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Sample records for hospitals percutan coronar

  1. Percutaneous cholecystostomy at the community hospital: value evaluation

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    Lee, Jeong Min; Lee, Mi Suk; Lee, Jin Hee; Ym, Seong Hee; Yoon, Young Gun [Namwon Medical Center, Namwon (Korea, Republic of); Sohn, Myung Hee; Kim, Chong Soo; Han, Young Min; Choi, Ki Chul [Chonbuk National Univ., Chonju (Korea, Republic of)

    1997-10-01

    To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalulous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy:liver cirrhosis(n=3D2), diabetes mellitus(n=3D3), cardiac disease(n=3D3), underlying malignancy(n=3D2), pulmonary dysfunction(n=3D1), septic cholangitis(n=3D5), and old age(n=3D2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion(n=3D2) and procedure failure(n=3D1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered:catheter dislodgment(n=3D3), and significant abdominal pain during the procedure(2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients(94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.=20.

  2. Results of percutaneous nephrolithotomy performed in a regional state hospital

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    Taner Çiftçi

    2011-12-01

    Full Text Available Aim: The aim of this study was to evaluate the results of percutaneous stone surgery that performe in a regional state hospital.Materials and methods: We retrospectively analyzed 183 percutaneous nephrolithotomy (PNL performed cases that treated at our clinic between June 2010 and July 2011. After necessary laboratory and radiological investigations, we performed PNL for the patients those diagnosed as having stones needed surgery. After surgery, we investigated radiologically whether residual stone fragments remained or not. When there were residual stone fragments (bigger than 4 mm, we performed ESWL, repeated percutaneous interventions and surveillance protocols. In six patients, open surgery was needed during PNL.Results: Of the totally 183 patients underwent PNL at our clinic, 102 were male and 81 were female. The mean age was 37.6 and mean stone burden was 35.5 mm2. Stone-free rate was 75.4% and the rate of the patients who have residual stones (bigger than 4mm was 25.7%. Stone free rates were 95% and 86% for stone burden lesser and more than 2 cm2, respectively. The mean blood loss was 186ml for per operational case. Totally four patients (8.5% underwent blood tranfusion.Conclusion: As a result, because of its high stone-free rates, the shorter hospital stay, minimal surgical scar and absence of wound infection, PNL is preserving its place for the treatment of stones bigger than 2 cm2. J Clin Exp Invest 2011; 2 (4: 371-374

  3. Repatriation to referral hospital after reperfusion of STEMI patients transferred for primary percutaneous coronary intervention

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    Ting, Rudee; Tejpal, Ambika; Finken, Laura

    2016-01-01

    BACKGROUND: In regional systems of ST-segment elevation myocardial infarction (STEMI) care, patients presenting to hospitals without percutaneous coronary intervention (PCI) are transferred to PCI-capable hospitals for primary PCI. Repatriation, a practice whereby such patients are transferred ba...

  4. Percutaneous

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    Hazem Khamis

    2014-03-01

    Conclusions: Our initial results with the MitraClip device in a very small number of patients indicate that percutaneous edge-to-edge mitral valve repair is feasible and may be accomplished with favorable short-term safety and efficacy results.

  5. Impact of Body Mass Index on In-Hospital Outcomes after Percutaneous Coronary Intervention

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    Bahram Sohrabi

    2013-02-01

    Full Text Available Objectives: The aim of current study is to evaluate relation between body mass index (BMI and in-hospital outcome in patients undergoing percutaneous coronary intervention (PCI.Background: Relation between body mass indexes (BMI with percutaneous coronary intervention (PCI has shown in different studies. Recent studies suggested a paradox relation between different BMI values and outcome in certain patients.Methods: In this prospective study, 1134 patients (81.7% male, 18.3% female with mean age of 58.18±11.16 years whom undergone PCI between January 2011 and December 2011 were chosen and their BMI and disease outcome was studied. Classification of BMI was: healthy weight (18.5 to 24.9 kg/m2, overweight (25 to 29.9 kg/m2, moderate obesity (30 to 34.9 kg/m2 and severe obesity (over 35 kg/m2. Baseline patient characteristics and in-hospital outcome were compared among BMI categories.Results: Major adverse cardiac events (MACE were significantly higher in patients with overweight and moderate obesity than two other groups. There was no difference in mortality, reinfarction, revascularisation, stroke and bleeding events among the 4 groups. Being overweight is an independent factor associated to in-hospital MACE (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.17 to 0.73, p=0.01 and mortality rate (OR 0.20, 95%CI 0.04 to 0.85, p=0.03.Conclusion: BMI overall is not correlated to in-hospital MACE and mortality; however, overweight patients are at reduced risk for MACE and mortality.

  6. Temporal Trends of Reperfusion Strategies and Hospital Mortality for Patients With STEMI in Percutaneous Coronary Intervention-Capable Hospitals.

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    Tran, Dat T; Welsh, Robert C; Ohinmaa, Arto; Thanh, Nguyen X; Kaul, Padma

    2017-04-01

    The aim of this study was to examine temporal trends and provincial variations in reperfusion strategies and in-hospital mortality among patients presenting with ST-segment elevation myocardial infarction (STEMI) at hospitals in Canada capable of performing percutaneous coronary intervention (PCI). We included patients aged ≥ 20 years who were hospitalized between fiscal years 2009 and 2013 in all provinces except Quebec. We categorized patients as receiving fibrinolysis (lysis), primary PCI (pPCI), or no reperfusion. Patients undergoing lysis were further categorized as (1) lysis + PCI ≤ 90 minutes, (2) lysis + PCI > 90 minutes, and (3) lysis only. Patients undergoing pPCI were further categorized as (1) pPCI ≤ 90 minutes and (2) pPCI > 90 minutes. We used logistic regression to examine the baseline-adjusted association between reperfusion strategy and in-hospital mortality. Among 44,650 STEMI episodes in 44,373 patients, 66.3% received pPCI (annual increase of 7.8%; P hospital mortality ranged from a high of 16.3% among patients receiving no reperfusion to a low of 1.9% among patients receiving lysis + PCI > 90 minutes (adjusted odds ratio of 0.42; 95% confidence interval, 0.32-0.55 compared with pPCI ≤ 90 minutes). The use of pPCI in STEMI has increased significantly in Canada; however, significant interprovincial variation remains. Changes in reperfusion strategies do not appear to have had an impact on in-hospital mortality rates. Patients who underwent lysis followed by PCI in a systematic fashion had the lowest mortality. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  7. Association of Physician Certification in Interventional Cardiology with In-Hospital Outcomes of Percutaneous Coronary Intervention

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    Fiorilli, Paul N.; Minges, Karl E.; Herrin, Jeph; Messenger, John C.; Ting, Henry H.; Nallamothu, Brahmajee K.; Lipner, Rebecca S.; Hess, Brian J.; Holmboe, Eric S.; Brennan, Joseph J.; Curtis, Jeptha P.

    2015-01-01

    Background The value of American Board of Internal Medicine (ABIM) certification has been questioned. We evaluated the association of interventional cardiology (ICARD) certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010. Methods and Results We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined ICARD status using ABIM data. We compared in-hospital outcomes of patients treated by certified and non-certified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary endpoints were all-cause in-hospital mortality and bleeding complications. Secondary endpoints included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510,708 PCI procedures performed by 5,175 physicians, case mix and unadjusted outcomes were similar among certified and non-certified physicians. The adjusted risks of in-hospital mortality (OR 1.10, 95% CI 1.02-1.19) and emergency CABG (OR 1.32, 95% CI 1.12-1.56) were higher in the non-ICARD certified group, but the risks of bleeding, vascular complications, and the composite endpoint were not statistically significantly different between groups. Conclusions We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency CABG in patients treated by non-ICARD certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes, and indicate a need to enhance the value of subspecialty certification. PMID:26384518

  8. Long-Term Results of Percutaneous Management of Liver Hydatid Cysts: - Experience of a University Hospital in Endemic Region –

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    Younès Cherradi

    2016-12-01

    Full Text Available Background and objective: Surgery was considered for years the standard treatment for all stages of liver hydatid cysts (LHC. Percutaneous treatment has becomes a fast, reliable and more efficient method in selected cases. The purpose of this study is to evaluate the effectiveness of percutaneous treatment of LHC on the basis of our department long-term results. Patients and Methods: This study includes all patients who benefited from percutaneous treatment for LHC from December 1998 to April 2012. Puncture aspiration, injection, and re-aspiration (PAIR were used for hydatid cysts smaller than 6 cm. Larger cysts, infected cysts and those with biliary fistula were treated by puncture associated to drainage (PA-PD. Absolute alcohol was used as sclerosing agent. Reduction of the size of the cyst more than 50%, pseudo-tumour echo pattern and disappearance of the cyst at the follow-up were retained as criteria of treatment efficacy. Results: Two hundred thirty patients (136 female and 94 male; mean age: 35 years old with 278 LHC underwent percutaneous treatment. Mean initial cyst diameter was 76.8 mm [20-180 mm]. According to Gharbi’s classification, types I and II LHC accounted for 74% and 25% respectively. Fourteen patients (6% presented with an infected cavity and 27 patients (12% had a biliary fistula at diagnosis (12%. PA-PD was initially performedin 23 patients. No mortality, abdominal dissemination, or tract seeding occurred. Minor complications like urticaria, cutaneous rash and fever were reported in 24 patients (10%. One case of anaphylactic shock was reported with good evolution. Mean hospitalization time was 3 days ± 1.5 for uncomplicated cases and 16.5 days± 4.2 for complicated cases. 229 out of 230 patients were cured, whereas one recurrence has been reported. Conclusion: Percutaneous treatmentis efficient and safe and offers complete cure in selected patients with the advantage of short hospitalization.

  9. Percutaneous retrieval of dislodged totally implantable central venous access system in 92 cases: Experience in a single hospital

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    Cheng, C.-C.; Tsai, T.-N. [Division of Cardiology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan (China); Yang, C.-C. [Department of Medicine, Armed Forces Tao-Yuan General Hospital, Taoyuan, Taiwan (China); Han, C.-L. [Division of Cardiology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan (China)], E-mail: allexll.cheng@msa.hinet.net

    2009-02-15

    Objective: To investigate the clinical presentation of dislodged totally implantable central venous access system (central venous port-catheter) fragments and the efficacy and safety of percutaneous retrieval of them in our hospital. Materials and methods: Ninety-two cancer patients, mean age of 53.8 years old with 51.1% male, were enrolled from January 2005 to March 2007. They were referred to our catheterization laboratory for retrieval of fractured central venous port-catheter in our hospital. All patients were followed in the outpatient department for at least 1 month after surgical insertion. The characteristics of disrupted central venous port-catheter were recorded. The procedure-related clinical condition was evaluated. Results: The most common presentation of central venous port-catheter dislodgement is irrigation resistance to infusion (51/92). The most common location of fractured fragments is between superior vena cava and right atrium (i.e. proximal end remained in superior vena cava and distal end in right atrium) (22/92). The most common fracture site of the catheter is at the anastomosis between injection port and catheter (77/92). The retrieval set used mostly is loop snare. The success rate of the percutaneous retrieval of dislodged fragment was 97.8% and the complication rate was 3.3% only. Conclusion: The faulty connection between catheter and injection port contributes mainly to dislodgement of central venous port-catheter. Percutaneous retrieval of dislodged catheter is a highly successful, safe and efficient method.

  10. Quality of Care at Hospitals Identified as Outliers in Publicly Reported Mortality Statistics for Percutaneous Coronary Intervention.

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    Waldo, Stephen W; McCabe, James M; Kennedy, Kevin F; Zigler, Corwin M; Pinto, Duane S; Yeh, Robert W

    2017-05-16

    Public reporting of percutaneous coronary intervention (PCI) outcomes may create disincentives for physicians to provide care for critically ill patients, particularly at institutions with worse clinical outcomes. We thus sought to evaluate the procedural management and in-hospital outcomes of patients treated for acute myocardial infarction before and after a hospital had been publicly identified as a negative outlier. Using state reports, we identified hospitals that were recognized as negative PCI outliers in 2 states (Massachusetts and New York) from 2002 to 2012. State hospitalization files were used to identify all patients with an acute myocardial infarction within these states. Procedural management and in-hospital outcomes were compared among patients treated at outlier hospitals before and after public report of outlier status. Patients at nonoutlier institutions were used to control for temporal trends. Among 86 hospitals, 31 were reported as outliers for excess mortality. Outlier facilities were larger, treating more patients with acute myocardial infarction and performing more PCIs than nonoutlier hospitals (Poutlier hospital after public report. The likelihood of PCI at outlier (relative risk [RR], 1.13; 95% confidence interval [CI], 1.12-1.15) and nonoutlier institutions (RR, 1.13; 95% CI, 1.11-1.14) increased in a similar fashion (interaction P=0.50) after public report of outlier status. The likelihood of in-hospital mortality decreased at outlier institutions (RR, 0.83; 95% CI, 0.81-0.85) after public report, and to a lesser degree at nonoutlier institutions (RR, 0.90; 95% CI, 0.87-0.92; interaction Poutlier institutions after public recognition of outlier status in comparison with prior (RR, 0.72; 9% CI, 0.66-0.79), a decline that exceeded the reduction at nonoutlier institutions (RR, 0.87; 95% CI, 0.80-0.96; interaction Poutliers. The rates of percutaneous revascularization increased similarly at outlier and nonoutlier institutions after report

  11. Percutaneous computed tomography-guided biopsy of the lung: data from a hospital; Biopsia pulmonar percutanea guiada por tomografia computadorizada: dados de um hospital

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    Carazzai, Emilio Humberto; Rossi, Marcelo D' Andrea [Maximagem Diagnosticos por Imagem, Sao Paulo, SP (Brazil); Andreosi, Maristela [Hospital Beneficencia Portuguesa, Sao Paulo, SP (Brazil); Gonzalez, Fabio Mota; Tornin, Olger de Souza [Hospital Heliopolis, Sao Paulo, SP (Brazil)]. E-mail: olger1@uol.com.br; Gonzalez, Sandra de Quadros Uzeda [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil)

    2006-07-15

    Objective: to present the experience of Santa Cecilia Hospital (Sao Paulo, SP, Brazil) radiology service in the handling of computed tomography-guided fine-needle aspiration biopsy and percutaneous core biopsy of pulmonary lesions, analyzing their importance and associated complications. Materials and methods: one hundred and sixty-eight computed tomography-guided biopsies were performed in 84 men and 84 women. Sixty-four patients underwent fine-needle aspiration biopsy, 68 underwent percutaneous core biopsy and 36 patients underwent both techniques. Results: pneumothorax occurred in 38 patients, and pulmonary hemorrhage in then cases. The biopsied lesions ranged in size from 0.5 to 15 cm. The diagnosis was achieved at the first attempt in 132 cases and at the second attempt, in ten cases. Conclusion: the accuracy of fine-needle aspiration and percutaneous core biopsies depends both on the size of the lesion and the patient's cooperation. These techniques are relatively safe and present a high diagnostic accuracy when performed by an experienced professional. (author)

  12. The role of out-of-hospital cardiac arrest in predicting hospital mortality for percutaneous coronary interventions in the Clinical Outcomes Assessment Program.

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    Maynard, Charles; Rao, Sunil V; Gregg, Mary; Phillips, Richard C; Reisman, Mark; Tucker, Eben; Goss, J Richard

    2009-01-01

    Published mortality models for percutaneous coronary intervention (PCI), including the Clinical Outcomes Assessment Program (COAP) model, have not considered the effect of out-ofhospital cardiac arrest. The primary objective of this study was to determine if the inclusion of out-of-hospital cardiac arrest altered the COAP mortality model for PCI. The COAP PCI database contains extensive demographic, clinical, procedural and outcome information, including out-of-hospital cardiac arrest, which was added to the data collection form in 2006. This study included 15,586 consecutive PCIs performed in 31 Washington State hospitals in 2006. Using development and test sets, the existing COAP PCI logistic regression mortality model was examined to assess the effect of out-of-hospital arrest on in-hospital mortality. Overall, 2% of individuals undergoing PCI had cardiac arrest prior to hospital arrival. Among 8 hospitals with PCI volumes 120 cases per year did. In-hospital mortality was 19% in the arrest group and was 1.0% in remaining procedures (p < 0.0001). In the new multivariate model, out-of-hospital cardiac arrest was highly associated with mortality (odds ratio = 5.50; 95% confidence interval [CI] = 3.28-9.25). When evaluated in the test set, the new model had excellent discrimination (c-statistic = 0.89; 95% CI = 0.85-0.93). Out-of-hospital cardiac arrest is an important determinant of risk-adjusted in-hospital mortality for PCI, particularly for hospitals with low volumes and relatively high volumes of cardiac arrest cases.

  13. Fiber optic bronchoscopy-assisted percutaneous tracheostomy: a decade of experience at a university hospital

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    Romero, Carlos M.; Cornejo, Rodrigo; Tobar, Eduardo; Gálvez, Ricardo; Luengo, Cecilia; Estuardo, Nivia; Neira, Rodolfo; Navarro, José Luis; Abarca, Osvaldo; Ruiz, Mauricio; Berasaín, María Angélica; Neira, Wilson; Arellano, Daniel; Llanos, Osvaldo

    2015-01-01

    Objective To evaluate the efficacy and safety of percutaneous tracheostomy by means of single-step dilation with fiber optic bronchoscopy assistance in critical care patients under mechanical ventilation. Methods Between the years 2004 and 2014, 512 patients with indication of tracheostomy according to clinical criteria, were prospectively and consecutively included in our study. One-third of them were high-risk patients. Demographic variables, APACHE II score, and days on mechanical ventilation prior to percutaneous tracheostomy were recorded. The efficacy of the procedure was evaluated according to an execution success rate and based on the necessity of switching to an open surgical technique. Safety was evaluated according to post-operative and operative complication rates. Results The mean age of the group was 64 ± 18 years (203 women and 309 males). The mean APACHE II score was 21 ± 3. Patients remained an average of 11 ± 3 days on mechanical ventilation before percutaneous tracheostomy was performed. All procedures were successfully completed without the need to switch to an open surgical technique. Eighteen patients (3.5%) presented procedure complications. Five patients experienced transient desaturation, 4 presented low blood pressure related to sedation, and 9 presented minor bleeding, but none required a transfusion. No serious complications or deaths associated with the procedure were recorded. Eleven patients (2.1%) presented post-operative complications. Seven presented minor and transitory bleeding of the percutaneous tracheostomy stoma, 2 suffered displacement of the tracheostomy cannula, and 2 developed a superficial infection of the stoma. Conclusion Percutaneous tracheostomy using the single-step dilation technique with fiber optic bronchoscopy assistance seems to be effective and safe in critically ill patients under mechanical ventilation when performed by experienced intensive care specialists using a standardized procedure. PMID:26340151

  14. Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

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    Montalescot, Gilles; van 't Hof, Arnoud W; Bolognese, Leonardo

    2016-01-01

    OBJECTIVES: The aim of this landmark exploratory analysis, ATLANTIC-H(24), was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ...

  15. Impact of coronary dominance on in-hospital outcomes after percutaneous coronary intervention in patients with acute coronary syndrome.

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    Toshiki Kuno

    Full Text Available OBJECTIVE: This study evaluated the manner in which coronary dominance affects in-hospital outcomes of acute coronary syndrome (ACS patients undergoing percutaneous coronary intervention (PCI. BACKGROUND: Previous studies have shown that left dominant coronary anatomies are associated with worse prognoses in patients with coronary artery disease. METHODS: Data were analyzed from 4873 ACS patients undergoing PCI between September 2008 and April 2013 at 14 hospitals participating in the Japanese Cardiovascular Database Registry. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right- or co-dominant anatomy (RD group and those with left-dominant anatomy (LD group. RESULTS: The average patient age was 67.6±11.8 years and both patient groups had similar ages, coronary risk factors, comorbidities, and prior histories. The numbers of patients presenting with symptoms of heart failure, cardiogenic shock, or cardiopulmonary arrest were significantly higher in the LD group than in the RD group (heart failure: 650 RD patients [14.7%] vs. 87 LD patients [18.8%], P = 0.025; cardiogenic shock: 322 RD patients [7.3%] vs. 48 LD patients [10.3%], P = 0.021; and cardiopulmonary arrest: 197 RD patients [4.5%] vs. 36 LD patients [7.8%], P = 0.003. In-hospital mortality was significantly higher among LD patients than among RD patients (182 RD patients [4.1%] vs. 36 LD patients [7.8%], P = 0.001. Multivariate logistic regression analysis revealed that LD anatomy was an independent predictor for in-hospital mortality (odds ratio, 1.75; 95% confidence interval, 1.06-2.89; P = 0.030. CONCLUSION: Among ACS patients who underwent PCI, LD patients had significantly worse in-hospital outcomes compared with RD patients, and LD anatomy was an independent predictor of in-hospital mortality.

  16. USG assisted and USG guided percutaneous renal biopsy at Nepal Medical College Teaching Hospital: a three and half years study.

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    Tuladhar, A S; Shrestha, A; Pradhan, S; Manandhar, D N; Chhetri Poudyal, P K; Rijal, A; Poudel, P; Maskey, A; Bhoomi, K K

    2014-09-01

    A prospective study was carried out from 2009 to 2013 in the Department of Radiology and Imaging of Nepal Medical College and Teaching Hospital, Attarkhel, Jorpati, Kathmandu, Nepal, in which a total of 75 patients underwent percutaneous renal biopsy with a 16 or 18 gauge needles. This was done blindly by marking a site on the skin, or, whenever there was difficulty with the blind procedure, by direct real time USG guidance. In all cases, the marking in the skin was done by the radiologist and the biopsy was performed by the Nephrologist, with the aid of the radiologist in cases of real-time USG guided renal biopsy. This study was carried out to assess the safety and efficacy of the USG aided, and USG guided renal biopsy, to see for the types and severity of complications arising from renal biopsies to determine the optimal period of observation required after the procedure. All renal biopsies were performed after the patients were admitted to the hospital at least 1 day prior to the procedure. Coagulation profile was done in all patients prior to the procedure. All patients were kept under strict complete bed rest for 24 hours post procedure. The ages of the patients ranged between 14 years to 71 years, with 42 female and 33 male patients. A mean of 21.8 glomeruli was obtained in each specimen, with absent glomerular yield seen in only 3 patients. Minimal change disease was seen in 19 patients, being the most common histopathological diagnosis followed by a spectrum of others. The overall complication rate was 4% and all of these were self-limiting needing no other intervention, or management except for observation and bed rest. Late complications were not seen. Percutaneous renal biopsy with the help of USG is a safe and efficacious procedure with less chance of minor complications.

  17. Coordinated Hospital-Home Fecal Microbiota Transplantation via Percutaneous Endoscopic Cecostomy for Recurrent Steroid-Dependent Ulcerative Colitis

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    Ni, Xiaodong; Fan, Shengxian; Zhang, Yongliang; Wang, Zhiming; Ding, Lan; Li, Yousheng; Li, Jieshou

    2016-01-01

    Since its introduction as an alternative intestinal microbiota alteration approach, fecal microbiota transplantation (FMT) has been increasingly used as a treatment of choice for patients with ulcerative colitis (UC), but no reports exist regarding FMT via percutaneous endoscopic cecostomy (PEC). This report describes the case of a 24-year-old man with a 7-year history of recurrent, steroid-dependent UC. He received FMT via PEC once per day for 1 month in the hospital. After the remission of gastrointestinal symptoms, he was discharged from the hospital and continued FMT via PEC twice per week for 3 months at home. The frequency of stools decreased, and the characteristics of stools improved soon thereafter. Enteral nutrition was regained after 1 week, and an oral diet was begun 1 month later. Two months after the FMT end point, the patient resumed a normal diet, with formed soft stools once per day. The follow-up colonoscopy showed normal mucus membranes; then, the PEC set was removed. On the subsequent 12 months follow-up, the patient resumed orthobiosis without any gastrointestinal discomfort and returned to work. This case emphasizes that FMT via PEC can not only induce remission but also shorten the duration of hospitalization and reduce the medical costs; therefore, this approach should be considered an alternative option for patients with UC. PMID:27282271

  18. Benchmarking of Percutaneous Injuries at the Ministry of Health Hospitals of Saudi Arabia in Comparison with the United States Hospitals Participating in Exposure Prevention Information Network (EPINet™

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    ZA Memish

    2015-01-01

    Full Text Available Background: Exposure to blood-borne pathogens from needle-stick and sharp injuries continues to pose a significant risk to health care workers. These events are of concern because of the risk to transmit blood-borne diseases such as hepatitis B virus, hepatitis C virus, and the human immunodeficiency virus.Objective: To benchmark different risk factors associated with needle-stick incidents among health care workers in the Ministry of Health hospitals in the Kingdom of Saudi Arabia compared to the US hospitals participating in Exposure Prevention Information Network (EPINet ™.Methods: Prospective surveillance of needle-stick and sharp incidents carried out during the year 2012 using EPINet™ ver 1.5 that provides uniform needle stick and sharp injury report form.Results: The annual percutaneous incidents (PIs rate per 100 occupied beds was 3.2 at the studied MOH hospitals. Nurses were the most affected job category by PIs (59.4%. Most PIs happened in patients' wards in the Ministry of Health hospitals (34.6%. Disposable syringes were the most common cause of PIs (47.20%. Most PIs occurred during use of the syringes (36.4%.Conclusion: Among health care workers, nurses and physicians appear especially at risk of exposure to PIs. Important risk factors of injuries include working in patient room, using disposable syringes, devices without safety features. Preventive strategies such as continuous training of health care workers with special emphasis on nurses and physicians, encouragement of reporting of such incidents, observation of sharp handling, their use and implementation of safety devices are warranted.

  19. Prevalence and factors associated with percutaneous injuries and splash exposures among health-care workers in a provincial hospital, Kenya, 2010.

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    Mbaisi, Everline Muhonja; Ng'ang'a, Zipporah; Wanzala, Peter; Omolo, Jared

    2013-01-01

    Accidental occupational exposure of healthcare workers to blood and body fluids after skin injury or mucous membrane contact constitutes a risk for transmission of blood-borne pathogens. Such pathogens include Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV). We conducted a study to determine the prevalence and associated factors for percutaneous injuries and splash exposures among health-care workers in Rift Valley provincial hospital. A cross-sectional study was carried out from October to November 2010. Self reported incidents, circumstances surrounding occupational exposure and post-exposure management were sought by use of interviewer administered questionnaire. Descriptive, bivariate and multiple logistic regression (forward stepwise procedure) analyses were performed. The level of significance was set at 0.05. Twenty five percent of health-care workers interviewed (N=305) reported having been exposed to blood and body fluids in the preceding 12 months. Percutaneous injuries were reported by 19% (n=305) and splash to mucous membrane by 7.2%. Higher rates of percutaneous injuries were observed among nurses (50%), during stitching (30%), and in obstetric and gynecologic department (22%). Health workers aged below 40 years were more likely to experience percutaneous injuries (OR=3.7; 95% CI=1.08-9.13) while previous training in infection prevention was protective (OR=0.52; 95% CI=0.03-0.90). Forty eight percent (n=83) reported the incidents with 20% (n=83) taking PEP against HIV. Percutaneous injuries and splashes are common in Rift Valley Provincial hospital. Preventive measures remain inadequate. Health institutions should have policies, institute surveillance for occupational risks and enhance training of health care workers.

  20. Importance of Hospital Entry: Walk-in STEMI and Primary Percutaneous Coronary Intervention

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    Eric Bansal

    2014-02-01

    Full Text Available Introduction: Patients with ST elevation myocardial infarction (STEMI require rapid identification and triage to initiate reperfusion therapy. Walk-in STEMI patients have longer treatment times compared to emergency medical service (EMS transported patients. While effective triage of large numbers of critically ill patients in the emergency department is often cited as the reason for treatment delays, additional factors have not been explored. The purpose of this study was to evaluate baseline demographic and clinical differences between walk-in and EMS-transported STEMI patients and identify factors associated with prolonged door to balloon (D2B time in walk-in STEMI patients. Methods: We performed a retrospective review of 136 STEMI patients presenting to an urban academic teaching center from January 2009 through December, 2010. Baseline demographics, mode of hospital entry (walk-in versus EMS transport, treatment times, angiographic findings, procedures performed and in-hospital clinical events were collected. We compared walk-in and EMS-transported STEMI patients and identified independent factors of prolonged D2B time for walk-in patients using stepwise logistic regression analysis. Results: Walk-in patients (n=51 were more likely to be Latino and presented with a higher heart rate, higher systolic blood pressure, prior history of diabetes mellitus and were more likely to have an elevated initial troponin value, compared to EMS-transported patients. EMS-transported patients (n=64 were more likely to be white and had a higher prevalence of left main coronary artery disease, compared to walk-in patients. Door to electrocardiogram (ECG, ECG to catheterization laboratory (CL activation and D2B times were significantly longer for walk-in patients. Walk-in patients were more likely to have D2B time > 90 minutes, compared to EMS- transported patients; odds ratio 3.53 (95% CI 1.03, 12.07, p = 0.04. Stepwise logistic regression identified hospital

  1. In-Hospital and One-Year Clinical Outcome of Percutaneous Coronary Intervention in a Tertiary Hospital in Oman: Oman PCI Registry

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    Prashanth Panduranga

    2017-01-01

    Full Text Available Objectives: The aim of the study was to investigate the in-hospital and one-year clinical outcome of patients treated with percutaneous coronary intervention (PCI in a tertiary hospital in Oman. Methods: We conducted a retrospective, single-center, observational study looking at patients > 18 years old who underwent a PCI from 1 January to 31 December 2013. The primary end point was the occurrence of a major adverse cardiovascular event (MACE, defined as death, any myocardial infarction (MI, cerebrovascular accident (CVA, and target vessel revascularization (TVR with either repeat PCI or coronary artery bypass surgery (CABG. Secondary end-points included procedural success rate, angina status, stent thrombosis, and the rate of redo-PCI/CABG for in-stent restenosis. Results: A total of 1 045 consecutive patients were analyzed. The mean age of the cohort was 58.2±11.2 years. Hyperlipidemia (66.8%, hypertension (55.1%, and diabetes mellitus (45.9% were the predominant risk factors. Stable angina, ST-elevation MI, non-ST-elevation MI, and post-acute coronary syndrome (ACS were common indications (approximately 20.0% each. The angiographic and procedural success rate was 95.0%. Forty-six percent of patients had single-vessel disease, 34.4% had double vessel disease, and triple vessel disease was seen in 19.1% of patients. Ninety-eight percent had balloon angioplasty with stenting, and only 1.9% of patients had balloon angioplasty without stenting. The majority of patients had single-vessel stenting (81.3%. A drug-eluting stent was used in 88.4% of patients, and a bare-metal stent in 11.6%. In-hospital MACE was 3.6%. There were 19 in-hospital deaths (1.8%, and four patients (0.4% had CVA/MI. Out of 1 026 patients discharged, 100 patients were lost to follow-up. Among the 926 patients followed-up, 673 patients (72.7% were asymptomatic. One-year MACE was 17.0%, including 5.0% death and 6.0% MI. Repeat revascularization was performed in 53 patients (5

  2. Renal insufficiency is an independent predictor of in-hospital mortality for patients with acute myocardial infarction receiving primary percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    Jian-ping LI; Mohetaboer MOMIN; Yong HUO; Chun-yan WANG; Yan ZHANG; Yan-jun GONG; Zhao-ping LIU; Xin-gang WANG; Bo ZHENG

    2012-01-01

    Objective:To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infarction (ASTEMI),who were treated with emergency percutaneous coronary intervention (PCI).Methods:420 patients hospitalized in Peking University First Hospital,diagnosed with ASTEMI treated with emergency (PCI) from January 2001 to June 2011 were enrolled in this study.Estimated glomerular filtration rate (eGFR) was used as a measure of renal function.We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function.Results:There was a significant increase in the concentrations of fibrinogen and D-Dimer (P<0.05) and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease (CKD; eGFR<60 ml/(min·1.73 m2)) (P<0.01).CKD (eGFR<60 ml/(min·1.73 m2)) was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly (P=0.032,odds ratio (OR) 4.159,95% confidence interval (CI) 1.127-15.346).Conclusions:Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.

  3. Impact of emergency percutaneous coronary intervention on outcomes of ST-segment elevation myocardial infarction patients complicated by out-of-hospital cardiac arrest.

    Science.gov (United States)

    Liu, Hong-wei; Pan, Wei; Wang, Lan-feng; Sun, Yan-ming; Li, Zhu-qin; Wang, Zhong-hua

    2012-04-01

    Cardiac arrest is one of the most serious complications of acute myocardial infarction (AMI), especially in the out-of-hospital patients. There is no general consensus as to whether percutaneous coronary intervention (PCI) is effective in treating ST-segment elevation myocardial infarction (STEMI) patients complicated by out-of-hospital cardiac arrest (OHCA). In our study, we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality, adverse cardiac events, stroke, acute renal failure, and gastrointestinal bleeding events. A total of 1827 STEMI patients were enrolled in this study, where 81 were STEMI with OHCA. Between the patients with and without OHCA, and the OHCA patients with and without PCI, we compared the clinical characteristics during hospitalization, including total mortality and incidences of adverse cardiac events, and stroke. Compared to the patients without OHCA, the OHCA patients had significantly lower systolic blood pressure (P Emergency PCI reduces the incidence of adverse events and decreases mortality during hospitalization, which is effective for treating STEMI with OHCA patients.

