michio; Lin, Yih-Fong; Satake, Kenzo; Asaki, Shigeru; Goto, Yoshio; Okuyama, Shinichi

1987-11-01

The therapeutic effect of pneumatic dilatation was evaluated quantitatively by radionuclide transit study in 11 achalasia patients. Before pneumatic dilatation, marked retention with more than 80 % of isotope in the esophagus at 15 minutes after ingestion was noted in all patients. Marked improvement in emptying was shown after pneumatic dilatation. Pneumatic dilatation is a safe and effective therapeutic aid for achalasia treatment, and radionuclide transit study is not only noninvasive and physiologic but also its procedure is easily performed. We conclude that radionuclide transit study is a good method to evaluate the result of the treatment quantitatively in achalasia patients.

Dilatancy of Shear Transformations in a Colloidal Glass

Science.gov (United States)

Lu, Y. Z.; Jiang, M. Q.; Lu, X.; Qin, Z. X.; Huang, Y. J.; Shen, J.

2018-01-01

Shear transformations, as fundamental rearrangement events operating in local regions, hold the key of plastic flow of amorphous solids. Despite their importance, the dynamic features of shear transformations are far from clear, which is the focus of the present study. Here, we use a colloidal glass under shear as the prototype to directly observe the shear-transformation events in real space. By tracing the colloidal-particle rearrangements, we quantitatively determine two basic properties of shear transformations: local shear strain and dilatation (or free volume). It is revealed that the local free volume undergoes a significantly temporary increase prior to shear transformations, eventually leading to a jump of local shear strain. We clearly demonstrate that shear transformations have no memory of the initial free volume of local regions. Instead, their emergence strongly depends on the dilatancy ability of these local regions, i.e., the dynamic creation of free volume. More specifically, the particles processing the high dilatancy ability directly participate in subsequent shear transformations. These results experimentally enrich Argon's statement about the dilatancy nature of shear transformations and also shed insight into the structural origin of amorphous plasticity.

Balloon dilatation of the esophageal stricture in infants and children

Energy Technology Data Exchange (ETDEWEB)

Choo, Sung Wook; Kim, In One; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Woo Ki; Park, Kwi Won; Han, Man Chung [Seoul Natioal University College of Medicine, Seoul (Korea, Republic of); Lee, Gi Jae [Inje University Paik Hospital, Seoul (Korea, Republic of); Yu, Pil Mun [Dankuk University College of Medicine, Seoul (Korea, Republic of)

1992-09-15

Balloon dilatation has been applied in treating of various pathologic narrowing of the hollow viscus. It is now accepted as a very effective modality especially in treating esophageal stenosis obviating surgical procedure. We performed 128 balloon dilatations in 29 patients with the number of dilatations in each patient ranging from once to 12 times. The age distribution of the patients was from 3 weeks to 6 years, with the median age of 3 months. Twenty nine patients consisted of 25 postoperative esophageal strictures (21 esophageal atresia with tracheoesophageal fistula, 1 congenital esophageal stenosis, 2 tracheobronchial remnant, and 1 congenital esophageal stenosis with esophageal atresia), 2 achalasia, 1 congenital esophageal stenosis, and 1 corrosive esophagitis. We had successful dilatation in 22 patients, who showed subsequent relief of symptoms and improvement in the diameter of stenotic segment. In 14 patients, esophageal perforation occurred during the procedure, one requiring emergency thoracotomy and the other three conservative management. Seven patients had no improvement in stenotic sites after several balloon dilatations. Failed cases were congenital stenosis, achalasia, corrosive esophagitis and four postoperative strictures. We believe that balloon dilatation is the procedure of choice in the treatment of postoperative esophageal stricture in infants and children and is a safe method as the perforation which can complicate the procedure could be managed conservatively.

Balloon dilatation of the esophageal stricture in infants and children

International Nuclear Information System (INIS)

Choo, Sung Wook; Kim, In One; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Woo Ki; Park, Kwi Won; Han, Man Chung; Lee, Gi Jae; Yu, Pil Mun

1992-01-01

Balloon dilatation has been applied in treating of various pathologic narrowing of the hollow viscus. It is now accepted as a very effective modality especially in treating esophageal stenosis obviating surgical procedure. We performed 128 balloon dilatations in 29 patients with the number of dilatations in each patient ranging from once to 12 times. The age distribution of the patients was from 3 weeks to 6 years, with the median age of 3 months. Twenty nine patients consisted of 25 postoperative esophageal strictures (21 esophageal atresia with tracheoesophageal fistula, 1 congenital esophageal stenosis, 2 tracheobronchial remnant, and 1 congenital esophageal stenosis with esophageal atresia), 2 achalasia, 1 congenital esophageal stenosis, and 1 corrosive esophagitis. We had successful dilatation in 22 patients, who showed subsequent relief of symptoms and improvement in the diameter of stenotic segment. In 14 patients, esophageal perforation occurred during the procedure, one requiring emergency thoracotomy and the other three conservative management. Seven patients had no improvement in stenotic sites after several balloon dilatations. Failed cases were congenital stenosis, achalasia, corrosive esophagitis and four postoperative strictures. We believe that balloon dilatation is the procedure of choice in the treatment of postoperative esophageal stricture in infants and children and is a safe method as the perforation which can complicate the procedure could be managed conservatively

Calcification of the splenic, iliac, and breast arteries and risk of all-cause and cardiovascular mortality

NARCIS (Netherlands)

Hendriks, Eva J E; Beulens, Joline W J; de Jong, Pim A; van der Schouw, Yvonne T; Sun, Wei-Ning; Wright, C Michael; Criqui, Michael H; Allison, Matthew A; Ix, Joachim H

2017-01-01

BACKGROUND AND AIMS: CVD risks associated with coronary artery calcification (CAC) and aortic calcification (AC) are well known, but less is known about other calcified arteries. We aimed to assess the associations of arterial calcification in the breast, splenic, and internal and external iliac

Radiocephalic Fistula Complicated by Distal Ischemia: Treatment by Ulnar Artery Dilatation

International Nuclear Information System (INIS)

Raynaud, Alain; Novelli, Luigi; Rovani, Xavier; Carreres, Thierry; Bourquelot, Pierre; Hermelin, Alain; Angel, C.; Beyssen, B.

2010-01-01

Hand ischemic steal syndrome due to a forearm arteriovenous fistula is a rare occurrence. However, its frequency is increasing with the rise in numbers of elderly and diabetic patients. This complication, which is more common for proximal than for distal accesses, can be very severe and may cause loss of hand function, damage to fingers, and even amputation of fingers or the hand. Its treatment is difficult and often leads to access loss. We report here a case of severe hand ischemia related to a radiocephalic fistula successfully treated by ulnar artery dilatation.

Psychological and neural mechanisms of subjective time dilation

Directory of Open Access Journals (Sweden)

Virginie evan Wassenhove

2011-04-01

Full Text Available For a given physical duration, certain events can be experienced as subjectively longer in duration than others. Try this for yourself: take a quick glance at the second hand of a clock. Immediately, the tick will pause momentarily and appear to be longer than the subsequent ticks. Yet, they all last exactly one second. By and large, a deviant or an unexpected stimulus in a series of similar events (same duration, same features can elicit a relative overestimation of subjective time (or "time dilation" but, as is shown here, this is not always the case. We conducted an event-related functional magnetic neuroimaging (fMRI study on the time dilation effect. Participants were presented with a series of five visual discs, all static and of equal duration (standards except for the fourth one, a looming or a receding target. The duration of the target was systematically varied and participants judged whether it was shorter or longer than all other standards in the sequence. Subjective time dilation was observed for the looming stimulus but not for the receding one, which was estimated to be of equal duration to the standards. The neural activation for targets (looming and receding contrasted with the standards revealed an increased activation of the anterior insula and of the anterior cingulate cortex. Contrasting the looming with the receding targets (i.e. capturing the time dilation effect proper revealed a specific activation of cortical midline structures. The implication of midline structures in the time dilation illusion is here interpreted in the context of self-referential processes.

Cystic dilatation of ventriculus terminalis in adults: MRI

International Nuclear Information System (INIS)

Matsubayashi, R.; Uchino, A.; Kato, A.; Kudo, S.; Sakai, S.; Murata, S.

1998-01-01

We report the MRI findings in two patients with cystic dilatation of the ventriculus terminalis. The latter is usually a tiny ependyma-lined cavity of the conus medullaris. In both cases the markedly dilated ventriculus terminalis was seen as a rounded cavity with regular margins, the content of which gave the same signal as cerebrospinal fluid with all MR pulse sequences. No contrast enhancement was seen. (orig.)

The impact of duct-to-duct interaction on the hex duct dilation

International Nuclear Information System (INIS)

Lee, M.J.; Chang, L.K.; Lahm, C.E.; Porter, D.L.

1992-01-01

Dilation of the hex duct is an important factor in the operational lifetime of fuel subassemblies in liquid metal fast reactors. It is caused primarily by the irradiation-enhanced creep and void swelling of the hex duct material. Excessive dilation may jeopardize subassembly removal from the core or cause a subassembly storage problem where the grid size of the storage basket is limited. Dilation of the hex duct in Experimental Breeder Reactor II (EBR-II) limits useful lifetime because of these storage basket limitations. It is, therefore, important to understand the hex duct dilation behavior to guide the design and in-core management of fuel subassemblies in a way that excessive duct deformation can be avoided. To investigate the dilation phenomena, finite-element models of the hex duct have been developed. The inelastic analyses were performed using the structural analysis code, ANSYS. Both Type 316 and D9 austenitic stainless steel ducts are considered. The calculated dilations are in good agreement with profilometry measurements made after irradiation. The analysis indicates that subassembly interaction is an important parameter in addition to neutron fluence and temperature in determining hex duct dilation. 5 refs

The Enright phenomenon. Stereoscopic distortion of perceived driving speed induced by monocular pupil dilation.

Science.gov (United States)

Carkeet, Andrew; Wood, Joanne M; McNeill, Kylie M; McNeill, Hamish J; James, Joanna A; Holder, Leigh S

The Enright phenomenon describes the distortion in speed perception experienced by an observer looking sideways from a moving vehicle when viewing with interocular differences in retinal image brightness, usually induced by neutral density filters. We investigated whether the Enright phenomenon could be induced with monocular pupil dilation using tropicamide. We tested 17 visually normal young adults on a closed road driving circuit. Participants were asked to travel at Goal Speeds of 40km/h and 60km/h while looking sideways from the vehicle with: (i) both eyes with undilated pupils; (ii) both eyes with dilated pupils; (iii) with the leading eye only dilated; and (iv) the trailing eye only dilated. For each condition we recorded actual driving speed. With the pupil of the leading eye dilated participants drove significantly faster (by an average of 3.8km/h) than with both eyes dilated (p=0.02); with the trailing eye dilated participants drove significantly slower (by an average of 3.2km/h) than with both eyes dilated (p<0.001). The speed, with the leading eye dilated, was faster by an average of 7km/h than with the trailing eye dilated (p<0.001). There was no significant difference between driving speeds when viewing with both eyes either dilated or undilated (p=0.322). Our results are the first to show a measurable change in driving behaviour following monocular pupil dilation and support predictions based on the Enright phenomenon. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms

International Nuclear Information System (INIS)

Okada, Takuya; Yamaguchi, Masato; Kitagawa, Atsushi; Kawasaki, Ryota; Nomura, Yoshikatsu; Okita, Yutaka; Sugimura, Kazuro; Sugimoto, Koji

2012-01-01

Purpose: To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). Materials and Methods: Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non–contrast-enhanced CT was performed in seven patients with chronic kidney disease. Results: All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47–2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly (p < 0.05) decreased from 42.0 (9.3) to 36.9 (13.6) mm and from 40.1 (13.0) to 33.6 (15.8) mm, respectively; the mean (SD) shrinkage rates were 15.1% (20.2%) and 18.9% (22.4%), respectively. The primary patency rate was 100%, and no secondary interventions were required. Four patients (21%) developed transient buttock claudication, and one patient (5%) developed colorectal ischaemia, which was treated conservatively. Conclusion: Endovascular tubular stent-graft placement for the repair of isolated IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.

Dutch iliac stent trial : Long-term results in patients randomized for primary or selective stent placement

NARCIS (Netherlands)

Klein, W.M.; van der Graaf, Y.; Seegers, J.; Spithoven, J.H.; Buskens, E.; van Baal, J.G.; Buth, J.; Moll, F.L.; Overtoom, T.T.C.; van Sambeek, M.R.H.M.; Mali, W.P.T.M.

Purpose: To determine long-term results of the prospective Dutch Iliac Stent Trial. Materials and Methods: The study protocol was approved by local institutional review boards. All patients gave written informed consent. Two hundred seventy-nine patients (201 men, 78 women; mean age, 58 years) with

Temporal evolution of intraocular pressure elevation after pupillary dilation in pigment dispersion syndrome.

Science.gov (United States)

Jewelewicz, Daniel A; Radcliffe, Nathan M; Liebmann, Jeffrey; Ritch, Robert

2009-03-01

To report 4 patients with pigment dispersion syndrome (PDS) who had delayed intraocular pressure (IOP) spikes after pharmacologic pupillary dilation. Four patients with a diagnosis of PDS with documented IOP spike after pharmacologic pupillary dilation were included. Study patients were examined before and after pupillary dilation. The amount of pigment present in the anterior chamber and the IOP were measured at hourly intervals. Although maximal pigment liberation occurred immediately after maximal dilation, the IOP continued to elevate for at least 1.5 hours. The increase in IOP after pupillary dilation may not occur simultaneously with maximal pigment liberation but may follow it after the pigment has settled out of the anterior chamber. This has implications for monitoring patients with PDS after dilation to detect and treat rises in IOP.

Mixed Mode cohesive law with interface dilatation

DEFF Research Database (Denmark)

Sørensen, Bent F.; Goutianos, Stergios

2014-01-01

displacements. As the crack faces displace relatively to each other, the roughness asperities ride on top of each other and result in an opening (dilatation) in the normal direction. Furthermore, the interaction of the crack surfaces in the contact zone gives rise to compressive normal stresses and frictional...... shear stresses opposing the crack face displacements. A phenomenological Mixed Mode cohesive zone law, derived from a potential function, is developed to describe the above mentioned fracture behaviour under monotonic opening. The interface dilatation introduces two new lengths. The cohesive law...

Nonsurgical Fluoroscopically Guided Dacryocystoplasty of Common Canalicular Obstructions

Energy Technology Data Exchange (ETDEWEB)

Wilhelm, Kai E; Hofer, Ulrich; Textor, Hans J [Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn (Germany); Boeker, Thorsten [Department of Ophthalmology, University Hospital Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn (Germany); Strunk, Holger; Schild, Hans H [Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn (Germany)

2000-01-15

Purpose: To assess dacryocystoplasty in the treatment of epiphora due to obstructions of the common canaliculus.Methods: Twenty patients with severe epiphora due to partial (n = 16) or complete (n = 4) obstruction of the common canaliculus underwent fluoroscopically guided dacryocystoplasty. In all cases of incomplete obstruction balloon dilation was performed. Stent implantation was attempted in cases with complete obstruction. Dacryocystography and clinical follow-up was performed at intervals of 1 week, and 3, 6, 12, and 18 months after the procedure. The mean follow-up was 6 months (range 3-18 months).Results: Balloon dilation was technically successfully performed in all patients with incomplete obstructions (n = 16). In three of four patients with complete obstruction stent implantation was performed successfully. Subsequent to failure of stent implantation in one of these patients balloon dilation was performed instead. The long-term primary patency rate in patients with incomplete obstructions was 88% (n = 14/16). In three of four cases with complete obstruction long-term patency was achieved during follow-up. Severe complications, infections, or punctal splitting were not observed.Conclusion: Fluoroscopically guided balloon dacryocystoplasty is a feasible nonsurgical therapy in canalicular obstructions with good clinical results that may be used as an alternative to surgical procedures. In patients with complete obstructions stent placement is possible but further investigations are needed to assess the procedural and long-term results.

Nonsurgical Fluoroscopically Guided Dacryocystoplasty of Common Canalicular Obstructions

International Nuclear Information System (INIS)

Wilhelm, Kai E.; Hofer, Ulrich; Textor, Hans J.; Boeker, Thorsten; Strunk, Holger; Schild, Hans H.

2000-01-01

Purpose: To assess dacryocystoplasty in the treatment of epiphora due to obstructions of the common canaliculus.Methods: Twenty patients with severe epiphora due to partial (n = 16) or complete (n = 4) obstruction of the common canaliculus underwent fluoroscopically guided dacryocystoplasty. In all cases of incomplete obstruction balloon dilation was performed. Stent implantation was attempted in cases with complete obstruction. Dacryocystography and clinical follow-up was performed at intervals of 1 week, and 3, 6, 12, and 18 months after the procedure. The mean follow-up was 6 months (range 3-18 months).Results: Balloon dilation was technically successfully performed in all patients with incomplete obstructions (n = 16). In three of four patients with complete obstruction stent implantation was performed successfully. Subsequent to failure of stent implantation in one of these patients balloon dilation was performed instead. The long-term primary patency rate in patients with incomplete obstructions was 88% (n = 14/16). In three of four cases with complete obstruction long-term patency was achieved during follow-up. Severe complications, infections, or punctal splitting were not observed.Conclusion: Fluoroscopically guided balloon dacryocystoplasty is a feasible nonsurgical therapy in canalicular obstructions with good clinical results that may be used as an alternative to surgical procedures. In patients with complete obstructions stent placement is possible but further investigations are needed to assess the procedural and long-term results

Robotic retroperitoneal partial nephrectomy: a step-by-step guide.