  4. Occurrence and predictors of left ventricular systolic dysfunction at hospital discharge and in long−term follow−up after acute myocardial infarction treated with primary percutaneous coronary intervention

    OpenAIRE

    Świątkiewicz, Iwona; Magielski, Przemysław; Woźnicki, Marek; Gierach, Joanna; Jabłoński, Mirosław; Fabiszak, Tomasz; Koziński, Marek; Sukiennik, Adam; Bronisz, Agata; Kubica, Jacek

    2011-01-01

    Background: Post-ST-segment elevation myocardial infarction (STEMI) left ventricular systolic dysfunction (LVSD) has been identified as an important marker of poor prognosis. Aim: To assess the prevalence and course of LVSD at hospital discharge and in long-term follow-up in STEMI patients treated with primary percutaneous coronary intervention (pPCI). Methods: We enrolled 205 patients (157 male, 48 female) with a first STEMI. Echocardiography was performed before hospital disc...

  5. [Long-term results of mitral percutaneous valvuloplasty with Inoue technique. Seven-years experience at the Cardiology Hospital of the National Medical Center "Siglo XXI", IMSS].

    Science.gov (United States)

    Flores Flores, Jesús; Ledesma Velasco, Mariano; Palomo Villada, José Antonio; Montoya Guerrero, Silvestre; Estrada Gallegos, Joel; Astudillo Sandoval, Raúl; Abundes Velasco, Arturo; González Díaz, Belinda; Argüero Sánchez, Rubén; Farell Campa, Javier

    2006-01-01

    Since the last decade, percutaneous balloon mitral valvuloplasty with Inoue catheter is considered the treatment of choice for selected patients (mobile valve, no calcification and minimal subvalvular disease) with rheumatic mitral stenosis. We present the seven-year follow-up experience of 456 patients treated with this technique in the catheter laboratory of the Cardiology Hospital in National Medical Center SXXI. It is a retrospective, transversal and observational study performed with data obtained from January 1994 and December 2000, with a follow-up of 58.5 +/- 26.6 months (range 12-96 mean 22). We achieve an initial success of 82.8%, improvement of initial mitral valve area from 0.9 +/- 0.1 to 1.8 +/- 0.3 cm2, with a gain area from 88 to 106% (p 90%. From these patients, 93.1% remained in NYHA-II or -I functional class and the incidence of restenosis decreased.

  6. Impact of chronic obstructive pulmonary disease on in-hospital morbidity and mortality in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.

    Science.gov (United States)

    Șerban, Răzvan Constantin; Hadadi, Laszlo; Șuș, Ioana; Lakatos, Eva Katalin; Demjen, Zoltan; Scridon, Alina

    2017-09-15

    Patients with chronic obstructive pulmonary disease (COPD) presenting with ST-segment elevation myocardial infarction (STEMI) are less likely to beneficiate of primary percutaneous coronary intervention (pPCI), and have poorer prognosis. We aimed to evaluate the impact of COPD on the in-hospital outcomes of pPCI-treated STEMI patients. Data were collected from 418 STEMI patients treated by pPCI. Inotropics and diuretics usage, cardiogenic shock, asystole, kidney dysfunction, and left ventricular ejection fraction were used as markers of hemodynamic complications. Atrial and ventricular fibrillation, conduction disorders, and antiarrhythmics usage were used as markers of arrhythmic complications. In-hospital mortality was evaluated. The associations between these parameters and COPD were assessed. COPD was present in 7.42% of STEMI patients. COPD patients were older (p=0.02) and less likely to receive beta-blockers (OR 0.29; 95%CI 0.13-0.64; p<0.01). They had higher Killip class on admission (p<0.001), received more often inotropics (p<0.001) and diuretics (p<0.01), and presented more often atrial (p=0.01) and ventricular fibrillation (p=0.02). Unadjusted in-hospital mortality was higher in COPD patients (OR 4.18, 95%CI 1.55-11.30, p<0.01). After adjustment for potentially confounding factors except beta-blockers, COPD remained an independent predictor of in-hospital mortality (p=0.02). After further adjustment with beta-blocker therapy, no excess mortality was noted in COPD patients. Despite being treated by pPCI, COPD patients with STEMI are more likely to develop hemodynamic and arrhythmic complications, and have higher in-hospital mortality. This appears to be due to lower beta-blockers usage in COPD patients. Increasing beta-blockers usage in COPD patients with STEMI may improve survival. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  7. Impact of emergency percutaneous coronary intervention on outcomes of ST-segment elevation myocardial infarction patients complicated by out-of-hospital cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    LIU Hong-wei; PAN Wei; WANG Lan-feng; SUN Yan-ming; LI Zhu-qin; WANG Zhong-hua

    2012-01-01

    Background Cardiac arrest is one of the most serious complications of acute myocardial infarction (AMI),especially in the out-of-hospital patients.There is no general consensus as to whether percutaneous coronary intervention (PCI) is effective in treating ST-segment elevation myocardial infarction (STEMI) patients complicated by out-of-hospital cardiac arrest (OHCA).In our study,we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality,adverse cardiac events,stroke,acute renal failure,and gastrointestinal bleeding events.Methods A total of 1827 STEMI patients were enrolled in this study,where 81 were STEMI with OHCA.Between the patients with and without OHCA,and the OHCA patients with and without PCI,we compared the clinical characteristics during hospitalization,including total mortality and incidences of adverse cardiac events,and stroke.Results Compared to the patients without OHCA,the OHCA patients had significantly lower systolic blood pressure (P <0.05) and a faster heart rate (P<0.05),and a higher percentage of Killip class IV or Glasgow coma scale (GCS) ≤7 onadmission (P <0.001).And the in-hospital mortality was higher in the OHCA patients (55.6% vs.2.4%,P <0.001).Comparing the OHCA patients without PCI to the patients with PCI,there was no obvious difference of heart rate,blood pressure or the percentage of Killip class IV and GCS ≤7 on admission,but the incidences of cardiogenic shock,stroke were significantly lower in the with-PCI group during hospitalization (P <0.001,P <0.05).And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower (36.7% vs.84.3%,P<0.001).Conclusions During hospitalization,the incidence of adverse events and mortality are higher in the STEMI with OHCA patients,comparing with the STEMI without OHCA.Emergency PCI reduces the incidence of adverse events and decreases mortality

  8. Achieving timely percutaneous reperfusion for rural ST-elevation myocardial infarction patients by direct transport to an urban PCI-hospital

    Science.gov (United States)

    Bennin, Charles-Lwanga K; Ibrahim, Saif; Al-Saffar, Farah; Box, Lyndon C; Strom, Joel A

    2016-01-01

    Backgrounds ST-elevation myocardial infarction (STEMI) guidelines recommend reperfusion by primary percutaneous coronary intervention (PCI) ≤ 90 min from time of first medical contact (FMC). This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service (EMS) STEMI field triage protocol. Methods Sixty STEMI patients directly transported by EMS from three rural counties (Nassau, Camden and Charlton Counties) within a 50-mile radius of University of Florida Health-Jacksonville (UFHJ) from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements: (1) a cooperative agreement between each of the rural emergency medical service (EMS) agency and UFHJ; (2) performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and (3) direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device (FMC2D), door-to-device (D2D), and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio (OR) of achieving FMC2D times was calculated. Results FMC2D times were shorter for in-state STEMIs (81 ± 17 vs. 87 ± 19 min), but D2D times were similar (37 ± 18 vs. 39 ± 21 min). FMC2D ≤ 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs (OR = 4.4, 95% CI: 1.24–15.57; P = 0.018). FMC2D times were homogenous after adjusting for weekday vs. weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D ≤ 120 min. Conclusions Guideline-compliant FMC2D ≤ 90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use

  9. Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Sørensen, Kristian Dahl Kragholm; Malta Hansen, Carolina; Dupre, Matthew E

    2017-01-01

    BACKGROUND: Practice guidelines recommend regional systems of care for out-of-hospital cardiac arrest. However, whether emergency medical services should bypass nonpercutaneous cardiac intervention (non-PCI) facilities and transport out-of-hospital cardiac arrest patients directly to PCI centers...... despite longer transport time remains unknown. METHODS AND RESULTS: Using the Cardiac Arrest Registry to Enhance Survival with geocoding of arrest location, we identified out-of-hospital cardiac arrest patients with prehospital return of spontaneous circulation and evaluated the association between direct...... transport to a PCI center and outcomes in North Carolina during 2012 to 2014. Destination hospital was classified according to PCI center status (catheterization laboratory immediately accessible 24/7). Inverse probability-weighted logistic regression accounting for age, sex, emergency medical services...

  10. In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J-CTO Registry (Multicenter CTO Registry in Japan).

    Science.gov (United States)

    Morino, Yoshihiro; Kimura, Takeshi; Hayashi, Yasuhiko; Muramatsu, Toshiya; Ochiai, Masahiko; Noguchi, Yuichi; Kato, Kenichi; Shibata, Yoshisato; Hiasa, Yoshikazu; Doi, Osamu; Yamashita, Takehiro; Morimoto, Takeshi; Abe, Mitsuru; Hinohara, Tomoaki; Mitsudo, Kazuaki

    2010-02-01

    Our aim was to investigate in-hospital outcomes of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) using contemporary techniques. Despite its increasing popularity and technical complexity, clinical outcomes of PCI for CTO using contemporary techniques have not been adequately evaluated. The J-CTO registry (multicenter CTO registry in Japan) is a large scale, multicenter registry enrolling consecutive patients undergoing PCI for CTO from 12 Japanese centers. In-hospital clinical outcomes were evaluated in 498 patients with 528 CTO lesions. Multiple wiring strategies were frequently attempted (parallel wiring 31% and retrograde approach 25%) with relatively long guidewire manipulation time (median 30 min). Utilizing these complex strategies, high procedural success rates (88.6% in the first attempt cases and 68.5% in the retry cases) were accomplished. In-hospital adverse event rates were strikingly low (cardiac death 0.2%, Q-wave myocardial infarction 0.2%, and stroke 0%). Potential disadvantages of these procedures, including a large amount of contrast volume (median 293 ml) and long fluoroscopic time (median 45 min), were not associated with serious clinical sequelae (contrast induced nephropathy 1.2% and radiation dermatitis 0%). Although coronary perforations were documented frequently by angiography (antegrade 7.2% and retrograde 13.6%), clinically significant perforation resulting in cardiac tamponade was rare (0.4%). Most CTO lesions can be safely and successfully treated with PCI utilizing contemporary advanced techniques. Invasiveness and potential risks of these strategies, which have been the greatest concerns of CTO treatment, may be acceptable in the majority of cases considering the actual incidences of related adverse events and the procedural success rates. Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  11. Impact of body mass index on in-hospital complications in patients undergoing percutaneous coronary intervention in a Japanese real-world multicenter registry.

    Directory of Open Access Journals (Sweden)

    Yohei Numasawa

    Full Text Available Obesity is associated with advanced cardiovascular disease. However, some studies have reported the "obesity paradox" after percutaneous coronary intervention (PCI. The relationship between body mass index (BMI and clinical outcomes after PCI has not been thoroughly investigated, especially in Asian populations.We studied 10,142 patients who underwent PCI at 15 Japanese hospitals participating in the JCD-KICS registry from September 2008 to April 2013. Patients were divided into four groups according to BMI: underweight, BMI <18.5 (n=462; normal, BMI ≥ 18.5 and <25.0 (n=5,945; overweight, BMI ≥ 25.0 and <30.0 (n=3,100; and obese, BMI ≥ 30.0 (n=635.Patients with a high BMI were significantly younger (p<0.001 and had a higher incidence of coronary risk factors such as hypertension (p<0.001, hyperlipidemia (p<0.001, diabetes mellitus (p<0.001, and current smoking (p<0.001, than those with a low BMI. Importantly, patients in the underweight group had the worst in-hospital outcomes, including overall complications (underweight, normal, overweight, and obese groups: 20.4%, 11.5%, 8.4%, and 10.2%, p<0.001, in-hospital mortality (5.8%, 2.1%, 1.2%, and 2.7%, p<0.001, cardiogenic shock (3.5%, 2.0%, 1.5%, and 1.6%, p=0.018, bleeding complications (10.0%, 4.5%, 2.6%, and 2.8%, p<0.001, and receiving blood transfusion (7.6%, 2.7%, 1.6%, and 1.7%, p<0.001. BMI was inversely associated with bleeding complications after adjustment by multivariate logistic regression analysis (odds ratio, 0.95; 95% confidence interval, 0.92-0.98; p=0.002. In subgroup multivariate analysis of patients without cardiogenic shock, BMI was inversely associated with overall complications (OR, 0.98; 95% CI, 0.95-0.99; p=0.033 and bleeding complications (OR, 0.95; 95% CI, 0.91-0.98; p=0.006. Furthermore, there was a trend that BMI was moderately associated with in-hospital mortality (OR, 0.94; 95% CI, 0.88-1.01; p=0.091.Lean patients, rather than obese patients are at greater risk

  12. Comparison of In-Hospital Mortality, Length of Stay, Postprocedural Complications, and Cost of Single-Vessel Versus Multivessel Percutaneous Coronary Intervention in Hemodynamically Stable Patients With ST-Segment Elevation Myocardial Infarction (from Nationwide Inpatient Sample [2006 to 2012]).

    Science.gov (United States)

    Panaich, Sidakpal S; Arora, Shilpkumar; Patel, Nilay; Schreiber, Theodore; Patel, Nileshkumar J; Pandya, Bhavi; Gupta, Vishal; Grines, Cindy L; Deshmukh, Abhishek; Badheka, Apurva O

    2016-10-01

    The primary objective of our study was to evaluate the in-hospital outcomes in terms of mortality, procedural complications, hospitalization costs, and length of stay (LOS) after multivessel percutaneous coronary intervention (MVPCI) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI). The study cohort was derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database, years 2006 to 2012. Percutaneous coronary interventions (PCI) performed during STEMI were identified using appropriate International Classification of Diseases, Ninth Revision, diagnostic and procedural codes. Patients in cardiogenic shock were excluded. Hierarchical mixed-effects logistic regression models were used for categorical dependent variables such as in-hospital mortality and composite of in-hospital mortality and complications, and hierarchical mixed-effects linear regression models were used for continuous dependent variables such as cost of hospitalization and LOS. We identified 106,317 (weighted n = 525,161) single-vessel PCI and 15,282 (weighted n = 74,543) MVPCIs. MVPCI (odds ratio, 95% confidence interval [CI], p value) was not associated with significant increase in in-hospital mortality (0.99, 0.85 to 1.15, 0.863) but predicted a higher composite end point of in-hospital mortality and postprocedural complications (1.09, 1.02 to 1.17, 0.013) compared to single-vessel PCI. MVPCI was also predictive of longer LOS (LOS +0.19 days, 95% CI +0.14 to +0.23 days, p <0.001) and higher hospitalization costs (cost +$4,445, 95% CI +$4,128 to +$4,762, p <0.001). MVPCI performed during STEMI in hemodynamically stable patients is associated with no increase in in-hospital mortality but a higher rate of postprocedural complications and longer LOS and greater hospitalization costs compared to single-vessel PCI.

  13. Percutaneous endoscopic gastrostomy in porcines performed with standard medical instruments used in a general hospital routine Gastrostomia percutânea endoscópica em suínos realizada com instrumentos de uso rotineiro em hospital geral

    Directory of Open Access Journals (Sweden)

    Luiz Roberto do Nascimento

    2004-10-01

    Full Text Available PURPOSE: To perform a endoscopic gastrostomy by the introducer method with routine instruments used in a general hospital, without special instruments or special kits. METHODS: This procedure was performed in pigs (Sus scrofa domesticus under observation for seven days and then submitted to euthanasia.The technique was evaluated for macroscopic and histologic parameters. RESULTS: All animals had a good evolution without major complications. Some minor complications occurred like a rupture of Foley catheter balloon and subcutaneous space abscess. CONCLUSION: The percutaneous gastrostomy with routine general hospital instruments is successful performed, is safe,cheap and must be performed by skilled endoscopists.OBJETIVO: Realizar uma gastrostomia endoscópica pelo método de punção, porém feita com instrumentos de uso rotineiro em um hospital geral, abolindo o uso de instrumentos especiais e de kits industrializados. MÉTODOS: O procedimento foi realizado em suinos da raça Landrace (Sus scrofa domesticus , que permaneceram em observação por sete dias, quando foram submetidos a eutanasia e avaliados por parâmetros macroscópicos e histológicos. RESULTADOS: Todos os animais tiveram boa evolução, não apresentando complicações importantes. Pequenas complicações, como ruptura do balão da sonda de Foley e abscesso subcutâneo ocorreram. CONCLUSÃO: A gastrostomia percutânea endoscópica é um procedimento seguro, barato e perfeitamente realizável com materiais de uso rotineiro em um hospital geral, porém deve ser realizada por endoscopistas devidamente treinados.

  14. Percutaneous coronary intervention for acute MI does not prevent in-hospital development of cardiogenic shock compared to fibrinolysis

    DEFF Research Database (Denmark)

    Lindholm, Matias G; Boesgaard, Søren; Thune, Jens Jakob

    2008-01-01

    -hospital development of cardiogenic shock compared to fibrinolysis. To evaluate whether mortality in patients who develop cardiogenic shock after treatment is dependent on revascularization strategy. METHODS AND RESULTS: DANAMI-2 randomly assigned 1572 STEMI patients to fibrinolysis (782 patients) or angioplasty (790......% of the total mortality was due to cardiogenic shock, and treatment strategy did not influence the risk associated with shock (hazard ratio of 1.05 (0.67-1.64) for angioplasty vs. fibrinolysis). CONCLUSIONS: Angioplasty does not prevent the in-hospital development of cardiogenic shock complicating acute MI...... compared to fibrinolysis. Cardiogenic shock is still the leading cause of death in patients hospitalised for acute MI. There was no difference in mortality, with regards to treatment strategy in patients developing cardiogenic shock after the initial treatment....

  15. [Percutaneous transluminal coronary angioplasty. The experience of the Hospital de Especialidades of the La Raza Medical Center, IMSS].

    Science.gov (United States)

    Murillo, H; Ayala, F; Almazán, A; Madrid, R; Rangel, A; Valdespino, A; Solorio, S; Lepe, L; Badui, E

    1993-01-01

    We analyzed the initial results of the PTCA program at the Hospital de Especialidades CMR, IMSS. During the last year we studied 33 patients in whom we performed 35 PTCA procedures with total of 45 lesions. The age of the patients varied from 27 to 75 years of age (average 57 year +/- 10.9). Among them, 84.8% were males and 15.2% females. In 54.5% of the patients, stable angina was present, whereas in 45.5% unstable angina was observed. Multivessel disease was detected in 39.4% of the cases. In 17.8% the coronary lesions were type "A", in 77.8% type "B" and in 4.4% type C. The most frequent lesions were present at the left anterior descending artery in 46.6%, right coronary artery in 40% and circumflex in 13.4%. The global procedural success was 88.5% (32/35 procedure) whereas the procedural success by isolated lesion was 88.8% (40/45 lesions). The average artery stenosis was decreased from 85 +/- 10.4% to 23 +/- 16%. A procedural failure occurred in 4 instances (11.4%), among them, 2 (5.71%) without complications and 2 more, associated to acute myocardial infarction. In the present study there were no emergency operation neither deaths. Although the number of PTCA performed in our hospital is limited, we consider that the initial results are good, with a success rate of 88.5% with a minimal complications.

  16. Information Needs in Relation to Physical Activity among Angina Patients before Percutaneous Coronary Intervention (PCI at a Private Hospital in Penang, Malaysia

    Directory of Open Access Journals (Sweden)

    Ho Siew Eng

    2016-10-01

    Full Text Available Background: Episodes experienced by angina patients are potentially frightening and life threatening. Angina patients lack awareness regarding Percutaneous Coronary Intervention (PCI as a prognostic benefit. Aim and Objectives: To identify the information needs in relation to physical activity among angina patients before PCI at a private hospital in Penang, Malaysia. Material and Methods: A cross-sectional study was conducted from April to July 2016; 150 respondents who fulfilled the inclusion criteria were recruited. A 16-item questionnaire related to physical limitations was adapted and modified from Seattle Angina Questionnaire (SAQ. Results: The findings reported that majority of respondents (103; 69% possessed more than one co-morbidity, while 47respondents (31% single co-morbidity. Those with secondary level education showed (M=15.98, SD±6.14 while tertiary level education reported (M=16.61, SD±6.11, with no significant difference (t= -0.623, p= 0.534 between respondents' education level and physical activity. In terms of occupation, employed (M=15.58, SD±6.42 and unemployed (M=17.31, SD±5.52 also reported significant difference with (t= -1.70, p= 0.04. There was likewise a significant difference between respondents with single co-morbidity (M=18.09, SD±6.88 and multiple co-morbidity (M=15.46, SD± 5.58 with (t= 2.475, p= 0.01.However, there was no significant difference between respondents with previous admission and physical activity (t= 0.868, p= 0.387, as well as respondents' age group with physical activity (t=-0.675, p= 0.501.Conclusion: In conclusion, respondents' information needs regarding PCI are significantly associated with occupation and co-morbidity towards physical activity before PCI. Age, educational level and previous admission did not have any effect on respondents' physical activity before PCI.

  17. [Radiological percutaneous gastrostomy (GRP), 17 años de experiencia, serie de casos del hospital Universitario Virgen del Rocío].

    Science.gov (United States)

    Navarro Falcón, Magnolia Del Carmen; Parejo Campos, Juana; Pereira Cunill, José Luis; García Luna, Pedro Pablo

    2014-10-25

    When assessing a patient nutritional support the state of the gastrointestinal tract is the most important point to consider, whenever possible we should choose the enteral nutrition (EN) over parenteral nutrition (PN) and recognized by its various advantages. The percutaneous gastrostomy (GRP) were introduced in clinical practice as an alternative to surgical gastrostomy (GQ). The speed, simplicity, low cost, low morbidity and low mortality of these techniques has allowed its rapid development.The feeding tubes types used were the balloon-retained devices catheter, the pig tail and the ballon-retained with gastropexia (gastropexia). It is a retrospective study of all patients who were placed GPR in the Virgen del Rocío University Hospital, Sevilla, between September 1996 and September 2013, which aims to study is to describe the characteristics of patients and the complications presented for different types of enteral feeding tubes used. GPR 186 were performed in 176 patients (135 males (76.70%), with an average duration of 303.6 days, the most frequent diseases were cancers of the head and neck 49.46%. The types of feeding tubes used were pigtail 118 (63.44%), balloon-retained devices 22 (11.83%), and gastropexia 46 (24.73%). The most common early complications in the pigtail group were early purulent exudate and early bleeding (2.5 and 3.4% respectively), while in the balloon catheter group the initial output of the probe was most frequent early complication (13.7%), none of these complications were observed in the group of gastropexy. The most common late complication was obstruction probe. The GPR is a safe technique with lower mortality of 1%; Low frequently of early and late complications. A better understanding of this technique can reduce the frequency of complications.

  18. Computed tomography-guided percutaneous core needle biopsy for diagnosis of mediastinal mass lesions: Experience with 110 cases in two university hospitals in Isfahan, Iran

    Science.gov (United States)

    Rabbani, Masoud; Sarrami, Amir Hossein

    2016-01-01

    Background: Computed tomography-guided percutaneous core needle biopsy (PCNB) is a diagnostic technique for initial assessment of mediastinal mass lesions. This study was conducted to evaluate its diagnostic yield and its complication rate. Materials and Methods: We reviewed the records of CT-guided PCNB in 110 patients with mediastinal mass lesions performed in Kashani and Alzahra Hospitals, Isfahan, from 2006 to 2012. Gender, age at biopsy, size, and anatomic location of the lesion, number of passes, site of approach, complications, and final diagnosis were extracted. Results: Our series encompasses 52 (47.2%) females and 58 (52/7%) males with mean age of 41 ± 8 years. The most common site of involvement was the anterior mediastinum (91.8% of cases). An average of 3/5 passes per patient has been taken for tissue sampling. Parasternal site was the most frequent approach taken for PCNB (in 78.1% of cases). Diagnostic tissue was obtained in 99 (90%) biopsies while, in 11 (10%) cases, specimen materials were inadequate. Lymphoma (49.5%) and bronchogenic carcinoma (33.3%) were the most frequent lesions in our series. The overall complication rate was 17.2% from which 10.9% was pneumothorax, 5.4% was hemoptysis, and 0.9% was vasovagal reflex. Conclusion: CT-guided PCNB is a safe and reliable procedure that can provide a precise diagnosis for patients with both benign and malignant mediastinal masses, and it is considered the preferred first diagnostic procedure use for this purpose.

  19. Biópsia pulmonar percutânea guiada por tomografia computadorizada: dados de um hospital Percutaneous computed tomography-guided biopsy of the lung: data from a hospital

    Directory of Open Access Journals (Sweden)

    Emílio Humberto Carazzai

    2006-08-01

    Full Text Available OBJETIVO: Apresentar a experiência do serviço de radiologia do Hospital Santa Cecília, São Paulo, SP, no manejo das biópsias pulmonares por aspiração através de agulha fina e biópsias por fragmentos guiadas por tomografia computadorizada e a análise de sua importância e associação com suas complicações. MATERIAIS E MÉTODOS: Foram analisadas 168 biópsias guiadas por tomografia, sendo 84 em homens e 84 em mulheres. Utilizou-se a técnica de biópsia por aspiração por agulha fina em 64 pacientes, a técnica de biópsia por fragmento em 68 pacientes e ambas as técnicas em 36 pacientes. RESULTADOS: Pneumotórax ocorreu em 38 pacientes e a hemorragia pulmonar, em dez pacientes. As dimensões das lesões biopsiadas variaram de 0,5 cm até 15 cm. O diagnóstico foi realizado na primeira tentativa em 132 casos e na segunda tentativa em dez casos. CONCLUSÃO: A acurácia das biópsias aspirativas por agulha fina e por fragmento de lesões pulmonares depende do tamanho da lesão e da colaboração do paciente. Essas técnicas são relativamente seguras e têm acurácia diagnóstica elevada quando feitas por um profissional experiente.OBJECTIVE: To present the experience of Santa Cecília Hospital (São Paulo, SP, Brazil radiology service in the handling of computed tomography-guided fine-needle aspiration biopsy and percutaneous core biopsy of pulmonary lesions, analyzing their importance and associated complications. MATERIALS AND METHODS: One hundred and sixty-eight computed tomography-guided biopsies were performed in 84 men and 84 women. Sixty-four patients underwent fine-needle aspiration biopsy, 68 underwent percutaneous core biopsy and 36 patients underwent both techniques. RESULTS: Pneumothorax occurred in 38 patients, and pulmonary hemorrhage in then cases. The biopsied lesions ranged in size from 0.5 to 15 cm. The diagnosis was achieved at the first attempt in 132 cases and at the second attempt in ten cases. CONCLUSION: The

  20. The practice of percutaneous liver biopsy in a gastrohepatology day hospital: a retrospective study on 835 biopsies.

    Science.gov (United States)

    Actis, Giovanni Clemente; Olivero, Alda; Lagget, Marco; Pellicano, Rinaldo; Smedile, Antonina; Rizzetto, Mario

    2007-10-01

    The evolving role of liver biopsy has induced the formulation of several guidelines on its appropriateness. However, the great divergence among hepatologists is still unresolved. We report the 4-year activity of a day hospital of gastrohepatology in northern Italy. Between January 2001 and July 2004, 835 subjects (mean age, 43+/-12 years) underwent this procedure in our facility. Etiologically, in 465 (56%) and 157 (19%) patients, chronic hepatitis C and nonspecific elevated liver biochemical tests were the first and second indications, followed by chronic hepatitis B and suspected nonalcoholic steatohepatitis. On a purpose basis, procedures requested for staging (n = 578) and/or for diagnosis (n = 217) were identified. Among the former, 80% had the scope of staging chronic hepatitis C, and in 15% of these unsuspected superimposed cirrhosis was detected. Among diagnostic procedures, nonspecific raised liver enzyme level ranked first. Twenty-two percent of patients reported unwanted effects following the procedure. In conclusion, these data accord with indications expressed by international guidelines. The impact of liver biopsy on therapeutic decision-making needs to be studied further.

  1. Percutaneous cholecystostomy

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan E-mail: akhano@tr.net; Akinci, Devrim; Oezmen, Mustafa N

    2002-09-01

    Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

  2. Pulmonary Cement Embolism following Percutaneous Vertebroplasty

    Directory of Open Access Journals (Sweden)

    Ümran Toru

    2014-01-01

    Full Text Available Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.

  3. Percutaneous tracheostomy

    Directory of Open Access Journals (Sweden)

    Chitra Mehta

    2017-01-01

    Full Text Available Percutaneous dilatational tracheostomy (PDT is a commonly performed procedure in critically sick patients. It can be safely performed bedside by intensivists.This has resulted in decline in the use of surgical tracheostomy in intensive care unit (ICU except in few selected cases. Most common indication of tracheostomy in ICU is need for prolonged ventilation. About 10% of patients requiring at least 3 days of mechanical ventilator support get tracheostomised during ICU stay. The ideal timing of PDT remains undecided at present. Contraindications and complications become fewer with increase in experience. Various methods of performing PDT have been discovered in last two decades. Preoperative work up, patient selection and post tracheostomy care form key components of a successful PDT. Bronchoscopy and ultrasound have been found to be useful procedural adjuncts, especially in presence of unfavorable anatomy. This article gives a brief overview about the use of PDT in ICU.

  4. Percutaneous gastroenterostomy

    Energy Technology Data Exchange (ETDEWEB)

    Wittich, G.R.; Van Sonnenberg, E.; Casola, G.; Jantsch, H.; Walter, R.; Lechner, G.

    1987-05-01

    Percutaneous gastrostomies or gastroenterostomies serve for temporary or permanent enteric feeding in patients with obstruction or functional derangement of the esophagus or hypopharynx. In addition, this radiological procedure may be indicated for small bowel decompression. The authors present their experience in 71 patients. Insufflation of air through a nasogastric tube or catheter is the preferred method for gastric distension. The inferior margin of the left lobe of the liver and the transverse colon are localized sonographically and fluoroscopically prior to puncture. Either Seldinger or Trocartechniques have proven effective in establishing access to the stomach. The feeding tube is advanced into the proximal jejunum to reduce the likelyhood of gastroesophageal reflux and possible aspiration. Complications were encountered in four patients and included catheter dislocation in three and respiratory distress in one patient.

  5. [Ultrasound guided percutaneous nephrolithotripsy].

    Science.gov (United States)

    Guliev, B G

    2014-01-01

    The study was aimed to the evaluation of the effectiveness and results of ultrasound guided percutaneous nephrolithotripsy (PNL) for the treatment of patients with large stones in renal pelvis. The results of PNL in 138 patients who underwent surgery for kidney stones from 2011 to 2013 were analyzed. Seventy patients (Group 1) underwent surgery with combined ultrasound and radiological guidance, and 68 patients (Group 2)--only with ultrasound guidance. The study included patients with large renal pelvic stones larger than 2.2 cm, requiring the formation of a single laparoscopic approach. Using the comparative analysis, the timing of surgery, the number of intra- and postoperative complications, blood loss and length of stay were evaluated. Percutaneous access was successfully performed in all patients. Postoperative complications (exacerbation of chronic pyelonephritis, gross hematuria) were observed in 14.3% of patients in Group 1 and in 14.7% of patients in Group 2. Bleeding requiring blood transfusion, and injuries of adjacent organs were not registered. Efficacy of PNL in the Group 1 was 95.7%; 3 (4.3%) patients required additional interventions. In Group 2, the effectiveness of PNL was 94.1%, 4 (5.9%) patients additionally underwent extracorporeal lithotripsy. There were no significant differences in the effectiveness of PNL, the volume of blood loss and duration of hospitalization. Ultrasound guided PNL can be performed in large pelvic stones and sufficient expansion of renal cavities, thus reducing radiation exposure of patients and medical staff.

  6. Percutaneous Achilles Tendon Lengthening

    Science.gov (United States)

    ... All Site Content AOFAS / FootCareMD / Treatments Percutaneous Achilles Tendon Lengthening Page Content ​ Pre-operative incision markings along ... What is the goal of a percutaneous Achilles tendon lengthening? The goal of this procedure is to ...

  7. Percutaneous Abscess Drainage

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Percutaneous Abscess Drainage An abscess is an infected fluid collection ... are the benefits vs. risks? What is Percutaneous Abscess Drainage? An abscess is an infected fluid collection ...

  8. Percutaneous treatment of liver hydatid cysts

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan; Oezmen, Mustafa N

    1999-10-01

    Hydatic disease caused by Echinococcus granulosus is an endemic disease and an important public health problem in some countries of the world. The results of surgical treatment are associated with a high rate of mortality, morbidity, postoperative recurrence and a long period of hospital stay and the medical treatment results are still controversial. Although the percutaneous aspiration and treatment of liver hydatid cysts were considered to be contraindicated due to risks of anaphylactic shock and dissemination of clear-crystal fluid into the abdomen, several reports of successful percutaneous treatment of liver hydatid cysts have been published in the literature. Today, percutaneous treatment of liver hydatid cysts is the most effective and reliable treatment procedure in the selected cases. In this review, indications, contraindications, method and techniques, healing criteria, complications, results and importance of the percutaneous treatment of liver hydatid cysts are discussed.

  9. Hospitals

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...

  10. Percutaneous mitral valve repair.

    Science.gov (United States)

    Gillinov, A Marc; Liddicoat, John R

    2006-01-01

    Surgical mitral valve repair is the procedure of choice to treat mitral regurgitation of all etiologies. Whereas annuloplasty is the cornerstone of mitral valve repair, a variety of other surgical techniques are utilized to correct dysfunction of the leaflets and subvalvular apparatus; in most cases, surgical repair entails application of multiple repair techniques in each patient. Preclinical studies and early human experience have demonstrated that some of these surgical repair techniques can be performed using percutaneous approaches. Specifically, there has been great progress in the development of novel technology to facilitate percutaneous annuloplasty and percutaneous edge-to-edge repair. The objectives of this report were to (1) discuss the surgical foundations for these percutaneous approaches; (2) review device design and experimental and clinical results of percutaneous valve repair; and (3) address future directions, including the key challenges of patient selection and clinical trial design.

  11. Percutaneous forefoot surgery.

    Science.gov (United States)

    Bauer, T

    2014-02-01

    Percutaneous methods can be used to perform many surgical procedures on the soft tissues and bones of the forefoot, thereby providing treatment options for all the disorders and deformities seen at this site. Theoretical advantages of percutaneous surgery include lower morbidity rates and faster recovery with immediate weight bearing. Disadvantages are the requirement for specific equipment, specific requirements for post-operative management, and lengthy learning curve. At present, percutaneous hallux valgus correction is mainly achieved with chevron osteotomy of the first metatarsal, for which internal fixation and a minimally invasive approach (2 cm incision) seem reliable and reproducible. This procedure is currently the focus of research and evaluation. Percutaneous surgery for hallux rigidus is simple and provides similar outcomes to those of open surgery. Lateral metatarsal malalignment and toe deformities are good indications for percutaneous treatment, which produces results similar to those of conventional surgery with lower morbidity rates. Finally, fifth ray abnormalities are currently the ideal indication for percutaneous surgery, given the simplicity of the procedure and post-operative course, high reliability, and very low rate of iatrogenic complications. The most commonly performed percutaneous techniques are described herein, with their current indications, main outcomes, and recent developments.

  12. hospital

    African Journals Online (AJOL)

    Pattern of congenital orthopaedic malformations in an African teaching hospital ... malformation in this environment while congenital hip dislocation (CDH) is rare when .... malformations of radial dysplasia and other congenital malformations.

  13. Percutaneous liver biopsy.

    Science.gov (United States)

    Rustagi, Tarun; Newton, Eric; Kar, Premashish

    2010-01-01

    Percutaneous liver biopsy has been performed for more than 120 years, and remains an important diagnostic procedure for the management of hepatobiliary disorders. Modern biochemical, immunologic, and radiographic techniques have facilitated the diagnosis and management of liver diseases but have not made liver biopsy obsolete. This comprehensive review article will discuss the history of development of percutaneous liver biopsy, its indications, contraindications, complications and the various aspects of the biopsy procedure in detail.

  14. Percutaneous antegrade pyelography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chang Guhn; Lim, Bang Eun; Kim, Jae Kyu; Song, Ok Ja; Nah, Byung Sik; Chung, Hyon De [Chonnam National University College of Medicine, Kwangju (Korea, Republic of)

    1985-02-15

    Percutaneous antegrade pyelography guided by ultrasonography and fluoroscopy was attempted in 25 patients with supravesical obstructive hydronephrosis and successful in 23 patients to evaluate the site and nature of urinary obstructions. The etiology of the obstructive uropathies were urinary stricture in 11 cases, urinary Tbc. in 5 cases, urinary stone in 3 cases, uterine prolapse with cystocele, pyonephrosis, ureteral metastatic testicular carcinoma in 1 case respectively. No significant complication of the percutaneous antegrade pyelography was observed. Percutaneous antegrade pyelography provides significant diagnostic information on the obstructive lesion and can be accomplished with ease and safe in patients with obstructive hydronephrosis as a diagnostic procedure of choice in infants and children or as an alternative to a retrograde pyelography.

  15. Percutaneous Treatment of Splenic Cystic Echinococcosis: Results of 12 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan, E-mail: akhano@tr.net; Akkaya, Selçuk, E-mail: selcuk.akkaya85@gmail.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Dağoğlu, Merve Gülbiz, E-mail: drmgkartal@gmail.com [Istanbul University, Department of Radiology, Istanbul School of Medicine (Turkey); Akpınar, Burcu, E-mail: burcu-akpinar@yahoo.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Erbahçeci, Aysun, E-mail: aysunerbahceci@yahoo.com [Istanbul Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Department of Radiology (Turkey); Çiftçi, Türkmen, E-mail: turkmenciftci@yahoo.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Köroğlu, Mert, E-mail: mertkoroglu@hotmail.com [Antalya Education and Research Hospital, Department of Radiology (Turkey); Akıncı, Devrim, E-mail: akincid@hotmail.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey)

    2016-03-15

    PurposeCystic echinococcosis (CE) in the spleen is a rare disease even in endemic regions. The aim of this study was to examine the efficacy of percutaneous treatment for splenic CE.Materials and MethodsTwelve patients (four men, eight women) with splenic CE were included in this study. For percutaneous treatment, CE1 and CE3A splenic hydatid cysts were treated with either the PAIR (puncture, aspiration, injection, respiration) technique or the catheterization technique.ResultsEight of the hydatid cysts were treated with the PAIR technique and four were treated with catheterization. The volume of all cysts decreased significantly during the follow-up period. No complication occurred in seven of 12 patients. Abscess developed in four patients. Two patients underwent splenectomy due to cavity infection developed after percutaneous treatment, while the spleen was preserved in 10 of 12 patients. Total hospital stay was between 1 and 18 days. Hospital stay was longer and the rate of infection was higher in the catheterization group. Follow-up period was 5–117 months (mean, 44.8 months), with no recurrence observed.ConclusionThe advantages of the percutaneous treatment are its minimal invasive nature, short hospitalization duration, and its ability to preserve splenic tissue and function. As the catheterization technique is associated with higher abscess risk, we suggest that the PAIR procedure should be the first percutaneous treatment option for splenic CE.

  16. Antiseptic skin agents for percutaneous procedures.

    Science.gov (United States)

    Lepor, Norman E; Madyoon, Hooman

    2009-01-01

    Infections associated with percutaneously implanted devices, such as pacemakers, internal cardiac defibrillators, and endovascular prostheses, create difficult and complex clinical scenarios because management can entail complete device removal, antibiotic therapy, and prolonged hospitalization. A source for pathogens is often thought to be the skin surface, making skin preparation at the time of the procedure a critical part of minimizing implantation of infected devices and prostheses. The most common skin preparation agents used today include products containing iodophors or chlorhexidine gluconate. Agents are further classified by whether they are aqueous-based or alcoholbased solutions. Traditional aqueous-based iodophors, such as povidone-iodine, are one of the few products that can be safely used on mucous membrane surfaces. Alcohol-based solutions are quick, sustained, and durable, with broader spectrum antimicrobial activity. These agents seem ideal for percutaneous procedures associated with prosthesis implantation, when it is critical to minimize skin colony counts to prevent hardware infection.

  17. Percutaneous tracheostomy with the guide wire dilating forceps technique : presentation of 171 consecutive patients

    NARCIS (Netherlands)

    Fikkers, Bernard G; van Heerbeek, Niels; Krabbe, Paul F M; Marres, Henri A M; van den Hoogen, Frank J A

    2002-01-01

    BACKGROUND: Evaluation of percutaneous tracheostomy (PT) with the guide wire dilating forceps (GWDF) technique. METHODS: Prospective study of perioperative complications, retrospective analysis of early and late complications in an ICU in a teaching university hospital. RESULTS: The success rate of

  18. Percutaneous dilatational tracheostomy

    DEFF Research Database (Denmark)

    Johnsen, R.

    2015-01-01

    Introduction Since the introduction and development of percutaneous dilatational tracheostomy (PDT), this procedure is accepted and incorporated in ICUs worldwide. In spite of obvious benefits for the patients, who obtain more comfort and mobility and less use of sedatives, the procedure also imp...

  19. Percutaneous nephrolithotomy for pediatric urolithiasis

    Directory of Open Access Journals (Sweden)

    Arvind P Ganpule

    2010-01-01

    Full Text Available Pediatric urolithiasis is a management dilemma as a number of treatment options are available such as shock wave lithotripsy (SWL, percutaneous nephrolithotomy (PCNL, and retrograde intrarenal surgery (RIRS. PCNL offers good clearance rates in a single hospital stay. The concerns with PCNL include the use of large instrument in pediatric kidneys, parenchymal damage and the associated effects on renal function, radiation exposure with fluoroscopy, and the risk of major complications including sepsis and bleeding. Evolution of pediatric PCNL technique such as miniaturization of instruments, limitation of tract size and advanced intracorporeal lithotripters have resulted in this technique being widely utilized for achieving stone-free status in appropriate patients. Many of the patients in our country come from remote areas thereby requiring special considerations during treatment. This also necessitates complete clearance in a single shorter hospital stay. PCNL appears to be the optimal option available in this scenario. The literature suggests that even complex and staghorn calculi can be tackled with this approach. The choice of the method to gain access is a matter of experience and personal preference. Ultrasound offers the advantage of visualization of spleen, liver and avoids injury. Miniaturization of instruments, particularly smaller nephroscopes and the potential to use lasers will decrease the morbidity and improve the clearance rates further. In this article, we analyze the management of pediatric urolithiasis with PCNL. We discuss our technique and analyze the results, complications and technique mentioned in the contemporary literature.

  20. Echogeleide percutane drainage : toepassingen in het abdomen

    NARCIS (Netherlands)

    J.S. Laméris (Johan )

    1987-01-01

    textabstractDit proefschrift behandelt een aantal toepassingen van de echogeleide punctie en drainagetechniek in het abdomen, namelijk: - de percutane abcesdrainage - de percutane galblaasdrainage - de percutane galwegdrainage Abdominale abcessen zijn in de chirurgische praktijk altijd een groot pro

  1. Percutaneous vertebroplasty: technical considerations

    Institute of Scientific and Technical Information of China (English)

    Gao-jun TENG; Shi-cheng HE

    2005-01-01

    Percutaneous vertebroplasty (PVP) is a relative new interventional technique, which is widely used in treatment of vertebral collapse caused by vertebral neoplasms and osteoporotic compression fractures. The general technical considerations of PVP techniques are discussed based on authors' experience obtained over 400 patients in the past years in this article, including preparation of PMMA, instrument of PVP, guidance and puncture approaches, and technique of the procedure, etc. The conclusion is that PVP is a safe procedure if the physicians handle it properly.

  2. Complications of percutaneous vertebroplasty

    OpenAIRE

    Saracen, Agnieszka; Kotwica, Zbigniew

    2016-01-01

    Abstract Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral fractures of different origins—osteoporotic, traumatic, or neoplastic. PVP is minimally invasive, but the complications are not rare; however, they are in most cases not significant clinically. The most frequent is cement leakage, which can occur onto veins, paravertebral soft tissue, into the intervertebral disk, or to the spinal canal, affecting foraminal area ...

  3. Appropriateness of Percutaneous Coronary Intervention

    Science.gov (United States)

    Chan, Paul S.; Patel, Manesh R.; Klein, Lloyd W.; Krone, Ronald J.; Dehmer, Gregory J.; Kennedy, Kevin; Nallamothu, Brahmajee K.; Douglas Weaver, W.; Masoudi, Frederick A.; Rumsfeld, John S.; Brindis, Ralph G.; Spertus, John A.

    2012-01-01

    Context Despite the widespread use of percutaneous coronary intervention (PCI), the appropriateness of these procedures in contemporary practice is unknown. Objective To assess the appropriateness of PCI in the United States. Design, Setting, and Patients Multicenter, prospective study of patients within the National Cardiovascular Data Registry undergoing PCI between July 1, 2009, and September 30, 2010, at 1091 US hospitals. The appropriateness of PCI was adjudicated using the appropriate use criteria for coronary revascularization. Results were stratified by whether the procedure was performed for an acute (ST-segment elevation myocardial infarction, non–ST-segment elevation myocardial infarction, or unstable angina with high-risk features) or nonacute indication. Main Outcome Measures Proportion of acute and nonacute PCIs classified as appropriate, uncertain, or inappropriate; extent of hospital-level variation in inappropriate procedures. Results Of 500 154 PCIs, 355 417 (71.1%) were for acute indications (ST-segment elevation myocardial infarction, 103 245 [20.6%]; non–ST-segment elevation myocardial infarction, 105 708 [21.1%]; high-risk unstable angina, 146 464 [29.3%]), and 144 737 (28.9%) for nonacute indications. For acute indications, 350 469 PCIs (98.6%) were classified as appropriate, 1055 (0.3%) as uncertain, and 3893 (1.1%) as inappropriate. For nonacute indications, 72 911 PCIs (50.4%) were classified as appropriate, 54 988 (38.0%) as uncertain, and 16 838 (11.6%) as inappropriate. The majority of inappropriate PCIs for nonacute indications were performed in patients with no angina (53.8%), low-risk ischemia on noninvasive stress testing (71.6%), or suboptimal (≤1 medication) antianginal therapy (95.8%). Furthermore, although variation in the proportion of inappropriate PCI across hospitals was minimal for acute procedures, there was substantial hospital variation for nonacute procedures (median hospital rate for inappropriate PCI, 10

  4. Peritonitis following percutaneous gastrostomy tube insertions in children.

    Science.gov (United States)

    Dookhoo, Leema; Mahant, Sanjay; Parra, Dimitri A; John, Philip R; Amaral, Joao G; Connolly, Bairbre L

    2016-09-01

    Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

  5. Peritonitis following percutaneous gastrostomy tube insertions in children

    Energy Technology Data Exchange (ETDEWEB)

    Dookhoo, Leema [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada); University of Toronto, Faculty of Medicine, Toronto, ON (Canada); Mahant, Sanjay [The Hospital for Sick Children, Department of Pediatrics, Toronto, ON (Canada); Parra, Dimitri A.; John, Philip R.; Amaral, Joao G.; Connolly, Bairbre L. [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

    2016-09-15

    Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

  6. Paravalvular Regurgitation: Clinical Outcomes in Surgical and Percutaneous Treatments

    Science.gov (United States)

    Pinheiro, Carlos Passos; Rezek, Daniele; Costa, Eduardo Paiva; de Carvalho, Edvagner Sergio Leite; Moscoso, Freddy Antonio Brito; Taborga, Percy Richard Chavez; Jeronimo, Andreia Dias; Abizaid, Alexandre Antonio Cunha; Ramos, Auristela Isabel de Oliveira

    2016-01-01

    Background Paravalvular regurgitation (paravalvular leak) is a serious and rare complication associated with valve replacement surgery. Studies have shown a 3% to 6% incidence of paravalvular regurgitation with hemodynamic repercussion. Few studies have compared surgical and percutaneous approaches for repair. Objectives To compare the surgical and percutaneous approaches for paravalvular regurgitation repair regarding clinical outcomes during hospitalization and one year after the procedure. Methods This is a retrospective, descriptive and observational study that included 35 patients with paravalvular leak, requiring repair, and followed up at the Dante Pazzanese Institute of Cardiology between January 2011 and December 2013. Patients were divided into groups according to the established treatment and followed up for 1 year after the procedure. Results The group submitted to percutaneous treatment was considered to be at higher risk for complications because of the older age of patients, higher prevalence of diabetes, greater number of previous valve surgeries and lower mean creatinine clearance value. During hospitalization, both groups had a large number of complications (74.3% of cases), with no statistical difference in the analyzed outcomes. After 1 year, the percutaneous group had a greater number of re-interventions (8.7% vs 20%, p = 0.57) and a higher mortality rate (0% vs. 20%, p = 0.08). A high incidence of residual mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p = 0.08). Conclusion Surgery is the treatment of choice for paravalvular regurgitation. The percutaneous approach can be an alternative for patients at high surgical risk. PMID:27305109

  7. Paravalvular Regurgitation: Clinical Outcomes in Surgical and Percutaneous Treatments

    Directory of Open Access Journals (Sweden)

    Carlos Passos Pinheiro

    2016-01-01

    Full Text Available Abstract Background: Paravalvular regurgitation (paravalvular leak is a serious and rare complication associated with valve replacement surgery. Studies have shown a 3% to 6% incidence of paravalvular regurgitation with hemodynamic repercussion. Few studies have compared surgical and percutaneous approaches for repair. Objectives: To compare the surgical and percutaneous approaches for paravalvular regurgitation repair regarding clinical outcomes during hospitalization and one year after the procedure. Methods: This is a retrospective, descriptive and observational study that included 35 patients with paravalvular leak, requiring repair, and followed up at the Dante Pazzanese Institute of Cardiology between January 2011 and December 2013. Patients were divided into groups according to the established treatment and followed up for 1 year after the procedure. Results: The group submitted to percutaneous treatment was considered to be at higher risk for complications because of the older age of patients, higher prevalence of diabetes, greater number of previous valve surgeries and lower mean creatinine clearance value. During hospitalization, both groups had a large number of complications (74.3% of cases, with no statistical difference in the analyzed outcomes. After 1 year, the percutaneous group had a greater number of re-interventions (8.7% vs 20%, p = 0.57 and a higher mortality rate (0% vs. 20%, p = 0.08. A high incidence of residual mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p = 0.08. Conclusion: Surgery is the treatment of choice for paravalvular regurgitation. The percutaneous approach can be an alternative for patients at high surgical risk.

  8. Percutaneous vertebroplasty; Perkutane Vertebroplastie

    Energy Technology Data Exchange (ETDEWEB)

    Hierholzer, J.; Fuchs, H. [Kliniken fuer Diagnostische und Interventionelle Radiologie, Klinikum Ernst von Bergmann, Potsdam (Germany); Depriester, C. [Strahlenklinik und Poliklinik, Charite, Humboldt-Univ. Berlin (Germany); Clinique du Bois, Lille (France); Venz, S. [Strahlenklinik und Poliklinik, Charite, Humboldt-Univ. Berlin (Germany); Maier-Hauff, K. [Neurochirurgische Klinik, Bundeswehrkrankenhaus, Berlin (Germany); Schulz, R. [Unfall- und Wiederherstellungschirurgie, Klinikum Ernst von Bergmann, Potsdam (Germany); Koch, K. [Strahlentherapie, Klinikum Ernst von Bergmann, Potsdam (Germany)

    2002-03-01

    Purpose: To describe the procedure of percutaneous vertebroplasty and to present our first clinical results of patients treated for benign or malignant painful vertebral body disease. Material and Methods: We performed percutaneous vertebroplasty in 31 painful lesions of the spine. Liquid bone cement was injected into the affected vertebral body using fluoroscopic guidance through a bilateral transpedicular approach. Etiology of the bone disease was assessed by biopsy. Pain intensity was assessed before and 1 week after the procedure by standardized catalogue. Results: Percutaneous vertebroplasty was performed in 17 thoracic and in 14 lumbar spine bodies of benign (n = 23) or malignant (n = 8) disease; no clinically relevant complications occurred. All patients reported significant pain relief 1 week after the intervention. One week after treatment, patients were pain-free in 15/31 vertebral bodies, and reported mild residual pain not necessitating narcotic medication in 16/31 cases. Conclusion: In accordance with the literature, percutaneous vertebroplasty proved to be a highly effective, minimal invasive interventional procedure to treat severely painful bone lesions of benign and malignant origin. (orig.) [German] Ziel der Arbeit ist es, die Methodik der perkutanen Vertebroplastie zu beschreiben und die eigenen Ergebnisse bei Patienten mit schmerzhaften Knochenlaesionen vorzustellen. Material und Methoden: 31 schmerzhafte Wirbelkoerperlaesionen wurden durch radiologisch gestuetzte perkutane Injektion von fluessigem Knochenzement (perkutane Vertebroplastie) behandelt. In allen Faellen wurde der bilaterale transpedikulaere Zugan zum Wirbelkoerper gewaehlt. Die Genese der zugrunde liegenden Erkrankung wurde durch Knochenbiopsie gesichert, die in koaxialer Technik durch die Vertebroplastiekanuele moeglich wurde. Die Schmerzintensitaet wurde vor und eine Woche nach der Intervention standardisiert erhoben. Ergebnisse: Bei allen Patienten gelang die Intervention ohne

  9. SAFETY AND EFFICACY OF TUBELESS PERCUTANEOUS NEPHROLITHOTOMY

    Directory of Open Access Journals (Sweden)

    S Falahatkar

    2008-11-01

    Full Text Available "nPercutaneous nephrolithotomy (PNL is commonly used to treat patients with complex renal calculi. Placing a nephrostomy tube is the last step after completing PNL. Significant early postoperative discomfort after percutaneous procedure is usually secondary to nephrostomy tubes. The goal of this study is to evaluate the safety of tubeless PNL. A total of 45 patients with mean age of 46.6 years entered the study. Tubeless PNL was performed in 28 patients and 17 patients were treated with standard PNL. The results of 2 groups were compared with t test. In both groups, PNL was performed successfully without any significant complication. Postoperative hospitalization in standard group was 3.71 day and in tubeless group was 1.65 day that significant statistical difference was observed (P < 0.05. Analgesic dose using in standard group was 101.56 mg (pethidine vs 99.07 mg (pethidine in tubeless group, with no significant statistical difference. There wasn't any organ trauma. Rate of complications, including hematuria, extravasation, fever, UTI and urosepsis, didn't have any significant statistical difference in two groups. It seems that tubeless PNL may be an effective and safe method in renal stone treatment in selected patients. In comparison with standard PNL, tubeless PNL has some benefits including reduction the length of hospitalization. Further studies on more patients are needed to determine the advantages of this technique.

  10. Percutaneous injuries correlates in the nursing team of a Brazilian tertiary-care university hospital Factores asociados con heridas percutáneas en el equipo de enfermería de un hospital universitario de nivel terciario Fatores associados a acidentes percutâneos na equipe de enfermagem de um hospital universitário de nível terciário

    Directory of Open Access Journals (Sweden)

    Silvia Rita Marin da Silva Canini

    2008-10-01

    Full Text Available The study aims to identify percutaneous injuries correlates in the nursing team from a Brazilian tertiary-care hospital. A case-control study was conducted from January 2003 to July 2004, including 200 cases and 200 controls. Cases and controls were paired by gender, professional category, and work section. To evaluate the relationship between potential risk/protective factors and the outcome, odds ratios were estimated, using multivariate logistic regression methods. The results shown six predictors of percutaneous injuries: "recapping needles" (OR 9.48; CI(95%: 5.29-16.96; "hours worked per week > 50 hours" (OR 2.47; CI(95%: 1.07-5.67; "years in nursing practice La finalidad del estudio fue identificar factores asociados a los accidentes percutáneos en el equipo de enfermería de un hospital terciario. Un estudio caso-control fue conducido entre enero de 2003 y julio de 2004, con selección de 200 casos y 200 controles, emparejados según género, categoría profesional y sector de trabajo. Las medidas de asociación utilizadas fueron las razones de momios, estimados mediante la regresión logística multivariada. Seis predictores para los accidentes percutáneos fueron identificados: "reencapsular agujas" (OR 9.48; CI(95%: 5.29-16.96; "jornada semanal > 50 horas" (OR 2.47; CI(95%: 1.07-5.67; "experiencia en la enfermería O estudo teve por objetivo identificar fatores associados aos acidentes percutâneos na equipe de enfermagem de um hospital terciário. Um estudo caso-controle foi conduzido entre janeiro de 2003 a julho de 2004, com seleção de 200 casos e 200 controles, emparelhados segundo gênero, categoria profissional e setor de trabalho. As medidas de associação utilizadas foram os odds ratios, estimados por meio da regressão logística multivariada. Seis preditores para os acidentes percutâneos foram identificados: "reencapar agulhas" (OR 9.48; CI(95%: 5.29-16.96; "jornada semanal > 50 horas" (OR 2.47; CI(95%: 1

  11. Emergency Percutaneous Coronary Intervention Through the Left Radial Artery is Associated with Less Vascular Complications than Emergency Percutaneous Coronary Intervention Through the Femoral Artery.

    Science.gov (United States)

    Qi, Guoqing; Sun, Qi; Xia, Yue; Wei, Liye

    2017-01-01

    To compare the advantages and disadvantages of emergency percutaneous coronary intervention through the left radial artery with those of emergency percutaneous coronary intervention through the femoral artery. A total of 206 patients with acute myocardial infarction who required emergency percutaneous coronary intervention and were admitted to our hospital between January 2011 and August 2013 were divided into the following two groups: a group that underwent percutaneous coronary intervention through the left radial artery and a group that underwent percutaneous coronary intervention through the femoral artery. The times required for angiographic catheter and guiding catheter placement, the success rate of the procedure and the incidence of vascular complications in the two groups were observed. There was no significant difference in catheter placement time or the ultimate success rate of the procedure between the two groups. However, the left radial artery group showed a significantly lower incidence of vascular complications than the femoral artery group (pEmergency percutaneous coronary intervention through the left radial artery is associated with less vascular complications than emergency percutaneous coronary intervention through the femoral artery and is thus potentially advantageous for patients.

  12. Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage

    Institute of Scientific and Technical Information of China (English)

    Anthony Yuen Bun Teoh; Vinay Dhir; Zhen-Dong Jin; Mitsuhiro Kida; Dong Wan Seo; Khek Yu Ho

    2016-01-01

    AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage.METHODS: Comparative studies published between January 1980 and May 2014 were identified on Pub Med, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities.RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound(EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies comparedEUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits.CONCLUSION: In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities.

  13. AB095. Five concerns need to be pay attention to in percutaneous nephrolithotomy

    OpenAIRE

    Zhang, Xiaochun

    2015-01-01

    Objective To recommend our clinical experiences in five important concerns which common to be met in percutaneous nephrolithotomy (PCNL), helping the beginners easy to handle this kind of procedures. Methods Review PCNL in ten years in our hospital, we analyzed five important aspects which could influence the results of operations. Include selection of access site, loss of percutaneous access while dilation, different methods of stone fragmentation, controlling pressure of irrigation in PCNL,...

  14. Percutaneous Nephrolithotomy in Children

    Directory of Open Access Journals (Sweden)

    Romano T. DeMarco

    2011-01-01

    Full Text Available The surgical management of pediatric stone disease has evolved significantly over the last three decades. Prior to the introduction of shockwave lithotripsy (SWL in the 1980s, open lithotomy was the lone therapy for children with upper tract calculi. Since then, SWL has been the procedure of choice in most pediatric centers for children with large renal calculi. While other therapies such as percutaneous nephrolithotomy (PNL were also being advanced around the same time, PNL was generally seen as a suitable therapy in adults because of the concerns for damage in the developing kidney. However, recent advances in endoscopic instrumentation and renal access techniques have led to an increase in its use in the pediatric population, particularly in those children with large upper tract stones. This paper is a review of the literature focusing on the indications, techniques, results, and complications of PNL in children with renal calculi.

  15. Advances in percutaneous stone surgery

    Directory of Open Access Journals (Sweden)

    Christopher Hartman

    2015-01-01

    Full Text Available Treatment of large renal stones has changed considerably in recent years. The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before, and this has been met with improvements in percutaneous stone surgery. In this review paper, we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, exit strategies, and post-operative antibiotic prophylaxis.

  16. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases

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    Kanthila Mahesha

    2017-01-01

    Full Text Available Background: Lumbar disc herniation is a major cause of back pain and sciatica. The surgical management of lumbar disc prolapse has evolved from exploratory laminectomy to percutaneous endoscopic discectomy. Percutaneous endoscopic discectomy is the least invasive procedure for lumbar disc prolapse. The aim of this study was to analyze the clinical outcome, quality of life, neurologic function, and complications. Materials and Methods: One hundred patients with lumbar disc prolapse who were treated with percutaneous endoscopic discectomy from May 2012 to January 2014 were included in this retrospective study. Clinical followup was done at 1 month, 3 months, 6 months, 1 year, and at yearly interval thereafter. The outcome was assessed using modified Macnab′s criteria, visual analog scale, and Oswestry Disability Index. Results: The mean followup period was 2 years (range 18 months - 3 years. Transforaminal approach was used in 84 patients, interlaminar approach in seven patients, and combined approach in nine patients. An excellent outcome was noted in ninety patients, good outcome in six patients, fair result in two patients, and poor result in two patients. Minor complications were seen in three patients, and two patients had recurrent disc prolapse. Mean hospital stay was 1.6 days. Conclusions: Percutaneous endoscopic lumbar discectomy is a safe and effective procedure in lumbar disc prolapse. It has the advantage that it can be performed on a day care basis under local anesthesia with shorter length of hospitalization and early return to work thus improving the quality of life earlier. The low complication rate makes it the future of disc surgery. Transforaminal approach alone is sufficient in majority of cases, although 16% of cases required either percutaneous interlaminar approach or combined approach. The procedure definitely has a learning curve, but it is acceptable with adequate preparations.

  17. Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan

    Institute of Scientific and Technical Information of China (English)

    Yutaka; Suzuki; Seryna; Tamez; Akihiko; Murakami; Akihiko; Taira; Akihiro; Mizuhara; Akira; Horiuchi; Chie; Mihara; Eiji; Ako; Hirohito; Muramatsu; Hitoshi; Okano; Hitoshi; Suenaga; Kazuaki; Jomoto; Junya; Kobayashi; Katsunari; Takifuji; Kazuhiro; Akiyama; Koh; Tahara; Koji; Onishi; Makoto; Shimazaki; Masami; Matsumoto; Masashi; Ijima; Masato; Murakami; Masato; Nakahori; Michiaki; Kudo; Michio; Maruyama; Mikako; Takahashi; Naohiro; Washizawa; Shigeru; Onozawa; Satoshi; Goshi; Satoyoshi; Yamashita; Shigeki; Ono; Shin; Imazato; Shinji; Nishiwaki; Shuichirou; Kitahara; Takao...

    2010-01-01

    AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan. METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient’s characteristics at PEG using log-rank tests and Cox proportional hazard m...

  18. Percutaneous Nephrolithotripsy for Renal Transplant Lithiasis : A Case Report

    OpenAIRE

    種田, 建史; 金光, 俊行; 林, 哲也; 藤本, 宜正; 小出, 卓生

    2016-01-01

    A 54-year-old man was introduced to our hospital for follow-up examinations after renal transplantation. At the initial visit, a 25 mm renal transplant stone was noted, which had enlarged to 32 mm at an examination 1 year later. We first attempted transurethral lithotripsy (TUL), but failed due to ureteral stricture. However, we could completely remove the stone in 2 sessions of percutaneous nephrolithotripsy (PNL). The incidence of urinary lithiasis after renal transplantation ranges from 0....

  19. Complications of Percutaneous Nephrolithotomy and their Management

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    Neeraj Thapa

    2016-11-01

    Full Text Available Introduction: Increasing global prevalence of nephrolithiasis has resulted in the development of new minimally invasive techniques and has also led to the resurgence of established methods such as percutaneous nephrolithotomy (PCNL. This procedure is now recommended as the first option for the treatment of single large or multiple renal stones and those in the inferior calyx. This study was done to assess the complications of PCNL and their management, in our centre.   Methods: Medical records of 144 patients who underwent PCNL at Lumbini Medical College Teaching Hospital, during the last one year were reviewed. The demographic data, size, tract number and location of the calculi, and intraoperative and postoperative complications were evaluated. The various parameters of the calculi were evaluated. Descriptive analysis with frequencies was done.   Results: Complications occurred in 13 (9.02% patients. Post operative bleeding occurred in seven (4.8% patients, out of which one patient developed pseudoaneurysms and the other developed arteriovenous fistula. One patient developed hypovolemic shock immediately after surgery. Frequent blockage of urine, excessive drainage of urine from the drain site, hemothorax and colonic perforation was seen in one  patient each. One patient had mortality due to post operative bleeding. Complications increased with the number and size of stones and number and site of the tracts.   Conclusion: Percutaneous nephrolithotomy has low complication rate in experienced hands and complications depend upon stone size, history of open stone surgery, tract number, and tract location.

  20. Percutaneous umbilical cord blood sampling - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100196.htm Percutaneous umbilical cord blood sampling - series—Normal anatomy To use the ... or blood disorder, your doctor may recommend percutaneous umbilical cord blood sampling (PUBS), which is performed at 18 ...