Science.gov (United States)

Ghani, Khurshid R; Porter, James; Menon, Mani; Rogers, Craig

2014-08-01

To describe a step-by-step guide for successful implementation of the retroperitoneal approach to robotic partial nephrectomy (RPN) PATIENTS AND METHODS: The patient is placed in the flank position and the table fully flexed to increase the space between the 12th rib and iliac crest. Access to the retroperitoneal space is obtained using a balloon-dilating device. Ports include a 12-mm camera port, two 8-mm robotic ports and a 12-mm assistant port placed in the anterior axillary line cephalad to the anterior superior iliac spine, and 7-8 cm caudal to the ipsilateral robotic port. Positioning and port placement strategies for successful technique include: (i) Docking robot directly over the patient's head parallel to the spine; (ii) incision for camera port ≈1.9 cm (1 fingerbreadth) above the iliac crest, lateral to the triangle of Petit; (iii) Seldinger technique insertion of kidney-shaped balloon dilator into retroperitoneal space; (iv) Maximising distance between all ports; (v) Ensuring camera arm is placed in the outer part of the 'sweet spot'. The retroperitoneal approach to RPN permits direct access to the renal hilum, no need for bowel mobilisation and excellent visualisation of posteriorly located tumours. © 2014 The Authors. BJU International © 2014 BJU International.

Use of physical therapy to augment dilator treatment for vaginal agenesis.

Science.gov (United States)

McVearry, Mary E; Warner, William B

2011-05-01

: Dilator therapy has been used successfully for many years to treat vaginal agenesis. Our objective was to show how established physical therapy techniques can be used to augment dilator therapy. : A 36-year-old woman desiring nonsurgical management of vaginal agenesis was instructed in the use of vaginal dilators by a pelvic-floor physical therapist. Manual stretching of the vaginal tissues was performed during office visits after application of heat and therapeutic ultrasound to the perineum. In addition, the patient's husband was taught how to perform the vaginal stretching at home in conjunction with dilator therapy. : The patient was able to attempt intercourse after 6 weeks of treatment and achieved full penetration by 9 weeks. At the completion of treatment, she scored 31.9 on the Female Sexual Function Index. The patient and her husband were very satisfied with the treatment approach, especially the encouragement and guidance received in physical therapy. : By using established physical therapy techniques in conjunction with dilator therapy, a faster time to intercourse may be achieved with high patient and spouse satisfaction. We recommend the involvement of a physical therapist specializing in the pelvic floor as an adjunct to standard dilator therapy in the treatment of vaginal agenesis.

Concentration profiling of minerals in iliac crest bone tissue of opium addicted humans using inductively coupled plasma and discriminant analysis techniques.

Science.gov (United States)

Mani-Varnosfaderani, Ahmad; Jamshidi, Mahbobeh; Yeganeh, Ali; Mahmoudi, Mani

2016-02-20

Opium addiction is one of the main health problems in developing countries and induces serious defects on the human body. In this work, the concentrations of 32 minerals including alkaline, heavy and toxic metals have been determined in the iliac crest bone tissue of 22 opium addicted individuals using inductively coupled plasma-optical emission spectroscopy (ICP-OES). The bone tissues of 30 humans with no physiological and metabolomic diseases were used as the control group. For subsequent analyses, the linear and quadratic discriminant analysis techniques have been used for classification of the data into "addicted" and "non-addicted" groups. Moreover, the counter-propagation artificial neural network (CPANN) has been used for clustering of the data. The results revealed that the CPANN is a robust model and thoroughly classifies the data. The area under the curve for the receiver operating characteristic curve for this model was more than 0.91. Investigation of the results revealed that the opium consumption causes a deficiency in the level of Calcium, Phosphate, Potassium and Sodium in iliac crest bone tissue. Moreover, this type of addiction induces an increment in the level of toxic and heavy metals such as Co, Cr, Mo and Ni in iliac crest tissue. The correlation analysis revealed that there were no significant dependencies between the age of the samples and the mineral content of their iliac crest, in this study. The results of this work suggest that the opium addicted individuals need thorough and restricted dietary and medical care programs after recovery phases, in order to have healthy bones. Copyright © 2015 Elsevier B.V. All rights reserved.

Long-term outcome of a modified balloon dilatation in the treatment of patients with achalasia

Directory of Open Access Journals (Sweden)

Doder Radoje

2013-01-01

Full Text Available Background/Aim. Balloon dilatation is a standard approach to the initial achalasia treatment. Modified dilatation is also applied to rise efficacy and to lower complications. Methods. A total of 57 patients were analysed within a median follow-up of 8.2 years. No premedication was used, dilatation was performed up to the pain treshold, while introduction and positioning of a dilatator was done in combination of endoscopic and radiological control. Dilatation effect was estimated by both Kim Symptom Scoring and objective parameters: body weight rise and radiological scintigraphic findings. Results. Excellent and good results were obtained in 50 (88% of the patients, while in 7 (12% of the patients surgery was performed. There was no difference in dilatation efficacy regarding sex of the patients, but the results were better in the patients above 40 years. Duration of symptoms, body weight loss, esophageal lumen width do not indicate the definitive dilatation outcome. Esophageal scintigraphy and body weight increase were in a direct correlation with the effect of dilatation measured with the Kim Symptom Scoring. After the one to two repeated dilatations the efficacy increased from 74% to 88% justifying the repetition of dilatation. In 2 (3.57% of the patients, that is in 2.65% of the totally dilated patients, perforation was recorded. There was no lethal outcome of dilatation, and the other complications were not clinically significant. Conclusion. Modified balloon dilatation can be recommended for initial method in achalasia treatment due to high efficacy, easy performance in daily hospital while complications are in standard range.

Sciatica caused by a dilated epidural vein: MR findings

International Nuclear Information System (INIS)

Demaerel, P.; Petre, C.; Wilms, G.; Plets, C.

1999-01-01

We report the MR imaging findings in a 41-year-old woman presenting with sudden low back pain and sciatica. At surgery a dilated epidural vein was found compressing the nerve root. The MR findings may suggest the diagnosis. Magnetic resonance imaging of a dilated epidural vein or varix causing sciatica has not been reported until now. (orig.) (orig.)

Texture classification using non-Euclidean Minkowski dilation

Science.gov (United States)

Florindo, Joao B.; Bruno, Odemir M.

2018-03-01

This study presents a new method to extract meaningful descriptors of gray-scale texture images using Minkowski morphological dilation based on the Lp metric. The proposed approach is motivated by the success previously achieved by Bouligand-Minkowski fractal descriptors on texture classification. In essence, such descriptors are directly derived from the morphological dilation of a three-dimensional representation of the gray-level pixels using the classical Euclidean metric. In this way, we generalize the dilation for different values of p in the Lp metric (Euclidean is a particular case when p = 2) and obtain the descriptors from the cumulated distribution of the distance transform computed over the texture image. The proposed method is compared to other state-of-the-art approaches (such as local binary patterns and textons for example) in the classification of two benchmark data sets (UIUC and Outex). The proposed descriptors outperformed all the other approaches in terms of rate of images correctly classified. The interesting results suggest the potential of these descriptors in this type of task, with a wide range of possible applications to real-world problems.

Balloon catheter dilatation of benign urethral strictures

International Nuclear Information System (INIS)

Perini, L.; Cavallo, A.; Perin, B.; Bighi, G.

1988-01-01

The authors report their experience of benign urethral stricture dilatation by balloon catheter in 11 male patients. Ten posterior and 2 anterior urethral strictures were treated; in 1 patients several narrowings coexisted at various levels. Etiology was inflammatory in 4 cases, iatrogen in 3, post-traumatic in 2, and equivocal in 2. The patients were studied both before and soon after dilatation by means of retrograde and voiding cystourethrogram and uroflowgraphy; the follow-up (2-14 months) was performed by urodynamic alone. In all cases, dilatation was followed by the restoration of urethral gauge, together with prompt functional improvement of urodynamic parameters. The latter result subsisted in time in 9 patients. In 2 cases recurrences were observed demonstrated at once by clinics and urodynamics. Both lesions were successfully re-treated. Neither early not late complication occurred. In spite of the limited material, the valuable results obtained, together with the absence of complications, the peculiar morphology of recurrences, and the chance of repeating it make the procedure advisable as a valid alternative to conventional techniques for these pathologies

Time dilation in quantum systems and decoherence

International Nuclear Information System (INIS)

Pikovski, Igor; Zych, Magdalena; Costa, Fabio; Brukner, Časlav

2017-01-01

Both quantum mechanics and general relativity are based on principles that defy our daily intuitions, such as time dilation, quantum interference and entanglement. Because the regimes where the two theories are typically tested are widely separated, their foundational principles are rarely jointly studied. Recent works have found that novel phenomena appear for quantum particles with an internal structure in the presence of time dilation, which can take place at low energies and in weak gravitational fields. Here we briefly review the effects of time dilation on quantum interference and generalize the results to a variety of systems. In addition, we provide an extended study of the basic principles of quantum theory and relativity that are of relevance for the effects and also address several questions that have been raised, such as the description in different reference frames, the role of the equivalence principle and the effective irreversibility of the decoherence. The manuscript clarifies some of the counterintuitive aspects arising when quantum phenomena and general relativistic effects are jointly considered. (paper)

Achalasia of the cardia: experience with hydrostatic balloon dilatation in children

Energy Technology Data Exchange (ETDEWEB)

Upadhyaya, Manasvi; Sajwany, Mohammed Jaffer [Department of Paediatric Surgery, Royal Hospital, Muscat (Oman); Fataar, Shadley [Department of Radiology, Royal Hospital, Muscat (Oman)

2002-06-01

Background: Achalasia is a disorder of oesophageal motility and is rare in children. The mainstay of therapy has been surgery with its attendant complications and long postoperative stay. Treatment by hydrostatic balloon dilatation, a less morbid procedure, has not found much favour. Objective: To review the overall efficacy of balloon dilatation for the treatment of achalasia in children and to highlight the high incidence of non-syndromic familial cases in Oman. Materials and methods: This is a retrospective study of all patients (n=12) with achalasia treated with balloon dilatation at the Royal Hospital, Muscat, from 1991 to 1999. The diagnosis was established with a barium oesophagogram. Dilatation was performed under general anaesthesia. On follow-up, the weight and recurrence of symptoms were recorded. Investigations were done only if the patients were symptomatic on follow-up. Recurrence was treated with further dilatation. Results: Of the 12 patients, 10 had excellent alleviation of symptoms. Two patients developed recurrence of symptoms which responded favourably to further dilatation. The average length of postoperative stay in the hospital was 2 days. Of these 12 patients, there were 3 sets of siblings who did not have any other syndromic associations. This group also showed very good prognosis. The mean follow-up period was 3.5 years for all patients. Conclusions: The results of balloon dilatation were very satisfactory. We also recommend this procedure when there is recurrence of symptoms. It has lower morbidity than surgery and hospital stay is shorter. Furthermore, we have a high rate of non-syndromic familial cases, all with a favourable outcome. (orig.)

Risk factors associated with refractoriness to esophageal dilatation for benign dysphagia.

Science.gov (United States)

Rodrigues-Pinto, Eduardo; Pereira, Pedro; Ribeiro, Armando; Lopes, Susana; Moutinho-Ribeiro, Pedro; Silva, Marco; Peixoto, Armando; Gaspar, Rui; Macedo, Guilherme

2016-06-01

Benign esophageal strictures need repeated dilatations to relieve dysphagia. Literature is scarce on the risk factors for refractoriness of these strictures. This study aimed to assess the risk factors associated with refractory strictures. This is a retrospective study of patients with benign esophageal strictures who were referred for esophageal dilatation over a period of 3 years. A total of 327 esophageal dilatations were performed in 103 patients; 53% of the patients reported dysphagia for liquids. Clinical success was achieved in 77% of the patients. There was a need for further dilatations in 54% of patients, being more frequent in patients with dysphagia for liquids [78 vs. 64%, P=0.008, odds ratio (OR) 1.930], in those with caustic strictures (89 vs. 70%, P=0.007, OR 3.487), and in those with complex strictures (83 vs. 70%, P=0.047, OR 2.132). Caustic strictures, peptic strictures, and complex strictures showed statistical significance in the multivariate analysis. Time until subsequent dilatations was less in patients with dysphagia for liquids (49 vs. 182 days, Pdysphagia for liquids [hazard ratio (HR) 1.506, P=0.004], in those with peptic strictures (HR 1.644, P=0.002), in those with caustic strictures (HR 1.581, P=0.016), and in patients with complex strictures (HR 1.408, P=0.046). Caustic, peptic, and complex strictures were associated with a greater need for subsequent dilatations. Time until subsequent dilatations was less in patients with dysphagia for liquids and in those with caustic, peptic, and complex strictures.

Achalasia of the cardia: experience with hydrostatic balloon dilatation in children

International Nuclear Information System (INIS)

Upadhyaya, Manasvi; Sajwany, Mohammed Jaffer; Fataar, Shadley

2002-01-01

Background: Achalasia is a disorder of oesophageal motility and is rare in children. The mainstay of therapy has been surgery with its attendant complications and long postoperative stay. Treatment by hydrostatic balloon dilatation, a less morbid procedure, has not found much favour. Objective: To review the overall efficacy of balloon dilatation for the treatment of achalasia in children and to highlight the high incidence of non-syndromic familial cases in Oman. Materials and methods: This is a retrospective study of all patients (n=12) with achalasia treated with balloon dilatation at the Royal Hospital, Muscat, from 1991 to 1999. The diagnosis was established with a barium oesophagogram. Dilatation was performed under general anaesthesia. On follow-up, the weight and recurrence of symptoms were recorded. Investigations were done only if the patients were symptomatic on follow-up. Recurrence was treated with further dilatation. Results: Of the 12 patients, 10 had excellent alleviation of symptoms. Two patients developed recurrence of symptoms which responded favourably to further dilatation. The average length of postoperative stay in the hospital was 2 days. Of these 12 patients, there were 3 sets of siblings who did not have any other syndromic associations. This group also showed very good prognosis. The mean follow-up period was 3.5 years for all patients. Conclusions: The results of balloon dilatation were very satisfactory. We also recommend this procedure when there is recurrence of symptoms. It has lower morbidity than surgery and hospital stay is shorter. Furthermore, we have a high rate of non-syndromic familial cases, all with a favourable outcome. (orig.)

Acoustic Emission Characteristics of Gas-Containing Coal during Loading Dilation Process

Directory of Open Access Journals (Sweden)

Z. Q. Yin

2015-12-01

Full Text Available Raw coal was used as the study object in this paper to identify the evolution characteristics of acoustic emission (AE during the dilation process of gas-containing coal. The coal specimens were stored in gas seal devices filled with gas at different pressures (0, 0.5, 1.0, and 1.5 MPa for 24 h prior to testing. Then, the specimens were tested in a rock-testing machine, and the deformation and crack fracture patterns were recorded by using strain gauges and an AE system. The axial and volumetric strains–stress curves were analyzed in relation to the AE and the failure mode. Results show that as gas pressure increases, the uniaxial compression strength and elasticity modulus of gas-containing coal decreases, whereas the Poisson’s ratio increases. In all the coal specimens, the dilation initiation stress decreases, and the dilation degree increases. During the dilation process, before the loaded coal specimens reach peak stress, and as the load increases, the changes in the specimens and in the AE energy parameter of specimens can be divided into four phases: crack closure deformation, elastic deformation, stable crack propagation, and unstable crack propagation (dilation process. Across the four phases, the AE energy increases evidently during crack closure and elastic deformation but decreases during stable crack propagation. As the gas pressure increases, the AE signal frequency increases from 4.5 KHz to 8.1 KHz during the dilation process. Thus, the gas presence in coal specimens exerts a significant influence on the closure of sample cracks and dilation damage.

[Tracheotomy-endoscop for dilatational percutaneous tracheotomy (TED)].

Science.gov (United States)

Klemm, Eckart

2006-09-01

While surgical tracheotomies are currently performed using state-of-the-art operative techniques, percutaneous dilatational tracheostomy (PDT) is in a rapidly evolving state with regard to its technology and the number of techniques available. This has resulted in a range of new complications that are difficult to quantify on a scientific basis, given the fact that more than half of the patients who are tracheotomized in intensive care units die from their underlying disease. The new Tracheotomy Endoscope (TED) is designed to help prevent serious complications in dilatational tracheotomies and facilitate their management. The endoscope has been specifically adapted to meet the require-ments of percutaneous dilatational tracheotomies. It is fully compatible with all current techniques of PDT. The method is easy to learn. The percutaneous dilatational tracheotomy with the Tracheotomy Endoscope is a seven-step procedure: Advantages of the Tracheotomy Endoscope: Injuries to the posterior tracheal wall ar impossible (tracheoesophageal fistulas, pneumothorax). Minor bleeding sites on the tracheal mucosa can be controlled with a specially curved suction-coagulation tube introudeced through the Tracheotomy Endoscope. In cases with heavy bleeding and a risk of aspiration, the rigid indwelling Tracheotomy Endoscope provides a secure route for reintubating the patient with a cuffed endotracheal tube. It also allows for rapid conversion to an open surgical procedure if necessary. All the parts are easy to clean and are autoclavable. This type of endoscopically guided PDT creates an optimal link between the specialties of intensive care medicine and otorhinolaryngology. The Tracheotomy Endoscope (TED) increases the standard of safety in PDT.