  1. Percutaneous transhepatic cholangiography using special needle

    Energy Technology Data Exchange (ETDEWEB)

    Auh, Yong Ho [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1974-10-15

    Using the special needle (22 Gauze, 17 cm long, flexible needle) percutaneous transhepatic cholangiography were performed in 23 cases at Seoul National University Hospital during the period from July 1973 to August 1974. The results were as follows:1. Successful cholangiograms are obtained in 20 cases among the total of 23 cases. The 3 cases of the unsuccessful are two cases of sclerosing cholangitis and one case of hepatoma. 2. Average attempts of puncture in successful care are 3. It was not necessary to puncture more than 6 times to visualize biliary tree in dilated biliary tree. 3. Lateral approach (midaxillary line and 8th or 9th intercostal space) was used. The advantage of this method was briefly discussed. 4. Over all complication are occurred in 6 cases. 3 cases: transient fever 1 case: bile leakage without peritonitis 1 case: local peritonitis probably due to bile leakage 1 case: septicemia (the organism can not be detected even after blood culture)

  2. Percutaneous Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis

    Science.gov (United States)

    Malhotra, Rohit; Sharma, Anjali; Kakouros, Nikolaos

    2017-01-01

    Percutaneous transcatheter tricuspid balloon valvuloplasty (PTTBV) is an accepted treatment option for symptomatic severe native tricuspid valve stenosis, although surgical tricuspid valve replacement remains the treatment of choice. There have been few reports of successful PTTBV for bioprosthetic tricuspid valve stenosis. We present case reports of 3 patients from our hospital experience. Two of the 3 cases were successful, with lasting clinical improvement, whereas the 3rd patient failed to show a reduction in valve gradient. We describe the standard technique used for PTTBV. We present results from a literature review that identified 16 previously reported cases of PTTBV for bioprosthetic severe tricuspid stenosis, with overall favorable results. We conclude that PTTBV should perhaps be considered for a select patient population in which symptomatic improvement and hemodynamic stability are desired immediately, and particularly for patients who are inoperable or at high surgical risk.

  3. Percutaneous transbiliary biopsy.

    Science.gov (United States)

    Andrade, Gustavo Vieira; Santos, Miguel Arcanjo; Meira, Marconi Roberto; Meira, Mateus Duarte

    2017-01-01

    Percutaneous drainage of the bile ducts is an established procedure for malignant obstructions, in which a histological diagnosis is often not obtained. We describe the biopsy technique of obstructive lesions through biliary drainage access, using a 7F endoscopic biopsy forceps, widely available; some are even reusable. This technique applies to lesions of the hepatic ducts, of the common hepatic duct and of all extension of the common bile duct. RESUMO A drenagem percutânea das vias biliares é um procedimento estabelecido para obstruções malignas, nos quais, muitas vezes, não se consegue um diagnóstico histológico. Descrevemos a técnica de biópsia da lesão obstrutiva através do acesso de drenagem biliar, utilizando um fórcipe de biópsia endoscópica 7F, amplamente disponível e alguns reutilizáveis. Esta técnica aplica-se a lesões dos ductos hepáticos, do hepático comum e de toda extensão do colédoco.

  4. COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY

    Directory of Open Access Journals (Sweden)

    Ottra

    2016-03-01

    Full Text Available BACKGROUND The increasing global prevalence of nephrolithiasis continues to burden the health care delivery systems of developing nations. Percutaneous Nephrolithotomy (PCNL is considered the standard treatment for many types of calculi. This study focuses on the complications of PCNL in private practice setting at a peripheral center using the modified Clavien system and role of Guy’s stone score as a predictor of stone free rate and complications. METHODS This is a prospective cohort study of 480 patients who underwent PCNL during August 2011 to July 2015. The complications were classified according to modified Clavien system and correlated with the stone complexity as per the Guy’s stone score. RESULTS It was found that overall 120 complications were reported in 480 patients with the incidence of complications of Grade I, II, IIIa, IIIb, IVb being 48 (10%, 38 (7.9%, 15 (3.5%, 12 (2.5% and 4 (0.8% respectively. As per the Guy’s stone score there were 336, 104 and 40 cases belonging to GSS I, II and III respectively. All grades of complications were more common in GSS II and III. The stone clearance was found to be complete in 95%, 82% and 75% of GSS I, II, III respectively. CONCLUSION The stone complexity is related to complication rate and GSS helps to predict stone free rate and complications

  5. Percutaneous renal tumour biopsy.

    Science.gov (United States)

    Delahunt, Brett; Samaratunga, Hemamali; Martignoni, Guido; Srigley, John R; Evans, Andrew J; Brunelli, Matteo

    2014-09-01

    The use of percutaneous renal tumour biopsy (RTB) as a diagnostic tool for the histological characterization of renal masses has increased dramatically within the last 30 years. This increased utilization has paralleled advances in imaging techniques and an evolving knowledge of the clinical value of nephron sparing surgery. Improved biopsy techniques using image guidance, coupled with the use of smaller gauge needles has led to a decrease in complication rates. Reports from series containing a large number of cases have shown the non-diagnostic rate of RTB to range from 4% to 21%. Re-biopsy has been shown to reduce this rate, while the use of molecular markers further improves diagnostic sensitivity. In parallel with refinements of the biopsy procedure, there has been a rapid expansion in our understanding of the complexity of renal cell neoplasia. The 2013 Vancouver Classification is the current classification for renal tumours, and contains five additional entities recognized as novel forms of renal malignancy. The diagnosis of tumour morphotype on RTB is usually achievable on routine histology; however, immunohistochemical studies may be of assistance in difficult cases. The morphology of the main tumour subtypes, based upon the Vancouver Classification, is described and differentiating features are discussed.

  6. Effects of percutaneous endoscopic gastrostomy on survival of patients in a persistent vegetative state after stroke.

    Science.gov (United States)

    Wu, Kunpeng; Chen, Ying; Yan, Caihong; Huang, Zhijia; Wang, Deming; Gui, Peigen; Bao, Juan

    2017-10-01

    To assess the effect of percutaneous endoscopic gastrostomy on short- and long-term survival of patients in a persistent vegetative state after stroke and determine the relevant prognostic factors. Stroke may lead to a persistent vegetative state, and the effect of percutaneous endoscopic gastrostomy on survival of stroke patients in a persistent vegetative state remains unclear. Prospective study. A total of 97 stroke patients in a persistent vegetative state hospitalised from January 2009 to December 2011 at the Second Hospital, University of South China, were assessed in this study. Percutaneous endoscopic gastrostomy was performed in 55 patients, and mean follow-up time was 18 months. Survival rate and risk factors were analysed. Median survival in the 55 percutaneous endoscopic gastrostomy-treated patients was 17·6 months, higher compared with 8·2 months obtained for the remaining 42 patients without percutaneous endoscopic gastrostomy treatment. Univariate analyses revealed that age, hospitalisation time, percutaneous endoscopic gastrostomy treatment status, family financial situation, family care, pulmonary infection and nutrition were significantly associated with survival. Multivariate analysis indicated that older age, no gastrostomy, poor family care, pulmonary infection and poor nutritional status were independent risk factors affecting survival. Indeed, percutaneous endoscopic gastrostomy significantly improved the nutritional status and decreased pulmonary infection rate in patients with persistent vegetative state after stroke. Interestingly, median survival time was 20·3 months in patients with no or one independent risk factors of poor prognosis (n = 38), longer compared with 8·7 months found for patients with two or more independent risk factors (n = 59). Percutaneous endoscopic gastrostomy significantly improves long-term survival of stroke patients in a persistent vegetative state and is associated with improved nutritional status

  7. Current perspectives in percutaneous atrial septal defect closure devices

    Directory of Open Access Journals (Sweden)

    Bissessor N

    2015-07-01

    Full Text Available N Bissessor1–4 1Department of Cardiology, The Epworth Hospital, Melbourne, VIC, Australia; 2Division of Interventional Cardiology, The Alfred Hospital, Melbourne, VIC, Australia; 3Department of Clinical Science, Charles Sturt University Albury Campus, NSW, Australia; 4Heart Foundation, Griffith University, QLD, Australia Abstract: In the last decade, percutaneous atrial septal defect (ASD closure has become the treatment of choice in most clinical presentations of ASD. Percutaneous ASD closure has established procedural safety through operator experience and improved device structure and deliverability. There have also been advances in diagnostic capabilities. Devices have evolved from large bulky meshes to repositionable, minimal residual mesh content that easily endothelializes and conforms well to surrounding structures. Biodegradable technology has been introduced and will be closely watched as a future option. The evolution of ASD closure device usage in the last four decades incorporates development that minimizes a wide range of serious side effects that have been reported over the years. Complications reported in the literature include thrombus formation, air embolization, device embolization, erosions, residual shunts, and nickel hypersensitivity. Modern devices have intermediate to long term data with outcomes that have been favorable. Devices are available in multiple sizes with improved delivery mechanisms to recapture, reposition, and safely close simple and complex ASDs amenable to percutaneous closure. In this review, commonly used devices and deployment procedures are discussed together with a look at devices that show promise for the future. Keywords: ASD, congenital, Amplatzer, Gore Helex, Biostar, Figulla

  8. Percutaneous transluminal coronary angioplasty. A review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Przybojewski, J.Z.; Weich, H.F.H. (Tygerberg Hospital, Stellenbosch (South Africa). Dept. of Internal Medicine)

    1984-01-25

    The purpose of this article is to review PTCA, percutaneous transluminal coronary angioplasty, which can be considered to be a truly revolutionary and fairly simple invasive form of intervention to atherosclerotic obstruction. The 'epidemic' of IHD, ischaemic heart disease, in the Republic of South Africa calls for the employment of this technique, which has already been carried out in a few teaching hospitals in this country. Very recently, modified balloon dilatation catheters have been used percutaneously in the non-operative transluminal correction of congenital coarctation of the aorta in infants and children, congenital pulmonary value stenosis, and hypoplasia and stenosis of the pulmonary arteries. It has also been employed for PTCA and for the simultaneous occlusion of coronary-bronchial artery anastomosis using a detachable balloon. The isotopes thallium 201 and technetium 99 were also used in scintiscanning.

  9. Percutaneous drainage of abdominal abcess

    Energy Technology Data Exchange (ETDEWEB)

    Men, Sueleyman E-mail: suleyman.men@deu.edu.tr; Akhan, Okan; Koeroglu, Mert

    2002-09-01

    The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. Percutaneous routes that have been described to drain pelvic abscesses include transrectal or transvaginal approach with sonographic guidance, a transgluteal, paracoccygeal-infragluteal, or perineal approach through the greater sciatic foramen with CT guidance. Both the renal and the perirenal abscesses are amenable to percutaneous drainage. Percutaneous drainage provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses as well.

  10. Percutaneous dissolution of renal calculi.

    Science.gov (United States)

    Dretler, S P; Pfister, R C

    1983-01-01

    The use of percutaneous nephrostomy catheters has allowed access to intrarenal urinary calculi for dissolution. Renacidin is the successful agent for dissolving struvite stones. THAM-E is the most effective agent for the intrarenal dissolution of cystine stone. Calcium oxalate stones are still resistant to dissolution techniques.

  11. Nephrostomy in percutaneous nephrolithotomy (PCNL)

    DEFF Research Database (Denmark)

    Cormio, Luigi; Preminger, Glenn; Saussine, Christian

    2013-01-01

    PURPOSE: To explore the relationships between nephrostomy tube (NT) size and outcome of percutaneous nephrolithotomy (PCNL). METHODS: The Clinical Research Office of the Endourological Society (CROES) prospectively collected data from consecutive patients treated with PCNL over a 1-year period at...

  12. Image guided percutaneous splenic interventions

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Mandeep [Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India)], E-mail: mandykang2005@yahoo.com; Kalra, Naveen; Gulati, Madhu; Lal, Anupam; Kochhar, Rohit [Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India); Rajwanshi, Arvind [Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India)

    2007-10-15

    Aim: The objective of this study is to evaluate the efficacy and safety of image-guided percutaneous splenic interventions as diagnostic or therapeutic procedures. Materials and methods: We performed a retrospective review of our interventional records from July 2001 to June 2006. Ninety-five image-guided percutaneous splenic interventions were performed after informed consent in 89 patients: 64 men and 25 women who ranged in age from 5 months to 71 years (mean, 38.4 years) under ultrasound (n = 93) or CT (n = 2) guidance. The procedures performed were fine needle aspiration biopsy of focal splenic lesions (n = 78) and aspiration (n = 10) or percutaneous catheter drainage of a splenic abscess (n = 7). Results: Splenic fine needle aspiration biopsy was successful in 62 (83.78%) of 74 patients with benign lesions diagnosed in 43 (58.1%) and malignancy in 19 (25.67%) patients. The most common pathologies included tuberculosis (26 patients, 35.13%) and lymphoma (14 patients, 18.91%). Therapeutic aspiration or pigtail catheter drainage was successful in all (100%) patients. There were no major complications. Conclusions: Image-guided splenic fine needle aspiration biopsy is a safe and accurate technique that can provide a definitive diagnosis in most patients with focal lesions in the spleen. This study also suggests that image-guided percutaneous aspiration or catheter drainage of splenic abscesses is a safe and effective alternative to surgery.

  13. Complications of percutaneous vertebroplasty

    Science.gov (United States)

    Saracen, Agnieszka; Kotwica, Zbigniew

    2016-01-01

    Abstract Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral fractures of different origins—osteoporotic, traumatic, or neoplastic. PVP is minimally invasive, but the complications are not rare; however, they are in most cases not significant clinically. The most frequent is cement leakage, which can occur onto veins, paravertebral soft tissue, into the intervertebral disk, or to the spinal canal, affecting foraminal area or epidural space. We analyzed results of treatment and complications of vertebroplasty performed with the use of polimethylomethylacrylate cement (PMMA) on 1100 vertebrae, with a special regard to the severity of complication and eventual clinical manifestation. One thousand one hundred PVP were analyzed, performed in 616 patients. There were 468 (76%) women and 148 men (24%), 24 to 94-year old, mean age 68 years. From 1100 procedures, 794 treated osteporotic and 137 fractures due to malignant disease, 69 PVP were made in traumatic fractures. One hundred patients had painful vertebral hemangiomas. Seven hundred twenty-six (66%) lesions were in thoracic, and 374 (34%) in lumbar area. Results of treatment were assessed using 10 cm Visual Analogue Scale (VAS) 12 hours after surgery, 7 days, 30 days, and then each 6 months, up to 3 years. Before surgery all patients had significant pain 7 to 10 in VAS scale, mean 8.9 cm. Twelve  hours after surgery 602 (97.7%) reported significant relief of pain, with mean VAS of 2,3 cm. Local complications occurred in 50% of osteoporotic, 34% of neoplastic, 16% of traumatic fractures, and 2% of vertebral hemangiomas. The most common was PMMA leakage into surrounding tissues—20%; paravertebral vein embolism—13%; intradiscal leakage—8%; and PMMA leakage into the spinal canal—0.8%. Results of treatment did not differ between patients with and without any complications. From 104 patients who had chest X-ray or CT study performed

  14. Fever after percutaneous nephrolithotomy: contributing factors.

    Science.gov (United States)

    Sharifi Aghdas, Farzaneh; Akhavizadegan, Hamed; Aryanpoor, Aryan; Inanloo, Hassan; Karbakhsh, Mojgan

    2006-08-01

    The exact mechanism of fever and urosepsis after percutaneous procedures has not been established. This research studied the frequency of fever after percutaneous nephrolithotomy (PCNL) and the contributing factors. In a cross-sectional study, from September 2003 to March 2004, all 217 patients with nephrolithiasis treated with PCNL at the Labbafinegad Specialized Urology Center were studied. Data were collected before, during, and after surgery. The frequency of fever after PCNL was 25.8% (n=56) although in 62.2% of the cases (n=135), no prophylactic antibiotics had been administered. The mean durations of hospitalization in patients with and without fever were 5.4+/-2.3 and 3.4+/-1.7 days, respectively (p=0.001). Significant correlations were observed between fever and female sex (p=0.005), positive urine culture (p=0.02), and nephrostomy tube insertion (p=0.041). Other variables did not prove to be significant. In logistic regression analysis, female sex and nephrostomy tube insertion were independently related to post-operative fever. Although a considerable proportion of our patients had not received prophylactic antibiotics, the rate of fever after PCNL was no higher than is reported in the literature. Use of only a short course of antibiotics before surgery for staghorn stones did not result in a higher rate of fever. Female sex created a higher risk for fever, probably because of the greater propensity to urinary tract infection. The significant relation of a nephrostomy tube to fever could be attributed to its role as a foreign body or to use in more complicated cases.

  15. Percutaneous nephrolithotomy in children: A preliminary report

    Directory of Open Access Journals (Sweden)

    Ahmad A. Elderwy

    2014-01-01

    Full Text Available Objectives: The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. Materials and Methods: During the period of the month between May 2011 and April 2013, 38 children (47 renal units underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24. Results: The median age at presentation was 8-year (range: 3-12. The operative time ranged from 30 to 120 min (median 90. Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3. Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6% of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1 and were managed conservatively. Conclusions: Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.

  16. Analysis of percutaneous nephrostomy in 72 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Chul; Park, Jae Hyung; Han, Man Chung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1985-08-15

    Percutaneous nephrostomy has been effectively performed 107 times in 72 patients for relief of obstruction, drainage of urinary fistula and renal or extrarenal fluid collection, and functional preservation of urinary system, and follow-up check has been made for recent 3 years at Department of Radiology in Seoul National University Hospital. All procedures were successful and bilateral nephrostomy was done in 1 case of bilateral congenital UPJ obstruction. Percutaneous nephrostomy was done in left kidney in 38 cases (52.8%), permanent drainage was done in 55 cases (76.4%) and external drainage was done in 65 cases (90.3%), and the duration of follow-up was up to 8 months. Underlying diseases were supravesical obstruction in 63 cases (87.5%), urinary fistula in 3 cases, inflammatory disease in 5 cases and intravesical obstruction in 1 case. Satisfactory outcomes were made in 68 patients, whose BUN and serum creatinine levels have decreased near to upper normal range in at least 3 weeks. Major complications have occurred in 7 cases; symptomatic urinary infection in 3 cases, fracture of the catheter in 2 cases, pneumothorax in 1 case and sepsis in 1 case. Minor complications have occurred in 76 cases; catheter dislodgement or obstruction in 42 cases, fever in 10 cases, perirenal extravasation in 2 cases and periureteral leakage in 2 cases, etc. These complications can be prevented by adequate method using Seldinger technique under ultrasonography, CT or fluoroscopy, prophylactic and post-nephrostomy antibiotics, use of disposable catheter kits, frequent irrigation of the catheter and dressing of catheter fixation site when contaminated, prevention of extraction of the catheter due to patient's carelessness, adequate fixation of the catheter to skin, and continuous follow-up of patients. It is expected that the territory of this interventional procedure will be extended by instrument insertion and drug instillation through the nephrostomy tract.

  17. Sextant percutaneous pedicle screw fixation for correcting single-segment thoracolumbar fractures

    Institute of Scientific and Technical Information of China (English)

    Ming Jiang-hua; Zheng Hui-feng; Zhao Qi; Chen Qing; Wang Gang

    2014-01-01

    BACKGROUND:Though the effects of conservative or traditional open reduction and internal fixation in the treatment of thoracolumbar fractures are reliable and satisfactory for most cases, two methods also have shortages. Minimal-invasive percutaneous pedicle screw system provides a new available method. OBJECTIVE:To investigate the clinical effect of Sextant percutaneous pedicle screw system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or traditional open internal fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics of Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. RESULTS AND CONCLUSION:Except two patients in traditional open internal fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. Operative time, intraoperative blood loss, postoperative drainage amount and hospital day were better in percutaneous pedicle screw fixation group than in the traditional open internal fixation group (P0.05). The results show that percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, obeying indication strictly is very important for clinical application.

  18. Prognostic value of serum total bilirubin in patients with acute coronary syndrome after percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    孙同文

    2013-01-01

    Objective To investigate the predictive value of serum total bilirubin (STB) level in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) .Methods A total of 1273 consecutive patients treated with PCI in cardiology department,First Affiliated Hospital of Zhengzhou University from June

  19. Percutaneous transthoracic computed tomography-guided AICD insertion in a patient with extracardiac Fontan conduit.

    LENUS (Irish Health Repository)

    Murphy, Darra T

    2011-02-01

    Percutaneous pulmonary venous atrial puncture was performed under computed tomography guidance to successfully place an automated implantable cardiac defibrillator into a 26-year-old patient with extracardiac Fontan conduit who had presented with two out-of-hospital cardiac arrests. The procedure avoided the need for lead placement at thoracotomy.

  20. The Factors That Effects Hemorrhage in Percutaneous Nephrolitotomy

    Directory of Open Access Journals (Sweden)

    Fatih Duz

    2014-03-01

    Full Text Available Aim: Today, PNL has become primary treatment alternative in multiple or large kidney stones where ESWL treatment has failed. In our study, we have analyzed the facts that affect hemorrhage in PNL surgeries. Material and Method: Between March 2008 and December 2009, 204 patient%u2019s histories who had undergone percutaneous nephrolithotomy surgery in Izmir Bozyaka Training & Research Hospital, Urology Department were analyzed retrospectively. The patients were assembled under four groups according to the effect of some factors related to stone (size and localization, operation (number and localization of the entrances and the effects of PNL hemorrhage between these groups was investigated. Results: Of the 204 patients undergoing percutaneous nephrolithotomy, 76 were female, 128 were male, with an average age of 46.9±14.2 (18-80. The preoperation and postoperation Hb differences of the 176 patients whose stone load was less than 1000 mm2 and 28 patients whose stone load was over 1000 m2 were compared, yielding no statistically significant difference (p=0.942. Also no statistically significant difference was observed with regard to stone type, number of entries and percutaneous entry location. Discussion: In our study, it has been observed the size and localization of the stone is not an independent factor that affects the hemorrage itself. And also it has been observed that number and localization of entrances are not an independent factor that affecting haemorrhage.

  1. Percutaneous gastrostomy -a report of twenty-seven cases-

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Ho; Lee, Ho Suk; Kim, Yong Joo; Kim, Tae Hun; Suh, Kyung Jin; Kang, Duk Sik [College of Medicine, Kyungpook National University, Daegu (Korea, Republic of)

    1991-05-15

    Nutritional support by gastrostomy feeding is an important treatment adjunct when major swallowing difficulty or debilitating diseases is present. This technique for percutaneous placement of a gastric feeding tube now provides many patients with a simple, safe, and well-tolerated alternative to surgical feeding gastrostomy. We experienced 27 cases of percutaneous gastrostomy from January 1989 to February 1991 at Kyungpook National University Hospital. The underlying diseases of the patients were esophageal cancer (11), pyriform sinus cancer (4), laryngeal cancer (3), tongue cancer (2), lye stricture (1), lung cancer (1), chordoma (1), lethal midline granuloma (1), malignant lymphoma (1), maxillary cancer (1), and tonsil cancer (1). Selding method was used in all cases. In five patients it was difficult to insert the nasogastric tube for air insufflation, and one patient had subtotal gastrectomy with gastrojejunostomy, but gastrostomy was performed in all cases. The general condition improved in all patients. We experienced one case of mild peritonitis, but no other significant complications were observed. Gastrostomy tubes were patient in all patients during their survival period, except two patients who experienced obstruction 2 and 6 months after the procedure. Percutaneous gastrostomy can be used safely and effectively in such patients who have pharyngoesophageal or CNS lesions precluding oral intake.

  2. Percutaneous nephrolithotomy in early pregnancy.

    Science.gov (United States)

    Shah, A; Chandak, P; Tiptaft, R; Glass, J; Dasgupta, P

    2004-08-01

    Most cases of urolithiasis in pregnancy are managed conservatively either with ureteric stents or percutaneous nephrostomy tubes, which need to be changed at regular intervals. Definitive management of the stone is usually delayed till after delivery. We describe a patient who presented with pyonephrosis in the fifth week of gestation, due to a stone obstructing the right ureteropelvic junction. This was managed by insertion of a nephrostomy tube. She declined nephrostomy tube/stent changes during the rest of her pregnancy and requested termination as an alternative. She successfully underwent percutaneous nephrolithotomy in the 14th week of pregnancy, with radiation exposure strictly localised to the kidney for 6 s. A healthy male baby was delivered at term.

  3. Morbidity after percutaneous liver biopsy.

    OpenAIRE

    Lichtman, S; Guzman, C; Moore, D.; Weber, J L; Roberts, E.A.

    1987-01-01

    The safety of percutaneous liver biopsy with a 1.2 mm Menghini needle in infants aged one year or less was investigated. One hundred and eighty four procedures performed from 1975 to 1985 were reviewed. There were no deaths or major complications within 48 hours associated with the procedure. In five instances specific complications occurred: a drop in haemoglobin concentration (three), transient hypotension (one), and haematoma at the biopsy site (one). The result of liver biopsy was diagnos...

  4. An update on percutaneous nephrolithotomy

    DEFF Research Database (Denmark)

    Tefekli, A; Cordeiro, E; de la Rosette, J J M C H

    2013-01-01

    Since its introduction in late 1970's, percutaneous nephrolithotomy (PNL) has undergone an evolution in both equipment and technique. This evolution still continues today in the era of minimally invasive treatment options, and is evidenced by the numerous publications. PNL is generally advantageo...... patients managed with PNL worldwide and analyzed the data in detail, producing more than 25 scientific papers. And this update focuses on the lessons learned from the CROES PCNL Global Study....

  5. Radiofrequency thermal ablation (RFA) of liver tumors: open surgical or percutaneous approach?

    Science.gov (United States)

    Crucitti, A; Danza, F M; Pirulli, P G V; Antinori, A; Antonacci, V; La Greca, A; Bock, E; Magistrelli, P

    2004-11-01

    RFA was used to ablate 81 liver lesions: 61 liver metastases and 20 hepatomas. An open surgical approach was adopted in 19 instances (27.5%), 12 of which were simultaneously treated for associated diseases, and percutaneous treatment was adopted in 50 instances (72.5%). The CT liver control at 6 months showed a complete necrosis in 50 lesions (66.3%). The advantages of the percutaneous approach include less invasiveness, reduced postoperative pain, shorter hospitalization, reduced costs and less discomfort in repeating the procedure. In conclusion, radiofrequency liver nodule ablation could be considered, today, as one of the promising and versatile techniques for loco-regional liver cancer control.

  6. Smoker's Paradox in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

    Science.gov (United States)

    Gupta, Tanush; Kolte, Dhaval; Khera, Sahil; Harikrishnan, Prakash; Mujib, Marjan; Aronow, Wilbert S; Jain, Diwakar; Ahmed, Ali; Cooper, Howard A; Frishman, William H; Bhatt, Deepak L; Fonarow, Gregg C; Panza, Julio A

    2016-04-22

    Prior studies have found that smokers undergoing thrombolytic therapy for ST-segment elevation myocardial infarction have lower in-hospital mortality than nonsmokers, a phenomenon called the "smoker's paradox." Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention. We used the 2003-2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Multivariable logistic regression was used to compare in-hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6%) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in-hospital mortality compared with nonsmokers (2.0% versus 5.9%; unadjusted odds ratio 0.32, 95% CI 0.31-0.33, Pparadox also applies to ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  7. Budget impact analysis of the percutaneous septal occluder for treatment of ostium secundum atrial septal defects in the Brazilian Unified National Health System

    Directory of Open Access Journals (Sweden)

    Kátia Marie Simões e Senna

    2015-08-01

    Full Text Available The aim of this study was to perform a budget impact analysis on the adoption of percutaneous occlusion of ostium secundum atrial septal defects in the Brazilian Unified National Health System. Costs were collected using micro-costing technique from medical records for each treatment technique (conventional surgery versus percutaneous septal occluder at a public federal hospital specialized in high-complexity cardiology. The analysis showed that expenditures associated with percutaneous occlusion were lower than with conventional surgery, and sensitivity analysis confirmed the cost reduction in several scenarios, showing a significant budget impact with a 30% adoption rate for the percutaneous occluder (savings of approximately 1.5 million dollars per year. The study indicates that the adoption of the percutaneous septal occluder would mean cost savings of approximately 3.5 million dollars for the Brazilian public health system.

  8. Duodenal perforation during percutaneous nephrolithotomy (PCNL ...

    African Journals Online (AJOL)

    A. Bansal

    2016-06-03

    Jun 3, 2016 ... Paediatric;. Percutaneous ... Percutaneous nephrolithotomy (PCNL) is a treatment of choice for large, complex or ... plications are minor, like for instance postoperative fever. Major ... A 7-year-old girl presented with bilateral flank pain. .... Written informed consent was obtained from the patient's parent.

  9. ANTITHROMBOTIC THERAPY AT PERCUTANEOUS CORONARY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2008-01-01

    Full Text Available Possibilities of modern antiplatelet and antithrombotic therapy at percutaneous coronary interventions in patients with coronary artery disease are surveyed. Data of multicenter randomized clinical trials and meta-analyses are discussed. Possibilities of various drugs at percutaneous coronary interventions are reported from position of the international clinical guidelines.

  10. Percutaneously implanted markers in peripheral lung tumours

    DEFF Research Database (Denmark)

    Persson, G.F.; Josipovic, Mirjana; Nygaard, Ditte Eklund

    2013-01-01

    A letter to the editor is presented which is concerned with research which investigated percutaneously implanted markers in peripheral lung tumours and their complications.......A letter to the editor is presented which is concerned with research which investigated percutaneously implanted markers in peripheral lung tumours and their complications....

  11. Percutaneous transhepatic cholangiography using fine needle

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Kyoo Byung; Kim, Yun Hwan; Lee, Nam Joon; Suh, Won Hyuck [College of Medicine, Korea University, Seoul (Korea, Republic of)

    1980-12-15

    In recent years, percutaneous transhepatic cholangiography (PTC) using fine needle has become widely employed as the procedure of choice for direct opacification of the biliary trees because of its high success rate, easy performance and relative low complication rate. Authors present the clinical and PTC findings of experienced cases during last four years, from May 1976 to June 1980, at the Department of Radiology, Korea University Hospital. We tried to study of PTC in 44 cases, 32 males and 12 females, and succeeded in visualization of bile ducts in 41 cases, but the other three cases were failed to visualize the bile ducts. Final confirmative diagnosis was achieved in 29 cases by operation, laparoscopy and other clinical methods. The PTC diagnosis was correct in 24 of 29 cases, and the others were incorrect. The 29 final diagnosis was including 13 cases of biliary stones, 6 cases of biliary cancer, 3 cases of pancreatic cancer, 3 cases of clonorchiasis, one case of CBD ascariasis and 3 cases of others. Incorrect PTC diagnosis was made in five cases. They were one case of nonvisualized intrahepatic stones, one case of hepatoma PTC diagnosed as cholangiocarcinoma, one case of pancreatic cancer diagnosed as cholangiocarcinoma, one case of clonorchiasis diagnosed as biliary stones and one case of normal CBD which was diagnosed as distal CBD cancer. And we experienced one case of bile peritonitis as complication, who was 35 year-old female patient with multiple CBD stones, and aspirated about 500ml of bile stained ascites during operation.

  12. Incidence of retrorenal colon during percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Mehmet Balasar

    2015-04-01

    Full Text Available Objective The aim of this study was to investigate retrorenal colon incidence in percutaneous nephrolithotomy (PNL interventions made in our clinic. Materials and Methods Clinical data of 804 PNL patients, accumulated over a 7 year period (2006-2012, was surveyed. The patient files were reviewed retrospectively, and only those who had abdominal computed tomography (CT images before PNL intervention were included in the study. In the CT images, the position of both the ascending and descending colon in relation to the right and left kidneys were evaluated. Results According to our hospital reports, 394 patients with CT images were included in the present study 27 patients (6.9% had retrorenal colon, of which 18 (4.6% were on the left side, 4 (1.0% on the right side and 5 (1.3% had bilateral retrorenal colons. Colonic perforation complication was seen only in two patients and the colonic perforation rate was 0.3%. These two cases had no CT images. Conclusions PNL, in the process of becoming the standard treatment modality, is a safe and reliable technique for renal stone treatment. Colonic injury should be taken into consideration during PNL interventions of the lower pole of the kidney (especially on the left side due to the location of retrorenal colon.

  13. "Hybrid" and combined percutaneous and surgical intervention to treat selected cardiac patients: a new strategy.

    Science.gov (United States)

    Presbitero, P; Gallotti, R; Belli, G; Franciosi, G; Maiello, L; Nicolini, F; Manasse, E; Citterio, E; Carcagnì, A; Foresti, A

    1999-01-01

    The term "hybrid revascularization" describes the combined use of minimally-invasive surgery without cardiopulmonary bypass and percutaneous coronary revascularization in selected cases. The theoretical advantage of a less invasive surgical intervention must be weighted against the need for additional percutaneous procedures, with their own risks and limitations. We describe our initial experience with hybrid revascularization at the Istituto Clinico Humanitas in Milan. From 7/97 to 10/98, twelve patients underwent hybrid revascularization or a combined percutaneous and surgical intervention. A "classic" hybrid approach, consisting of minimally-invasive direct coronary artery bypass to the left anterior descending coronary artery and angioplasty or stenting of arteries in the right coronary artery or circumflex territories, was used in nine patients. In three patients, myocardial revascularization could be completed with percutaneous procedures after bypass surgery without cardiopulmonary bypass (in two patients because of severe aortic calcification) or valve surgery in a patient with two previous bypass operations. In-hospital complications were observed in three patients. Two required urgent median sternotomy (one for impending cardiac tamponade, one for conversion to bypass on extra-corporeal circulation). One patient developed atheroembolism after percutaneous intervention: after hospital discharge, there was a recurrence of symptoms, clinical deterioration with renal failure and eventually death. At a mean follow-up of 152 +/- 91 days (range 17 to 283) after minimally-invasive surgery and 166 +/- 122 days (range 13 to 397) after angioplasty, all surviving patients are well and free of anginal symptoms. Closer collaboration between surgical and interventional operators may offer a novel approach to effective treatment of difficult patient subsets. However, our initial experience suggests that a cautious evaluation of possible risks and benefits must carefully

  14. Percutaneous cementoplasty for painful osteolytic distal femur metastases: a case report

    Directory of Open Access Journals (Sweden)

    Lei M

    2016-10-01

    Full Text Available Mingxing Lei,1 Yaosheng Liu,1 Shaoxing Yang,2 Weigang Jiang,1 Yuncen Cao,1 Shubin Liu1 1Department of Orthopedic Surgery, 2Department of Pulmonary Neoplasms Internal Medicine, The Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People’s Republic of China Abstract: Percutaneous cementoplasty has been shown to immediately restore the mechanical stability of affected bones, prevent further risk of bone fractures, and allow immediate weight bearing. It is emerging as one of the most promising procedures for patients with painful bone metastasis who are unsuitable for surgery or who show resistance to radiotherapy and/or analgesic therapies. This study aimed at describing the procedure, indications, and benefits of percutaneous cementoplasty for painful osteolytic distal femur metastases. We report the case of a painful metastatic lesion in the left distal femur secondary to non-small-cell lung cancer in a 58-year-old woman. The patient underwent percutaneous cementoplasty and experienced effective pain relief and recovery of knee function postoperatively. In addition, no perioperative complication was observed. Percutaneous cementoplasty for osteolytic distal femur metastases offers effective pain relief and restores impaired knee function. Although this method may be a safe option, larger samples of retrospective or prospective confirmation are warranted. Keywords: minimally invasive procedure, percutaneous cementoplasty, bone metastasis, distal femur

  15. 急性心肌梗死患者行经皮冠状动脉介入术后住院期间死亡的危险因素分析%Risk factors analysis of in-hospital death of acute myocardial infarction patients following percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    崔海明; 桂艳萍; 任雨笙; 杨靖; 梁春; 潘晓明; 樊民; 顾兴建; 吴宗贵

    2012-01-01

    目的 探讨影响急性心肌梗死(AMI)患者行经皮冠状动脉介入术(PCI)后住院期间死亡的危险因素.方法 回顾性分析2009年1月至2011年9月因AMI入住我院并行PCI的275例患者的一般情况、既往史、入院情况、术中及术后情况、并发症等资料,对可能影响术后死亡的危险因素通过logistic回归模型进行分析.结果 多因素logistic回归分析表明,女性( P=0.047,OR=2.91)、广泛前壁心肌梗死(P=0.044,OR=3.07)、肾功能不全史(P=0.021,OR=7.98)、发生心源性休克(P=0.008,OR=15.71)、术后心肌梗死溶栓(TIMI)血流<3级(P=0.016,OR=5.61)、置入主动脉内球囊反搏(IABP;P=0.043,OR=3.49).结论 影响AMI患者行PCI术后院内死亡的危险因素为女性、广泛前壁心肌梗死、置入IABP、术后TIMI血流<3级、肾功能不全史和发生心源性休克.%Objective To explore the risk factors of in-hospital death of acute myocardial infarction (AMI) patients following percutaneous cornary intervenion (PCI). Methods We retrospectively analyzed the clinical data of 275 AMI patients, including the general condition, medical history, admission, intra- and post-operation condition, and complication. The patients underwent PCI in our hospital from January 2009 to September 2011. Logistic regression analysis was used to predict the risk factor of in-hospital death of AMI patients following PCI. Results Logistic regression analysis found that female sex (P = 0.047, OR=2. 91), extensive anterior myocardial infarction (P = 0. 044, OR = 3. 07), history of renal insufficiency (P = 0.021, OR = 7. 98), cardiogenic shock (P = 0. 008, OR= 15. 71), postoperative thrombolysis in myocardial infarction (TIMI) flow grade <3 (P=0.016, OR=5. 61), and placement of the intra-aortic balloon pumpdABP, P = 0. 043,OR=3. 49) were associated with an increased risk of in-hospital mortality of AMI patients following PCI. Conclusion Female sex, extensive anterior myocardial infarction, placement

  16. The comparison of standard and tubeless percutaneous nephrolithotomy procedures

    Directory of Open Access Journals (Sweden)

    Ismail Nalbant

    2012-12-01

    Full Text Available Purpose To compare totally tubeless and standard percutaneous nephrolitotomy procedures on many parameters. Materials and Methods Percutaneous nephrolitotomy was performed on 195 patients between June 2009 and May 2012. The data of those patients were evaluated retrospectively. Totally tubeless cases were enrolled to Group 1, and Group 2 consisted of non-tubeless cases (re-entry or Foley catheter. Results Group 1 included 85 cases and group 2 a total of 110 patients. Paper tracing values for the kidney stones were 321.25 ± 102.4 mm2 and 324.10 ± 169.5 mm2 respectively. Mean fluoroscopy time was 4.9 ± 1.9 min and 5.08 ± 2.7 min, mean operation time was 78.8 ± 27.9 min and 81.9 ± 28.77 min and mean decrease in hematocrit was 2.6 ± 1.6 and 3.74 ± 1.9 respectively. All these comparisons were statistically significant. Length of hospitalization was 1.6 ± 1.1 and 3.5 ± 1.5 days for Groups 1 and 2 respectively. Mean superficial pain score was 5.8 ± 1.6 and 6.7 ± 1.2 respectively for both groups after 1 hour. At 6 hours, the scores changed to 3.87 ± 1.22 and 4.84 ± 1.3 respectively. The analgesic dose was 1.00 ± 0.7 and 1.53 ± 0.6 for the groups respectively at 6 hours. All the statistical differences were significant for these three parameters. Conclusions We believe that, because of their post operative patient comfort and decreased length of hospital stay, totally tubeless procedures should be considered as an alternative to standard percutaneous nephrolitotomy.

  17. [The percutaneous absorption of diclofenac].

    Science.gov (United States)

    Riess, W; Schmid, K; Botta, L; Kobayashi, K; Moppert, J; Schneider, W; Sioufi, A; Strusberg, A; Tomasi, M

    1986-07-01

    The percutaneous absorption of diclofenac diethylammonium 1.16% (w/w) in a combination of emulsion cream and gel (Voltaren Emulgel) and of diclofenac sodium 1% (w/w) in a cream formulation (Voltaren cream) was investigated in guinea-pig, rabbit and man. The percutaneous absorption of diclofenac sodium in guinea-pig was 3 to 6% of the dose when the cream formulation in doses of 320, 100 or 40 mg was applied on 10 cm2 of occluded skin and left in place for 6 h. The transdermal delivery of 14C-labelled diclofenac yielded plateau plasma concentrations of radiotracer from 1.5 h after application until removal of the residual cream. Subsequently the steady state drug depots in the skin and muscle tissue were depleted promptly. During daily administration the steady state levels in the muscle tissue in proximity to the application site were about 3 times higher than in distant muscle tissue. By topical application on knee joints of rabbits diclofenac penetrated into the patellar ligament, the adipose corpus and the synovial fluid. In man the percutaneous absorption was 6% of the dose when the Emulgel formulation was spread by 5 mg/cm2 and left for 12 h on non-occluded skin. The pattern of metabolites of diclofenac in human urine was the same after topical and oral administration. In man, upon daily topical administration of 3 times 2.5 g cream formulation (10 mg/cm2) the diclofenac steady state plasma levels were 20 to 40 nmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Ultra-mini-percutaneous nephrolithotomy: A minimally-invasive option for percutaneous stone removal

    Directory of Open Access Journals (Sweden)

    Madhu Sudan Agrawal

    2016-01-01

    Full Text Available Introduction: Percutaneous nephrolithotomy (PCNL has witnessed rapid advancements, the latest being ultra-mini-percutaneous nephrolithotomy (UMP, which makes the use of 11-13F sheaths as compared to 24-30F sizes used in conventional PCNL. This miniaturization aims to reduce morbidity and improve patient outcomes. We evaluated the safety and efficacy of UMP and report our ourtcomes. Patients and Methods: A total of 120 patients underwent UMP from July 2012 to March 2014. These patients had a single unilateral renal stone measuring between 8 and 20 mm. All patients underwent UMP using a 3F nephroscope, 7.5F inner sheath, and 11F or 13F outer metallic cannula, which served as the Amplatz sheath. Stone fragmentation and clearance were achieved with holmium laser. No nephrostomy or stent was used routinely. Results: Complete stone fragmentation was achieved in 114 out of 120 patients (95% using UMP; whereas the remaining 6 were converted into mini-PCNL using a 12.5F nephroscope and 15F Amplatz sheath. The mean operative time was 39.7 ± 15.4 min, and the mean postoperative hospital stay was 22.3 ± 2.2 h. Postoperatively, 6 (5% patients had residual fragments measuring ≤4 mm. At the 2 weeks follow-up, the stone-free status was >99% (119/120. There were no significant postoperative complications. Conclusion: This study shows UMP to be an effective and safe procedure for managing stones up to 20 mm. This procedure offers an attractive alternative to shock wave lithotripsy and retrograde intrarenal surgery for managing small stones.

  19. Percutaneous Surgery of the Forefoot.

    Science.gov (United States)

    Redfern, David; Vernois, Joel; Legré, Barbara Piclet

    2015-07-01

    This article describes some of the common techniques used in percutaneous surgery of the forefoot. Techniques such as minimally invasive chevron Akin osteotomy for correction of hallux valgus, first metatarsophalangeal joint cheilectomy, distal minimally invasive metatarsal osteotomies, bunionette correction, and hammertoe correction are described. This article is an introduction to this rapidly developing area of foot and ankle surgery. Less invasive techniques are continually being developed across the whole spectrum of surgical specialties. The surgical ethos of minimizing soft-tissue disruption in the process of achieving surgical objectives remains at the center of this evolution.

  20. Recent Advances in Percutaneous Nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Erem Kaan Basok

    2014-05-01

    Full Text Available The continuous innovations in technology, instrumentations, and techniques allow urologists to perform percutaneous nephrolithotomy (PCNL with increasing efficacy. Although recent advances have facilitated the procedure, some steps are still challenging. A thorough review of the recent urologic literature was performed to identify these improvements in PCNL technique. The newer developments mainly focused on multimodal imaging techniques, miniaturisation of instruments, tracking and navigation systems during access to the stone, and robotic systems. Further studies are necessary to better define the benefits of these new fruitful developments which remain an active research field.

  1. Outpatient Percutaneous Release of Trigger Finger: A Cost Effective and Safe Procedure

    Directory of Open Access Journals (Sweden)

    Marij Z

    2017-03-01

    Full Text Available INTRODUCTION: Trigger finger is a common cause of pain and disability of the hand. Percutaneous release results in earlier functional recovery and patient satisfaction. This is a rapid and cost-effective method which saves a surgical procedure and results in better functional outcome. MATERIALS AND METHODS: This is a prospective observational study conducted on fifty-two fingers and thumbs in 52 patients treated from 1st July 2014 till 31st December 2014, in the Orthopaedic Section, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. All the baseline characteristics of the patients, like demographics, symptoms, Quinell's criteria and functional outcome were recorded. The patients were treated at our hospital with trigger finger, managed with percutaneous release using an 18 gauge needle and followed up for a minimum period of three months. The follow-up information included range of motion scoring, patient satisfaction and overall outcome of the procedure in terms of patient acceptance. The data was analyzed to determine the functional outcome at three months. RESULTS: There was complete release of A1 pulleys in 52 out of 52 digits (100% in the patients undergoing percutaneous release and significant patient satisfaction. No recurrence was observed. CONCLUSION: Percutaneous release of trigger finger with needle was not only associated with excellent functional outcome and recovery in terms of patient satisfaction and range of finger motion three months post-procedure but also was found to be cost effective.

  2. Percutaneous penetration studies for risk assessment

    DEFF Research Database (Denmark)

    Sartorelli, Vittorio; Andersen, Helle Raun; Angerer, Jürgen

    2000-01-01

    . In order to predict the systemic risk of dermally absorbed chemicals and to enable agencies to set safety standards, data is needed on the rates of percutaneous penetration of important chemicals. Standardization of in vitro tests and comparison of their results with the in vivo data could produce...... of percutaneous penetration. This paper is an outcome of the meetings of the Percutaneous Penetration Subgroup and reports the presentations on the key issues identified throughout the 3-year duration of the Dermal Exposure Network (1997-1999)....

  3. [Recurrent bleeding following the renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage: causes and countermeasure].

    Science.gov (United States)

    Ren, Y M; Wu, X M; Wen, Y; Lai, Q; Chen, W Z; Qian, Y X; Liang, R G

    2017-01-03

    Objective: To explore the causes and countermeasure in recurrent bleeding following the selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage. Methods: A total of 334 patients of severe renal hemorrhage associated with percutaneous nephrolithotomy (PCNL) from March 2011 to April 2015 were analyzed retrospectively.All the patients underwent super selective angiography and renal artery embolization.The causes of recurrent hemorrhage were analyzed and principles for diagnosis and embolization were studied. Results: The initial embolization was performed in 329 cases hospitalized in the First Affiliated Hospital of Guangzhou Medical University and 318 cases were successfully stopped bleeding with a hemostatic rate of 96.7 %(318/329). Of total 334 consecutive cases, there were 16 cases of recurrent renal hemorrhage, 11 cases were initially embolized in this hospital, and otherwise the other 5 cases were in other hospitals. Causes of recurrent hemorrhage were missed embolization of tiny pseudoaneurysm (n=12), and two cases of 12, the tiny pseudoaneurysm were feeding by accessory renal arteries, undetected arteriovenous fistula(n=2), recanalization of the embolized arteries (n=2). Conclusion: The causes of recurrent bleeding fallowing the initial selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage are varied, and missed embolization of tiny pseudoaneurysm is the major cause of unsuccessful initial renal artery embolization. To strengthen the understanding of tiny pseudoaneurysm is helpful to improve the success rate of hemostasis.

  4. Prone and supine percutaneous nephrolithotomy.

    Science.gov (United States)

    Lucarelli, G; Breda, A

    2013-06-01

    Since the first successful stone extraction through a nephrostomy in 1976, percutaneous nephrolithotomy (PCNL) has became the preferred procedure especially for treatment of large, complex and staghorn calculi. For decades this method has been performed with the patient in the prone position. More recently, particular interest has been taken on supine PCNL due to less anestesiological risks and the possibility of simultaneous anterograde and retrograde access to the whole urinary tract. Although many retrospective studies have been published, only two prospective trials comparing the two positions are reported in the literature. The best access to PCNL represents still a controversial issue. The overall experience reported in literature indicates that each modality is equally feasible and safe. Therefore, to date the surgeon's preference is the prime indication to one access over the other.

  5. The correlation of anemia and contrast-induced nephropathy in patients with chronic kidney disease undergoing percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    刘远辉

    2014-01-01

    Objective To investigate the correlation of anemia and contrast-induced nephropathy(CIN)in patients with chronic kidney disease(CKD)undergoing percutaneous coronary intervention(PCI).Methods A total of 292 patients with CKD undergoing PCI admitted to Guangdong General Hospital from October 2010 to December 2012were consecutively enrolled in this study.Anemia was

  6. Bivalirudin in percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Sam J Lehman

    2006-12-01

    Full Text Available Sam J Lehman, Derek P ChewDepartment of Medicine, Flinders University, South Australia, AustraliaAbstract: Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants. It has been evaluated as an alternative to unfractionated and low-molecular-weight heparins in the settings of percutaneous coronary intervention (PCI and acute coronary syndrome (ACS. Results of clinical trials to date suggest bivalirudin is a viable alternative to the use of a heparin combined with a glycoprotein (GP IIb/IIIa inhibitor in these settings. Thrombin has a central role in coagulation and platelet activation in ACS and during PCI. Its direct inhibition is an attractive target for therapy in these settings. Bivalirudin is a 20 amino acid polypeptide hirudin analog. It displays bivalent and reversible binding to the thrombin molecule, inhibiting its action. Direct inhibition of thrombin with bivalirudin has theoretical pharmacokinetic and pharmacodynamic advantages over the indirect anticoagulants. A reduction in rates of bleeding without loss of anti-thrombotic efficacy has been a consistent finding across multiple clinical trials. There may be economic benefits to the use of bivalirudin if it permits a lower rate of use of the GP IIb/IIIa inhibitors. This article reviews the pharmacology of bivalirudin and clinical trial evidence to date. There are now data from multiple clinical trials and meta-analyses in the setting of ACS and PCI. Early results from the acute catheterization and urgent intervention strategy (ACUITY trial are discussed. Keywords: bivalirudin, direct thrombin inhibitor, acute coronary syndrome, percutaneous coronary intervention

  7. [Percutaneous myocardial laser revascularization (PMR)].

    Science.gov (United States)

    Lauer, B; Stahl, F; Bratanow, S; Schuler, G

    2000-09-01

    In patients with severe angina pectoris due to coronary artery disease, who are not candidates for either percutaneous coronary angioplasty or coronary artery bypass surgery, transmyocardial laser revascularization (TMR) often leads to improvement of clinical symptoms and increased exercise capacity. One drawback of TMR is the need for surgical thoracotomy in order to gain access to the epicardial surface of the heart. Therefore, a catheter-based system has been developed, which allows creation of laser channels into the myocardium from the left ventricular cavity. Between January 1997 and November 1999, this "percutaneous myocardial laser revascularization" (PMR) has been performed in 101 patients at the Herzzentrum Leipzig. In 63 patients, only 1 region of the heart (anterior, lateral, inferior or septal) was treated with PMR, in 38 patients 2 or 3 regions were treated in 1 session. There were 12.3 +/- 4.5 (range 4 to 22) channels/region created into the myocardium. After 3 months, the majority of patients reported significant improvement of clinical symptoms (CCS class at baseline: 3.3 +/- 0.4, after 6 months: 1.6 +/- 0.8) (p PMR, the CCS class after 2 years was 1.3 +/- 0.7, exercise capacity was 500 +/- 193 s. However, thallium scintigraphy failed to show increased perfusion in the PMR treated regions. The pathophysiologic mechanisms of myocardial laser revascularization is not yet understood. Most of the laser channels are found occluded after various time intervals after intervention. Other possible mechanisms include myocardial denervation or angioneogenesis after laser revascularization, however, unequivocal evidence for these theories is not yet available. In conclusion, PMR seems to be a safe and feasible new therapeutic option for patients with refractory angina pectoris due to end-stage coronary artery disease. The first results indicate improvement of clinical symptoms and increased exercise capacity, whereas evidence of increased perfusion after laser

  8. Duodenal damage complicating percutaneous access to kidney

    OpenAIRE

    Antonio Corrêa Lopes Neto; Marcos Tobias-Machado; Roberto Vaz Juliano; Marco Aurélio Lipay; Milton Borrelli; Eric Roger Wroclawski

    2000-01-01

    CONTEXT: Since the first percutaneous nephrostomy performed by Goodwin in 1954, technical advances in accessing the kidneys via percutaneous puncture have increased the use of this procedure and thus the complications too. Among these complications, digestive tract damage is not common. DESIGN: Case report. CASE REPORT: We report a duodenal lesion that was corrected using surgical exploration and we touch on the therapeutic options, which may be conservative or interventionist. We chose conse...

  9. Infective endocarditis following percutaneous pulmonary valve replacement

    DEFF Research Database (Denmark)

    Cheung, Gary; Vejlstrup, Niels; Ihlemann, Nikolaj;

    2013-01-01

    Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult.......Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult....

  10. Percutaneous catheter drainage of intrapulmonary fluid collection

    Energy Technology Data Exchange (ETDEWEB)

    Park, E. D.; Kim, H. J.; Choi, P. Y.; Jung, S. H. [Gyeongsang National University Hospital, Chinju (Korea, Republic of)

    1994-01-15

    With the success of percutaneous abdominal abscess drainage, attention is now being focused on the use of similar techniques in the thorax. We studied to evaluate the effect of percutaneous drainage in parenchymal fluid collections in the lungs. We performed percutaneous drainage of abscesses and other parenchymal fluid collections of the lungs in 15 patients. All of the procedures were performed under the fluoroscopic guidance with an 18-gauge Seldinger needle and coaxial technique with a 8-10F drainage catheter. Among 10 patients with lung abscess, 8 patients improved by percutaneous catheter drainage. In one patient, drainage was failed by the accidental withdrawal of the catheter before complete drainage. One patient died of sepsis 5 hours after the procedure. Among three patients with complicated bulla, successful drainage was done in two patients, but in the remaining patient, the procedure was failed. In one patient with intrapulmonary bronchogenic cyst, the drainage was not successful due to the thick internal contents. In one patient with traumatic hematoma, after the drainage of old blood clots, the signs of infection disappeared. Overally, of 14 patients excluding one who died, 11 patients improved with percutaneous catheter drainage and three patients did not. There were no major complications during and after the procedure. We conclude that percutaneous catheter drainage is effective and safe procedure for the treatment of parenchymal fluid collections of the lung in patients unresponsive to the medical treatment.

  11. Appraisal of the Prognosis in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

    Institute of Scientific and Technical Information of China (English)

    马晓娟; 殷惠军; 陈可冀

    2009-01-01

    Acute myocardial infarction(AMI) is still the leading factor causing crippling and death in cardiovascular disease.Percutaneous coronary intervention(PCI) can significantly reduce inpatient mortality and incidence of complication.But owing to the existence of restenosis,in-stent thrombosis,etc.,recurrent post-PCI cardiovascular events and high repeatability of hospitalization,as well as its crippling rate and mortality, remain a serious threat to the society and the patients' family.Therefore,the apprais...

  12. The Effects of Percutaneous Endoscopic Gastrostomy on Quality of Life in Patients With Dementia

    OpenAIRE

    2012-01-01

    Background To examine the effects of percutaneous endoscopic gastrostomy (PEG) on quality of life (QOL) in patients with dementia. Methods We retrospectively included 53 Japanese community and tertiary hospitals to investigate the relationship between the newly developed PEG and consecutive dementia patients with swallowing difficulty between Jan 1st 2006 and Dec 31st 2008. We set improvements in 1) the level of independent living, 2) pneumonia, 3) peroral intake as outcome measures of QOL an...

  13. Ten Year Trend of Percutaneous Coronary Intervention in Central-western Urban Hospitals of China--Results From China PEACE-Retrospective CathPCI Study%中国中西部城市医院经皮冠状动脉介入治疗十年趋势--China PEACE回顾性CathPCI研究结果

    Institute of Scientific and Technical Information of China (English)

    郑昕; 白雪珂; 王斌; 霍西茜; 王思铭; 苏萌; 李静; 李希; 蒋立新

    2016-01-01

    Objective: To assess the trends in clinical characteristics, treatment, and outcomes for hospitalized patients undergoing percutaneous coronary intervention (PCI) in central-western urban hospitals of China in 2001, 2006 and 2011. Methods: We used a 2-stage, random sampling strategy to create a Chinese central-western urban hospital representative sample of 2152 patients undergoing PCI at 26 hospitals in China PEACE- retrospective CathPCI study and calculated the weighted data of clinical information in each year. Results: Between 2001 and 2011, the admission rate for PCI increased by 46 folds. Compared with 2001, the patients undergoing PCI were more likely to be female, older than 80 years, and to have history of diabetes, dyslipidemia and PCI in 2011. The proportion of trans-radial PCIs increased from 3.5% in 2001 to 87.6% in 2011 (Ptrend < 0.0001); the proportion of drug eluting stents (DES) among all the implanted stents increased from 16.4% in 2001 to 95.7% in 2011 (Ptrend < 0.0001), largely due to increased use of domestic DES. Less than 5% of medical record of admission for PCI documented door time and balloon time. The median length of stay decreased from 13 days in 2001 to 10 days in 2011 (Ptrend < 0.0001). In-hospital mortality did not change signiifcantly, but both any bleeding and access bleeding events were decreased signiifcantly over time (Ptrend < 0.05). Conclusion: There has been a rapid increase in the volume and significant change in treatment patterns of PCI over the 10-year period from 2001 to 2011 in Chinese central-western urban hospitals. We identiifed quality gaps that represent opportunities to improve medical care.%目的:评价2001年至2011年间中国中西部城市医院行经皮冠状动脉介入治疗(PCI)患者的临床特征、治疗模式和院内结局的变化趋势。方法:使用“冠心病医疗结果评价和临床转化(China PEACE)研究”——回顾性冠脉造影和介入治疗(Cath

  14. Percutaneous vertebroplasty in osteoporosis, myeloma and Langerhans' cell histiocytosis.

    LENUS (Irish Health Repository)

    Kevane, B

    2012-01-09

    This review aims to assess the effectiveness of percutaneous vertebroplasty as a treatment for the severe refractory pain associated with vertebral fracture, in a group of patients with fractures secondary to either osteoporotic or neoplastic disease. A retrospective review of 20 patients treated with percutaneous vertebroplasty in Cork University Hospital up until March 2007 was carried out and a questionnaire was prepared and distributed. Prior to vertebroplasty, patients had been symptomatic with severe pain for a mean of 20.9 weeks. Of those thirteen whom replied to a postal questionnaire, 12 (92.3%) reported pain relief and this improvement occurred within 7 days in 9 (81.8%). This was associated with decreased analgesic requirements, as determined on chart review. Prior to the procedure only 5 (38.4%) were independently mobile and this figure rose to 10 (76.9%) afterwards, occurring within one week in the majority. Subjective outcomes were better in the group of patients with neoplasm-induced fractures.

  15. Percutaneous osteosynthesis in the pelvis in cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Deschamps, Frederic; Baere, Thierry de; Tselikas, Lambros [Gustave Roussy, Interventional Radiology Department, Villejuif (France); Univeristy Paris-Sud, Le Kremlin Bicetre (France); Hakime, Antoine; Pearson, Ernesto; Farouil, Geoffroy; Teriitehau, Christophe [Gustave Roussy, Interventional Radiology Department, Villejuif (France)

    2016-06-15

    Screw fixation (osteosynthesis) can be performed percutaneously by interventional radiologists. We report our experience in cancer patients. We retrospectively reviewed all cases of percutaneous osteosynthesis (PO) of the pelvic ring and proximal femur performed in our hospital. PO were performed for fracture palliation or for osteolytic metastases consolidation. Screws were inserted under CT- or cone-beam CT- guidance and general anaesthesia. Patients were followed-up with pelvic-CT and medical consultation at 1 month, then every 3 months. For fractures, the goal was pain palliation and for osteolytic metastases, pathologic fracture prevention. Between February 2010 and August 2014, 64 cancer patients were treated with PO. Twenty-one patients had PO alone for 33 painful fractures (13 bone-insufficiency, 20 pathologic fractures). The pain was significantly improved at 1 month (VAS score = 20/100 vs. 80/100). In addition, 43 cancer patients were preventively consolidated using PO plus cementoplasty for 45 impending pathologic fractures (10 iliac crests, 35 proximal femurs). For the iliac crests, no fracture occurred (median-FU = 75 days). For the proximal femurs, 2 pathological fractures occurred (fracture rate = 5.7 %, median-FU = 205 days). PO is a new tool in the therapeutic arsenal of interventional radiologists for bone pain management. (orig.)

  16. Efficacy of Percutaneous Nephrolithotomy in Patients with Neurogenic Bladder Dysfunction

    Directory of Open Access Journals (Sweden)

    Abdulkadir Tepeler

    2010-09-01

    Full Text Available Aim: Patients with neurogenic bladder dysfunction (NBD are at increased risk of urolithiasis. We review our experience with percutaneous nephrolithotomy (PCNL on this group of patients with special attention paid to the risks of surgical complications. Methods: A total of 18 cases with NBD underwent PCNL at our institution. Neurogenous lesions included traumatic spinal cord injuries in 8 cases, sequel of cerebrovascular accident in 2, meningitis in 2, polio in 4 and kyphoscoliosis in 2. Percutaneous access was achieved under fluoroscopic guidance with a patient in the prone position and tract was formed using balloon dilation system. Stone disintegration was accomplished with a pneumatic lithotripter. Results: There were 8 staghorn stones, 6 pelvi-calyceal stones, and 4 isolated renal pelvic stones. The mean operation time was 97.5±18.7 (range: 80-120 minutes and the mean hospitalization time was 3 (range: 2-5 days. Stone-free status was achieved in 13 (72.2% renal units. 4 (22% patients with 2 staghorn stones and 2 pelvi-calyceal stones had clinically insignificant residual fragments (CIRF. Hydropneumothorax was encountered in 1 case with kyphoscoliosis, in whom an intercostal access was necessary. Conclusion: PCNL in patients with NBD is safe and effective, with outcomes comparable to that of patients without such a disorder. (The Medical Bulletin of Haseki 2010; 48: 76-9

  17. 经皮浅静脉连续环形缝扎术治疗大隐静脉曲张在基层医院的应用%Application of percutaneous continuous circumsuture for superficial varicose veins in treatment of great saphenous vein varicosity in the community hospital

    Institute of Scientific and Technical Information of China (English)

    伍忠礼; 梁发亮; 黄力若

    2016-01-01

    目的:评价经皮下连续环形缝扎术治疗下肢大隐静脉曲张的在基层医院的应用经验。方法回顾分析2009年6月~2013年6月我院治疗86例大隐静脉曲张患者的临床资料,选择行传统大隐静脉高位结扎加剥脱术为传统组(43例),另43例行经皮下连续环形缝扎术为 PCCS组,比较两组患者的临床效果。结果两组患者术后近期下肢浅静脉曲张均消失,比较两组患者的手术时间、切口数量、出血量、并发症和住院时间,差异有统计学意义;而术后发生疼痛天数、足肿以及下肢深静脉血栓两组比较无明显统计学差异。PCCS 组43例平均随访34月,曲张静脉复发1例;传统组平均随访38月,无曲张静脉复发。结论经皮下连续环形缝扎术治疗下肢大隐静脉曲张的操作简单、效果确切,且具有微创、外观美容的效果,适于基层医院。%Objective To summarize up experience and clinical efficacy of percutaneous continuous circumsuture (PCCS) for treatment of great saphenous vein varicosity in the community hospital. Methods A retrospective analysis was conducted on the clinical data of 86 cases of varicosis of great saphenous vein from June 2009 to June 2013. The patients were assigned to tradition group (n=43) and PCCS group (n=43). Patients in tradition group were performed by traditional high ligation and exfoliation procedure. The clinical data of the two groups were compared. Results Superficial varicose veins of lower extremities disappeared in both groups after treatment. There were statistical differences between two groups in operation duration, incision number, blood loss complications and postoperative hospital stay time (all P values were less than 0.05). There was no statistical difference in days of postoperative pain, forced foot and deep veins thrombosis between two groups. Varicose vein recurrence happened on one patient in PCCS group after the average of 34-month

  18. Cause Analysis of Open Surgery Used After Percutaneous Vertebroplasty and Kyphoplasty

    Science.gov (United States)

    Xu, Zhengwei; Hao, Dingjun; Liu, Tuanjiang; He, Baorong; Guo, Hua; He, Limin

    2016-01-01

    Background The aim of this study was to analyze reasons why open surgery was done after percutaneous vertebroplasty and kyphoplasty. Material/Methods Patients (587 vertebral bodies) treated with percutaneous vertebroplasty or kyphoplasty in the Xi’an Honghui Hospital of Shanxi Province from January 2008 to January 2012 were retrospectively analyzed and 13 patients were enrolled in the study. These 13 patients had serious adverse events after percutaneous vertebroplasty or kyphoplasty. Their average age was 64.5 years old. Nine patients had spinal cord injury and 4 had nerve root injury. All the patients underwent open surgery within 4–12 h after definitive diagnosis. Results All 13 cases were followed up (average time 14.1 months, range 3–47 months). Reasons for open surgery included cement extravasation (6 cases, 46.2%), puncture mistake (3 cases, 23.1%), and false selection of indications (4 cases, 30.8%). At last follow-up, skin feeling was better than that before open surgery in 4 cases with nerve root injury, and muscle strength recovered to grade 5 (3 cases) and grade 4 (1 case). In 9 cases with spinal cord injury, 7 patients improved and 2 remained at the same ASIA level. Conclusions The main reasons for open surgery after percutaneous vertebroplasty and kyphoplasty were cement extravasation (the most common reason), puncture mistake, and false selection of indications. PMID:27444135

  19. [Percutaneous nephrostomy associated with extracorporeal shockwave lithotripsy in the treatment of renoureteral lithiasis].