Percutaneous Dilational Tracheotomy in Solid-Organ Transplant Recipients.

Science.gov (United States)

Ozdemirkan, Aycan; Ersoy, Zeynep; Zeyneloglu, Pinar; Gedik, Ender; Pirat, Arash; Haberal, Mehmet

2015-11-01

Solid-organ transplant recipients may require percutaneous dilational tracheotomy because of prolonged mechanical ventilation or airway issues, but data regarding its safety and effectiveness in solid-organ transplant recipients are scarce. Here, we evaluated the safety, effectiveness, and benefits in terms of lung mechanics, complications, and patient comfort of percutaneous dilational tracheotomy in solid-organ transplant recipients. Medical records from 31 solid-organ transplant recipients (median age of 41.0 years [interquartile range, 18.0-53.0 y]) who underwent percutaneous dilational tracheotomy at our hospital between January 2010 and March 2015 were analyzed, including primary diagnosis, comorbidities, duration of orotracheal intubation and mechanical ventilation, length of intensive care unit and hospital stays, the time interval between transplant to percutaneous dilational tracheotomy, Acute Physiology and Chronic Health Evaluation II score, tracheotomy-related complications, and pulmonary compliance and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen. The median Acute Physiology and Chronic Health Evaluation II score on admission was 24.0 (interquartile range, 18.0-29.0). The median interval from transplant to percutaneous dilational tracheotomy was 105.5 days (interquartile range, 13.0-2165.0 d). The only major complication noted was left-sided pneumothorax in 1 patient. There were no significant differences in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen before and after procedure (170.0 [interquartile range, 102.2-302.0] vs 210.0 [interquartile range, 178.5-345.5]; P = .052). However, pulmonary compliance results preprocedure and postprocedure were significantly different (0.020 L/cm H2O [interquartile range, 0.015-0.030 L/cm H2O] vs 0.030 L/cm H2O [interquartile range, 0.020-0.041 L/cm H2O); P = .001]). Need for sedation significantly decreased after tracheotomy (from 17 patients [54.8%] to

Fluoroscopy-guided balloon dilation in patients with Eustachian tube dysfunction

Energy Technology Data Exchange (ETDEWEB)

Kim, Kun Yung; Tsauo, Jiaywei; Song, Ho-Young [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Park, Hong Ju; Kang, Woo Seok [University of Ulsan College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, Seoul (Korea, Republic of); Park, Jung-Hoon [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); University of Ulsan College of Medicine, Department of Biomedical Engineering Research Center, Asan Medical Center, Seoul (Korea, Republic of); Wang, Zhe [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Tianjin Medical University General Hospital, Department of Radiology (China)

2018-03-15

To prospectively evaluate the technical feasibility and safety of fluoroscopy-guided balloon dilation in patients with Eustachian tube (ET) dysfunction. Patients who could not do a Valsalva manoeuvre for more than 6 months and diagnosed with chronic otitis media or ET dysfunction were prospectively enrolled. A 0.035-in. guide wire and 6-mm long balloon catheter with a diameter of 2 mm were used to dilate the cartilaginous portion of the ET under fluoroscopic guidance. The balloon was inflated by manual injection twice for 1 min each time. Clinical outcomes were assessed by the patient's ability to perform a Valsalva manoeuvre, and symptoms were assessed using the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score. Balloon dilation was attempted in a total of ten adult patients from October 2016 to March 2017. Technical success was achieved in all procedures (10/10). Ninety percent (9/10) of the balloons were fully dilated without waist deformity. There were no major complications. All patients were able to perform a Valsalva manoeuvre at the time of their last visit and/or improvement of at least one ETDQ-7 score. Fluoroscopy-guided balloon dilation seems to be technically feasible and safe in the treatment of ET dysfunction. (orig.)

Stress-Dilatancy of Cambria Sand for Triaxial Tests at High Pressures

Science.gov (United States)

Szypcio, Zenon

2017-12-01

In this paper, the stress-dilatancy relationship of Cambria sand for drained triaxial compression and extension tests at high stress level is investigated. The stress dilatancy relationship is obtained by use of frictional state theory and experimental tests data published in literature. It is shown that stress-dilatancy relationship is bilinear, described by three parameters of frictional state theory: critical frictional angle and two other parameters. It is accepted that critical friction angle is independent of confining pressure. The two additional parameters are strongly dependent on confining pressure and different for initial and advanced stages. The point at which the values of these parameters change is termed as Transformation Shear Point. This point is not simply visible either in stress ratio-strain or the volume strain-shear strain relationship which are traditionally shown in soil mechanics papers. Transformation Shear Point is very characteristic in stress ratio-plastic dilatancy plane. Thus, stress ratio- plastic dilatancy is very important for describing stress-strain behaviour of soils. The relationship shown in the paper can be used in soil modelling in the future.

Computerized determination of 3-D connectivity density in human iliac crest bone biopsies

DEFF Research Database (Denmark)

Thomsen, J.S.; Mosekilde, Li.; Barlach, J.

1996-01-01

Combining the physical disector principle with an algorithm for automatic non-linear alignment of disector pairs we have developed a software system for direct measurement of 3D connectivity densities in iliac crest bone biopsies. The method was applied to biopsies from 14 non-selected autopsy...... cases: 7 men (age range 20-84 yr) and 7 women (age range 20-86 yr). The study reveals decreases in both trabecular bone mass and connectivity density with age in women....

Use of multi-detector CT angiography in identification and classification of aorto-iliac diseases; clinical and surgical application

Directory of Open Access Journals (Sweden)

Reda Abdelsamie Alarabawy

2016-03-01

Conclusions: MDCT angiography is excellent noninvasive scanning technique for patients suspected of having aorto-iliac occlusive disease, with higher spatial resolution and faster acquisition times, allowing assessment of the aorta and its branches with greater accuracy than other modalities.

Construction of wavelets with composite dilations

International Nuclear Information System (INIS)

Wu Guochang; Li Zhiqiang; Cheng Zhengxing

2009-01-01

In order to overcome classical wavelets' shortcoming in image processing problems, people developed many producing systems, which built up wavelet family. In this paper, the notion of AB-multiresolution analysis is generalized, and the corresponding theory is developed. For an AB-multiresolution analysis associated with any expanding matrices, we deduce that there exists a singe scaling function in its reducing subspace. Under some conditions, wavelets with composite dilations can be gotten by AB-multiresolution analysis, which permits the existence of fast implementation algorithm. Then, we provide an approach to design the wavelets with composite dilations by classic wavelets. Our way consists of separable and partly nonseparable cases. In each section, we construct all kinds of examples with nice properties to prove our theory.

Umbilical vein draining into the inferior vena cava via the internal iliac vein, bypassing the liver

International Nuclear Information System (INIS)

Currarino, G.; Stannard, M.W.; Texas Univ., Dallas, TX; Kolni, H.

1991-01-01

This is the third report of an anomalous umbilical vein draining ectopically in a left pelvic vein, probably the left internal iliac, and through the inferior vena cava into the right atrium. The anomaly was encountered in a newborn infant with nonimmune hydrops fetalis, hypertrophic cardiomyopathy, multiorgan failure and possibly Noonan Syndrome. (orig.)

Umbilical vein draining into the inferior vena cava via the internal iliac vein, bypassing the liver

Energy Technology Data Exchange (ETDEWEB)

Currarino, G.; Stannard, M.W. (Children' s Medical Center, Dallas, TX (United States). Dept. of Radiology Texas Univ., Dallas, TX (United States). Southwestern Medical Center); Kolni, H. (Methodist Hospital, Dallas, TX (United States). Dept. of Pediatrics)

1991-05-01

This is the third report of an anomalous umbilical vein draining ectopically in a left pelvic vein, probably the left internal iliac, and through the inferior vena cava into the right atrium. The anomaly was encountered in a newborn infant with nonimmune hydrops fetalis, hypertrophic cardiomyopathy, multiorgan failure and possibly Noonan Syndrome. (orig.).

Left coronary aneurysmal dilation and subaortic stenosis in a dog.

Science.gov (United States)

Hernandez, Juan L; Bélanger, Marie-Claude; Benoit-Biancamano, Marie-Odile; Girard, Christiane; Pibarot, Philippe

2008-06-01

A 6-month-old German shepherd dog was referred for evaluation of a cardiac murmur. Upon physical examination, the auscultated heart rate was 120 beats/min, and a grade IV/VI systolic heart murmur with a point of maximal intensity over the left heart base radiating up the neck was heard. The standard echocardiographic examination showed subaortic stenosis and an anechoic tubular structure extending from the sinus of Valsalva to the left ventricular posterior wall. Aneurysmal left coronary artery (CA) was confirmed by angiography. The dog was euthanized and post-mortem examination showed severe dilatation of the proximal left CA and confirmed the subaortic stenosis. Histopathology did not demonstrate abnormalities in the walls of the CA, aorta or pulmonary artery. The exact cause of the CA aneurysmal dilation remains unknown. Subaortic stenosis, elevated coronary vascular resistance or a congenital anomaly may have contributed to the dilation. To our knowledge, coronary aneurysmal dilation has never been described in dogs. Standard echocardiography provides reliable information on coronary anatomy.

Aortic dilatation in patients with Turner's syndrome without structural cardiac anomaly.

Science.gov (United States)

Alami Laroussi, Nassiba; Dahdah, Nagib; Dallaire, Frédéric; Thérien, Johanne; Fournier, Anne

2016-03-01

Dilatation of the ascending aorta is described in Turner's syndrome with variable prevalence (6.8-32%). Reported series typically include patients with associated cardiac anomalies. To characterise the prevalence, age of onset, and the progress of dilatation of the ascending aorta in Turner's syndrome patients free of structural cardiac anomalies. Potential risk factors such as karyotype and growth hormone therapy were analysed for correlation with aortic dilatation. We carried out a retrospective study with data collected from medical records and echocardiography studies. Patients with Tuner's syndrome followed-up between 1992 and 2010 with at least two echocardiography studies were eligible. Patients with previous cardiac surgery or under anti-hypertensive medication were excluded. Ascending aorta diameter measurements were adjusted for body surface area, and dilatation was defined as Z-score>2. The study population consisted of 44 patients, aged 11.9±7.4 years at the first echocardiogram and 17.9±7.3 years at the last follow-up, with a follow-up duration of 6.0±3.7 years. A total of 13 (29.5%) patients exhibited aortic dilatation during follow-up, suggesting an actuarial estimate of the freedom from aortic dilatation dropping from 86 to 70% and then to 37% at 10, 20, and 30 years of age, respectively. There was no statistically significant impact of karyotype or growth hormone therapy on aortic Z-score progression. The prevalence of dilatation of the ascending aorta in Turner's syndrome patients free of structural aortic anomalies is comparable with published data with associated lesions. Growth hormone therapy and karyotype had no significant impact; however, longitudinal follow-up is warranted.

Meaning of ureter dilatation during ultrasonography in infants for evaluating vesicoureteral reflux

Energy Technology Data Exchange (ETDEWEB)

Park, Yae-won, E-mail: yaewonpark@yuhs.ac [Department of Radiology and Research Institute of Radiological Science, Severance Children' s Hospital, Yonsei University College of Medicine, 120-752 Seoul (Korea, Republic of); Kim, Myung-Joon, E-mail: mjkim@yuhs.ac [Department of Radiology and Research Institute of Radiological Science, Severance Children' s Hospital, Yonsei University College of Medicine, 120-752 Seoul (Korea, Republic of); Han, Sang Won, E-mail: swhan58@yuhs.ac [Department of Pediatric Urology, Severance Children' s Hospital, Yonsei University College of Medicine, 120-752 Seoul (Korea, Republic of); Kim, Dong Wook, E-mail: kimdw@yuhs.ac [Biostatistics Collaboration Unit, Yonsei University, College of Medicine, 120-752 Seoul (Korea, Republic of); Lee, Mi-Jung, E-mail: mjl1213@yuhs.ac [Department of Radiology and Research Institute of Radiological Science, Severance Children' s Hospital, Yonsei University College of Medicine, 120-752 Seoul (Korea, Republic of)

2015-02-15

Purpose: To investigate the meaning of ureter dilatation during ultrasonography (US) in infants for evaluating vesicoureteral reflux (VUR). Materials and methods: We retrospectively reviewed abdominal US images of infants who were diagnosed with urinary tract infection (UTI group) or only hydronephrosis without UTI (control group). Hydronephrosis (graded 0–4) and ureter dilatation (present or absent) were evaluated on each side with US. Voiding cystourethrography (VCUG) within 3 months time interval with US was also reviewed and VUR was graded (0–5) on each side. Hydronephrosis, ureter dilatation, and VUR were then compared between the two groups. Results: Four hundred and three infants (142 in the UTI group and 261 in the control group) were included and VCUG was performed in 129 infants (68 in UTI and 61 in control groups). VUR grades were not different between the two groups (p = 0.252). Hydronephrosis grade was not related to VUR in either group (p > 0.05). However, ureter dilatation had a significant relationship with VUR in the UTI group (p = 0.015), even among patients with a high-grade VUR (p = 0.005). Whereas, ureter dilatation was not associated with VUR in the control group (p = 0.744). The relationship between ureter dilatation and VUR was different between the two groups for both all grades (p = 0.014) and high-grade (p = 0.004) VUR. Ureter dilatation had 66.7% sensitivity, 80.3% specificity, and 79.4% accuracy for evaluating high-grade VUR in the UTI group. Conclusion: Ureter dilatation on US can be a helpful finding for detecting VUR in infants with UTI, but not infants without UTI.

Meaning of ureter dilatation during ultrasonography in infants for evaluating vesicoureteral reflux

International Nuclear Information System (INIS)

Park, Yae-won; Kim, Myung-Joon; Han, Sang Won; Kim, Dong Wook; Lee, Mi-Jung

2015-01-01

Purpose: To investigate the meaning of ureter dilatation during ultrasonography (US) in infants for evaluating vesicoureteral reflux (VUR). Materials and methods: We retrospectively reviewed abdominal US images of infants who were diagnosed with urinary tract infection (UTI group) or only hydronephrosis without UTI (control group). Hydronephrosis (graded 0–4) and ureter dilatation (present or absent) were evaluated on each side with US. Voiding cystourethrography (VCUG) within 3 months time interval with US was also reviewed and VUR was graded (0–5) on each side. Hydronephrosis, ureter dilatation, and VUR were then compared between the two groups. Results: Four hundred and three infants (142 in the UTI group and 261 in the control group) were included and VCUG was performed in 129 infants (68 in UTI and 61 in control groups). VUR grades were not different between the two groups (p = 0.252). Hydronephrosis grade was not related to VUR in either group (p > 0.05). However, ureter dilatation had a significant relationship with VUR in the UTI group (p = 0.015), even among patients with a high-grade VUR (p = 0.005). Whereas, ureter dilatation was not associated with VUR in the control group (p = 0.744). The relationship between ureter dilatation and VUR was different between the two groups for both all grades (p = 0.014) and high-grade (p = 0.004) VUR. Ureter dilatation had 66.7% sensitivity, 80.3% specificity, and 79.4% accuracy for evaluating high-grade VUR in the UTI group. Conclusion: Ureter dilatation on US can be a helpful finding for detecting VUR in infants with UTI, but not infants without UTI

Long-term effect of urethral dilatation and internal urethrotomy for urethral strictures.

Science.gov (United States)

Veeratterapillay, Rajan; Pickard, Rob S

2012-11-01

Urethral dilatation and direct visual internal urethrotomy (DVIU) are widely used minimally invasive options to manage men with urethral strictures. Advances in open urethroplasty with better long-term cure rates have fuelled the continuing debate as to which treatment is best for primary and recurrent urethral strictures. We reviewed recent literature to identify contemporary practice of urethral dilatation and DVIU and the long-term outcome of these procedures. Systematic literature search for the period January 2010 to December 2011 showed that urethral dilatation and DVIU remain frequently used treatment options as confirmed by surveys of urologists in the USA and the Netherlands. Multiple reports of laser DVIU confirm the safety of this approach but long-term data were lacking. Stricture free rates from urethra dilatation and DVIU vary from 10 to 90% at 12 months, although adjunctive intermittent self-dilatation can reduce time to recurrence. Although quality-of-life benefit appears good in the short term, repeated procedures may harm sexual function in the long-term. Urethral dilatation and DVIU remain widely used in urethral stricture management but high-level comparative evidence of benefit and harms against urethroplasty in the short and long-term is still lacking.

Can FDG-PET/CT replace blind bone marrow biopsy of the posterior iliac crest in Ewing sarcoma?

NARCIS (Netherlands)

Kasalak, Omer; Glaudemans, Andor W. J. M.; Overbosch, Jelle; Jutte, Paul C.; Kwee, Thomas C.