    Science.gov (United States)

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodriguez, M; Valdes Gómez, A C; Báez Hernández, D; Ramirez Hernández, L

    1993-01-01

    From a series of 5000 cases that had undergone extracorporeal shock wave lithotripsy at the Hospital Clinico Quirúrgico "Hermanos Ameijeiras" from March, 1986 to April, 1988, 220 cases that required percutaneous nephrostomy due to obstructive hydronephrosis from stone fragments were studied. We analyzed the clinical, radiological and ultrasound features of these cases, as well as the criteria for performing percutaneous nephrostomy. We identified the risk factors that made the procedure necessary, particularly urinary tract infection. No important complications ascribable to the foregoing procedure were observed. Performing the procedure early improved patient clinical course and reduced cost of treatment. To eliminate stone fragments completely, percutaneous nephrostomy was combined with other procedures in 198 cases (90%). The stone fragments were passed spontaneously in 10 cases (4.5%) following diversion. At 2 months 190 cases (86%) were completely stone free, 18 (8%) had residual stones and 12 (6%) required open surgery. The foregoing results show that percutaneous nephrostomy is a very useful procedure in septic-obstructive complications following extracorporeal shock wave lithotripsy and acquiring the skill to perform it is essential.

  20. [Transradial percutaneous approach for cardiac catheterization in patients with previous brachial artery cutdown].

    Science.gov (United States)

    Magariños, Eduardo; Solioz, Germán; Cermesoni, Gabriel; Koretzky, Martín; Carnevalini, Mariana; González, Daniel

    2013-01-01

    The percutaneous punction of the radial artery for catheterization procedures has gained acceptance lately. This was a consequence of achieving results similar to the femoral approach, with the benefits of a lower rate of complications and increased comfort for the patients post procedure. Recently it has gained an additional impulse with the better prognosis obtained in acute coronary syndromes. In this trial we have evaluated if the feasibility, results and advantages related with the use of the radial artery percutaneous approach to perform catheterization procedures, continues when used in patients who have had a previous brachial artery cutdown. Out of a total of 1356 percutaneous radial accesses, 53 were in patients with previous brachial artery cutdown. Through this access 71 catheterization procedures were performed, achieving access success in 96.2% (51/53) of the punctions. Once the access success was obtained, 93.6% (44/47) of the diagnostic procedures and 100% (24/24) of the therapeutics procedures were successful. During hospitalization, in this group of patients, no major adverse cardiac events occurred and there was a 1.4% (1/71) rate of minor events. At seven days follow up, no new complications were recorded. Although this is a small group, we believe that it is enough to show that percutaneous punctions of the radial artery to perform catheterization procedures, in patients with previous brachial artery cutdown, are feasible, allowing high access and procedure success rates, with a low frequency of complications.

  1. Percutaneous radiofrequency thermal lumbar sympathectomy and its clinical use

    NARCIS (Netherlands)

    J. Pernak (Jamina)

    1988-01-01

    textabstractPercutaneous radiofrequency thermolesion techniques are commonly used in the treatment of chronic pain in different pain syndromes. There are many reports describing techniques of percutaneous radiofrequency thermolesion for denervation of central & spinal nerves (Mullan 1963), 1965,

  2. Percutaneous local therapies for hepatocellular carcinoma impair gastric function

    Institute of Scientific and Technical Information of China (English)

    Fumihiko Kinekawa; Shigeki Kuriyama; Kazuya Matsuda; Tsutomu Masaki; Kazutaka Kurokohchi; Hirohito Yoneyama; Hideyuki Inoue; Hirohide Kurata; Yoshihito Uchida; Seishiro Watanabe

    2006-01-01

    @@ TO THE EDITOR Percutaneous local therapies, such as percutaneous ethanol injection (PEI), microwave coagulation and radiofrequency ablation (RFA), are frequently used worldwide for the treatment of hepatocellular carcinoma (HCC) because of their high effectiveness.

  3. [Percutaneous Nephrolithotripsy for Renal Transplant Lithiasis: A Case Report].

    Science.gov (United States)

    Oida, Takeshi; Kanemitsu, Toshiyuki; Hayashi, Tetsuya; Fujimoto, Nobumasa; Koide, Takuo

    2016-02-01

    A 54-year-old man was introduced to our hospital for follow-up examinations after renal transplantation. At the initial visit, a 25 mm renal transplant stone was noted, which had enlarged to 32 mm at an examination 1 year later. We first attempted transurethral lithotripsy (TUL), but failed due to ureteral stricture. However, we could completely remove the stone in 2 sessions of percutaneous nephrolithotripsy (PNL). The incidence of urinary lithiasis after renal transplantation ranges from 0.17-1.8%, for which PNL and TUL are frequently used. Although considered to be accompanied with risks of bleeding, bowel injury, and renal dysfunction, PNL is effective for urinary lithiasis after renal transplantation. TUL is less invasive, but access may be difficult when the ureter has an unusual course or ureteral stricture exists, as in our patient.

  4. [Percutaneous diagnostic angioscopy. Primary lesions].

    Science.gov (United States)

    Carlier, C; Foucart, H; Baudrillard, J C; Cécile, J P

    1993-01-01

    Efficacy of percutaneous treatments of arterial affections requires the correct choice of indications, necessitating precise knowledge of elementary arterial lesions. Arterial endoscopy appears to be more specific than angiography for this use, since it allows direct vision in vivo of the lesion, a histopathologic approach compared with the non univocal images produced by angiography (for example, an arterial obstruction can result from varied causes). Different accidents to the endothelial surface can be observed: golden yellow atheromatous elevations on a straw yellow background, intimal flaps, mobile intra-luminal vegetations. Established atheromatous stenosis are smooth and regular, or on the contrary ulcerated and edged with irregular flaps capable of provoking an eccentric residual lumen. The vegetating atheromatous lesions may project into the lumen, often as calcified and thus pearly white scales adhering to the wall, or as larger occlusive lesions. When capable of being isolated, a thrombus often completes the stenosis: its recognition is therefore fundamental since its removal exposes the subjacent lesions to be treated. The fresh clot is coral shaped, bright red and mobile in the blood flow. Established clots are compact and greenish brown. At an advanced stage of atheroma the surface of the occluding clot is covered with a regular straw yellow endothelium. In the presence of a dissecting vessel the fibroscope may be introduced into the false channel, no longer showing typical endothelium but a coagulated mass interspersed with fibrous bands. Prosthetic stenosis result from either intimal hyperplasia or a suturing fault with plication.

  5. Percutaneous biopsies: indications and techniques.

    Science.gov (United States)

    Bouic-Pagès, Emmanuelle; Perrochia, Hélène; Millet, Ingrid; Taourel, Patrice

    2012-02-01

    Breast inflammation is a difficult clinical problem as it can result from a variety of causes: specific or non-specific infectious mastitis, which may or may not be complicated, primary or secondary inflammatory mastitis or inflammatory cancer. The main objective of radiology is to eliminate an inflammatory cancer. Other objectives are to characterise an inflammatory condition (where the clinical context is valuable in guiding diagnosis but which often requires a micro- or macrobiopsy) or to obtain a microorganism in cases of complicated infectious mastitis (a diagnostic procedure but also comprising the first stage of treatment). Whether for bacteriological or histological purposes, percutaneous samples therefore play a large part in the diagnostic procedure, other than in the clinical context of pregnancy where mastitis is more easily diagnosed because of its frequency. The guidance method is usually ultrasound, and the needle chosen will depend on the radiological or ultrasound signal: puncture with an 18G needle will be used for a bacteriological sample, microbiopsy of a mass or lymph nodes, or macrobiopsy in the case of microcalcifications. Copyright © 2011 Éditions française de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  6. Imaging in percutaneous musculoskeletal interventions

    Energy Technology Data Exchange (ETDEWEB)

    Gangi, Afshin; Guth, Stephane [University Hospital of Strasbourg, 67 (France). Dept. of Radiology B; Guermazi, Ali (eds.) [Boston Univ. School of Medicine, MA (United States). Dept. of Radiology

    2009-07-01

    This is one of the first books to deal specifically with imaging in percutaneous musculoskeletal interventions. The use of different imaging modalities during these procedures is well described. In the first chapter, the basic procedures and different guidance techniques are presented and discussed. The ensuing chapters describe in exhaustive detail the abilities and uses of imaging in guiding procedures ranging from biopsy and joint injection to management of pain and tumors. These procedures are extensively documented in adults as well as in the pediatric population. The third part of the book describes the different indications for vascular interventions in musculoskeletal lesions. The final chapter focuses on ultrasound-guided interventions, as they are more common and tend to be fashionable. The book is well illustrated with carefully chosen and technically excellent images. Each of the 18 chapters is written by an expert of international repute, making this book the most current and complete treatment of the subject available. It should be of great interest to interventional radiologists and also musculoskeletal and general radiologists. (orig.)

  7. Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients

    Directory of Open Access Journals (Sweden)

    Helena Duarte

    2012-12-01

    Full Text Available CONTEXT: Healthcare-associated infection represents the most frequent adverse event during care delivery. Medical advances like percutaneous endoscopic gastrostomy have brought improvement on quality of life to patients but an increased risk of healthcare-associated infection. Predictive risk factors for peristomal wound infection are largely unknown but evidence suggests that antibiotic prophylaxis and preventive strategies related to infection control may reduce infection rates. OBJECTIVES: The primary aim was to evaluate the global prevalence rate of peristomal infection. Secondary objectives were to characterise the positive culture results, to evaluate the prophylactic antibiotic protocol and to identify potential risk factors for peristomal infection. METHODS: Retrospective study of 297 patients with percutaneous endoscopic gastrostomy performed at a general hospital between January 2004 and September 2010. Patients received prophylactic cefazolin before the endoscopic gastrostomy procedure. Medical records were reviewed for demographic data, underling disease conditions to percutaneous endoscopic gastrostomy and patient potential intrinsic risk factors. Statistical analysis was made with the statistical program SPSS 17.0. RESULTS: A total of 297 percutaneous endoscopic gastrostomy tubes were inserted. Wound infection occurred in 36 patients (12.1%. Staphylococcus aureus methicillin resistant was the most frequently isolated microorganism (33.3% followed by Pseudomonas aeruginosa (30.6%. The incidence rate had been rising each year and differ from 4.65% in 2004/2007 to 17.9% in 2008/2010. This finding was consistent with the increasing of prevalence global infection rates of the hospital. Most of the infections (55.6% were detected in the first 10 days post procedure. There was no significant difference in age, body mass index values, mean survival time and duration of percutaneous endoscopic gastrostomy feeding between patients with and

  8. [Current options for percutaneous endoscopic access to the digestive tract

    NARCIS (Netherlands)

    Romkens, T.E.H.; Jong, D.J. de; Kristinsson, J.O.; Wanten, G.J.A.

    2008-01-01

    Four patients, aged 67, 52, 56 and 64 years, respectively, undergoing percutaneous colostomy or jejunostomy are presented to illustrate current options for percutaneous endoscopic access to the digestive tract. The first patient had Parkinson's disease and required percutaneous jejunostomy for conti

  9. Percutaneous epidural drainage through a burr hole

    Directory of Open Access Journals (Sweden)

    Priscila M Falsarella

    2016-01-01

    Full Text Available Intracranial extradural collection may cause an increase in intracranial pressure, requiring rapid emergency treatment to reduce morbidity and mortality. We described an alternative CT-guided percutaneous access for extradural collection drainage. We report a case of a patient with previous craniectomy for meningioma ressection who presented to the Emergency Department with symptoms of intracranial hypertension. Brains CT showed a extradural collection with subfalcine herniation. After multidisciplinary discussion a CT-guided percutaneous drainage through previous burr hole was performed. The patient was discharged after 36 hours of admission, without further symptoms. We describe a safe and effective alternative percutaneous access for extradural collection drainage in patients with previous burr hole.

  10. Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan [Keimyung University, College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Shin, Tae Beom [Gyeonsang National University, College of Medicine, Jinju (Korea, Republic of)

    2011-04-15

    To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

  11. Discussion on the risking factors of pneumothorax complicated by CT guided percutaneous lung biopsy in elderly pa-tients with long-term hospitalization%长期住院老年患者采取CT引导下经皮肺穿刺并发气胸的危险因素探讨

    Institute of Scientific and Technical Information of China (English)

    苗振伟; 张福刚; 陈振岗; 李文贵

    2014-01-01

    目的:分析在CT引导下行经皮肺穿刺的老年长期住院患者发生气胸的危险因素。方法选取我院行CT引导下经皮肺穿刺检查的长期住院老年患者130例,其中90例患者(对照组)未采用术后快速翻转患者体位技术;40例患者(实验组)采用术后快速翻转患者体位技术。分析总结两组患者并发气胸的发生率及临床资料,探讨导致患者发生气胸的危险因素。结果对照组患者气胸合并症发生率(36.7%)与实验组患者气胸合并症发生率(17.5%)的差异有统计学意义(P30min、穿刺角度>30°、穿刺次数>3次、病灶大小5cm及合并病灶周围肺气肿均为并发气胸的危险因素(P0.05). The inci-dence rate of pneumothorax in two groups had significant difference (P<0.05). Multiple factor of Logistic analysis for control group showed:puncture time was over 30min,puncture angle was over 30°, the number of puncture was over 3,the size of the lesions was over 3cm, the depth of lesion was over 5cm, emphysema around the lesions were the risking factors for pneumothorax (P<0.05). In experiment group, Mean rapid needle-out patient-rollover time was(12.3±5.1)s,70%patients (28/40) achieved a needle-out patient-rollover time of 12.3s or less. No risking factors for pneumothorax were identified in experiment group. Conclusion Percutaneous lung puncture under CT in elderly patients with long-term hospitalization should pay attention to the above risking factors in order to avoid complicated pneumothorax. Patients with postoperative should be assisted rollover to the puncture point downward position as soon as possible, it can reduce the incidence rate of pneumothorax. Use of this technique can attenuate the influence of traditional risking factors for pneumothorax.

  12. [Comparison of early and late percutaneous tracheotomies in adult intensive care unit].

    Science.gov (United States)

    Duran, Mehmet; Abdullayev, Ruslan; Cömlekçi, Mevlüt; Süren, Mustafa; Bülbül, Mehmet; Aldemir, Tayfun

    2014-01-01

    Percutaneous tracheotomy has become a good alternative for patients thought to have prolonged intubation in intensive care units. The most important benefits of tracheotomy are early discharge of the patient from the intensive care unit and shortening of the time spent in the hospital. Prolonged endotracheal intubation has complications such as laryngeal damage, vocal cord paralysis, glottic and subglottic stenosis, infection and tracheal damage. The objective of our study was to evaluate potential advantages of early percutaneous tracheotomy over late percutaneous tracheotomy in intensive care unit. Percutaneous tracheotomies applied to 158 patients in adult intensive care unit have been analyzed retrospectively. Patients were divided into two groups as early and late tracheotomy according to their endotracheal intubation time before percutaneous tracheotomy. Tracheotomies at the 0-7th days of endotracheal intubation were grouped as early and after the 7th day of endotracheal intubation as late tracheotomies. Patients having infection at the site of tracheotomy, patients with difficult or potential difficult intubation, those under 18 years old, patients with positive end-expiratory pressure above 10cmH2O and those with bleeding diathesis or platelet count under 50,000dL(-1) were not included in the study. Durations of mechanical ventilation and intensive care stay were noted. There was no statistical difference among the demographic data of the patients. Mechanical ventilation time and time spent in intensive care unit in the group with early tracheotomy was shorter and the difference was statistically significant (p<0.05). Early tracheotomy shortens mechanical ventilation duration and intensive care unit stay. For that reason we suggest early tracheotomy in patients thought to have prolonged intubation. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  13. Percutaneous Endoscopic Gastrostomy Experience Ižn A General Surgery Clinic

    Directory of Open Access Journals (Sweden)

    Ahmet Serdar Karaca

    2015-11-01

    Full Text Available Aim: Percutaneous endoscopic gastrostomy is the most preferable procedure for nutritional support in patients starving for a long time, who have difficulty in swallowing or feeding by oral way due to various diseases. The five years%u2019 experience of this surgery clinic was obtained in this study. Material and Method: The indications, complications and long term follow-up were recorded by physicians for 197 patients who had undergone percutaneous endoscopic gastrostomy. We used standart pull method for lite application of gastrostomy. Results: Percutaneous endoscopic gastrostomy was performed successfully in 141 (%71 chronic neurological patients, 35 (%17 patients with malignancy and 21 (%10 patients with various diseases with especially long time ventilation. It was performed on 141 male and 56 female patients, with a median age of 52.7 years (range 14-93 years. One hundred thirdy nine (total mortality 71% patients died because of the primary disease and after being discharged from the hospital. There was no mortality attributable to the procedure. The median time the patients used percutaneous endoscopic gastrostomy was 101.4 days (range 1-322 days excluding 37 (19% patients in whom the communication was lost during follow-up. There were a catheter leakage early in 34 and later in 19 patients, unsettled cathether in 6 patients, obstruction in 8 patients and catheter area inflamation in patients. PEG was performed twice in 7 patients. Discussion: Percutaneous endoscopic gastrostomy is a safe and reliable procedure for enteral feeding. The important complications are generally related to catheter care. In order to reduce complicatoins in the long run, further education of caretakers of patients and organization of the nutrition outpatient unit is advisable.

  14. Percutaneous Cryotherapy of Vascular Malformation: Initial Experience

    Energy Technology Data Exchange (ETDEWEB)

    Cornelis, F., E-mail: francoiscornelis@hotmail.com [Institut Bergonie, Department of Radiology (France); Neuville, A. [Institut Bergonie, Department of Pathology (France); Labreze, C. [Pellegrin Hospital, Department of Pediatric Dermatology (France); Kind, M. [Institut Bergonie, Department of Radiology (France); Bui, B. [Institut Bergonie, Department of Oncology (France); Midy, D. [Pellegrin Hospital, Department of Vascular Surgery (France); Palussiere, J. [Institut Bergonie, Department of Radiology (France); Grenier, N. [Pellegrin Hospital, Department of Radiology (France)

    2013-06-15

    The present report describes a case of percutaneous cryotherapy in a 36-year-old woman with a large and painful pectoral venous malformation. Cryoablation was performed in a single session for this 9-cm mass with 24 h hospitalisation. At 2- and 6-month follow-up, the pain had completely disappeared, and magnetic resonance imaging demonstrated a significant decrease in size. Percutaneous cryoablation shows promise as a feasible and apparently safe method for local control in patients with symptomatic venous vascular malformations.

  15. New developments in percutaneous stone surgery

    Directory of Open Access Journals (Sweden)

    S. Derisavifard

    2016-09-01

    Full Text Available Percutaneous stone surgery is the gold standard in removing large renal calculi. In light of the increase in prevalence and size of renal stones being addressed in recent years, numerous advances have been made in attempts of improving the morbidity, efficacy, and technical ease of stone clearance. In this review article, we assess new advancements in percutaneous stone surgery including diagnosis and surgical planning, methods of renal access, patient positioning, tract dilation, nephroscopes, lithotripsy, and post-operative drainage and antibiotic prophylaxis.

  16. Percutaneous tricuspid valve replacement in childhood

    Directory of Open Access Journals (Sweden)

    Mathias Emmel

    2015-01-01

    Full Text Available Percutaneous replacement of the tricuspid valve with a bovine jugular venous valve (melody valve was successfully undertaken in a 9-year-old boy. The patient had a previous history of bacterial endocarditis of the native tricuspid valve in infancy. Initially, a pericardial patch valve was created, followed by surgical replacement of the valve using a biological tissue valve at 4 years of age. Progressive stenosis and regurgitation of the biological valve, with severe venous congestion and resulting hepatic dysfunction prompted percutaneous valve replacement.

  17. Exit strategies following percutaneous nephrolithotomy (PCNL)

    DEFF Research Database (Denmark)

    Cormio, Luigi; Gonzalez, Gaspar Ibarlucea; Tolley, David

    2013-01-01

    PURPOSE: To compare the characteristics and outcomes of exit strategies following percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database. MATERIALS AND METHODS: Two matched data sets were prepared in order to compare...... stent only versus NT only and TTL versus NT only. Patients were matched on the exit strategy using the following variables: case volume of the center where they underwent PCNL, stone burden, the presence of staghorn stone, size of sheath used at percutaneous access, the presence of bleeding during...

  18. Percutaneous endoscopic gastrostomy in children

    Directory of Open Access Journals (Sweden)

    Jye Hae Park

    2011-01-01

    Full Text Available Purpose: Percutaneous endoscopic gastrostomy (PEG can improve nutritional status and reduce the amount of time needed to feed neurologically impaired children. We evaluated the characteristics, complications, and outcomes of neurologically impaired children treated with PEG. Methods: We retrospectively reviewed the records of 32 neurologically impaired children who underwent PEG between March 2002 and August 2008 at our medical center. Forty-two PEG procedures comprising 32 PEG insertions and 10 PEG exchanges, were performed. The mean follow-up time was 12.2 (6.6 months. Results: Mean patient age was 9.4 (4.5 years. The main indications for PEG insertion were swallowing difficulty with GI bleeding due to nasogastric tube placement and/or the presence of gastroesophageal reflux disease (GERD. The overall rate of complications was 47%, with early complications evident in 25% of patients and late complications in 22%. The late complications included one gastro-colic fistula, two cases of aggravated GERD, and four instances of wound infection. Among the 15 patients with histological evidence of GERD before PEG, 13 (87% had less severe GERD, experienced no new aspiration events, and showed increased body weight after PEG treatment. Conclusion: PEG is a safe, effective, and relatively simple technique affording long-term enteral nutritional support in neurologically impaired children. Following PEG treatment, the body weight of most patients increased and the levels of vomiting, GI bleeding, and aspiration fell. We suggest that PEG with post-procedural observation be considered for enteral nutritional support of neurologically impaired children.

  19. Percutaneous coronary intervention in the elderly with ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Gao L

    2014-07-01

    Full Text Available Lei Gao,* Xin Hu,* Yu-Qi Liu, Qiao Xue, Quan-Zhou FengInstitute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workAbstract: As a result of increased life expectancy, octogenarians constitute an increasing ­proportion of patients admitted to hospital for ST-segment elevation myocardial infarction (STEMI. Primary percutaneous coronary intervention is currently the treatment of choice for octogenarians presenting with STEMI. The recent literature on this topic has yielded controversial results, even though advances in drug-eluting stents and new types of antithrombotic agents are improving the management of STEMI and postoperative care. In this paper, we review the current status of percutaneous coronary intervention in the elderly with STEMI, including the reasons for their high mortality and morbidity, predictors of mortality, and strategies to improve outcomes.Keywords: octogenarians, percutaneous coronary intervention, ST-segment elevation myocardial infarction

  20. Subglottic stenosis following percutaneous tracheostomy: a single centre report as a descriptive study.

    Science.gov (United States)

    Karvandian, K; Jafarzadeh, A; Hajipour, A; Zolfaghari, N

    2011-08-01

    Tracheal stenosis is a potential complication of tracheostomy. The present study aimed to describe the epidemiologic profile of subglottic stenosis in a referral medical centre. During a 4-year period, all patients who had been admitted in an Intensive Care Unit of Imam Khomeini Hospital (affiliated to Tehran University of Medical Sciences) and had undergone percutaneous tracheostomy during 7-10 days after endotracheal intubation were enrolled in the study. After removing the tracheostomy tube, patients were evaluated regarding development of tracheal stenosis using fiberoptic bronchoscopy and multi-slice computed tomography scan. During the study period, percutaneous tracheostomy was performed in 140 patients with a mean age of 38 years. Overall 54 patients died due to the severity of the disorder during hospitalization. In the remaining 86 patients, 54 cases needed permanent or long-term mechanical ventilation and were excluded from the study. Twelve patients died during the first 3 months and 20 patients were left for final assessment. Multi-slice computed tomography scan imaging showed subglottic stenosis in 17 cases (85%). Of these, 9 patients (52%) had tracheal stenosis of subglottic stenosis is frequent in patients who have undergone percutaneous tracheostomy in the Intensive Care unit setting. However, the stenosis is generally mild and is not associated with serious and/ or life-threatening clinical manifestations.

  1. Percutaneous endoscopic colostomy: A new technique for the treatment of recurrent sigmoid volvulus

    Directory of Open Access Journals (Sweden)

    Al-Alawi Ibrahim

    2010-01-01

    Full Text Available Sigmoid volvulus is a common cause of large bowel obstruction in western countries and Africa. It accounts for 25% of the patients admitted to the hospital for large bowel obstruction. The acute management of sigmoid volvulus is sigmoidoscopic decompression. However, the recurrence rate can be as high as 60% in some series. Recurrent sigmoid volvulus in elderly patients who are not fit for definitive surgery is difficult to manage. The percutaneous endoscopic placement of two percutaneous endoscopic colostomy tube placement is a simple and relatively safe procedure. The two tubes should be left open to act as vents for the colon from over-distending. In our opinion, this aspect is key to its success as it keeps the sigmoid colon deflated until adhesions form between the colon and the abdominal wall.

  2. Selective percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia:report on 1860 cases

    Institute of Scientific and Technical Information of China (English)

    吴承远; 孟凡刚; 徐淑军; 刘玉光; 王宏伟

    2004-01-01

    @@Trigeminal neuralgia (TN) is defined by the International Association for the Study of Pain as "a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve".1 The incidence rate is about three to five cases per year per 100000 persons and increases with age.2 In our hospital, percutaneous radiofrequency therapy was performed on 1860 patients with TN from June 1986 to April 2003, and percutaneous trigeminal ganglion radiofrequency therapy on 579 cases. Among this group of patients, X-ray, 3-D CT, and navigational localization of the oval foramen were performed on 42 cases. The indications, techniques, and results are reported here.

  3. Percutaneous endoscopic lumbar discectomy: clinical and quality of life outcomes with a minimum 2 year follow-up

    Directory of Open Access Journals (Sweden)

    Tan Seang B

    2009-06-01

    Full Text Available Abstract Background Percutaneous endoscopic lumbar discectomy is a relatively new technique. Very few studies have reported the clinical outcome of percutaneous endoscopic discectomy in terms of quality of life and return to work. Method 55 patients with percutaneous endoscopic lumbar discectomy done from 2002 to 2006 had their clinical outcomes reviewed in terms of the North American Spine Score (NASS, Medical Outcomes Study Short Form-36 scores (SF-36 and Pain Visual Analogue Scale (VAS and return to work. Results The mean age was 35.6 years, the mean operative time was 55.8 minutes and the mean length of follow-up was 3.4 years. The mean hospital stay for endoscopic discectomy was 17.3 hours. There was significant reduction in the severity of back pain and lower limb symptoms (NASS and VAS, p Conclusion Percutaneous endoscopic lumbar discectomy is associated with improvement in back pain and lower limb symptoms postoperation which translates to improvement in quality of life. It has the advantage that it can be performed on a day case basis with short length of hospitalization and early return to work thus improving quality of life earlier.

  4. Management of closed tibial plateau fractures with percutaneous cancellous screw fixation

    Directory of Open Access Journals (Sweden)

    Tushar Agarwal

    2013-01-01

    Full Text Available Background: Tibial plateau fractures, intra-articular in nature and caused by high-velocity trauma, constitute approximately 1% of all fractures. Primary goal in the management of proximal tibial articular fracture aims for a stable, congruous, pain-free, mobile joint. Objective: To study the technique, results, and complications of percutaneous cancellous screw fixation for tibial plateau fractures. Materials and Methods: Twenty-three men and seven women aged 18-65 years (mean = 36.8 years underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with <5 mm depression. According to the Schatzker classification, patients were grouped as type I (n = 18, type II (n = 4, type III (n = 0, type IV (n = 8, type V (n = 2, and type VI (n = 1. Closed reduction was achieved by manual ligamentotaxis technique under image intensifier control and fixed percutaneously with two cancellous screws (6.5 mm with or without washers in a parallel fashion. Results: Functional outcome was evaluated using the Mason Hohl evaluation system. A total score of 19-24 was considered as excellent, 13-18 as good, 7-12 as fair, and <6 as poor. Outcomes were excellent in 10 patients, good in 15, fair in 4, and poor in 1 patient. Patients were allowed partial weight bearing with walker after 1 month and full weight bearing after radiological union in approximately 3-4 months. The mean period of hospital stay was 5 (range 2-15 days. All the fractures united radiologically after a mean of 3 (range 2.5- 5 months. Patients were evaluated at a mean of 3 years after injury. No patient had any complication like infection, wound dehiscence, or hardware problem. Conclusion: Percutaneous cancellous screw fixation for closed tibial plateau fractures is minimally invasive. It reduces hospital stay and cost, enables early mobilization with minimal instrumentation, and achieves satisfactory outcomes.

  5. Percutaneous needle fasciotomy in dupuytren's disease

    NARCIS (Netherlands)

    van Rijssen, A L; Werker, P M N

    2006-01-01

    The aim of this study was to examine our results of 74 percutaneous needle fasciotomies for Dupuytren's contracture. Pre-operative and postoperative total passive extension deficit was measured. Patients were seen at the outpatient clinic at 32 months for final follow-up. Extension deficit and

  6. Percutaneous penetration studies for risk assessment

    NARCIS (Netherlands)

    Sartorelli, P.; Andersen, H.R.; Angerer, J.; Corish, J.; Drexler, H.; Göen, T.; Griffin, P.; Hotchkiss, S.A.M.; Larese, F.; Montomoli, L.; Perkins, J.; Schmelz, M.; Sandt, J. van de; Williams, F.

    2000-01-01

    During the last few years the general interest in the percutaneous absorption of chemicals has increased. It is generally accepted that there is very few reliable quantitative and qualitative data on dermal exposure to chemicals in the general population and in occupationally exposed workers. In ord

  7. Imaging in percutaneous ablation for atrial fibrillation

    NARCIS (Netherlands)

    R. Maksimović (Ružica); T. Dill (Thorsten); A.D. Ristić (Arsen); P.M. Seferovic (Petar)

    2006-01-01

    textabstractPercutaneous ablation for electrical disconnection of the arrhythmogenic foci using various forms of energy has become a well-established technique for treating atrial fibrillation (AF). Success rate in preventing recurrence of AF episodes is high although associated with a significant

  8. New developments in percutaneous stone surgery

    African Journals Online (AJOL)

    S. Derisavifard

    2016-08-01

    Aug 1, 2016 ... Percutaneous stone surgery is the gold standard in removing large renal calculi. In light of the .... tailoring antibiotics if a patient were to develop sepsis. ..... small size of the micro-PCNL instrumentation, it is best suited for.

  9. Improvements in Intracorporeal Lithotripters for Percutaneous Nephrolithotomy

    Science.gov (United States)

    Kuo, Ramsay L.

    2007-04-01

    Percutaneous nephrolithotomy (PNL) is an effective minimally invasive surgical approach for the treatment of large renal stone burden. Intracorporeal lithotripters (ICL) are utilized during PNL to fragment calculi, with some devices capable of concurrently removing fragments as well. Much progress has been made in the design of ICL devices, resulting in potentially more efficient treatment of nephrolithiasis.

  10. Gastrostomie percutanée endoscopique

    National Research Council Canada - National Science Library

    Le Sidaner, Anne

    2002-01-01

    La gastrostomie percutanée endoscopique est actuellement la voie d’abord de référence pour l’alimentation entérale prolongée. La simplicité et la rapidité de la technique, l’évolution du matériel font que les gastro...

  11. Magnetic Navigation in Percutaneous Cardiac Intervention

    NARCIS (Netherlands)

    M.S. Patterson (Mark)

    2010-01-01

    textabstractMagnetic navigation is the use of a magnetic fi eld to re-orientate a magnetically-enabled wire or device. The fi eld is directed by external magnets that are moved by a computercontrolled system. This technology could improve percutaneous coronary interventional procedures as it

  12. Late complications of percutaneous tracheostomy using the balloon dilation technique.

    Science.gov (United States)

    Araujo, J B; Añón, J M; García de Lorenzo, A; García-Fernandez, A M; Esparcia, M; Adán, J; Relanzon, S; Quiles, D; de Paz, V; Molina, A

    2017-06-22

    The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. A prospective, observational cohort study was carried out. Two medical-surgical intensive care units (ICU). All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. All patients underwent PT according to the Ciaglia Blue Dolphin(®) method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. Percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  13. [Percutaneous lithotripsy: how to make it safer. Personal experience].

    Science.gov (United States)

    Granata, M; Costanzo, V; Condorelli, S; Pisciotta, F; Matera, M; Costantino, G

    2002-09-01

    Percutaneous surgery (PCN) is now a routinary method for the treatment of the majority of renal stones, since it has become safer than in the past, because, thanks to new endourologic instruments and to ultrasounds, it has been possible to reduce the mistakes of the renal puncture. Furthermore, the use of balloons catheters for the dilatation of the nephrostomic channel allows the reduction of operating time and hemorrhage risk. In this paper, the authors expose their experience in PCN operations carried out with the help of X-ray and ultrasonography, during the indirect laying of the stones, and the use of a balloon catheter for the creation of a working channel. The Authors report their experience with the use of ultrasounds and concomitant X-rays for renal puncture, and of balloon catheter as track dilator, during 68 consecutive PCN carried out for renal lithiasis, 55 primary and 13 secondary to ESWL treatments; every stone has been cracked by a "Swiss-lithoclast" balistic lithotripter. For every patient, time of operation, complications and hospitalization-days were registered. Only three patients (4.4%) had haemorrhages and in one case of A-V fistula nephrectomy was necessary. The patients stayed in hospital approx. four days; the nephrostomic drainage was generally removed 3 days after the operation. The very low incidence of complications and the very short time of hospitalization suggest that ultrasounds and balloon-catheters may be useful to this surgery and may make it safer than in the past. Moreover, ultrasonography reduces the rate of X-rays exposition for operators and patients; the cost of the balloon is easily balanced by the reduction of operating times and hospitalization-days.