OBJECTIVE: To determine and compare the value of (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) to blind bone marrow biopsy (BMB) of the posterior iliac crest in detecting metastatic bone marrow involvement in newly diagnosed Ewing sarcoma. MATERIALS AND

Acute gastric dilatation secondary to septicemia in newborn: A rare ...

African Journals Online (AJOL)

... case of acute gastric dilatation that developed in a two-days old child who was born premature and was suffering from septicemia and respiratory distress. The causes and the differential diagnosis of the rare condition are discussed. Keywords: Acute, dilatation, gastric, newborn. African Journal of Paediatric Surgery Vol.

The impact law of confining pressure and plastic parameter on Dilatancy of rock

Science.gov (United States)

Wang, Bin; Zhang, Zhenjie; Zhu, Jiebing

2017-08-01

Based on cyclic loading-unloading triaxle test of marble, the double parameter dilation angle model is established considering confining pressure effect and plastic parameter. Research shows that not only the strength but also the militancy behavior is highly depended on its confining pressure and plastic parameter during process of failure. Dilation angle evolution law shows obvious nonlinear characteristic almost with a rapid increase to the peak and then decrease gradually with plastic increasing, and the peak dilation angle value is inversely proportional with confining pressure. The proposed double parameter nonlinear dilation angle model can be used to well describe the Dilatancy of rock, which helps to understand the failure mechanism of surrounding rock mass and predict the range of plastic zone.

Fluid dynamics of dilatant fluid

DEFF Research Database (Denmark)

Nakanishi, Hiizu; Nagahiro, Shin-ichiro; Mitarai, Namiko

2012-01-01

of the state variable, we demonstrate that the model can describe basic features of the dilatant fluid such as the stress-shear rate curve that represents discontinuous severe shear thickening, hysteresis upon changing shear rate, and instantaneous hardening upon external impact. An analysis of the model...

Sciatica caused by a dilated epidural vein: MR findings

Energy Technology Data Exchange (ETDEWEB)

Demaerel, P.; Petre, C.; Wilms, G. [Dept. of Radiology, Catholic University of Leuven (Belgium); Plets, C. [Dept. of Neurosurgery, Catholic University of Leuven (Belgium)

1999-02-01

We report the MR imaging findings in a 41-year-old woman presenting with sudden low back pain and sciatica. At surgery a dilated epidural vein was found compressing the nerve root. The MR findings may suggest the diagnosis. Magnetic resonance imaging of a dilated epidural vein or varix causing sciatica has not been reported until now. (orig.) (orig.) With 1 fig., 4 refs.

Segmental dilatation of the ileum covered almost entirely by gastric mucosa: report of a case.

Science.gov (United States)

Kobayashi, Tsutomu; Uchida, Nobuyuki; Shiojima, Masayuki; Sasamoto, Hajime; Shimura, Tatsuo; Takahasi, Atsusi; Kuwano, Hiroyuki

2007-01-01

A 13-year-old boy was referred to our hospital for investigation of intermittent abdominal colic pain and vomiting. He underwent an emergency laparotomy, which revealed a volvulus and segmental dilatation of the ileum. The dilated intestine was not associated with poor intestinal circulation. Because the dilated ileum did not seem to be the cause of the volvulus, we simply released the volvulus. However, after surgery, the patient still suffered from persistent abdominal pain, further episodes of volvulus, and invagination of the dilated ileum. Thus, we performed a second operation to resect the segmental dilatation of the ileum. Pathological examination revealed that most of the mucosa of the dilated ileum was composed of ectopic gastric mucosa. We postulate that the ectopic gastric mucosa led to the formation of segmental dilatation of the ileum.

Outcomes of the Endovascular Treatment of Stenotic Lesions versus Chronic Total Occlusions in the Iliac Sector.

Science.gov (United States)

Revuelta Suero, Sergio; Martínez López, Isaac; Hernández Mateo, Manuela; Marqués de Marino, Pablo; Cernuda Artero, Iñaki; Cabrero Fernández, Maday; Serrano Hernando, Francisco Javier

2016-07-01

This study compares outcomes of the endovascular treatment (EVT) of iliac artery occlusive disease according to whether the treated lesion is a stenosis or a chronic total occlusion (CTO). Patients undergoing EVT from 2003 to 2013 for iliac artery occlusive disease were identified and the lesions treated stratified into stenotic (Group 1, n = 375) or CTO (Group 2, n = 87). Patients were followed clinically and hemodynamically (thigh-brachial index, TBI). Comorbidities, procedural factors, and outcomes were compared between the 2 groups using Kaplan-Meier, Breslow, and Cox models. Four hundred sixty-two iliac endovascular procedures in 378 patients were included in a retrospective study. The 2 groups only differed in preprocedural TBI [0.77 (Group 1) vs. 0.67 (Group 2), P P2) patency rates [P1 93.0% and 85.8% vs. 83.1% and 74.7%, hazard ratio (HR) 1.90 (1.15-3.14), P = 0.018; P2 97.8% and 96.8% vs. 93.0% and 87.4%, HR 2.86 (1.39-5.90), P = 0.007] and freedom from reintervention (FFR) rates [91.6% and 83.5% vs. 84.1% and 78.9%, HR 1.51 (0.90-2.53), P = 0.132]. In a multivariate analysis, CTO showed a worse P2 than stenotic lesions [HR 2.81 (1.17-6.76), P = 0.021], yet no differences emerged in P1 [HR 1.41 (0.76-2.63), P = 0.277] or FFR [HR 1.43 (0.79-2.57), P = 0.237]. A lower preprocedural TBI was correlated with a greater risk of EVT failure in terms of patency and FFR (P 40 mm were related to a worse stent patency. Copyright © 2016 Elsevier Inc. All rights reserved.

Transposition of the acetabulum after iliac ischial osteotomy in the treatment of hip dysplasia in infants

Directory of Open Access Journals (Sweden)

Vladimir E Baskov

2016-06-01

Conclusion. Transposition of the acetabulum after iliac and ischial pelvic osteotomy is an effective treatment for dysplastic instability of the acetabulum in children aged 9–16 years. The procedure is indicated when it is necessary to rotate the acetabular fragment by more than 25°, and there is no need for hip medialization.

Eder Puestow dilatation of benign rectal stricture following anterior resection.

Science.gov (United States)

Woodward, A; Tydeman, G; Lewis, M H

1990-01-01

Benign anastomotic stricture following anterior resection can be difficult to manage when the stricture is proximal. The acceptable surgical options are either a redo low resection with its accompanying hazards or, alternatively, the formation of a permanent colostomy. Although dilatation of such strictures is possible by blind passage of metal bougies, the authors believe that this technique must be regarded as hazardous. A technique of dilatation is described that is usually reserved for esophageal stricture, namely, Eder Puestow dilatation over a guide wire inserted under direct vision. Although this technique may not be without risk, this readily available equipment may be valuable in making a further resection unnecessary.

Application of INAA in the assessment of selected elements in cancellous bone of human iliac crest

International Nuclear Information System (INIS)

Zaichick, V.

2007-01-01

The effect of age and sex was investigated on the concentration of chemical elements in intact cancellous bone of iliac crest of 74 relatively healthy, 15-55 years old women (n = 29) and men (n = 45). Concentrations of Ca, Cl, K, Mg, Mn, Na, P, and Sr in bone samples were determined by instrumental neutron activation analysis using short-lived radionuclides. Mean values (M±S.E.M.) of the mass fraction of the investigated elements (on dry weight basis) for female and male all together were: 127±4 g/kg, 1620±80 mg/kg, 1310±70 mg/kg, 1550±50 mg/kg, <0.32±0.02 mg/kg, 4240±110 mg/kg, 61.8±1.8 g/kg, and 235±18 mg/kg, respectively. The statistically significant (≤0.05) decrease of Ca, Mg, and P concentrations in the iliac cancellous bone with age was found only for women. Sex-related comparison has shown that the mean values of Mg mass fractions in male bone samples were less than in female ones. (author)

Endoscope-guided pneumatic dilation for treatment of esophageal achalasia

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Chuah, Seng-Kee; Wu, Keng-Liang; Hu, Tsung-Hui; Tai, Wei-Chen; Changchien, Chi-Sin

2010-01-01

Pneumatic dilation (PD) is considered to be the first line nonsurgical therapy for achalasia. The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial force. The endoscope-guided procedure is done without fluoroscopic control. Clinicians usually use a low-compliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal achalasia. It has the advantage of determining mucosal injury during the dilation process, so that a repeat endoscopy is not needed to assess the mucosal tearing. Previous studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment modalities. Although the results may be promising, long-term follow-up is required in the near future. PMID:20101764

Esophagogastric junction distensibility measurements during hydraulic dilation therapy in achalasia patients

NARCIS (Netherlands)

Kappelle, W.F.; Bogte, A.; Siersema, P.D.

2016-01-01

Increasing evidence suggests that esophagogastric junction (EGJ) distensibility is predictive of long-term clinical success after achalasia treatment. A new commercially available hydraulic dilation balloon is capable of measuring EGJ opening diameters whilst simultaneously dilating the EGJ.

Sports-related flow limitations in the iliac arteries in endurance athletes : aetiology, diagnosis, treatment and future developments

NARCIS (Netherlands)

Bender, M.H.M.; Schep, G.; Vries, de W.R.; Hoogeveen, A.R.; Wijn, P.F.F.

2004-01-01

Approximately one in five top-level cyclists will develop sports-related flow limitations in the iliac arteries. These flow limitations may be caused by a vascular lumen narrowing due to endofibrotic thickening of the intima and/or by kinking of the vessels. In some athletes, extreme vessel length

Pupil dilation reveals top-down attentional load during spatial monitoring.

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Lisi, Matteo; Bonato, Mario; Zorzi, Marco

2015-12-01

It has long been known that the diameter of human pupil enlarges with increasing effort during the execution of a task. This has been observed not only for purely mechanical effort but also for mental effort, as for example the computation of arithmetic problems with different levels of difficulty. Here we show that pupil dilation reflects changes in visuospatial awareness induced by attentional load during multi-tasking. In the single-task condition, participants had to report the position of lateralized, briefly presented, masked visual targets ("right", "left", or "both" sides). In the multitasking conditions, participants also performed additional tasks, either visual or auditory, to increase the attentional load. Sensory stimulation was kept constant across all conditions to rule out the influence of low-level factors. Results show that event-related pupil dilation strikingly increased with task demands, mirroring a concurrent decrease in visuospatial awareness. Importantly, pupil dilation significantly differed between two dual-task conditions that required to process the same number of stimuli but yielded differed levels of accuracy (difficulty). In contrast, pupil dilation did not differ between two conditions which were equally challenging but differed both in the modality of the dual task (auditory vs. visual) and in the number of stimuli to be attended. We conclude that pupil dilation genuinely reflects the top-down allocation of supramodal attentional resources. Copyright © 2015 Elsevier B.V. All rights reserved.

Dilatations and factorizable equations

International Nuclear Information System (INIS)

Humi, Mayer

2005-01-01

In this paper, we show that the dilatation operator in one dimension can be used to enlarge the Lie algebra generated by the raising and lowering operators for some classes of special functions. As a result, we are able to derive new recursion relations and addition formulae for these functions. Furthermore, we derive generalized ladder operators for these functions under coordinate stretching and translations

Genetics Home Reference: familial dilated cardiomyopathy

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... Dilated cardiomyopathy: the complexity of a diverse genetic architecture. Nat Rev Cardiol. 2013 Sep;10(9):531- ... Health & Human Services National Institutes of Health National Library of Medicine Lister Hill National Center for Biomedical ...

21 CFR 876.5365 - Esophageal dilator.

Science.gov (United States)

2010-04-01

... and weighted with mercury or a metal olive-shaped weight that slides on a guide, such as a string or... esophageal or gastrointestinal bougies and the esophageal dilator (metal olive). (b) Classification. Class II...

Retrograde transurethral balloon dilation of the prostate

International Nuclear Information System (INIS)

Castaneda, F.; Reddy, P.; Wasserman, N.F.; Lund, G.; Hulbert, J.; Hunter, D.; Castaneda-Zuniga, W.R.; Amplatz, K.

1986-01-01

A series of patients with documented benign prostatic hypertrophy evaluated by urodynamic studies, voiding cystourethrography, retrograde urethrography, and MR imaging underwent dilation performed using a retrograde transurethral approach with 25-mm balloon dilators inflated at a pressure of 3-4 atm for 10 minutes. Immediately after the procedure, retrograde and voiding cystourethrography as well as MR imaging were performed. A Foley catheter was left in place for 24 hours. Complete relief of symptoms has occurred in all of the patients during the follow-up period. No significant complications other than transient hematuria resulted from the procedure. Results of the comparison studies and of MR imaging are discussed

Aortic dilatation in Turner syndrome: the role of MRI in early recognition

International Nuclear Information System (INIS)

Chalard, Francois; Ferey, Solene; Kalifa, Gabriel; Teinturier, Cecile

2005-01-01

Aortic dilatation and dissection are rare but important complications of Turner syndrome that increase the risk of sudden death in young patients. To assess the value of aortic MRI in patients with Turner syndrome; in particular to demonstrate early aortic dilatation. A total of 21 patients with Turner syndrome underwent MRI of the thoracic aorta with measurement of vessel diameter at four levels. Measurements were normal for age in 15 cases, two patients presented with values at the upper limit of normal and four had obvious dilatation of the ascending aorta. All were symptom free. MRI allows the non-invasive demonstration of early aortic dilatation, which may lead to earlier surgery in asymptomatic individuals. (orig.)

Aortic dilatation in Turner syndrome: the role of MRI in early recognition

Energy Technology Data Exchange (ETDEWEB)

Chalard, Francois; Ferey, Solene; Kalifa, Gabriel [Saint Vincent de Paul Hospital, Department of Paediatric Radiology, Paris Cedex 14 (France); Teinturier, Cecile [Saint Vincent de Paul Hospital, Department of Paediatric Endocrinology, Paris (France)

2005-03-01

Aortic dilatation and dissection are rare but important complications of Turner syndrome that increase the risk of sudden death in young patients. To assess the value of aortic MRI in patients with Turner syndrome; in particular to demonstrate early aortic dilatation. A total of 21 patients with Turner syndrome underwent MRI of the thoracic aorta with measurement of vessel diameter at four levels. Measurements were normal for age in 15 cases, two patients presented with values at the upper limit of normal and four had obvious dilatation of the ascending aorta. All were symptom free. MRI allows the non-invasive demonstration of early aortic dilatation, which may lead to earlier surgery in asymptomatic individuals. (orig.)

Aortic dilatation in Turner syndrome: the role of MRI in early recognition.

Science.gov (United States)

Chalard, François; Ferey, Solène; Teinturier, Cécile; Kalifa, Gabriel

2005-03-01

Aortic dilatation and dissection are rare but important complications of Turner syndrome that increase the risk of sudden death in young patients. To assess the value of aortic MRI in patients with Turner syndrome; in particular to demonstrate early aortic dilatation. A total of 21 patients with Turner syndrome underwent MRI of the thoracic aorta with measurement of vessel diameter at four levels. Measurements were normal for age in 15 cases, two patients presented with values at the upper limit of normal and four had obvious dilatation of the ascending aorta. All were symptom free. MRI allows the non-invasive demonstration of early aortic dilatation, which may lead to earlier surgery in asymptomatic individuals.

Enhancement of the repair of dog alveolar cleft by an autologous iliac bone, bone marrow-derived mesenchymal stem cell, and platelet-rich fibrin mixture.

Science.gov (United States)

Yuanzheng, Chen; Yan, Gao; Ting, Li; Yanjie, Fu; Peng, Wu; Nan, Bai

2015-05-01

Autologous bone graft has been regarded as the criterion standard for the repair of alveolar cleft. However, the most prominent issue in alveolar cleft treatment is the high absorption rate of the bone graft. The authors' objective was to investigate the effects of an autologous iliac bone, bone marrow-derived mesenchymal stem cell, and platelet-rich fibrin mixture on the repair of dog alveolar cleft. Twenty beagle dogs with unilateral alveolar clefts created by surgery were divided randomly into four groups: group A underwent repair with an autologous iliac bone, bone marrow-derived mesenchymal stem cell, and platelet-rich fibrin mixture; group B underwent repair with autologous iliac bone and bone marrow-derived mesenchymal stem cells; group C underwent repair with autologous iliac bone and platelet-rich fibrin; and group D underwent repair with autologous iliac bone as the control. One day and 6 months after transplantation, the transplant volumes and bone mineral density were assessed by quantitative computed tomography. All of the transplants were harvested for hematoxylin and eosin staining 6 months later. Bone marrow-derived mesenchymal stem cells and platelet-rich fibrin transplants formed the greatest amounts of new bone among the four groups. The new bone formed an extensive union with the underlying maxilla in groups A, B, and C. Transplants with the bone marrow-derived mesenchymal stem cells, platelet-rich fibrin, and their mixture retained the majority of their initial volume, whereas the transplants in the control group showed the highest absorption rate. Bone mineral density of transplants with the bone marrow-derived mesenchymal stem cells, platelet-rich fibrin, and their mixture 6 months later was significantly higher than in the control group (p platelet-rich fibrin mixed transplants. Hematoxylin and eosin staining showed that the structure of new bones formed the best in group A. Both bone marrow-derived mesenchymal stem cells and platelet

Balloon dilatation in esophageal strictures in epidermolysis bullosa and the role of anesthesia.