  14. Noncardiac surgery and bleeding after percutaneous coronary intervention.

    Science.gov (United States)

    To, Andrew C Y; Armstrong, Guy; Zeng, Irene; Webster, Mark W I

    2009-06-01

    The decision on whether to implant a drug-eluting or bare-metal stent during percutaneous coronary intervention (PCI) depends in part on the perceived likelihood of the patient developing late stent thrombosis. Noncardiac surgery and bleeding are associated with discontinuation of dual antiplatelet therapy and with increased stent thrombosis. We assessed the incidence of and predictors for subsequent noncardiac surgery and bleeding episodes in patients who had undergone PCI. Hospital discharge coding data were used to identify all adult patients undergoing public hospital PCI in New Zealand from 1996 to 2001. Hospital admissions during the ensuing 5 years were analyzed for noncardiac surgery and bleeding episodes. Eleven thousand one hundred fifty-one patients (age, 62+/-11 years; 30% women) underwent PCI, mainly for an acute coronary syndrome (73%). During the 5-year follow-up, 26% of the population underwent at least 1 noncardiac surgical procedure (23% orthopedic, 20% abdominal, 12% urologic, 10% vascular, 35% others) and 8.6% had at least 1 bleeding episode either requiring or occurring during hospitalization. Of those, half were gastrointestinal, and one quarter of bleeding events required blood transfusion. The main clinical predictors of noncardiac surgery were advanced age, previous noncardiac surgery, osteoarthritis, and peripheral vascular disease. A previous bleeding admission and age were the strongest predictors of subsequent bleeding. Noncardiac surgery is required frequently after PCI, whereas bleeding is less common. Before implanting a drug-eluting or bare-metal stent, individual patient risk stratification by the interventional cardiologist should include assessment of whether there is an increased likelihood of needing noncardiac surgery or developing bleeding.

  15. Two-Year Follow Up After Surgical Versus Percutaneous Paravalvular Leak Closure: A Non-Randomized Analysis.

    Science.gov (United States)

    Angulo-Llanos, Rocío; Sarnago-Cebada, Fernando; Rivera, Allan R; Elízaga Corrales, Jaime; Cuerpo, Gregorio; Solis, Jorge; Gutierrez-Ibañes, Enrique; Sanz-Ruiz, Ricardo; Vázquez Álvarez, M E; Fernandez-Avilés, Francisco

    2016-10-01

    Percutaneous closure of paravalvular leak (PVL) has emerged as an alternative treatment. Predictors of survival and procedural success are unknown. To review our experience in the treatment of PVL and evaluate efficacy, mortality, predictors of success, and outcomes. Retrospective review of percutaneous PVL procedures between years 2008 and 2014. Survival and results were compared with a control cohort of surgical patients. Percutaneous closure was attempted in 51 patients. The surgical group had 36 patients. Defects were perimitral in 67 patients (77%). Mean follow-up (FU) was 784.5 days. After propensity score analysis in-hospital mortality was higher in the surgical group (30.6% vs. 9.8%, OR 6, P 0.01). Clinical improvement was higher in the percutaneous group (71.4% vs. 36.4%, P 0.002). Multivariate analysis showed normal creatinine (OR 15, P < 0.001) as independent predictor of clinical improvement. For the composite end-point of all-cause mortality or readmission, older age (OR 10.7, P 0.001), renal failure, (OR 18, P < 0.01), poor functional class and the absence of clinical improvement (OR 3.9, P < 0.001) were related with a higher risk. There were no differences in survival free from the composite end-point according to the treatment received (surgical or percutaneous). Percutaneous PVL closure has a reasonable rate of success and low complication rates, and results compare favorably with surgical treatment. Older patients and those with poor functional class or renal failure (RF) showed a worse prognosis even after a successful closure. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  16. Closed reduction and percutaneous pinning of displaced supracondylar fractures of humerus in children with delayed presentation

    Institute of Scientific and Technical Information of China (English)

    Aman Dua; Krishna Kiran Eachempati; Rajesh Malhotra; Lalit Sharma; Mallinath Gidaganti

    2011-01-01

    Objective: Supracondylar fractures of the humerus account for 60% of all the fractures around the pediatric elbow and even in developed countries 18% of patients undergo surgery 48 hours or longer following presentation in the hospital. Management guidelines are not clear yet for these patients who present late. The aim of this prospective study was to evaluate the clinical, radiological and functional outcome following closed reduction and percutaneous pinning of widely displaced supracondylar fractures of the humerus presenting 12 hours or more after injury.Methods: We reviewed the functional and radiological results of closed reduction and percutaneous pinning using crossed K-wires in 40 patients with displaced extension type supracondylar fracture of the humerus (Gartland type Ⅲ) with a delay of more than 12 hours in presentation. The average age of patients was 4.5 years and the mean delay in presentation was 17.55 hours.Results: Closed reduction and percutaneous pinning was successful in 90% of patients. The mean follow up period was 15 months. The Baumann's angle was restored within 4 degrees of the unaffected side in all patients. Use of a small medial incision in patients with severe swelling helped us avoid ulnar nerve injury. Using Flynn's criteria,38 patients (95%) had an excellent result. Two patients had mild myositis and both had a poor result. None of the patients developed cubitus varus.Conclusion: Closed reduction and crossed pinning of displaced supracondylar fractures of humerus in children is a safe and effective method even with delayed presentation.

  17. Percutaneous Fixation of Anterior Column Acetabular Fracture in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Halil Ceylan

    2013-01-01

    Full Text Available Renal transplantation, performed per million population, ranges from 30 to 60 in developed countries. The transplanted kidney is generally placed in iliac fossa; therefore the treatment procedure of the pelvic trauma in these patients should be selected carefully. The gold standard technique for the treatment of displaced acetabulum fractures is open reduction and internal fixation. Our patient had received a living-related-donor renal transplant due to chronic renal failure. In the second year of transplantation, she had been injured in a motor-vehicle accident, and radiographs showed a right acetabular anterior column fracture and left pubic rami fractures. The patient was treated with percutaneous fixation techniques and at one year of postoperative period there was no evidence of degenerative signs and the clinical outcome was good. Beside having the advantage of avoiding dissection through the iliac fossa by the standard ilioinguinal approach, percutaneous techniques, with shorter surgical time, decreasing soft tissue disruption, and the potential for early discharge from hospital might be ideal for a renal transplant recipient carrying a higher risk of infection. Percutaneous fixation of selected acetabular fractures in a renal transplant recipient would presumably have the potential to decrease the morbidity associated with traditional open surgical procedures.

  18. Cost comparison of open fasciectomy versus percutaneous needle aponeurotomy for treatment of Dupuytren contracture.

    Science.gov (United States)

    Herrera, Fernando Antonio; Benhaim, Prosper; Suliman, Ahmed; Roostaeian, Jason; Azari, Kodi; Mitchell, Scott

    2013-04-01

    Many surgical options exist for the treatment of Dupuytren contracture. Little has been written regarding their financial implications. The purpose of this study was to compare the immediate direct costs of open fasciectomy to percutaneous needle aponeurotomy (NA) for the surgical treatment of Dupuytren contracture. A retrospective review was performed comparing patients treated with open fasciectomy (group 1) to patients treated with percutaneous NA (group 2) for the treatment of Dupuytren disease from 2008 to 2010. Financial and medical records were reviewed. Direct cost of treatment was calculated from hospital billing records, including surgical, anesthesia, and facility fees. Statistical analysis was performed using unpaired t test. Twenty-four patients received open segmental palmar and/or digital fasciectomy (group 1). Average preoperative metacarpophalangeal joint flexion contracture was 30 degrees, and proximal interphalangeal joint flexion contracture was 42 degrees. Group 2 consisted of 24 patients. Average preoperative metacarpophalangeal flexion contracture was 31 degrees, and proximal interphalangeal flexion contracture was 27 degrees. Mean cost for group 1 was $11,240 and mean cost for group 2 was $4657 (P < 0.0001). Immediate postoperative contracture correction was similar between both. Two complications occurred in group 1 (wound dehiscence and nerve injury); no complications in group 2. Percutaneous NA is associated with decreased direct costs in the short-term compared to traditional open fasciectomy with comparable deformity correction.

  19. [Percutaneous fluoroscopic and arthroscopic controlled screw fixation of posterior facet fractures of the calcaneus].

    Science.gov (United States)

    Nehme, A; Chaminade, B; Chiron, P; Fabie, F; Tricoire, J-L; Puget, J

    2004-05-01

    We describe a new technique for reduction and percutaneous osteosynthesis of displaced posterior facet fractures of the calcaneus which appears to overcome the problems encountered with other percutaneous methods described for this type of surgery. The method relies on the use of traction which allows automatic reduction of the greater tubersosity. The patient is installed on an orthopedic traction table. Pin traction provides anatomic reduction of the posterior articular surface and restitution of Böhler's angle under fluoroscopic and arthroscopic control. We used this technique in thirteen patients with fifteen displaced posterior facet fractures of the calcaneum. Mean patient age was 50.4 Years. Mean follow-up was twenty Months. We did not have any cutaneous or infectious complications in this short series. In the majority of the cases, the overall functional and physical results were excellent or good. The mean Böhler's angle was 27 degrees, corresponding to 83% correction compared with the healthy side. These preliminary results are encouraging. We were able to restitute calcaneum anatomy, shorten hospital stay, and avoid all skin complications. Indications for this percutaneous technique could be widened. It is a valid alternative to open treatment of posterior facet fractures of the calcaneum.

  20. Image-Guided Surgical Robotic System for Percutaneous Reduction of Joint Fractures.

    Science.gov (United States)

    Dagnino, Giulio; Georgilas, Ioannis; Morad, Samir; Gibbons, Peter; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

    2017-08-16

    Complex joint fractures often require an open surgical procedure, which is associated with extensive soft tissue damages and longer hospitalization and rehabilitation time. Percutaneous techniques can potentially mitigate these risks but their application to joint fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces involved in the fragment manipulation (due to the presence of soft tissue, e.g., muscles) which might result in fracture malreduction. Integration of robotic assistance and 3D image guidance can potentially overcome these issues. The authors propose an image-guided surgical robotic system for the percutaneous treatment of knee joint fractures, i.e., the robot-assisted fracture surgery (RAFS) system. It allows simultaneous manipulation of two bone fragments, safer robot-bone fixation system, and a traction performing robotic manipulator. This system has led to a novel clinical workflow and has been tested both in laboratory and in clinically relevant cadaveric trials. The RAFS system was tested on 9 cadaver specimens and was able to reduce 7 out of 9 distal femur fractures (T- and Y-shape 33-C1) with acceptable accuracy (≈1 mm, ≈5°), demonstrating its applicability to fix knee joint fractures. This study paved the way to develop novel technologies for percutaneous treatment of complex fractures including hip, ankle, and shoulder, thus representing a step toward minimally-invasive fracture surgeries.

  1. Percutaneous heart valves; past, present and future.

    Science.gov (United States)

    Rozeik, M M; Wheatley, D J; Gourlay, T

    2014-09-01

    Percutaneous heart valves provide a promising future for patients refused surgery on the grounds of significant technical challenges or high risk for complications. Since the first human intervention more than 10 years ago, over 50 different types of valves have been developed. The CoreValve and Edwards SAPIEN valves have both experienced clinical trials and the latter has gained FDA approval for implantation in patients considered inoperable. Current complications, such as major vascular bleeding and stroke, prevent these valves from being commonly deployed in patients considered operable in conventional surgery. This review focuses on the past and present achievements of these valves and highlights the design considerations required to progress development further. It is envisaged that, with continued improvement in valve design and with increased clinical and engineering experience, percutaneous heart valve replacement may one day be a viable option for lower-risk operable patients.

  2. Percutaneous penetration through slightly damaged skin

    DEFF Research Database (Denmark)

    Nielsen, Jesper B

    2005-01-01

    Guidelines for experimental studies of percutaneous penetration prescribe optimal barrier integrity of the skin. The barrier integrity of the skin exposed in occupational or household situations is, however, not always ideal, and skin problems are among the most dominant reasons for absence from...... work. We have therefore evaluated an experimental model for percutaneous penetration through slightly damaged skin. The influence of a slight damage to the skin was evaluated using five pesticides covering a wide range of solubilities. We used an experimental model with static diffusion cells mounted...... with human skin. A slight damage to the barrier integrity was induced by pre-treatment of the skin with sodium lauryl sulphate (SLS) before pesticide exposure. The experimental model with 3 h pre-treatment with SLS (0.1% or 0.3%) assured a significant but controlled damage to the barrier integrity, a damage...

  3. Percutaneous treatment in patients presenting with malignant cardiac tamponade

    Energy Technology Data Exchange (ETDEWEB)

    Marcy, P.Y. [Antoine Lacassagne Center, Interventional Radiology Department, Nice (France); Bondiau, P.Y. [Antoine Lacassagne Center, Radiation Therapy Department, Nice (France); Brunner, P. [Centre Hospitalier Princesse, Grace (Monaco). Interventional Radiology Department

    2005-09-01

    The percutaneous treatment of pericardial effusion resulting in cardiac tamponade has undergone an evolution in recent years with the use of less invasive drainage techniques in selected cases. To determine optimal therapy modalities for oncology patients with malignant pericardial tamponade (MPT), the authors review their institutional experience with percutaneous needle puncture routes, means of imaging-guided drainage and percutaneous management of the pericardial fluid effusion (pericardial sclerosis and balloon pericardiotomy). Advantages and limits of the percutaneous techniques will be compared to the surgical treatment. (orig.)

  4. Ultrasound Guided Percutaneous Nephrostomy For Obstructive Uropathy

    Directory of Open Access Journals (Sweden)

    Abdullah Gedik

    2008-01-01

    Full Text Available We retrospectively evaluated the indications and complications in our patients that were performed of percutaneous nephrostomy applications with ultrasonography guidance.We evaluated 371 all patients whom applied percutaneous nephrostomy with ultrasonography guidance between January 2002 and December 2005 were evaluated retrospectively. The demographic data, cause of the obstruction, minor and major complications of patients were discussed.In this period, totally 455 Percutaneous nephrostomies (84 bilaterally, 287 unilaterally in 371 patients (were placed in 113 females (30.45 % and 258 males were placed. The male (69.55% patients whom mean age of the patients were 32.17 year (range 5 months to 85 years. In 17 of 371 (3.73% patients, it was determined with antegrade pyelography that nephro stomy catheters were not in the kidney. Total success ratio was 96.37%. Causes of the obstructions were malignant diseases in for 76 patients (20.48% and were benign diseases in for 295 patients (79.52%. The major complications were determined twenty-four of patients (6.46%. Major complications included macroscopic hematuria which needs transfusion (7 patients, septicemia (14 patients, and retroperitoneal colon perforation with needle (3 patients were observed in 24 of the 371 patients. Minor complications were observed in 51 of the 371 patients (13.74 %. All of the minor complications were macroscopic hematuria that resolved in less than 24 hours. In conclusion, percutaneous nephrostomy with ultrasonography guidance were found as an effective and, safe and successful method for the drainage of upper urinary tract in the obstructive uropaty.

  5. Percutaneous ultrasound guided umbilical cord blood sampling

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Hyup; Choi, B. I.; Kim, C. W.; Youn, B. H.; Shin, H. C.; Kim, S. O. [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1989-12-15

    This report describes a technique and the result of percutaneous ultrasound-guided umbilical cord blood sampling and its potential use in the management of diagnostic problems in the second and third trimester of pregnancy. This method has been employed in the prenatal assessment of 19 fetuses at risk for chromosomal disorders, fetal hypoxia and hematologic disorders. This simple and rapid procedure offers a safe access to the fetal circulation

  6. Promising results after percutaneous mitral valve repair

    DEFF Research Database (Denmark)

    Ihlemann, Nikolaj; Franzen, Olaf; Jørgensen, Erik;

    2011-01-01

    Mitral valve regurgitation (MR) is the secondmost frequent valve disease in Europe. Untreated MR causes considerable morbidity and mortality. In the elderly, as many as half of these patients are denied surgery because of an estimated high surgical risk. Percutaneous mitral valve repair with the ...... with the MitraClip system resembles the Alfieristitch where a clip is used to connect the tip of the mitral valve leaflets....

  7. Promising results after percutaneous mitral valve repair

    DEFF Research Database (Denmark)

    Ihlemann, Nikolaj; Franzen, Olaf; Jørgensen, Erik;

    2011-01-01

    Mitral valve regurgitation (MR) is the secondmost frequent valve disease in Europe. Untreated MR causes considerable morbidity and mortality. In the elderly, as many as half of these patients are denied surgery because of an estimated high surgical risk. Percutaneous mitral valve repair...... with the MitraClip system resembles the Alfieristitch where a clip is used to connect the tip of the mitral valve leaflets....

  8. A Percutaneous Knotless Technique for SLAP Repair.

    Science.gov (United States)

    Tennent, Duncan; Pearse, Eyiyemi

    2016-02-01

    We describe a percutaneous technique for repair of type II SLAP lesions. Through the Neviaser portal, a spinal needle is used to pass a FiberStick suture (Arthrex, Naples, FL) through the labrum to create 2 mattress sutures that are secured with PushLock anchors (Arthrex). This technique is simple, reproducible, and knotless and requires no cannulas. At the end of the procedure, minimal suture material remains in the joint.

  9. Management of hemorrhage after percutaneous renal surgery.

    Science.gov (United States)

    Gallucci, M; Fortunato, P; Schettini, M; Vincenzoni, A

    1998-12-01

    Percutaneous renal surgery is routine therapy for a number of renal pathologies. It is a technique not without complications, often serious ones, of which the worst is bleeding. We reviewed our experience of the incidence, etiology, and management of this serious complication to determine a protocol of treatment that will minimize the consequences. Between 1984 and 1996, we carried out 976 percutaneous operations for reno-calix stones, pyeloureteral junction stenosis, neoplasia of the renal pelvis, diagnosis, and ureteral prostheses. In all cases, the percutaneous access was achieved through a lower calix in the posterior axillary line with the patient in a prone position. The lithotripsy was performed with ultrasound and balistic energy lithotripters. Antegrade endopyelotomy was performed according to our technique. At the end of the procedure, a nephrostomy tube was positioned, 24F for lithotripsy and 16F for endopyelotomy. The nephrostomy tube was removed after 24 to 48 hours. In this series, 146 patients (15%) presented significant perioperative bleeding. In 97 cases (10%), this complication was resolved with the repositioning of the nephrostomy tube, bedrest in a supine position, and observation, whereas in 49 cases (5%), clamping of the nephrostomy tube for 24 hours was necessary. In 56 patients (5.7%), two blood transfusions were necessary, and three patients (0.3%) had bleeding 10, 12, and 20 days after the operation, which was resolved by embolization of the lacerated vessel.

  10. Imaging in percutaneous ablation for atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Maksimovic, Ruzica [Erasmus Medical Center, Department of Radiology, GD Rotterdam (Netherlands); Institute for Cardiovascular Diseases of the University Medical Center, Belgrade (Czechoslovakia); Dill, Thorsten [Kerckhoff-Heart Center, Department of Cardiology, Bad Nauheim (Germany); Ristic, Arsen D.; Seferovic, Petar M. [Institute for Cardiovascular Diseases of the University Medical Center, Belgrade (Czechoslovakia)

    2006-11-15

    Percutaneous ablation for electrical disconnection of the arrhythmogenic foci using various forms of energy has become a well-established technique for treating atrial fibrillation (AF). Success rate in preventing recurrence of AF episodes is high although associated with a significant incidence of pulmonary vein (PV) stenosis and other rare complications. Clinical workup of AF patients includes imaging before and after ablative treatment using different noninvasive and invasive techniques such as conventional angiography, transoesophageal and intracardiac echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI), which offer different information with variable diagnostic accuracy. Evaluation before percutaneous ablation involves assessment of PVs (PV pattern, branching pattern, orientation and ostial size) to facilitate position and size of catheters and reduce procedure time as well as examining the left atrium (presence of thrombi, dimensions and volumes). Imaging after the percutaneous ablation is important for assessment of overall success of the procedure and revealing potential complications. Therefore, imaging methods enable depiction of PVs and the anatomy of surrounding structures essential for preprocedural management and early detection of PV stenosis and other ablation-related procedures, as well as long-term follow-up of these patients. (orig.)

  11. Percutaneous Cryoablation for Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Tsitskari Maria

    2015-06-01

    Full Text Available Renal cell carcinoma (RCC is the most common type of kidney cancer in adults. Nephron sparing resection (partial nephrectomy has been the “gold standard” for the treatment of resectable disease. With the widespread use of cross sectional imaging techniques, more cases of renal cell cancers are detected at an early stage, i.e. stage 1A or 1B.  This has provided an impetus for expanding the nephron sparing options and especially, percutaneous ablative techniques.  Percutaneous ablation for RCC is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection or when there is a need to preserve renal function due to comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. During the last few years, percutaneous cryoablation has been gaining acceptance as a curative treatment option for small renal cancers. Clinical studies to date indicate that cryoablation is a safe and effective therapeutic method with acceptable short and long term outcomes and with a low risk, in the appropriate setting.  In addition it seems to offer some advantages over radio frequency ablation (RFA and other thermal ablation techniques for renal masses.

  12. Percutaneous Zenith endografting for abdominal aortic aneurysms.

    Science.gov (United States)

    Heyer, Kamaldeep S; Resnick, Scott A; Matsumura, Jon S; Amaranto, Daniel; Eskandari, Mark K

    2009-03-01

    A completely percutaneous approach to infrarenal abdominal aortic aneurysm (AAA) endografting has the theoretic benefits of being minimally invasive and more expedient. Our goal was to demonstrate the utility of this approach using a suprarenal fixation device and a suture-mediated closure system. We conducted a single-institution, retrospective review of 14 patients who underwent percutaneous AAA repair with the Zenith device between August 2003 and March 2007. Immediate and delayed access-related outcomes were examined over a mean follow-up of 12.1+/-2.0 months. Mean AAA size was 5.6 cm. Immediate arterial closure and technical success rate was 96% (27/28 vessels). One immediate hemostatic failure required open surgical repair. Over follow-up, one vessel required operative repair for new-onset claudication. No other immediate or delayed complications (thrombosis, pseudoaneurysm, infection, or deep venous thrombosis) were detected. A percutaneous approach for the treatment of AAA has several advantages over femoral artery cutdown but also has its own unique set of risks in the immediate and late postoperative period. Ultimately, the "preclose technique" can be safely applied for the Zenith device despite its large-bore delivery system.

  13. FacilitiesHospitals_HOSPITAL

    Data.gov (United States)

    Vermont Center for Geographic Information — This data layer contains point locations of all major community, regional, comprehensive health, and healthcare provider hospitals in the state of Vermont. The...

  14. Hospitals; hospitals13

    Data.gov (United States)

    University of Rhode Island Geospatial Extension Program — Hospital Facilities information was compiled from several various sources. Main source was the RI Department of Health Facilities Regulation database, License 2000....

  15. MANAGEMENT OF DISPLACED SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN BY CLOSED REDUCTION AND PERCUTANEOUS PINNING

    Directory of Open Access Journals (Sweden)

    Srinivas

    2015-06-01

    Full Text Available INTRODUCTION: Supracondylar fracture of the humerus is common injury in children between the ages of 5 to 10 years. With males are affected twice high than females . The average age incidence was 8.3 years. Proper clinical and radiological examination is necessary for type of displacement and type of treatment. Percutaneous pinning of supracondylar fracture is certainly not a new technique ( 5 , but it had excellent results in various series , compar atively with other techniques. Closed reduction and crossed percutaneous pinning is a reliable method of treatment for severely displaced supracondylar fractures of the humerus in children . MATERIALS: In our study 25 patients were treated with closed reduction and percutaneous pinning between 2009 - 2014 . All 25 fractures were extension type III and closed variety. Left s ide was involved in 20 patients and Right side in 5 patients. The commonest mode of injury was by fall while playing and fall from bicy le. The displacement of the fracture was posteromedial in 19 patients and posterolateral in 6 patients. RESULTS: In our study we had 84% excellent or good results and 16% fair or poor results. Results were assessed according to the flynn’s criteria. W e had following complications after percutaneous pinning . In one patient ulnar neuropraxia developed because of the medial pin. After 1 week medial pin was removed and following that patient recovered completely. In our study one patient had radial and median n erve injury and developed myositis ossificans . Mild degree of volkmann’s ischaemia and restriction of elbow movements. All these were because of the patient had massage and manipulation elsewhere before the treatment. Another patient had mild degree of cub itus varus deformity. DISCUSSION: Closed reduction with immobilization in cast and Dunlop’s traction , skeletal traction necessitates either longer duration of hospitalization or supervision of the patient constantly . Open

  16. Percutaneous closure of secundum type atrial septal defects:More than 5-year follow-up

    Institute of Scientific and Technical Information of China (English)

    Roel; JR; Snijder; Maarten; J; Suttorp; Jurri?n; M; Ten; Berg; Martijn; C; Post

    2015-01-01

    AIM: To investigate long-term efficacy of two different devices more than five years after percutaneous atrial septal defect(ASD) closure in adults.METHODS: All patients who underwent percutaneous closure of an ASD in the St. Antonius Hospital, Nieuwegein, The Netherlands, between February 1998 and December 2006 were included. Percutaneous closure took place under general anaesthesia and transesophageal echocardiographic moni toring. Transthoracic echocardiography(TTE) was performed 24 h post-procedure to visualize the device position and to look for residual shunting using color Doppler. All complications were registered. All patients were invited for an outpatient visit and contrast TTE more than 5-years after closure. Efficacy was based on the presence of a residual right-to-left shunt(RLS), graded as minimal, moderate or severe. The presence of a residual left-to-right shunt(LRS) was diagnosed using color Doppler, and was not graded. Descriptive statistics were used for patients’ characteristics. Univariate analysis was used to identify predictors for residual shunting.RESULTS: In total, 104 patients(mean age 45.5 ± 17.1 years) underwent percutaneous ASD closure using an Amplatzer device(ASO) in 76 patients and a Cardioseal/Starflex device(CS/SF) in 28 patients. The mean follow-up was 6.4 ± 3.4 years. Device migration occurred in 4 patients of whom two cases occurred during the index hospitalization(1 ASO, 1 CS/SF). The other 2 cases of device migration occurred during the first 6 mo of follow-up(2 CS/SF). The recurrent thrombo-embolic event rate was similar in both groups: 0.4% per follow-up year. More than 12 mo post-ASD closure and latest follow-up, new-onset supraventricular tachyarrhythmia’s occurred in 3.9% and 0% for the ASO and CS/SF group, respectively. The RLS rate at latest follow-up was 17.4%(minimal 10.9%, moderate 2.2%, severe 4.3%) and 45.5%(minimal 27.3%, moderate 18.2%, severe 0%) for the ASO- and CS/SF groups, respectively. There was no

  17. Influence of ultrasonic adsorption lithotripsy by percutaneous nephroscope on inflammation mediators and stress hormones of patients with infectious renal calculi

    Institute of Scientific and Technical Information of China (English)

    Dong Lu; Xiao-Lei Jiang; Ming-Hui Wu; Yun-Jun Wu; Qiang Yuan

    2016-01-01

    Objective:To investigate the influence of ultrasonic adsorption lithotripsy by percutaneous nephroscope on inflammation mediators and stress hormones of the patients with infectious renal calculi. Methods:A total of 62 patients with infectious renal calculi in our hospital from January 2014 to June 2015 were selected as the study object,and they were randomly divided into control group(pneumatic ballistic lithotripsy by percutaneous nephroscope group) 31 cases and observation group(ultrasonic adsorption lithotripsy by percutaneous nephroscope group) 31 cases,then the serum expression levels of inflammation mediators and stress hormones of two groups before the treatment and at 12 h-24 h and 48 h after the treatment were compared. Results:The serum expression levels of inflammation mediators and stress hormones of two groups before the treatment were compared,all P>0.05,and the serum expression levels of observation group at 12 h-24 h and 48 h after the treatment were significantly lower than those of control group,while the expression levels of two groups after the treatment were all significantly higher than those before the treatment,all P<0.05. Conclusions:The inflammation mediators and stress hormones of patients with infectious renal calculi who are treated with pneumatic ballistic lithotripsy by percutaneous nephroscope are relatively lower,and it shows that the trauma and bad stress for the body are better controlled, so its clinical application value are relatively higher.

  18. Fatty acid profile of Albizia lebbeck and Albizia saman seed oils: Presence of coronaric acid

    Science.gov (United States)

    In this work, the fatty acid profiles of the seed oils of Albizia lebbeck and Albizia saman (Samanea saman) are reported. The oils were analyzed by GC, GC-MS, and NMR. The most prominent fatty acid in both oils is linoleic acid (30-40%), followed by palmitic acid and oleic acid for A. lebbeck and ol...

  19. Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis in the treatment of symptomatic lower extremity deep venous thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Sh, Hongjian [Department of Radiology, Affiliated Wujin Hospital of Jiangsu University, 2 North Yongning Road, Changzhou 213002 (China)], E-mail: shihongjian@sina.com; Huang Youhua; Shen Tao; Xu Qiang [Department of Radiology, Affiliated Wujin Hospital of Jiangsu University, 2 North Yongning Road, Changzhou 213002 (China)

    2009-08-15

    Purpose: To evaluate the efficacy of percutaneous mechanical thrombectomy (PMT) combined with catheter-directed thrombolysis (CDT) in the treatment of massive symptomatic lower limb deep venous thrombosis (DVT). Materials and methods: One hundred and three clinically confirmed DVT patients were discharged from our institution. Sixteen patients with massive lower limb DVT were included in this retrospective study. After prophylactic placement of inferior vena cava filters (IVCFs), percutaneous mechanical thrombectomy (ATD, n = 10; Straub, n = 6) and catheter-directed thrombolysis were performed in all patients. Complementary therapy included percutaneous transluminal venous angioplasty (PTA, n = 3) and stent placement (n = 1). The doses of thrombolytic agents, length of hospital stay, peri-procedure complications and discharge status were reviewed. Oral anticoagulation was continued for at least 6 months during follow-up. Results: The average hospital stay was 7 days. The technical success rate (complete and partial lysis of clot) was 89%, the other 11% patients only achieved less than 50% clot lysis. The mean dose of urokinase was 3.3 million IU. There were no significant differences of clinical outcome between the ATD and Straub catheter group. The only major complication was an elderly male who experienced a fatal intracranial hemorrhage while still in the hospital (0.97%, 1/103). Minor complications consisted of three instances of subcutaneous bleeding. No transfusions were required. Vascular patency was achieved in 12 limbs during follow-up. No pulmonary emboli occurred. There is one recurrent DVT 4.5 months after the treatment. Conclusions: Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis is an effective and safe method for the treatment of symptomatic DVT. A randomized prospective study is warranted.

  20. Renal lymphangiomatosis during pregnancy: management with percutaneous drainage

    Energy Technology Data Exchange (ETDEWEB)

    Oezmen, M.; Akata, D.; Akhan, O. [Hacettepe Univ., Ankara (Turkey). Dept. of Radiology; Deren, Oe.; Durukan, T. [Hacettepe Univ., Ankara (Turkey). Dept. of Obstetrics and Gynecology; Oezen, H. [Hacettepe Univ., Ankara (Turkey). Dept. of Urology

    2001-01-01

    We report a unique case of exacerbation of renal lymphangiomatosis during pregnancy which was managed percutaneously until delivery. Renal lymphangiomatosis is a very rare benign disorder that might cause abdominal pain and rarely hypertension and hematuria. Surgical treatment options may result in nephrectomy. Percutaneous drainage of symptomatic renal lymphangiomas should be viewed as an efficient therapeutic option particularly when surgery is contraindicated. (orig.)

  1. A Rare Complication of Percutaneous Nephrolithotomy: Biliary Peritonitis

    Directory of Open Access Journals (Sweden)

    Sadi Turkan

    2014-04-01

    Full Text Available Percutaneous nephrolithotomy is a common method in stone therapy in the last 30 years. High success rates as well as high complication rates are also available. We present offer patient who developing gallbladder injury and peritonitis in percutaneous nephrolithotomy for the right renal pelvis, mid, and lower calyces stone.

  2. A Rare Complication of Percutaneous Nephrolithotomy: Biliary Peritonitis

    OpenAIRE

    Sadi Turkan

    2014-01-01

    Percutaneous nephrolithotomy is a common method in stone therapy in the last 30 years. High success rates as well as high complication rates are also available. We present offer patient who developing gallbladder injury and peritonitis in percutaneous nephrolithotomy for the right renal pelvis, mid, and lower calyces stone.