Science.gov (United States)

Gollu, Gulnur; Ergun, Ergun; Ates, Ufuk; Can, Ozlem S; Dindar, Huseyin

2017-02-01

Esophageal involvement, which causes stricture, is a complication in epidermolysis bullosa. This causes dysphagia and malnutrition and leads to deterioration of skin lesions in these patients. The charts of 11 patients with epidermolysis bullosa and esophageal stricture who were included into dilatation program between 2003 and 2015 were retrospectively reviewed. Seven of the patients were female and four were male. The median age was 14 (2-32) years. The mean body weight of patients was 27.8 (9-51) kg. The location and number of strictured parts of the esophagus were previously evaluated with upper gastrointestinal contrast study and after that flexible endoscopy was used for dilatation. Eight patients had middle esophageal, three patients had proximal esophageal and one of them had both proximal and middle esophageal strictures. The strictures were dilated 56 times in total (mean 5 times). One patient underwent gastrostomy and was medically followed-up after a perforation occurrence during the dilatation procedure. In a 32-year-old female patient, colon interposition was performed after four dilatations since optimal nutritional and developmental status could not be achieved. The dilatation program of nine patients is still in progress. Seven of them can easily swallow solid food but two of them have some difficulties in swallowing between dilatations. One patient rejected the program and quitted, while one patient refused colon interposition and died because of complications related to amyloidosis during the dilatation program. After resolution of the swallowing problem, skin lesions were observed to heal quickly. Epidermolysis bullosa is a rare cause of dysphagia. Esophageal balloon dilatation with flexible endoscopy is a safe and efficient method in patients with this condition. © 2016 International Society for Diseases of the Esophagus.

Canine candidate genes for dilated cardiomyopathy: annotation of and polymorphic markers for 14 genes

OpenAIRE

Wiersma, Anje C; Leegwater, Peter AJ; van Oost, Bernard A; Ollier, William E; Dukes-McEwan, Joanna

2007-01-01

Abstract Background Dilated cardiomyopathy is a myocardial disease occurring in humans and domestic animals and is characterized by dilatation of the left ventricle, reduced systolic function and increased sphericity of the left ventricle. Dilated cardiomyopathy has been observed in several, mostly large and giant, dog breeds, such as the Dobermann and the Great Dane. A number of genes have been identified, which are associated with dilated cardiomyopathy in the human, mouse and hamster. Thes...

Endoscopic minor papilla balloon dilation for the treatment of symptomatic pancreas divisum.

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Yamamoto, Natsuyo; Isayama, Hiroyuki; Sasahira, Naoki; Tsujino, Takeshi; Nakai, Yousuke; Miyabayashi, Koji; Mizuno, Suguru; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

2014-08-01

A subpopulation of patients with pancreas divisum experience symptomatic events such as recurrent acute pancreatitis and chronic pancreatitis. Minor papilla sphincterotomy has been reported as being an effective treatment. The aim of this study was to evaluate the safety and efficacy of endoscopic balloon dilation for the minor papilla. Between 2000 and 2012, 16 patients were retrospectively included in this study. After endoscopic balloon dilation for the minor papilla was received, a pancreatic stent or a nasal pancreatic drainage catheter was placed for 1 week. If a stricture or obstruction was evident, it was treated with balloon dilation followed by long-term stent placement (1 year). When an outflow of pancreatic juice was disturbed by a pancreatic stone, endoscopic stone extraction was performed. Balloon dilation and stent placement were achieved and were successful in all the cases (16/16; 100%). Clinical improvement was achieved in 7 (84.7%) of the 9 patients with recurrent acute pancreatitis and in 6 (85.7%) of the 7 patients with chronic pancreatitis. Early complications were observed in 1 (6.3%) patient. Pancreatitis or bleeding related to balloon dilation was not observed. Endoscopic balloon dilation for the minor papilla is feasible for the management of symptomatic pancreas divisum.

Levels of muscle enzymes in the serum after esophageal pneumatic dilation in patients with achalasia.

Science.gov (United States)

Kimchi, N A; Ron, Y; Abramowich, D; Shirin, H; Scapa, E; Avni, Y

2005-01-01

The success rate of pneumatic dilation of the esophagus in patients with achalasia is variable. We aim to assess whether levels of muscle enzymes in the serum are useful for predicting the efficacy of this procedure. Consecutive adults with symptomatic achalasia treated with pneumatic dilation were included. Blood samples were taken immediately before the procedure and after 12, 24 and 32 h. Clinical efficacy of the pneumatic dilation was evaluated on the basis of a symptom score defined prior to, and 2 months after the procedure. Eleven patients underwent 13 pneumatic dilations. In nine patients this was the first dilation attempt. Ten dilations were clinically effective. The study was discontinued after enzyme levels did not show a trend of increase in any of our patients. Moreover, a statistically significant unexpected decrease in creatine phosphokinase values was found 12 h after the procedure, among the 10 successful dilations. We believe that levels of muscle enzymes in the serum cannot predict the efficacy of pneumatic dilation in patients with achalasia.

Laryngotracheal Stenosis: Risk Factors for Tracheostomy Dependence and Dilation Interval

Science.gov (United States)

Gadkaree, Shekhar K; Pandian, Vinciya; Best, Simon; Motz, Kevin M; Allen, Clint; Kim, Young; Akst, Lee; Hillel, Alexander T

2017-02-01

Objective Laryngotracheal stenosis (LTS) is a fibrotic process that narrows the upper airway and has a significant impact on breathing and phonation. Iatrogenic injury from endotracheal and/or tracheostomy tubes is the most common etiology. This study investigates differences in LTS etiologies as they relate to tracheostomy dependence and dilation interval. Study Design Case series with chart review. Setting Single-center tertiary care facility. Subjects and Methods Review of adult patients with LTS was performed between 2004 and 2015. The association of patient demographics, comorbidities, disease etiology, and treatment modalities with patient outcomes was assessed. Multiple logistic regression analysis and Kaplan-Meier analysis were performed to determine factors associated with tracheostomy dependence and time to second procedure, respectively. Results A total of 262 patients met inclusion criteria. Iatrogenic patients presented with greater stenosis ( P = .023), greater length of stenosis ( P = .004), and stenosis farther from the vocal folds ( P tracheostomy dependence. Nonsmokers, patients without tracheostomy, and idiopathic LTS patients had a significantly longer time to second dilation procedure. Conclusion Iatrogenic LTS presents with a greater disease burden and higher risk of tracheostomy dependence when compared with other etiologies of LTS. Comorbid conditions promoting microvascular injury-including smoking, COPD, and diabetes-were prevalent in the iatrogenic cohort. Changes in hospital practice patterns to promote earlier tracheostomy in high-risk patients could reduce the incidence of LTS.

Analyzing gene expression profiles in dilated cardiomyopathy via bioinformatics methods.

Science.gov (United States)

Wang, Liming; Zhu, L; Luan, R; Wang, L; Fu, J; Wang, X; Sui, L

2016-10-10

Dilated cardiomyopathy (DCM) is characterized by ventricular dilatation, and it is a common cause of heart failure and cardiac transplantation. This study aimed to explore potential DCM-related genes and their underlying regulatory mechanism using methods of bioinformatics. The gene expression profiles of GSE3586 were downloaded from Gene Expression Omnibus database, including 15 normal samples and 13 DCM samples. The differentially expressed genes (DEGs) were identified between normal and DCM samples using Limma package in R language. Pathway enrichment analysis of DEGs was then performed. Meanwhile, the potential transcription factors (TFs) and microRNAs (miRNAs) of these DEGs were predicted based on their binding sequences. In addition, DEGs were mapped to the cMap database to find the potential small molecule drugs. A total of 4777 genes were identified as DEGs by comparing gene expression profiles between DCM and control samples. DEGs were significantly enriched in 26 pathways, such as lymphocyte TarBase pathway and androgen receptor signaling pathway. Furthermore, potential TFs (SP1, LEF1, and NFAT) were identified, as well as potential miRNAs (miR-9, miR-200 family, and miR-30 family). Additionally, small molecules like isoflupredone and trihexyphenidyl were found to be potential therapeutic drugs for DCM. The identified DEGs (PRSS12 and FOXG1), potential TFs, as well as potential miRNAs, might be involved in DCM.

Analyzing gene expression profiles in dilated cardiomyopathy via bioinformatics methods

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Liming Wang

Full Text Available Dilated cardiomyopathy (DCM is characterized by ventricular dilatation, and it is a common cause of heart failure and cardiac transplantation. This study aimed to explore potential DCM-related genes and their underlying regulatory mechanism using methods of bioinformatics. The gene expression profiles of GSE3586 were downloaded from Gene Expression Omnibus database, including 15 normal samples and 13 DCM samples. The differentially expressed genes (DEGs were identified between normal and DCM samples using Limma package in R language. Pathway enrichment analysis of DEGs was then performed. Meanwhile, the potential transcription factors (TFs and microRNAs (miRNAs of these DEGs were predicted based on their binding sequences. In addition, DEGs were mapped to the cMap database to find the potential small molecule drugs. A total of 4777 genes were identified as DEGs by comparing gene expression profiles between DCM and control samples. DEGs were significantly enriched in 26 pathways, such as lymphocyte TarBase pathway and androgen receptor signaling pathway. Furthermore, potential TFs (SP1, LEF1, and NFAT were identified, as well as potential miRNAs (miR-9, miR-200 family, and miR-30 family. Additionally, small molecules like isoflupredone and trihexyphenidyl were found to be potential therapeutic drugs for DCM. The identified DEGs (PRSS12 and FOXG1, potential TFs, as well as potential miRNAs, might be involved in DCM.

Impaired activity of adherens junctions contributes to endothelial dilator dysfunction in ageing rat arteries.

Science.gov (United States)

Chang, Fumin; Flavahan, Sheila; Flavahan, Nicholas A

2017-08-01

Ageing-induced endothelial dysfunction contributes to organ dysfunction and progression of cardiovascular disease. VE-cadherin clustering at adherens junctions promotes protective endothelial functions, including endothelium-dependent dilatation. Ageing increased internalization and degradation of VE-cadherin, resulting in impaired activity of adherens junctions. Inhibition of VE-cadherin clustering at adherens junctions (function-blocking antibody; FBA) reduced endothelial dilatation in young arteries but did not affect the already impaired dilatation in old arteries. After junctional disruption with the FBA, dilatation was similar in young and old arteries. Src tyrosine kinase activity and tyrosine phosphorylation of VE-cadherin were increased in old arteries. Src inhibition increased VE-cadherin at adherens junctions and increased endothelial dilatation in old, but not young, arteries. Src inhibition did not increase dilatation in old arteries treated with the VE-cadherin FBA. Ageing impairs the activity of adherens junctions, which contributes to endothelial dilator dysfunction. Restoring the activity of adherens junctions could be of therapeutic benefit in vascular ageing. Endothelial dilator dysfunction contributes to pathological vascular ageing. Experiments assessed whether altered activity of endothelial adherens junctions (AJs) might contribute to this dysfunction. Aortas and tail arteries were isolated from young (3-4 months) and old (22-24 months) F344 rats. VE-cadherin immunofluorescent staining at endothelial AJs and AJ width were reduced in old compared to young arteries. A 140 kDa VE-cadherin species was present on the cell surface and in TTX-insoluble fractions, consistent with junctional localization. Levels of the 140 kDa VE-cadherin were decreased, whereas levels of a TTX-soluble 115 kDa VE-cadherin species were increased in old compared to young arteries. Acetylcholine caused endothelium-dependent dilatation that was decreased in old

Fecal impaction: a cause of isolated small bowel dilatation on abdominal radiographs

International Nuclear Information System (INIS)

Torigian, Drew A.; Levine, Marc S.; Rubesin, Stephen E.; Laufer, Igor

2001-01-01

Objective: The purpose of this study was to assess the frequency of isolated small bowel dilatation on abdominal radiographs in patients with colonic fecal impaction and also to elucidate the cause of this finding. Methods: A computerized search of radiology files revealed 515 patients with colonic fecal impaction on abdominal radiographs. The radiologic reports described isolated small bowel dilatation not related to other known causes of ileus or obstruction in 18 (3.5%) of the 515 patients. The films were reviewed to determine the distribution of fecal impaction and the degree and extent of small bowel dilatation. In 16 cases, medical records were reviewed to determine the clinical presentation, treatment, and course. Finally, follow-up radiographs were reviewed in four cases to determine the response to treatment of the impaction. Results: All 16 patients with available medical records had abdominal symptoms. The average diameter of the dilated small bowel on abdominal radiographs was 3.7 cm. Fourteen patients (78%) had a diffuse colonic fecal impaction (nine) or a predominantly right-sided fecal impaction (five) that involved the cecum, and the remaining four (22%) had a left-sided colonic fecal impaction. All 12 patients with clinical follow-up had resolution of symptoms and all four with follow-up radiographs had resolution of small bowel dilatation after treatment of the underlying impaction. Conclusion: Fecal impaction should be considered in the differential diagnosis of small bowel dilatation on abdominal radiographs, as treatment of the underlying impaction usually produces a dramatic clinical response with resolution of the small bowel dilatation on follow-up radiographs

Repair of sheep long bone cortical defects filled with COLLOSS, COLLOSS E, OSSAPLAST, and fresh iliac crest autograft.

NARCIS (Netherlands)

Huffer, W.E.; Benedict, J.J.; Turner, A.S.; Briest, A.; Rettenmaier, R.; Springer, M.; Walboomers, X.F.

2007-01-01

COLLOSS and COLLOSS E are osteoinductive bone void fillers consisting of bone collagen and noncollagenous proteins from bovine and equine bone, respectively. The aim of this study was to compare COLLOSS, COLLOSS E, iliac bone autograft, sintered beta tricalcium phosphate (beta-TCP; OSSAPLAST), and

Hemoperitoneum secondary to cecocolic dilation in a pregnant mare

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Alejandro R. Palomar

2017-06-01

Full Text Available Hemoperitoneum is known as the abnormal accumulation of blood within the abdominal cavity, most commonly caused by gastrointestinal bleeding, abdominal abscesses, liver tumors, migration of parasitic larvae (Strongylus vulgaris, direct trauma and blood clotting disorders. Lethargy, anorexia, weakness, muscle twitching, sweating, hyperthermia, tachycardia, tachypnea, and the accumulation of free fluid in the abdomen were the most commonly recorded signs. In this report, a pregnant mare was diagnosed with hemoperitoneum secondary to cecocolic dilatation, due to corn ingestion. The protocol for clinical treatment and tests varies in similar reported cases. Due to this, the present report discusses the outcome of a clinical case and suggests a medical protocol -based on evidence – for treatment in a pregnant mare. The treatment was aimed to stop the bleeding, while normalize or maintain a stable blood pressure and provide supportive therapy. The mare presented colic pains due to fermentation of the corn, which were solved in few hours. The final abdominal ultrasonogram showed intra-abdominal hypoechoic fluid and living fetus.

Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

Directory of Open Access Journals (Sweden)

D D Baksi

2016-01-01

Full Text Available Background: Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8-30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals. Materials and Methods: Of the 293 patients operated during the period from June 1977 to June 2009, 42 were lost to followup. Seven patients with gluteus medius muscle pedicle bone grafting (MPBG were excluded. Thus, out of 244 patients, 208 (85.3% untreated nonunion and 36 (14.7% following failure of primary internal fixation were available for studies. Time interval between the date of injury and operation in untreated nonunion cases was mean 6.5 months and in failed internal fixation cases was mean 11.2 months. Ages of the patients varied from 16 to 55 years. Seventy patients had partial and 174 had subtotal absorption of the femoral neck. Evidence of avascular necrosis (AVN femoral head was found histologically in 135 (54.3% and radiologically in 48 (19.7% patients. The patients were operated by open reduction of fracture

[CLINICAL APPLICATION OF THREE DIMENSIONAL PRINTED NAVIGATION TEMPLATES FOR TREATMENT OF OSTEONECROSIS OF FEMORAL HEAD WITH PEDICLED ILIAC BONE GRAFT].

Science.gov (United States)

Yu, Kaifu; Xu, Yongqing; Tan, Hongbo; He, Xiaoqing; Cai, Dixin; Zhou, Tianhua; Luo, Haotian; Duan, Jiazhang

2016-03-01

To investigate the feasibility and early effectiveness to treat osteonecrosis of the femoral head (ONFH) with pedicled iliac bone graft assisted by individual digital design and three dimensional (3D) printed navigation templates. Between February and June 2014, 15 patients (24 hips) with ONFH underwent pedicled iliac bone graft assisted by individual digital design and 3D printed navigation templates. There were 11 males (17 hips) and 4 females (7 hips) with a mean age of 38 years (range, 18-56 years) and a mean disease duration of 7.5 months (range, 1-24 months); the left hip was involved in 2 cases, the right hip in 4 cases, and both hips in 9 cases. There were 7 cases (12 hips) of steroid-induced ONFH, 5 cases (8 hips) of alcohol-induced ONFH, 1 case (1 hip) of traumatic ONFH, and 2 cases (3 hips) of idiopathic ONFH. The preoperative Harris score was 56.60 ± 6.97. According to Association Research Circulation Osseous (ARCO) staging system, 5 hips were classified as stage IIB, 8 hips as stage IIC, 6 hips as stage IIIB, and 5 hips as stage IIIC. The navigation templates were designed and printed to assist accurate location and debridement of necrosis area according to preoperative CT scanning at the beginning of pedicled iliac bone grafting procedure. The mean operation time was 135 minutes (range, 120-160 minutes), mean amount of bleeding was 255 mL (range, 200-300 mL). All the wounds healed primarily, no complication of deep vein thrombosis or infection was observed. All patients were followed up 12-16 months (mean, 14 months). The location of necrosis area was in accordance with preoperative design, which was removed completely without penetration of joint surface, pedicled iliac bone graft was performed at the right site according to postoperative imaging examination. Radiographically, graft fusion was achieved at 2.7 months (range, 2-3 months) in all patients. All the hips had no collapse during follow-up. Hip pain was relieved, and range of motion was

Balloon dilation and airway stenting for benign and malignant tracheal stenosis

International Nuclear Information System (INIS)

Guo Jianhai; Yang Renjie; Zhang Hongzhi

2009-01-01

Objective: To assess the effectiveness of balloon dilation and airway stenting performed under fluoroscopic guidance for the treatment of benign and malignant tracheal stenosis. Methods: Under fluoroscopic guidance, balloon dilation and airway stenting were performed in 45 patients with tracheobronchial stricture. Of the 45 patients,malignant tracheal stenosis was seen in 37, including mediastinal nodal metastases (n=14), esophageal carcinoma (n=13), lung carcinoma (n= 4), adenocarcinoma of bronchus (n=3), lymphoma (n=2) and laryngocarcinoma (n=1), and benign tracheal stenosis was seen in 8, including endobronchial tuberculosis (n=6), retrosternal thyroid adenoma (n=1) and endotracheal intubation (n=1). Airway stenting with self-expandable metal stent was employed in 38 patients and balloon dilation in 7 patients. All the procedures were performed under fluoroscopic guidance. Results: A total of 53 self-expandable metal stents was implanted in 38 patients. The clinical symptoms were immediately relived after the procedure in all patients except for one patient who died from choking of sputum. No stent migration was observed. Restenosis developed in 4 patients, which was successfully treated with repeated stenting and balloon dilation. Nineteen times of balloon dilation procedure were accomplished in 7 patients. Marked remission of clinical symptoms was seen in most cases. During a follow-up period (ranged from 0 to 124 months with a mean of 24.5 months) 31 patients died. Conclusion: For both benign and malignant tracheal stenosis, balloon dilation with airway stenting performed under fluoroscopic guidance is a safe and efficient therapy with instant curative effect in relieving clinical symptoms. (authors)

Balloon dilatation of tuberculous bronchial stenosis: immediate and long term effect

International Nuclear Information System (INIS)

Lee, Sang Yoon; Kwak, Byung Kook; Kang, Ho Yeong; Kim, Tae Hoon; Kim, Soo Rhan; Park, Hyun Sun; Lee, Shin Hyung; Lee, Chang Joon

1997-01-01

To evaluate the long-term immediate effects of balloon dilatation of the tuberculous bronchial stenosis. Twenty-three women with tuberculous bronchial stenosis (19, left main bronchus ; 4, right main bronchus) underwent balloon dilatation (13 bronchoscopically guided ; 10 fluoroscopically guided). Immediate (n=23) and long-term follow-up (mean, 17.2 months; range, 1month-6years 3months ; n=20) assessments focused on changes in the results of the pulmonary function test (PFT). An increase in FVC or FEVI of more than 10% after the procedure was considered effective. In all patients, any complications were evaluated. Balloon dilatation was effective at immediate follow-up in 69.5% of patients(16/23) and in 75.0%(15/20) at long-term follow-up. Bronchoscopically and fluoroscopically-guided balloon dilatation proved effective in 61.5%(8/13) and 80.0% of patients(8/10) on immediate follow-up respectively, but in 90.0%(9/10) and 60.0%(6/10) on long term follow-up respectively. Balloon dilatation was effective in the active(n 10) and inactive(n = 13) stage of tuberculous bronchitis in 80.0%(8/10) and 61.5% of cases(8/13) on immediate follow-up respectively, but in 66.6%(6/9) and 81.8%(9/11) on long term follow-up study, respectively. On immediate follow-up, balloon dilatation of tubular bronchial stenosis was more effective in the active than in the inactive stage, but on long-term follow-up was less effective ; long-term improvement in the inactive stage was, however, well-maintained

Malignant Esophagogastric Junction Obstruction: Efficacy of Balloon Dilation Combined with Chemotherapy and/or Radiation Therapy

International Nuclear Information System (INIS)

Ko, Gi-Young; Song, Ho-Young; Hong, Heuk-Jin; Sung, Kyu-Bo; Seo, Tae-Seok; Yoon, Hyun-Ki

2003-01-01

Purpose: To assess the efficacy of balloon dilation combined with chemotherapy and/or radiation therapy for palliation of dysphagia due to malignant esophagogastric junction strictures. Methods: Fluoroscopically guided balloon dilation was attempted in 20 patients. The causes of strictures were gastric adenocarcinoma (n = 10) and esophageal squamous cell carcinoma (n = 10). Scheduled chemotherapy and/or radiation therapy followed balloon dilation in all patients. Results: There were no technical failures or major complications. After balloon dilation, 15 (75%) patients showed improvement of dysphagia. No patient complained of reflux esophagitis during the follow-up period. Among the 15 patients, seven needed no further treatment for palliation of dysphagia until their deaths. The remaining eight patients underwent repeat balloon dilation(n = 4) or stent placement (n = 4)3-43 weeks (mean 15 weeks) after the initial balloon dilation because of recurrent dysphagia. Conclusion: Balloon dilation combined with chemotherapy and/or radiation therapy seems to be an easy and reasonably effective palliative treatment for malignant esophagogastric strictures

[Congenital adrenal hyperplasia: a qualitative study on sex definition and redesignation dilation surgery and psychological support (part II)].

Science.gov (United States)

Telles-Silveira, Mariana; Tonetto-Fernandes, Vânia F; Schiller, Paulo; Kater, Claudio E

2009-12-01

To identify relevant questions related to sex definition and re-designation and reconstructive surgery in patients with congenital adrenal hyperplasia (CAH), and to understand the role of the psychologist in providing care for these patients. We selected 21 subjects: 7 pediatric endocrinologists from 5 Brazilian Public Health System institutions, 9 parents and 6 patients with CAH, according to a qualitative research model. In this paper, 3 of the studied categories are analyzed: 'sex definition and re-designation', 'reconstructive surgery/vaginal dilation', and 'psychology'. Parents' main anguish relates to the situation of an unnamed sex at birth, whereas sex re-designation was distressful to physicians. A sense of loneliness when dealing with the disease and treatment was a common anguish among patients; dilation procedures were the major complaint. In general, physicians recommend that genital reconstructive surgery be performed early on to avoid future trauma. In such a complex scenario, it is remarkable that not all the reference service staff have a psychologist on duty. Difficulties to deal with questions involving sexuality were evident and dilation procedures are an additional source of trauma for these patients.

Dilatancy induced ductile-brittle transition of shear band in metallic glasses

Science.gov (United States)

Zeng, F.; Jiang, M. Q.; Dai, L. H.

2018-04-01

Dilatancy-generated structural disordering, an inherent feature of metallic glasses (MGs), has been widely accepted as the physical mechanism for the primary origin and structural evolution of shear banding, as well as the resultant shear failure. However, it remains a great challenge to determine, to what degree of dilatation, a shear banding will evolve into a runaway shear failure. In this work, using in situ acoustic emission monitoring, we probe the dilatancy evolution at the different stages of individual shear band in MGs that underwent severely plastic deformation by the controlled cutting technology. A scaling law is revealed that the dilatancy in a shear band is linearly related to its evolution degree. A transition from ductile-to-brittle shear bands is observed, where the formers dominate stable serrated flow, and the latter lead to a runaway instability (catastrophe failure) of serrated flow. To uncover the underlying mechanics, we develop a theoretical model of shear-band evolution dynamics taking into account an atomic-scale deformation process. Our theoretical results agree with the experimental observations, and demonstrate that the atomic-scale volume expansion arises from an intrinsic shear-band evolution dynamics. Importantly, the onset of the ductile-brittle transition of shear banding is controlled by a critical dilatation.

Constraining friction, dilatancy and effective stress with earthquake rates in the deep crust

Science.gov (United States)

Beeler, N. M.; Thomas, A.; Burgmann, R.; Shelly, D. R.

2015-12-01

Similar to their behavior on the deep extent of some subduction zones, families of recurring low-frequency earthquakes (LFE) within zones of non-volcanic tremor on the San Andreas fault in central California show strong sensitivity to stresses induced by the tides. Taking all of the LFE families collectively, LFEs occur at all levels of the daily tidal stress, and are in phase with the very small, ~200 Pa, shear stress amplitudes while being uncorrelated with the ~2 kPa tidal normal stresses. Following previous work we assume LFE sources are small, persistent regions that repeatedly fail during shear within a much larger scale, otherwise aseismically creeping fault zone and that the correlation of LFE occurrence reflects modulation of the fault creep rate by the tidal stresses. We examine the predictions of laboratory-observed rate-dependent dilatancy associated with frictional slip. The effect of dilatancy hardening is to damp the slip rate, so high dilatancy under undrained pore pressure reduces modulation of slip rate by the tides. The undrained end-member model produces: 1) no sensitivity to the tidal normal stress, as first suggested in this context by Hawthorne and Rubin [2010], and 2) fault creep rate in phase with the tidal shear stress. Room temperature laboratory-observed values of the dilatancy and friction coefficients for talc, an extremely weak and weakly dilatant material, under-predict the observed San Andreas modulation at least by an order of magnitude owing to too much dilatancy. This may reflect a temperature dependence of the dilatancy and friction coefficients, both of which are expected to be zero at the brittle-ductile transition. The observed tidal modulation constrains the product of the friction and dilatancy coefficients to be at most 5 x 10-7 in the LFE source region, an order of magnitude smaller than observed at room temperature for talc. Alternatively, considering the predictions of a purely rate-dependent talc friction would

Atlas of the clinical genetics of human dilated cardiomyopathy

DEFF Research Database (Denmark)

Haas, Jan; Frese, Karen S; Peil, Barbara

2015-01-01

AIM: Numerous genes are known to cause dilated cardiomyopathy (DCM). However, until now technological limitations have hindered elucidation of the contribution of all clinically relevant disease genes to DCM phenotypes in larger cohorts. We now utilized next-generation sequencing to overcome...... these limitations and screened all DCM disease genes in a large cohort. METHODS AND RESULTS: In this multi-centre, multi-national study, we have enrolled 639 patients with sporadic or familial DCM. To all samples, we applied a standardized protocol for ultra-high coverage next-generation sequencing of 84 genes...... disease variants, we find titin, plakophilin-2, myosin-binding protein-C 3, desmoplakin, ryanodine receptor 2, desmocollin-2, desmoglein-2, and SCN5A variants among the most commonly mutated genes. The overlap between DCM, hypertrophic cardiomyopathy (HCM), and channelopathy causing mutations...

Prediction of 6 months left ventricular dilatation after myocardial infarction in relation to cardiac morbidity and mortality - Application of a new dilatation model to GISSI-3 data

NARCIS (Netherlands)

de Kam, PJ; Nicolosi, GL; Voors, AA; van den Berg, MP; Brouwer, J; van Veldhuisen, DJ; Barlera, S; Maggioni, AP; Giannuzzi, P; Temporelli, PL; Latini, R; van Gilst, WH

Aims To predict the long-term left ventricular volume index early after myocardial infarction and to investigate the relationship between long-term left ventricular dilatation risk and clinical outcome. Methods and Results By applying a previously developed dilatation model, we predicted the 6-month

Can the measurement of brachial artery flow-mediated dilation be applied to the acute exercise model?

Directory of Open Access Journals (Sweden)

Harris Ryan A

2007-11-01

Full Text Available Abstract The measurement of flow-mediated dilation using high-resolution ultrasound has been utilized extensively in interventional trials evaluating the salutary effect of drugs and lifestyle modifications (i.e. diet or exercise training on endothelial function; however, until recently researchers have not used flow-mediated dilation to examine the role of a single bout of exercise on vascular function. Utilizing the acute exercise model can be advantageous as it allows for an efficient manipulation of exercise variables (i.e. mode, intensity, duration, etc. and permits greater experimental control of confounding variables. Given that the application of flow-mediated dilation in the acute exercise paradigm is expanding, the purpose of this review is to discuss methodological and physiological factors pertinent to flow-mediated dilation in the context of acute exercise. Although the scientific rationale for evaluating endothelial function in response to acute exercise is sound, few concerns warrant attention when interpreting flow-mediated dilation data following acute exercise. The following questions will be addressed in the present review: Does the measurement of flow-mediated dilation influence subsequent serial measures of flow-mediated dilation? Do we need to account for diurnal variation? Is there an optimal time to measure post-exercise flow-mediated dilation? Is the post-exercise flow-mediated dilation reproducible? How is flow-mediated dilation interpreted considering the hemodynamic and sympathetic changes associated with acute exercise? Can the measurement of endothelial-independent dilation affect the exercise? Evidence exists to support the methodological appropriateness for employing flow-mediated dilation in the acute exercise model; however, further research is warranted to clarify its interpretation following acute exercise.

Fatal central venous air embolism: a rare complication of esophageal dilation by rendezvous.

Science.gov (United States)

Zald, Philip B; Andersen, Peter E

2011-03-01

Esophageal dilation by rendezvous is a useful technique for the treatment of complicated esophageal strictures. We present a case of a 74-year-old man with chronic dysphagia caused by a complete cervical esophageal stricture that developed after external beam radiotherapy for treatment of papillary thyroid carcinoma. During attempted dilation using the rendezvous technique, the patient suffered a fatal pulmonary air embolism. The technique of esophageal dilation by rendezvous, complications, and risk factors for development of venous air embolism are discussed. To the best of our knowledge, this is the first report in the literature of fatal venous air embolism after dilation by rendezvous. Copyright © 2009 Wiley Periodicals, Inc.

Incidence of gastric dilatation-volvulus following a splenectomy in 238 dogs.

Science.gov (United States)

Maki, Lynn C; Males, Kristina N; Byrnes, Madeline J; El-Saad, Anthony A; Coronado, George S

2017-12-01

There is contradicting information in the veterinary literature regarding canine splenectomy and the increased risk for subsequent gastric dilatation-volvulus. The main purpose of this study was to determine the rate of occurrence of gastric dilatation-volvulus following splenectomy in medium to large breed dogs compared with a control group undergoing other abdominal procedures. Follow-up was performed by reviewing the medical records and conducting phone interviews. Weight, gender, and presence of a hemoabdomen at the time of surgery were not significantly associated with occurrence of gastric dilatation-volvulus, while increasing age was. Ten of 238 (4%) dogs in the splenectomy group and 3/209 (1.4%) dogs in the control group subsequently developed gastric dilatation-volvulus, which was not significantly different ( P = 0.08). While the findings approach significance and support a need for future investigation, the current recommendation for gastropexy at time of splenic removal should be made on a case by case basis and while considering previously documented risk factors.

Predictors of Long-Term Results After Treatment of Iliac Artery Obliteration by Transluminal Angioplasty and Stent Deployment

International Nuclear Information System (INIS)

Funovics, M.A.; Lackner, B.; Cejna, M.; Peloschek, P.; Sailer, J.; Philipp, M.O.; Maca, T.; Ahmadi, A.; Minar, E.; Lammer, J.

2002-01-01

Purpose: To investigate initial and long-term success rate after percutaneous treatment of iliac artery occlusion with angioplasty and stent deployment. To investigate the influence of vascular comorbidity, lesion length, stent placement and lesion coverage as possible predictors of outcome. Methods: Between January 1994 and December 1999, 80 iliac recanalizations were performed on 78 patients, median age 61.1 ±11.5 (SD) years. All patients were followed up by clinical examinations, duplex ultrasound and intravenous digital subtraction angiography. Mean follow-up time was 2.0 ± 1.53 (SD) years.Multivariate Cox regression analysis was used to determine the influence of cofactors on patency. Results: One, 2 and 4 years after recanalization, primary patency was 78.1%, 74.5% and 64.0%; secondary patency was 88.8%, 88.8% and 77.9%, respectively.Patients with shorter occlusions, complete lesion coverage and patent ipsilateral femoral arteries had significantly longer patency rates.Complications included inguinal hematoma (n=1), technical failure (n=3) aortic dissection (n=1), embolic occlusions (n=7), gluteal claudication (n=1) and genital necrosis after subsequent urethral surgery in one patient with contralateral occlusion and ipsilateral overstenting of the internal iliac artery with subsequent stenosis. Complications were of permanent clinical significance in seven of 78 (9%) of the patients. In 17 (22%) cases, percutaneous reintervention was performed with angioplasty in the stent (n=16) or deployment of a new stent (n=1). Conclusion: Endoluminal stent placement has its place in an interdisciplinary therapeutic approach as a viable therapeutic alternative to major transabdominal bypass surgery and can be performed with comparable complication rates. Patients with short occlusions, patent femoral arteries, and stents covering the entire occlusion have significant longer patency

Improved test of time dilation in special relativity.

Science.gov (United States)

Saathoff, G; Karpuk, S; Eisenbarth, U; Huber, G; Krohn, S; Muñoz Horta, R; Reinhardt, S; Schwalm, D; Wolf, A; Gwinner, G

2003-11-07

An improved test of time dilation in special relativity has been performed using laser spectroscopy on fast ions at the heavy-ion storage-ring TSR in Heidelberg. The Doppler-shifted frequencies of a two-level transition in 7Li+ ions at v=0.064c have been measured in the forward and backward direction to an accuracy of Deltanu/nu=1 x 10(-9) using collinear saturation spectroscopy. The result confirms the relativistic Doppler formula and sets a new limit of 2.2 x 10(-7) for deviations from the time dilation factor gamma(SR)=(1-v2/c2)(-1/2).

Affine and quasi-affine frames for rational dilations

DEFF Research Database (Denmark)

Bownik, Marcin; Lemvig, Jakob

2011-01-01

In this paper we extend the investigation of quasi-affine systems, which were originally introduced by Ron and Shen [J. Funct. Anal. 148 (1997), 408-447] for integer, expansive dilations, to the class of rational, expansive dilations. We show that an affine system is a frame if, and only if......, the corresponding family of quasi-affine systems are frames with uniform frame bounds. We also prove a similar equivalence result between pairs of dual affine frames and dual quasi-affine frames. Finally, we uncover some fundamental differences between the integer and rational settings by exhibiting an example...

Isointense infant brain MRI segmentation with a dilated convolutional neural network

NARCIS (Netherlands)

Moeskops, P.; Pluim, J.P.W.

2017-01-01

Quantitative analysis of brain MRI at the age of 6 months is difficult because of the limited contrast between white matter and gray matter. In this study, we use a dilated triplanar convolutional neural network in combination with a non-dilated 3D convolutional neural network for the segmentation

Balloon dilatation and balloon-expandable stents for PTA of proximal venous stenoses in haemodialysis patients. Dilatation und ballonexpandierbare Stents zur Therapie zentralvenoeser Stenosen bei Dialysepatienten

Energy Technology Data Exchange (ETDEWEB)

Landwehr, P; Lackner, K [Wuerzburg Univ. (Germany, F.R.). Inst. fuer Roentgendiagnostik; Goetz, R [Wuerzburg Univ. (Germany, F.R.). Abt. fuer Nephrologie

1990-09-01

On 10 dialysis patients we performed 12 balloon dilatations, 2 catheter lyses, 6 stent implants (Palmaz stent) and one atherectomy of central venous stenoses or occlusions (v. subclavia, v. brachiocephalica) at the shunt arm of the patient. The primary success rate was, in balloon PTA and lysis, 12/14 interventions, and in stent placement and atherectomy 7/7. The angiographical and clinical primary result after stent implantation was significantly better than after conventional dilatation. After 66% of the balloon dilatations recidivation occurred within the first year; this can be treated by means of repeated PTA. Whether long-term exclusion of recurrence can be achieved by stent implantation, must be established by means of follow-up studies that are at present in progress. (orig.).

Cap plasticity models and compactive and dilatant pre-failure deformation

International Nuclear Information System (INIS)

Fossum, Arlo F.; Fredrich, Joanne T.

2000-01-01

At low mean stresses, porous geomaterials fail by shear localization, and at higher mean stresses, they undergo strain-hardening behavior. Cap plasticity models attempt to model this behavior using a pressure-dependent shear yield and/or shear limit-state envelope with a hardening or hardening/softening elliptical end cap to define pore collapse. While these traditional models describe compactive yield and ultimate shear failure, difficulties arise when the behavior involves a transition from compactive to dilatant deformation that occurs before the shear failure or limit-state shear stress is reached. In this work, a continuous surface cap plasticity model is used to predict compactive and dilatant pre-failure deformation. During loading the stress point can pass freely through the critical state point separating compactive from dilatant deformation. The predicted volumetric strain goes from compactive to dilatant without the use of a non-associated flow rule. The new model is stable in that Drucker's stability postulates are satisfied. The study has applications to several geosystems of current engineering interest (oil and gas reservoirs, nuclear waste repositories, buried targets, and depleted reservoirs for possible use for subsurface sequestration of greenhouse gases)

Evaluation of Urinary Tract Dilation Classification System for Grading Postnatal Hydronephrosis.

Science.gov (United States)

Hodhod, Amr; Capolicchio, John-Paul; Jednak, Roman; El-Sherif, Eid; El-Doray, Abd El-Alim; El-Sherbiny, Mohamed

2016-03-01

We assessed the reliability and validity of the Urinary Tract Dilation classification system as a new grading system for postnatal hydronephrosis. We retrospectively reviewed charts of patients who presented with hydronephrosis from 2008 to 2013. We included patients diagnosed prenatally and those with hydronephrosis discovered incidentally during the first year of life. We excluded cases involving urinary tract infection, neurogenic bladder and chromosomal anomalies, those associated with extraurinary congenital malformations and those with followup of less than 24 months without resolution. Hydronephrosis was graded postnatally using the Society for Fetal Urology system, and then the management protocol was chosen. All units were regraded using the Urinary Tract Dilation classification system and compared to the Society for Fetal Urology system to assess reliability. Univariate and multivariate analyses were performed to assess the validity of the Urinary Tract Dilation classification system in predicting hydronephrosis resolution and surgical intervention. A total of 490 patients (730 renal units) were eligible to participate. The Urinary Tract Dilation classification system was reliable in the assessment of hydronephrosis (parallel forms 0.92). Hydronephrosis resolved in 357 units (49%), and 86 units (12%) were managed by surgical intervention. The remainder of renal units demonstrated stable or improved hydronephrosis. Multivariate analysis revealed that the likelihood of surgical intervention was predicted independently by Urinary Tract Dilation classification system risk group, while Society for Fetal Urology grades were predictive of likelihood of resolution. The Urinary Tract Dilation classification system is reliable for evaluation of postnatal hydronephrosis and is valid in predicting surgical intervention. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Effect of scanning in the supine and prone positions on dilation of air-charged colon in CTVC

International Nuclear Information System (INIS)

Ye Jing; Chen Junkun; Zhang Zongjun; Wang Junpeng; Gao Dazhi

2003-01-01

Objective: To evaluate the effect of scanning in the supine and prone positions on dilation of air-charged colon in CT virtual colonoscopy (CTVC). Methods: Thirty cases underwent CTVC scanning in both the supine and prone positions immediately before colonoscopy, and the dilation of each intestine was graded. The differences of colon dilation in different positions were compared. Results: In supine and prone position, there were 26 (17.3%) and 22 (14.7%) insufficient dilating colon segments, respectively, and only 5 (3.3%) insufficient dilating colon segments in double positions. 15(50.0%) and 13(43.3%) colons dilated insufficiently in supine and prone position, respectively, and decreased to 5 (16.7%) in double positions. The dilation of rectum, sigmoid colon, and transverse colon had significant difference in different positions. Conclusion: When performing CTVC, it is highly necessary to scan in both the supine and prone positions in order to ensure the sufficient dilation of colon. In supine position, the dilation of transverse colon is better, while the dilation of rectum and sigmoid colon in prone position is superior to that in supine position

Accuracy of using computer-aided rapid prototyping templates for mandible reconstruction with an iliac crest graft

Science.gov (United States)

2014-01-01

Background This study aimed to evaluate the accuracy of surgical outcomes in free iliac crest mandibular reconstructions that were carried out with virtual surgical plans and rapid prototyping templates. Methods This study evaluated eight patients who underwent mandibular osteotomy and reconstruction with free iliac crest grafts using virtual surgical planning and designed guiding templates. Operations were performed using the prefabricated guiding templates. Postoperative three-dimensional computer models were overlaid and compared with the preoperatively designed models in the same coordinate system. Results Compared to the virtual osteotomy, the mean error of distance of the actual mandibular osteotomy was 2.06 ± 0.86 mm. When compared to the virtual harvested grafts, the mean error volume of the actual harvested grafts was 1412.22 ± 439.24 mm3 (9.12% ± 2.84%). The mean error between the volume of the actual harvested grafts and the shaped grafts was 2094.35 ± 929.12 mm3 (12.40% ± 5.50%). Conclusions The use of computer-aided rapid prototyping templates for virtual surgical planning appears to positively influence the accuracy of mandibular reconstruction. PMID:24957053

Frequency and echocardiographic study of dilated cardiomyopathy in children presenting with cardiac failure

International Nuclear Information System (INIS)

Khan, M.A.; Mohammad, J.; Hussain, M.

2004-01-01

Objective: To evaluate the role of echocardiography in diagnosis of dilated cardiomyopathy as a cause of cardiac failure in children. Design: This was descriptive study. Children presenting with cardiac failure from indoor patients were selected and echocardiography along with chest X- ray, ECG, cardiac enzymes and ASO titre was performed in all patients. Subject: Fifty hospitalized patients with congestive heart failure were selected consecutively from hospitalized patients. Main Outcome: Role of echocardiography in the diagnosis of dilated cardiomyopathy in children presenting with cardiac failure. Results: Out of fifty patients admitted with cardiac failure 27 (54%) cases were found to be dilated cardiomyopathy while congenital heart disease, myocarditis and rheumatic heart disease were found in 12 (24%), 8 (16%) and 3 (6%) cases respectively. Conclusion: Dilated cardiomyopathy is an important cause of cardiac failure in children and echocardiography is an important tool to diagnose and differentiate dilated cardiomyopathy from other causes of cardiac failure. (author)

A Rare Occurance with Epidermolysis Bullosa Disease: Dilated Cardiomyopathy

Directory of Open Access Journals (Sweden)

Derya Cimen

2014-02-01

Full Text Available Epidermolysis bullosa is a congenital and herediter vesiculobullous disease. Dystrophic form of this disease is characterized by severe malnutrition, failure to thrive, adhesions at fingers, joint contractures related with the formation of scar tissues, carcinoma of the skin, anemia, hipoalbuminemia, wound enfections and sepsis. Rarely, mortal dilated cardiomyopathy may occur in patients. In this report we present a 13 year-old pediatric patient with dilated cardiomyopathy, clinically diagnosed with Epidermolysis bullosa as well as a review of recent related literature.

The correlation between the dilated extent of bile duct and gallbladder and low bile duct obstructive jaundice diseases

International Nuclear Information System (INIS)

Wang Zhongqiu; Lu Guangming; Li Jieshou; Li Weiqin

2005-01-01

Objective: To evaluate the diagnostic value about the dilated extent of bile duct and gallbladder in low biliary obstructive diseases. Methods: CT and ERCP findings of 105 patients with low biliary obstructive disease were retrospectively analyzed. The dilated extent of intrahepatic and extra- hepatic bile duct and gallbladder were classified into seven types: Type I: severe dilatation of intrahepatic and extrahepatic bile duct and gallbladder; Type II: severe dilatation of extrahepatic bile duct and gallbladder and slight dilated intrahapetic bile duct; Type III: severe dilatation of intrahepatic and extrahepatic bile duct without or slight dilatation of gallbladder; Type IV: severe extrahepatic bile duct dilatation without or slight dilatation of intrahepatic bile duct and gallbladder; Type V: severe intrahepatic bile duct dilatation without or with slight dilatation of extrahepatic bile duct and gallbladder; Type VI: severe gallbladder dilatation without or with slight intrahepatic and extra- hepatic bile duct dilatation; Type VII: without or with slight dilatation of intrahepatic and extrahepatic bile duct and gallbladder. The biliary system dilated extent of low biliary obstructive disease on CT and ERCP were compared with results of clinical, operation, and pathology. Results: Thirty-three cases of tumor and 72 cases of non-tumor were proved by clinical and operation in 105 patients with low biliary obstructive disease. In 33 tumor patients, 16 patients were identified as Type I, 10 patients Type II, 4 patients Type III, 1 patient Type IV, 2 patients Type VII. In 72 non-tumor patients, 4 patients were identified as Type I, 4 patients Type II, 9 patients Type III, 33 patients Type IV, 2 patients Type V, 11 patients Type VI, 19 patients Type VII. A large difference between I, II type and III-VII type biliary dilatation existed in tumor and non-tumor group (χ 2 =47.33, P<0.01). Conclusion:Low obstructive biliary diseases are closely correlated with the dilated

Laser-driven short-duration heating angioplasty: dilatation performance in cadaver atherosclerotic femoral arteries

Science.gov (United States)

Shimazaki, Natsumi; Naruse, Sho; Arai, Tsunenori; Imanishi, Nobuaki; Aiso, Sadakazu

2013-03-01

The purpose of this study was to investigate the artery dilatation performance of the short-duration heating balloon catheter in cadaver stenotic arteries. We designed a prototype short-duration heating balloon catheter that can heat artery media to around 60 °C in 15-25 s by a combination of laser-driven heat generation and continuous fluid irrigation in the balloon. We performed ex vivo short-duration heating dilatation in the cadaver atherosclerotic femoral arteries (initial percent diameter stenosis was 36-98%), with the maximum balloon temperature of 65+/-5 °C, laser irradiation duration of 25 s, and balloon dilatation pressure of 3.5 atm. The artery lumen configurations before and after the dilatations were assessed with a commercial IVUS system. After the short-duration heating dilatations, the percent diameter stenosis was reduced below 30% without any artery tears or dissections. We estimated that the artery media temperature was raised to around 60 °C in which plaque thickness was below 0.8 mm by a thermal conduction calculation. The estimated maximum temperature in artery adventitia and surrounding tissue was up to 45 °C. We found that the short-duration heating balloon could sufficiently dilate the cadaver stenotic arteries, without thermal injury in artery adventitia and surroundings.

Interface dilation : the overflowing cylinder technique

NARCIS (Netherlands)

Bergink - Martens, D.J.M.

1993-01-01

A pure steady-state dilation of a liquid interface, either liquid-air or water-oil, can be accomplished far from equilibrium by means of the overflowing cylinder technique. The resulting dynamic surface tension data correlate well with characteristic parameters of processes like foaming,

Moving Phones Tick Slower: Creating an Android App to Demonstrate Time Dilation

Science.gov (United States)

Underwood, Bret; Zhai, Yunxiao

2016-05-01

Smartphones and tablets are packed with sensors that allow us to take experimental data, essentially making them mobile physics labs. Apps exist that make it easy to capture and analyze data from these sensors, allowing users to study diverse phenomena such as free fall acceleration, the speed of sound, radioactivity, and many others. Commonly, the use of apps in the physics classroom focuses on existing apps rather than on the creation of apps themselves. This is for a good reason-writing an app usually requires advanced knowledge of programming languages and experience with app design. These skills are generally regarded as beyond the typical physics student. However, there are app development environments, such as MIT App Inventor 2 for Android, which make the process of creating an app and utilizing the sensors much more accessible to students. Putting the ability to create and configure apps within the reach of students can also help integrate computation into the curriculum. In this article, we discuss our creation of an Android app, Time Dilation Calculator, done as part of a senior undergraduate capstone project, which uses App Inventor and a mobile device's global positioning system (GPS) receiver to calculate the time dilation effect of special relativity.

3D MR ventricle segmentation in pre-term infants with post-hemorrhagic ventricle dilation

Science.gov (United States)

Qiu, Wu; Yuan, Jing; Kishimoto, Jessica; Chen, Yimin; de Ribaupierre, Sandrine; Chiu, Bernard; Fenster, Aaron

2015-03-01

Intraventricular hemorrhage (IVH) or bleed within the brain is a common condition among pre-term infants that occurs in very low birth weight preterm neonates. The prognosis is further worsened by the development of progressive ventricular dilatation, i.e., post-hemorrhagic ventricle dilation (PHVD), which occurs in 10-30% of IVH patients. In practice, predicting PHVD accurately and determining if that specific patient with ventricular dilatation requires the ability to measure accurately ventricular volume. While monitoring of PHVD in infants is typically done by repeated US and not MRI, once the patient has been treated, the follow-up over the lifetime of the patient is done by MRI. While manual segmentation is still seen as a gold standard, it is extremely time consuming, and therefore not feasible in a clinical context, and it also has a large inter- and intra-observer variability. This paper proposes a segmentation algorithm to extract the cerebral ventricles from 3D T1- weighted MR images of pre-term infants with PHVD. The proposed segmentation algorithm makes use of the convex optimization technique combined with the learned priors of image intensities and label probabilistic map, which is built from a multi-atlas registration scheme. The leave-one-out cross validation using 7 PHVD patient T1 weighted MR images showed that the proposed method yielded a mean DSC of 89.7% +/- 4.2%, a MAD of 2.6 +/- 1.1 mm, a MAXD of 17.8 +/- 6.2 mm, and a VD of 11.6% +/- 5.9%, suggesting a good agreement with manual segmentations.

Achalasia: Dilation, Injection or Surgery?

OpenAIRE

Peracchia, Alberto; Bonavina, Luigi

2000-01-01

Achalasia results from irreversible alterations of the esophageal myenteric plexus. The target of treatment in this setting is to reduce lower esophageal sphincter resistance to passage of the bolus. Definitive treatment of the disease requires pneumatic dilation or Heller myotomy. Although no controlled studies comparing modern endoscopic and surgical techniques are available, laparoscopic surgery is emerging as the initial intervention of choice.

Giant mucocele of the appendix | Dogo | Nigerian Journal of ...

African Journals Online (AJOL)

A case of giant mucocele of the appendix is reported in a 50 years old Nigerian male. Presentation was that of sudden onset of pain in the right lower abdomen associated with tenderness in the right iliac fossa region, diagnosed as acute appendicitis. At appendicectomy, a large, pale sausage shaped dilation of the ...

Induction of labor in patients with an unfavorable cervix after a cesarean using an osmotic dilator versus vaginal prostaglandin.

Science.gov (United States)

Maier, Josefine T; Metz, Melanie; Watermann, Nina; Li, Linna; Schalinski, Elisabeth; Gauger, Ulrich; Rath, Werner; Hellmeyer, Lars

2018-04-25

Trial of labor after cesarean (TOLAC) is a viable option for safe delivery. In some cases cervical ripening and subsequent labor induction is necessary. However, the commonly used prostaglandins are not licensed in this subgroup of patients and are associated with an increased risk of uterine rupture. This cohort study compares maternal and neonatal outcomes of TOLAC in women (n=82) requiring cervical ripening agents (osmotic dilator vs. prostaglandins). The initial Bishop scores (BSs) were 2 (0-5) and 3 (0-5) (osmotic dilator and prostaglandin group, respectively). In this retrospective analysis, Fisher's exact test, the Kruskal-Wallis rank sum test and Pearson's chi-squared test were utilized. Vaginal birth rate (including operative delivery) was 55% (18/33) in the osmotic dilator group vs. 51% (25/49) in the dinoprostone group (P 0.886). Between 97% and 92% (32/33 and 45/49) (100%, 100%) of neonates had an Apgar score of >8 after 1 min (5, 10 min, respectively). The time between administration of the agent and onset of labor was 36 and 17.1 h (mean, Dilapan-S® group, dinoprostone group, respectively). Time from onset of labor to delivery was similar in both groups with 4.4 and 4.9 h (mean, Dilapan-S® group, dinoprostone group, respectively). Patients receiving cervical ripening with Dilapan-S® required oxytocin in 97% (32/33) of cases. Some patients presented with spontaneous onset of labor, mostly in the dinoprostone group (24/49, 49%). Amniotomy was performed in 64% and 49% (21/33 and 24/49) of cases (Dilapan-S® group and dinoprostone group, respectively). This pilot study examines the application of an osmotic dilator for cervical ripening to promote vaginal delivery in women who previously delivered via cesarean section. In our experience, the osmotic dilator gives obstetricians a chance to perform induction of labor in these women.

The dilatations with the balloon catheter in treatment of the patients with the benign oesophageal stenoses

International Nuclear Information System (INIS)

Valek, V.; Benda, K.; Hrobar, P.; Mrazova, J.; Prasek, J.; Bilicky, J.; Vomela, J.; Hep, A.; Muenzova, H.

1996-01-01

Between January 1989 and June 1995 the authors dilated in the Department of Radiology in University Hospital Bohunice the benign stenosis of the oesophagus with balloon dilatation catheter in 76 of other patients. The aetiology of the stenosis was long-term reflux oesophagitis in the 39 patients (51%), achalasia 14 patients, 18%) postoperative benign stenosis in anastomosis (7 patients, 9%), corrosive stricture (5 patients, 6,5%), post-radiation stricture (5 patients, 6,5%) and epidermolysis bulosa oesophagi (2 patients, 3%). In four patients (5%) the aetiology of the stenosis was unknown. The standing of the dilatation was from 15 second to 6 minutes and dilatation was technically successful in all cases. First the authors used Owman Oesophageal Dilatation Kit (William COOK), before three years they started to used Rigiflex ORW Dilators Kit (Microvasive). In the patients with achalasia the authors currently used Rigiflex ABD Achalasia Balloon Dilator (Microvasive). (authors). 2 tabs., 3 figs., 14 refs

Non-epiphyseal chondroblastoma arising in the iliac bone, and complicated by an aneurysmal bone cyst: a case report and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Kim, Jin; Kumar, Rajendra [The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX (United States); Raymond, A.K. [Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX (United States); Ayala, Alberto G. [The Methodist Hospital, Department of Pathology, Houston, TX (United States)

2010-06-15

Chondroblastoma is a benign bone tumor that typically arises in the epiphysis of a long bone. However, when it occurs in non-epiphyseal location in flat bones, it may create a diagnostic problem. We describe such a case of chondroblastoma arising in the iliac bone. A 29-year-old man was incidentally found to have a bony pelvic lesion while undergoing evaluation for Crohn's disease. The radiographs and CT revealed an expansile lytic lesion in the right iliac bone. A core biopsy of the lesion was performed. The histopathology revealed the lesion to be a chondroblastoma with secondary features of aneurysmal bone cyst. An en bloc surgical resection of the tumor was performed. (orig.)

A splice site mutation in a gene encoding for PDK4, a mitochondrial protein, is associated with the development of dilated cardiomyopathy in the Doberman pinscher.

Science.gov (United States)

Meurs, Kathryn M; Lahmers, Sunshine; Keene, Bruce W; White, Stephen N; Oyama, Mark A; Mauceli, Evan; Lindblad-Toh, Kerstin

2012-08-01

Familial dilated cardiomyopathy is a primary myocardial disease that can result in the development of congestive heart failure and sudden cardiac death. Spontaneous animal models of familial dilated cardiomyopathy exist and the Doberman pinscher dog is one of the most commonly reported canine breeds. The objective of this study was to evaluate familial dilated cardiomyopathy in the Doberman pinscher dog using a genome-wide association study for a genetic alteration(s) associated with the development of this disease in this canine model. Genome-wide association analysis identified an area of statistical significance on canine chromosome 14 (p(raw) = 9.999e-05 corrected for genome-wide significance), fine-mapping of additional SNPs flanking this region localized a signal to 23,774,190-23,781,919 (p = 0.001) and DNA sequencing identified a 16-base pair deletion in the 5' donor splice site of intron 10 of the pyruvate dehydrogenase kinase 4 gene in affected dogs (p dilation, marked pleomorphic mitochondrial alterations with megamitochondria, scattered mitochondria with whorling and vacuolization and mild aggregates of lipofuscin granules. In conclusion, we report the identification of a splice site deletion in the PDK4 gene that is associated with the development of familial dilated cardiomyopathy in the Doberman pinscher dog.

The role of prophylactic internal iliac artery ligation in abnormally invasive placenta undergoing caesarean hysterectomy: a randomized control trial.

Science.gov (United States)

Hussein, Ahmed M; Dakhly, Dina Mohamed Refaat; Raslan, Ayman N; Kamel, Ahmed; Abdel Hafeez, Ali; Moussa, Manal; Hosny, Ahmed Samir; Momtaz, Mohamed

2018-04-25

To identify the role of bilateral internal iliac artery (IIA) ligation on reducing blood loss in abnormally invasive placenta (AIP) undergoing caesarean hysterectomy. In this parallel-randomized control trial, 57 pregnant females with ultrasound features suggestive of AIP were enrolled. They were randomized into two groups; IIA group (n = 29 cases) performed bilateral IIA ligation followed by caesarean hysterectomies, while Control group (n = 28 cases) underwent caesarean hysterectomy only. The main outcome was the difference in the estimated intraoperative blood loss between the two groups. There was no significant difference between the two groups regarding the intraoperative estimated blood loss (1632 ± 804 versus 1698 ± 1251, p value .83). The operative procedure duration (minutes) (223 ± 66 versus 171 ± 41.4, p value .001) varied significantly between the two groups. Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.

Comparison of the Eder-Puestow and Celestin techniques for dilating benign oesophageal strictures.

OpenAIRE

Hine, K R; Hawkey, C J; Atkinson, M; Holmes, G K

1984-01-01

The Celestin and Eder-Puestow methods of dilating benign oesophageal strictures have been compared prospectively in a randomised trial. One hundred and thirty three dilatations were performed on 72 patients. There was no significant difference between the two techniques with regard to the long term relief of symptoms. Celestin dilatation was quicker, less likely to cause pharyngeal trauma, and less damaging to guide wires. It could not be used, however, in those patients in whom only a short ...

Cosmic time dilation: The clock paradox revisited

International Nuclear Information System (INIS)

Tomaschitz, Roman

2004-01-01

The relativistic time dilation is reviewed in a cosmological context. We show that a clock or twin paradox does not arise if cosmic time is properly taken into account. The receding galaxy background provides a unique frame of reference, and the proper times of geodesic as well as accelerated observers can be linked to the universal cosmic time parameter. This suggests to compare the proper time differentials of the respective observers by determining their state of motion in the galaxy grid. In this way, each observer can figure out whether his proper time is dilated or contracted relative to any other. In particular one can come to unambiguous conclusions on the aging of uniformly moving observers, without reference to asymmetries in measurement procedures or accelerations they may have undergone

Gallium 67 scintigraphic examination of dilated myocardiopathies

International Nuclear Information System (INIS)

Lanfranchi, J.; Sachs, R.N.; Beaudet, B.; Deblock, C.; Tellier, P.

1989-01-01

Twenty-seven patients were diagnosed as having dilated cardiomyopathies, based on increases in the cardiothoracic index > 0.50, in the diastolic and systolic diameters of the left ventricle, and in the telediastolic volume of the left ventricle, which was indexed by body surface determined by contrast ventriculography. They underwent gallium 67 scintigraphic examination of the myocardium, in order to non-invasively detect the presence of an inflammatory infiltrate. Fifteen of them also had endomyocardial biopsies and all had virology check-up. The results were disappointing. Only in one case was the scintigraphic image undeniably positive; in 20 other patients the findings were dubious or negative. This technique did not demonstrate the presence of an inflammatory infiltrate and thus an association between myocarditis and dilated cardiomyopathy, could not be established [fr

Irreversible dilation of NaCl contaminated lime-cement mortar due to crystallization cycles

International Nuclear Information System (INIS)

Lubelli, B.; Hees, R.P.J. van; Huinink, H.P.; Groot, C.J.W.P.

2006-01-01

The mechanism of damage occurring in NaCl contaminated materials has not been clarified yet. Apart from crystallization pressure, other hypotheses have been proposed to explain the cause of decay. Irreversible dilation has been observed in a few cases but has never been studied in a more systematic way. The aim of the research is to contribute to the modeling of this phenomenon. In the present paper the effect of NaCl on the hydric and hygric behavior of a lime-cement mortar is extensively studied. The results indicate that NaCl influences the hydric and hygric dilation behavior of the material. The material contaminated with NaCl shrinks during dissolution and dilates during crystallization of the salt. This dilation is irreversible and sufficient to damage the material after few dissolution/crystallization cycles. This behavior is not restricted to NaCl, but is observed in the presence of other salts as well (NaNO 3 and KCl). Outcomes of electron microscopy studies suggest that salts causing irreversible dilation tend to crystallize as layers on the pore wall

Outcome of emergency endovascular treatment of large internal iliac artery aneurysms with guidewires

International Nuclear Information System (INIS)

Cambj-Sapunar, Liana; Maskovic, Josip; Brkljacic, Boris; Radonic, Vedran; Dragicevic, Dragan; Ajduk, Marko

2010-01-01

Purpose: Guidewires have been reported as a useful occlusion material for large aneurysms of different locations with good short-term results. In this study we retrospectively evaluate long-term results of emergency embolization technique with guidewires in symptomatic internal iliac artery aneurysm (IIAA) impending rupture. Patients and methods: In four patients presented with acute abdominal pain, multidetector computed tomography revealed unstable, 7-14 cm large, IIAAs. Two patients were treated with coil embolization of distal branches followed by occlusion of aneurysmal sac with guidewires. In two patients embolization of aneurysmal sac alone was performed. Results: In three patients complete or near complete occlusion of the aneurysmal sac was achieved and abdominal pain ceased within hours. Two patients treated with embolization of distal iliac artery branches and aneurysmal sac developed claudication that lasted up to 1 year. Their aneurysms remained thrombosed and they were without symptoms until they died 31 and 56 months later of causes unrelated to IIAA. Two patients treated with embolization of the aneurysm alone were free of ischemic symptoms. Because of incomplete embolization of the sac in one patient open surgery treatment in a non-emergency setting was performed. Complete filling of aneurysmal sac was achieved in other patient but 2 years later his aneurysm re-opened and required open surgery treatment. Conclusion: Embolization of aneurysmal sac of large IIAA with guidewires may be effective for immediate treatment of impending rupture. Long-term results were better when embolization of the aneurysmal sac was combined with embolization of distal IIA branches.

The clinical importance and prediction of steal following femoro-femoral cross-over bypass: study of the donor iliac artery by intravascular ultrasound, arteriography, duplex scanning and pressure measurements

DEFF Research Database (Denmark)

Vogt, K C; Rasmussen, J G; Schroeder, T V

2000-01-01

to evaluate the clinical significance of the steal phenomenon following femoro-femoral bypass, and whether the addition of intravascular ultrasound (IVUS) to the established examinations of the donor iliac artery can improve the prediction of patients who will develop steal.......to evaluate the clinical significance of the steal phenomenon following femoro-femoral bypass, and whether the addition of intravascular ultrasound (IVUS) to the established examinations of the donor iliac artery can improve the prediction of patients who will develop steal....

Treatment of dilated pores with 1410-nm fractional erbium-doped fiber laser.

Science.gov (United States)

Suh, Dong-Hye; Chang, Ka-Yeun; Lee, Sang-Jun; Song, Kye-Yong; Choi, Jeong Hwee; Shin, Min Kyung; Jeong, Ki-Heon

2015-04-01

Dilated pores can be an early sign of skin aging and are a significant cosmetic concern. The 1410-nm wavelength is optimal for superficial dermal treatments up to 650 μm deep. The aim of the present study was to evaluate the clinical effectiveness and safety of the fractional erbium-doped fiber 1410-nm laser in the treatment of dilated pores. Fifteen patients with dilated facial pores underwent three laser treatments at 3-week intervals. Posttreatment skin responses and side effects were assessed at treatment and follow-up visits by study physicians. Clinical effectiveness of treatment was assessed by both study physicians and patients 3 months after the final laser treatment using a quartile grading scale. Histological examination was performed using biopsy samples taken at baseline (pretreatment) and 3 months after the last treatment. This study showed that greater than 51 % improvement in dilated pores was demonstrated in 14 of 15 patients after three sessions of laser treatments. Improvements in skin texture, tone, and smoothness were reported in all patients. Treatment was well tolerated in all patients, with no unanticipated side effects. This study demonstrates that the 1410-nm fractional erbium fiber laser is effective and safe for treatment of dilated facial pores in Fitzpatrick skin types III-IV.

Direct measured systolic pressure gradients across the aorto-iliac segment in multiple-level-obstruction arteriosclerosis

DEFF Research Database (Denmark)

Noer, Ivan; Praestholm, J; Tønnesen, K H

1981-01-01

Patients with severe ischemia due to multi-level obstructions in the leg arteries both above and below the region were assessed preoperatively by intraarterial brachial and femoral artery pressure measurements. The systolic pressure drop along aorto-iliac obstructions was compared to the angiogra....... Due to large variations, however, the angiographic information was found to be useless in the individual patient. No difference in the pressure drop was found between cases in which rich and poor collateral networks were visualized....

One shot tract dilation for percutaneous nephrolithotomy: is it safe and effective in preschool children?

Science.gov (United States)

Hosseini, Seyed Reza; Mohseni, Mohammad Ghasem; Alizadeh, Farshid

2014-01-01

To evaluate the safety and feasibility of percutaneous tract dilation by the one-stage method in preschool children. Between April 2009 and February 2013, all preschool (stage Amplatz according to Frattini et al. [J Endourol 2001;15:919-923] (group II, 31 patients). The primary endpoint of interest was fluoroscopy time. Secondary endpoints included tract creation and dilation time, success rate and complications. Stone-free status was defined as residuals ≤3 mm. Age, stone size, operation success and operation time were not significantly different between the studied groups. The most common stone composition was calcium oxalate in both groups. The mean ± standard deviation of access and fluoroscopy times in groups I and II were 7.3 ± 1.2 min vs. 5.9 ± 1.5 min (p > 0.05) and 70.0 ± 8.9 s vs. 22.0 ± 5.6 s (p stage method is safe and effective. Also, it is associated with considerably less radiation exposure in preschool children. © 2014 S. Karger AG, Basel.

[Iliac artery occlusion balloons for suspected placenta accreta during cesarean section].

Science.gov (United States)

Burgos Frías, N; Gredilla, E; Guasch, E; Gilsanz, F

2014-02-01

Massive obstetric hemorrhage still remains a major cause of maternal mortality and morbidity. The risk factors associated with this pathology must be identified in order to schedule the appropriate delivery with the necessary resources. A case is presented of an iliac artery occlusion with intravascular balloons for suspected placenta accreta during cesarean section. The perioperative treatment, as well as an analysis of the treatment options is described, along with their advantages and disadvantages, from the use of postpartum hemorrhage protocols, blood transfusion and procoagulant factors, and other maneuvers to control bleeding, until the hysterectomy. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.