  3. Percutaneous reduction and fixation of intraarticular calcaneal fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); L.M.M. Vogels (Lucas); I.B. Schipper (Inger); P. Patka (Peter)

    2008-01-01

    textabstractObjective: Percutaneous reduction by distraction and subsequent percutaneous screw fixation to restore calcaneal and posterior talocalcaneal facet anatomy. The aim of this technique is to improve functional outcome and to diminish the rate of secondary posttraumatic arthrosis compared to

  4. Percutaneous management of tumoral biliary obstruction in children

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan [Hacettepe School of Medicine, Department of Radiology, Sihhiye, Ankara (Turkey); Ekinci, Saniye [Hacettepe School of Medicine, Department of Paediatric Surgery, Sihhiye, Ankara (Turkey); Akcoren, Zuhal [Hacettepe School of Medicine, Department of Paediatric Pathology, Sihhiye, Ankara (Turkey); Kutluk, Tezer [Hacettepe School of Medicine, Department of Paediatric Oncology, Sihhiye, Ankara (Turkey)

    2007-10-15

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  5. Percutaneous transhepatic biliary drainage: analysis of 175 cases

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Kyung Jin; Lee, Sang Kwon; Kim, Tae Hun; Kim, Yong Joo; Kang, Duk Sik [College of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    1990-10-15

    Percutaneous transhepatic biliary drainage is a safe, effective and palliative means of treatment in biliary obstruction, especially in cases with malignant obstruction which are inoperable. 175 cases of transhepatic biliary drainage were performed on 119 patients with biliary obstruction from January 1985 to June 1989 at Kyung-pook National University Hospital. The causes of obstructive jaundice were 110 malignant diseases and 9 benign diseases. The most common indication for drainage was palliative intervention of obstruction secondary to malignant tumor in 89 cases. 86 cases of external drainage were performed including 3 cases of left duct approach, 29 cases of external-internal drainage and 60 cases of endoprosthesis. In external and external-internal drainages, immediate major complications (11.9%) occurred, including not restricted to, but sepsis, bile peritonitis and hemobilia. Delayed major complications (42.9%) were mainly catheter related. The delayed major complication of endoprosthesis resulted from obstruction of the internal stent. The mean time period to reobstruction of the internal stent was about 12 weeks. To improve management status, regular follow-up is required, as is education of both patients and their families as to when immediate clinical attention is mandated. Close communication amongst the varying medical specialities involved will be necessary to provide optional treatment for each patient.

  6. Percutaneous Nephrolithotomy for Kidney Stones in Patients with Hematological Malignancy

    Directory of Open Access Journals (Sweden)

    Baris Kuzgunbay

    2016-07-01

    Full Text Available Aim: To define the alterations in the outcomes of percutaneous nephrolithotomy (PNL operations for kidney stones in patients with history of hematological malignancy (HM. Material and Method: Between 2000 and 2013, 1700 adult patients underwent PNL for the treatment of kidney stones in our institution. Four of these patients had a history of HM and considered to be HM group (n=4. Ten elderly (>65 years patients who had no history of operation, HM or any other co-morbide diseases were chosen as the control group (n=10. Surgical parameters, success rates, additional treatments and complications were evaluated. Results: Statistical analyses showed no significant differences between HM and control group according to stone area, operation time, fluoroscopy time, hospitalization time, %u2206Hb, blood transfusion rates and INR values (p>0.05. Statistical analyses revealed no significant differences between HM and control groups according to the success rates (p=0.470. Statistical analyses revealed no significant difference between groups for additional treatment requirements (p=0.882. No major perioperative complication was seen in both of the groups. Discussion: The treatment of kidney stone disease by PNL in patients with hematological malignancy is feasible, safe and effective. However, close cooperation with the Hematology Department before the operation is mandatory.

  7. Does Diabetes Affect the Outcome of Percutaneous Nephrolithotomy?

    Directory of Open Access Journals (Sweden)

    Emrah Yürük

    2010-09-01

    Full Text Available Aim: The increased mortality and morbidity in diabetic patients who underwent cardiac surgery is well documented. However, there are few data about non-cardiac surgical interventions. This study is designed to evaluate whether diabetes has any effects on outcome of percutaneous nephrolithotomy (PNL. Methods: The records of 1658 patients who underwent PNL between October 2002 and December 2009 in our clinic were retrospectively analyzed. Data of patients with diagnosis of diabetes mellitus (group 1, 231 patients were compared with data of patients without diabetes (group 2, 1427 patients by means of operative and postoperative findings. Results: Complete stone clearance was achieved in 206 (89.1% patients in group 1 and 1355 (94.9% patients in group 2 (p:0.000. Auxiliary treatment modalities were needed in 44 (19.0% diabetic and 153 (10.7% non-diabetic patients (p:0.000. In diabetic patients, operation and hospitalization time, and time of nephrostomy tube removal were significantly longer. In addition, bleeding, fever and urosepsis rates were significantly higher in diabetic patients. Conclusion: PNL in diabetics is an effective procedure with acceptable complication rates in the treatment of renal stones. However, the increased risk of bleeding and infection needs extra attention in diabetic patients when compared with non-diabetics. (The Medical Bulletin of Haseki 2010; 48: 80-4

  8. Cervical cancer: Renal complications and survival after percutaneous nephrostomy

    Directory of Open Access Journals (Sweden)

    Alzira Carvalho Paula de Souza

    2016-06-01

    Full Text Available SUMMARY Introduction: Obstructive nephropathy is a frequent complication in the course of advanced cervical cancer (CC, and ultrasonography-guided percutaneous nephrostomy (PCN is a well established technique for fast ureteral desobstruction. Objective: To identify possible factors related to the survival and quality of life of patients with advanced CC presenting acute urinary obstructive complications that after desobstruction by PCN recovered urinary flux and renal function. Method: This is an analytical, descriptive, cross-sectional study that included 45 patients with CC who underwent PCN and were divided into 2 groups: “death” (DG and “survival” (SG, in a public hospital that is reference for oncologic diseases in Northern Brazil. Results: The mean serum creatinine of the patients preceding PCN was >10 mg/dL, and after PCN 8.7g/dL and Ht >27% were associated to longer survival, and the presence of low blood pressure during follow-up was associated with progression to death.

  9. The marvel of percutaneous cardiovascular devices in the elderly.

    Science.gov (United States)

    Guidoin, Robert; Douville, Yvan; Clavel, Marie-Annick; Zhang, Ze; Nutley, Mark; Pîbarot, Philippe; Dionne, Guy

    2010-06-01

    Thanks to minimally invasive procedures, frail and elderly patients can also benefit from innovative technologies. More than 14 million implanted pacemakers deliver impulses to the heart muscle to regulate the heart rate (treating bradycardias and blocks). The first human implantation of defibrillators was performed in early 2000. The defibrillator detects cardiac arrhythmias and corrects them by delivering electric shocks. The ongoing development of minimally invasive technologies has also broadened the scope of treatment for elderly patients with vascular stenosis and aneurysmal disease as well as other complex vascular pathologies. The nonsurgical cardiac valve replacement represents one of the most recent and exciting developments, demonstrating the feasibility of replacing a heart valve by way of placement through an intra-arterial or trans-ventricular sheath. Percutaneous devices are particularly well suited for the elderly as the surgical risks of minimally invasive surgery are considerably less as compared to open surgery, leading to a shorter hospital stay, a faster recovery, and improved quality of life.

  10. [Microsurgical resection of lumbar intraspinal tumors through paraspinal approach using percutaneous tubular retractor system].

    Science.gov (United States)

    Chunmei, Chen; Gangfeng, Cai; Rui, Wang; Weiqiang, Zhang; Yan, Chen; Feng, Li; Chunhua, Wang; Fan, Wang; Zhijie, Chen; Songsheng, Shi; Weizhong, Yang

    2015-04-07

    To evaluate the clinical outcomes and operative techniques of microsurgical resection of lumbar intraspinal tumors through paraspinal approach by percutaneous tubular retractor system. A retrospective study was conducted to analyze 21 patients with lumbar intraspinal tumors between November 2011 and February 2014, including Schwannoma (n = 19) and meningioma (n = 2) without lumbar instability on preoperative images. The length of tumors was 0.6-2.0 cm. Tracheal intubation anesthesia was performed prior to microsurgery using percutaneous tubular retractor system through paraspinal approach. Operative duration, blood loss volume, postoperative wound pain duration and hospital stay were analyzed. Creatine phosphokinase (CPK-MM) level was recorded at 1 day preoperatively, 1 day, 3 days and 5 days postoperatively. The scores of Japanese Orthopedic Association (JOA) and visual analog scale (VAS) were analyzed at 1 day preoperatively, 1, 3, 5 days and 6 months postoperatively to evaluate the function status of spinal cord. Computed tomography ( CT) three-dimensional reconstruction of lumbar vertebrae was performed at 1 week postoperatively. Magnetic resonance imaging ( MRI) plain scan and enhanced scan of lumbar vertebrae were conducted preoperatively, 1 week and 6 months postoperatively. Complete removal of tumors was achieved in all patients without the injuries of spinal cord or nerve root. Postoperative scores of JOA and VAS improved versus preoperative ones (P spinal instability was identified by CT three-dimensional reconstruction. And no spinal deformity occurred during a follow-up period of 6-28 months. Microsurgical resection of lumbar intraspinal tumors using percutaneous tubular retractor system through paraspinal approach minimizes the injuries of paraspinal muscles, facet joint, spinous process and ligaments. This technique offers the advantages of mini-invasiveness, shorter hospital stay, rapid recovery and preserved postoperative spinal stability.

  11. Percutaneous needle fasciotomy for recurrent Dupuytren disease.

    Science.gov (United States)

    van Rijssen, Annet L; Werker, Paul M N

    2012-09-01

    Increasing options to treat Dupuytren disease include percutaneous needle fasciotomy (PNF), a minimally invasive technique that has proven to be effective for the treatment of primary disease. However, its effect on recurrent disease is not clear. We studied 30 patients with recurrent Dupuytren disease in 40 fingers, with a mean follow-up of 4.4 years. Primary outcome measures were total passive extension deficit reduction and interval to a second recurrence, defined as an increase of more than 30° compared with the result at the end of the previous treatment. We noted complications. Total passive extension reduction was 76%. Percutaneous needle fasciotomy was especially effective for the metacarpophalangeal joint, with an average reduction of 93%, whereas the average reduction in the proximal interphalangeal joint was 57%. A total of 50% of patients did not develop a secondary recurrence during follow-up. The other 50% did, and we treated recurrence within an average of 1.4 years after PNF. By means of PNF, we postponed tertiary treatment an average of 2.9 years starting from the initial treatment for Dupuytren disease. We successfully treated all secondary recurrences by limited fasciectomy, according to patients' wishes. We noted no major adverse effects. Percutaneous needle fasciotomy can be applied effectively for recurrent disease; 50% of patients remain free of recurrence for a mean of 4.4 years. If a secondary recurrence occurs, it does so relatively early after treatment. Patients must therefore be willing to accept this uncertainty in the context of the advantages of PNF, such as fast recovery, low complication rate, and minimal invasiveness. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Spondylodiscitis: a rare complication following percutaneous nephrostomy.

    Science.gov (United States)

    Chiancone, Francesco; Fedelini, Maurizio; Meccariello, Clemente; Pucci, Luigi; Fabiano, Marco; Fedelini, Paolo

    2016-11-28

    Spondylodiscitis is an inflammation of the intervertebral disc and the adjacent vertebral bodies. The spondylodiscitis can not only be a complication of medical interventions such as an operation near spinal column but also urogenital and vascular interventions and intravenous catheter use. A 71-year-old man was admitted to our emergency department with fever and severe abdominal pain. Antibiotic therapy had been performed with intravenous administration of 2 g of ceftriaxone and the patient underwent the placement of a percutaneous nephrostomy according to Seldinger technique. After 1 week, the patient experienced a severe pain at the lumbar tract of the vertebral column associated with a moderate abdominal pain and septic fever. A magnetic resonance imaging (MRI) of the lumbar spine showed widespread impregnation of the upper portion of L3 and the lower portion of L2 compressing the spinal roots as well as the ileopsoas muscle such as a spondylodiscitis. Liquor culture showed an increase of liquor immunoglobulin G, total liquor protein and was positive for Extended-spectrum beta-lactamases (ESBL) - producing Escherichia coli. After the antibiotic therapy, the spondylodiscitis resolves without important sequelae. In the present case report, we describe a very rare complication of percutaneous nephrostomy tube placement, despite of the prophylactic antibiotic therapy according to the most recent guidelines. Predisposing factors to spondylodiscitis include the very young and elderly, the immunosuppressed, diabetic individuals and a general debilitating disease such as renal failure. This case suggests the importance of remembering spondylodiscitis when septic fever and back pain occurs following the placement of a percutaneous nephrostomy in a septic patient.

  13. Emergency percutaneous needle decompression for tension pneumoperitoneum

    Directory of Open Access Journals (Sweden)

    Körner Markus

    2011-05-01

    Full Text Available Abstract Background Tension pneumoperitoneum as a complication of iatrogenic bowel perforation during endoscopy is a dramatic condition in which intraperitoneal air under pressure causes hemodynamic and ventilatory compromise. Like tension pneumothorax, urgent intervention is required. Immediate surgical decompression though is not always possible due to the limitations of the preclinical management and sometimes to capacity constraints of medical staff and equipment in the clinic. Methods This is a retrospective analysis of cases of pneumoperitoneum and tension pneumoperitoneum due to iatrogenic bowel perforation. All patients admitted to our surgical department between January 2005 and October 2010 were included. Tension pneumoperitoneum was diagnosed in those patients presenting signs of hemodynamic and ventilatory compromise in addition to abdominal distension. Results Between January 2005 and October 2010 eleven patients with iatrogenic bowel perforation were admitted to our surgical department. The mean time between perforation and admission was 36 ± 14 hrs (range 30 min - 130 hrs, between ER admission and begin of the operation 3 hrs and 15 min ± 47 min (range 60 min - 9 hrs. Three out of eleven patients had clinical signs of tension pneumoperitoneum. In those patients emergency percutaneous needle decompression was performed with a 16G venous catheter. This improved significantly the patients' condition (stabilization of vital signs, reducing jugular vein congestion, bridging the time to the start of the operation. Conclusions Hemodynamical and respiratory compromise in addition to abdominal distension shortly after endoscopy are strongly suggestive of tension pneumoperitoneum due to iatrogenic bowel perforation. This is a rare but life threatening condition and it can be managed in a preclinical and clinical setting with emergency percutaneous needle decompression like tension pneumothorax. Emergency percutaneous decompression is no

  14. Percutaneous acetabuloplasty for metastatic acetabular lesions

    Directory of Open Access Journals (Sweden)

    Logroscino Giandomenico

    2008-05-01

    Full Text Available Abstract Background Osteolytic metastases around the acetabulum are frequent in tumour patients, and may cause intense and drug-resistant pain of the hip. These lesions also cause structural weakening of the pelvis, limping, and poor quality of life. Percutaneous acetabuloplasty is a mini-invasive procedure for the management of metastatic lesions due to carcinoma of the acetabulum performed in patients who cannot tolerate major surgery, or in patients towards whom radiotherapy had already proved ineffective. Methods We report a retrospective study in 25 such patients (30 acetabuli who were evaluated before and after percutaneous acetabuloplasty, with regard to pain, mobility of the hip joint, use of analgesics, by means of evaluation forms: Visual Analog Scale, Harris Hip Score, Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC, Eastern Cooperative Oncology Group (ECOG. The results obtained were analysed using the χ2 Test and Fisher's exact test. Significance was sent at P Results Marked clinical improvement was observed in all patients during the first six post-operative months, with gradual a worsening thereafter from deterioration of their general condition. Complete pain relief was achieved in 15 of our 25 (59% of patients, and pain reduction was achieved in the remaining 10 (41% patients. The mean duration of pain relief was 7.3 months. Pain recurred in three patients (12% between 2 weeks to 3 months. No major complications occurred. There was transient local pain in most cases, and 2 cases of venous injection of cement without clinical consequences. Conclusion Percutaneous acetabuloplasty is effective in improving the quality of life of patients with osteolytic bone tumours, even though the improvement is observed during the first 6 months only. It can be an effective aid to chemo- and radiotherapy in the management of acetabular metastases.

  15. Hospital Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find...

  16. HCAHPS - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...

  17. Rationale for Percutaneous Intervention of CTO.

    Science.gov (United States)

    Waram, Kethes C; Willis, Nicholas P; Girotra, Sudhakar; Shaker, Rimon L; Pershad, Ashish

    2012-07-01

    Chronic total occlusion accounts for 15% of cases during diagnostic angiography with higher referral rate to surgical revascularization. With contemporary strategies and techniques, the success rate with experienced operators can exceed 90%. Currently available observational studies in carefully selected patient populations show evidence of a trend toward symptom relief; improvement in quality of life, left ventricular function, and mortality; and improved tolerance toward future ischemic events. Lack of randomized controlled trials comparing current optimal medical management with percutaneous coronary intervention for chronic total occlusion is a major barrier to widespread adaptation of this advanced complex interventional technique. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Percutaneous catheter dilatation of carotid stenoses

    Energy Technology Data Exchange (ETDEWEB)

    Mathias, K.; Mittermayer, C.; Ensinger, H.; Neff, W.

    1980-09-01

    Thirty-one carotid artery stenoses were produced in thirty dogs by three different techniques. Twenty-three of these could be cured by transfemoral percutaneous catheter dilatation. High grade tight stenoses may present resistance which cannot be overcome by the catheter. Histological examination of the dilated vessels showed circumscribed changes in the vessel wall, with destruction of elastic membranes. From our experience of catheter dilatation of pelvic and lower limb arteries and of renal arteries, we consider it feasible to use this technique in selected patients with carotid stenosis.

  19. Percutaneous nephrolithotomy and ureteroscopy in children: evolutions.

    Science.gov (United States)

    Long, Christopher J; Srinivasan, Arun K

    2015-02-01

    The increasing incidence of pediatric stone disease has coincided with significant advances in technology and equipment, resulting in drastic improvements in management. Miniaturization of both ureteroscopes and percutaneous nephrolithotomy (PCNL) equipment has facilitated access to the entirety of the urinary tract and has made ureteroscopy a first-line therapy option along with shock-wave lithotripsy for kidney and ureteral stones. Advances in PCNL have decreased patient morbidity while preserving stone clearance rates. In this review, the advances in operative approach for ureteroscopy and PCNL in children and its applicability to current surgical management of pediatric stone disease are discussed.

  20. Percutaneous treatment of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Leonardi, M.; Resta, F.; Bettinelli, A. [Ospedale Maggiore di Milano (Italy); Lavaroni, A.; Fabris, G. [Ospedale Civile di Udine (Italy); Abelli, F. [Fondazione Clinica del Lavorno, Pavia (Italy)

    1994-12-31

    918 patients were subjected to percutaneous treatment of lumbar herniated disc. 733 of these were treated through enzymatic nucleolysis with chymopapain, for a total 883 levels. Chemonucleolysis was carried out on 733 patients (79.8%). Automated discectomy has been carried out in 185 cases (20.1%). Chemonucleolysis has led to the resolution of the symptoms in a high percentage of cases (82.2%). Nucleotomy has proved to be an effective method in 74.6% of cases. (author). 7 refs, 6 figs, 1 tab.

  1. Percutaneous renal puncture: requirements and preliminary results

    CERN Document Server

    Leroy, A; Payan, Y; Richard, F; Chartier-Kastler, E; Troccaz, J; Leroy, Antoine; Mozer, Pierre; Payan, Yohan; Chartier-Kastler, Emmanuel; Troccaz, Jocelyne

    2002-01-01

    This paper introduces the principles of computer assisted percutaneous renal puncture, that would provide the surgeon with an accurate pre-operative 3D planning on CT images and, after a rigid registration with space-localized echographic data, would help him to perform the puncture through an intuitive 2D/3D interface. The whole development stage relied on both CT and US images of a healthy subject. We carried out millimetric registrations on real data, then guidance experiments on a kidney phantom showed encouraging results.

  2. In-hospital delay to primary angioplasty for patients with ST-elevated myocardial infarction between cardiac specialized hospitals and non-specialized hospitals in Beijing, China.

    Science.gov (United States)

    Xun, Yi-Wen; Yang, Jin-Gang; Song, Li; Sun, Yi-Hong; Lu, Chang-Lin; Yang, Yue-Jin; Hu, Da-Yi

    2010-04-05

    Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention (PPCI) for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records. The median in-hospital delay was 98 (interquartile range 105 to 180) minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals (147 minutes vs. 120 minutes, P hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays. There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.

  3. Percutaneous Stabilization of Impending Pathological Fracture of the Proximal Femur

    Energy Technology Data Exchange (ETDEWEB)

    Deschamps, Frederic, E-mail: frederic.deschamps@igr.fr; Farouil, Geoffroy, E-mail: g.farouil@gmail.com; Hakime, Antoine, E-mail: thakime@yahoo.com; Teriitehau, Christophe, E-mail: cteriitehau@me.com; Barah, Ali, E-mail: ali.barah@gmail.com; Baere, Thierry de, E-mail: debaere@igr.fr [Institut Gustave Roussy, Interventional Radiology Department (France)

    2012-12-15

    Objective: Percutaneous osteosynthesis plus cementoplasty (POPC) is a minimally invasive technique that has never been reported before and that we have prospectively evaluated for patients with impending pathological fracture of the proximal femur. Methods: We performed POPC in 12 patients (3 males, 9 females) with metastasis of the proximal femur with a high risk of fracture (Mirels' score {>=}8) between February 2010 and July 2011. Patients were not candidates for standard surgical stabilization. We analyzed the feasibility, duration, and complication of the procedure, the risk of fracture, the decrease in pain (Visual Analog Scale, VAS), and length of stay in hospital. Data were prospectively collected in all patients. Results: The mean Mirels' score was 9.8 {+-} 1.2 (range, 8-11). The technical success was 100%. POPC was performed under general anesthesia (n = 6) or conscious sedation (n = 6). The mean duration was 110 {+-} 43 (range, 60-180) minutes. All patients stood up and walked the second day after the procedure. The average length of stay in the hospital was 4 {+-} 1.6 (range, 2-7) days. We experienced two hematomas in two patients and no thromboembolic complication. For symptomatic patients (n = 8), VAS decreased from 6.5/10 (range, 2-9) before treatment to 1/10 (range, 0-3) 1 month after. No fracture occurred after a median follow-up of 145 (range, 12-608) days. Conclusions: POPC for impending pathological fracture of the proximal femur seems to be a promising alternative for cancer patients who are not candidates for surgical stabilization. Further studies are required to confirm this preliminary experience.

  4. Percutaneous endoscopic gastrostomy technique: the outcome and complications

    Directory of Open Access Journals (Sweden)

    Sharifi A

    2013-03-01

    Full Text Available Background: Percutaneous endoscopic gastrostomy (PEG is one of the ways to non-oral feeding in patients with dysphagia caused by conditions such as stroke, oropharyngeal malignancy and motor neuron disease. The aim of study was assessment of early outcome of PEG in hospitalized patients according to clinical situation and underlying disease. Methods: This study was cross- sectional and prospective. Sixty five patients were included with PEG from April 2011 to July 2012, at Sina University Hospital, Tehran, Iran. Tube function, feeding, and patients' symptoms were assessed and patients were followed six month at least to one year after procedure .The follow up of patients were stopped if the patient died or removal of tube.Results: Sixty five patients (33 men, 32 women enrolled in this study. The mean age of patients was 57.45±16.83 years (19-94 years. Head trauma and postoperative thoracic surgery were in 15 (23.1% and 4 (6.2% cases. 36 of patients (55.39% had no symptoms. The complications include lickage (11 cases, stenosis (9 cases, cellulitis (7 cases, and PEG separation (2 cases. A total of 29 patients were complicated and 21 patients (72% of them complicated 2 -5 months after PEG. No statistical significant differences between two sexes in PEG complication. 27 patients (41% died that have no relation to complications of PEG.Conclusion: Finally, the study showed the PEG is a safe method to enteral nutrition. The advantages of this method include its simplicity, no need to general anesthesia and low rate of complications especially in inpatient under the supervision of medical staff. Therefore it can be used as a favorable method.

  5. Effectiveness of percutaneous biliary stone removal as primary treatment in case with difficulties in the use of an endoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sin Ae; Han, Young Min; Jin, Gong Yong; Lee, Seung Ok; Yu, Hee Chul [Chonbuk National University Medical School and Hospital, Jeonju(Korea, Republic of)

    2014-03-15

    To evaluate the effectiveness of percutaneous biliary stone removal as a primary treatment in cases with difficulties to use an endoscopy. From March 2004 to May 2011, 17 patients who underwent primary percutaneous biliary stone removal (Group 1) and 34 case-matched patients who underwent primary endoscopic biliary stone removal were selected (Group 2). The inclusion criteria were as follows: patients who had 1) ≥ 15 mm bile duct stones, 2) intrahepatic bile duct stones, 3) bile duct stones with a history of previous gastrointestinal bypass surgery. In the present study were analyzed the success rates, the length of postprocedural hospital stay, the change of Amylase/Lipase values and complications post procedure. Statistical analysis was performed using paired t-test and unpaired t-test. The success rate was higher in Group 1 (94.1%) than in Group 2 (85.3%). Length of post procedural hospital stay and the post procedural amylase level were significantly increased in Group 2 (p = 0.036 and p = 0.017, respectively). In cases of bile duct stones with difficulties in the use of an endoscopy a percutaneous biliary stone removal can be efficient as a primary treatment.

  6. Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Tranberg, Tinne; Knudsen Lippert, Freddy; Christensen, Erika F

    2017-01-01

    Aims: To evaluate whether the distance from the site of event to an invasive heart centre, acute coronary angiography (CAG)/percutaneous coronary intervention (PCI) and hospital-level of care (invasive heart centre vs. local hospital) is associated with survival in out-of-hospital cardiac arrest...

  7. Norovirus - hospital

    Science.gov (United States)

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... fluids ( dehydration ). Anyone can become infected with norovirus. Hospital patients who are very old, very young, or ...

  8. Effectiveness of percutaneous aspiration thrombectomy for acute or subacute thromboembolism in infrainguinal arteries

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Jung Guen; Kim, Chan Sun; Kim, Young Hwan; Kim, See Hyung [Dept. of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2017-06-15

    To report the feasibility and long-term clinical outcome of percutaneous aspiration thrombectomy for treating acute or subacute arterial thromboembolism in the infrainguinal arteries. Thirty limbs of 29 patients were enrolled in this retrospective study between January 2004 and March 2014. Nine limbs underwent overnight catheter-directed thrombolysis followed by percutaneous aspiration thrombectomy (PAT). Eighteen limbs underwent PAT with adjunctive selective intra-arterial thrombolysis in a single session. The remaining three limbs underwent PAT alone. Balloon angioplasty (n = 16) or stent placement (n = 3) was performed as required. In-hospital mortality and complications were estimated. The primary patency rate and the rate of freedom from reintervention were calculated using the Kaplan-Meier method. Technical success was achieved in 28 limbs. Clinical success was achieved in 27 limbs. The mean ankle-brachial index increased from 0.17 ± 0.26 to 0.98 ± 0.19 after the procedure. Three in-hospital deaths and no major amputations were recorded. Distal embolization of crural arteries occurred as a minor complication in five limbs, but no major complications occurred. The primary patency rate and the rate of freedom from reintervention were 74.9% and 90.9% at 1 year, respectively, and 66.6% and 80.8% at 2 years, respectively. PAT is a rapid and effective method to remove a thrombus from occluded infrainguinal arteries.

  9. FIRST METATARSOPHALANGEAL JOINT OSTEOARTHRITIS: PERCUTANEOUS SURGERY, CHOICE OF A SURGICAL PROCEDURE, CLINICAL AND RADIOGRAPHIC CLASSIFICATION

    Directory of Open Access Journals (Sweden)

    S. Yu. Berezhnoy

    2017-01-01

    Full Text Available Introduction. Hallux rigidus is observed in approximately 2.5% of the adult population. Until now neither a unified classification of hallux rigidus appears to exist nor any clear principles to choose the surgical method. The variety of clinical and radiological signs explains the difficulties in establishing a comprehensive classification system and in selection of the criteria for surgical procedure. There are few published reports about hallux rigidus percutaneous surgical treatment. Existing papers are dedicated to a limited number of percutaneous techniques.The purpose of this study was to evaluate the efficacy of percutaneous techniques for surgical treatment of the first metatarsophalangeal joint osteoarthritis; to specify factors determining the choice of procedure; to develop a grading system of the hallux rigidus severity which will help in selection of surgery. Materials and methods. Based on 156 surgeries (107 patients the author demonstrated the possibilities of percutaneous techniques in the surgical treatment of hallux rigidus of different stages as well as provided a brief description of used surgical techniques.Results. The mean age of patients was 48.8 years (ranged from 18 to 73. The mean follow-up was 7 months (ranged from 3 to 54. At the specified time the treatment outcomes of 103 patients (150 feet were analyzed. Mean hospital stay was 0.78 days (ranged from 0 to 1. No infectious or wound-healing problems were observed. Overall, the patients were completely satisfied with the outcomes of 89 surgical treatment, qualified satisfaction was reported with patients in respect of outcomes of 57 surgeries. Four unsatisfactory outcomes were observed. The role of the relatively long first metatarsal in the development of hallux rigidus was confirmed. Conclusion. Percutaneous techniques provide successful treatment for all stages of hallux rigidus. The choice of a specific surgical technique may be challenging and requires

  10. Fate of Patients With Coronary Perforation Complicating Percutaneous Coronary Intervention (from the Euro Heart Survey Percutaneous Coronary Intervention Registry).

    Science.gov (United States)

    Bauer, Timm; Boeder, Niklas; Nef, Holger M; Möllmann, Helge; Hochadel, Matthias; Marco, Jean; Weidinger, Franz; Zeymer, Uwe; Gitt, Anselm K; Hamm, Christian W

    2015-11-01

    Coronary perforation (CP) is a life-threatening complication that can occur during percutaneous coronary intervention (PCI). Little is known, however, about the incidence and clinical outcome of CP. We sought to investigate the occurrence of CP and its determinants and risk profile in a large-scale, prospective registry. From 2005 to 2008, unselected patients (n = 42,068) from 175 centers in 33 countries who underwent a PCI procedure were prospectively enrolled in the PCI registry of the Euro Heart Survey program. For the present analysis, patients experiencing CP during PCI (n = 124, 0.3%) were compared with those who underwent PCI without CP. Patients with CP were older, more often women, had more severe coronary disease, and underwent more complex types of coronary intervention. Independent factors associated with CP were the use of rotablation, intravascular ultrasound-guided PCI, bypass PCI, a totally occluded vessel, a type C lesion, peripheral arterial disease, and body mass index <25. More than 10% of the patients developed cardiac tamponade. In a small minority (3.3%), emergency bypass surgery had to be performed. The inhospital death rate was markedly elevated in patients with CP (7.3% vs 1.5%, p <0.001). After adjustment for the EuroHeart score, CP remained a strong predictor of hospital mortality (odds ratio 5.21, 95% confidence interval 2.34 to 11.60). In conclusion, in this real world, all-comers registry, the incidence of CP was low, occurred more often in patients who underwent more complex coronary interventions, and was associated with a fivefold higher hospital mortality.

  11. Blind percutaneous liver biopsy in infants and children: Comparison of safety and efficacy of percussion technique and ultrasound assisted technique.

    Science.gov (United States)

    Mogahed, Engy A; Mansy, Yasmeen A; Al Hawi, Yasmeen; El-Sayed, Rokaya; El-Raziky, Mona; El-Karaksy, Hanaa

    2016-12-01

    Liver biopsy remains the most reliable method to diagnose various hepatic disorders in children. We aimed to assess the technical success and complication rate of ultrasound (US) assisted percutaneous liver biopsy versus transthoracic percussion guided technique in paediatrics. This randomized controlled study included all cases performing liver biopsy at Paediatric Hepatology Unit, Cairo University Paediatric Hospital over 12months. Patients were 102 cases; 62 were males, with age range 18days to 12years. Fifty seven procedures were done using the percussion guided technique and 45 cases were US assisted. The total number of complicated biopsies was 14 (13.7%), with more serious complications occurring in the percussion group. Complications were more frequent with younger age, lower platelet count, number of passes and occurrence of hypotension. US assisted percutaneous liver biopsy, although more costly, but may be safer to perform particularly in younger age. Copyright © 2016 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.

  12. Percutaneous cholecystostome; 60 cases of experience

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Sung Gwon; Song, Ho Young; Yoon, Hyun Ki; Lee, Young Suk; Ki, Won Woo; Sung, Gyu Bo [Ulsan Univ College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    To review the effectiveness and complication of percutaneous cholecystostomy (PCCS). We performed PCCS in 60 patient who presented with acute cholecystitis. The causes of acute cholecystitis were as follows; acalculous cholecystitis(n=8), calculous cholecystitis(n=23), GB hydrops (n=3), GB empyema(n=15), septic cholangitis(n=11). Of 60 patients, 36 patients had high risk factor for cholecystectomy; underlying malignancy(n=13), severe trauma(n=6). Cholecystostomy was done under ultrasonographic and fluoroscopic guide. The cholecystostomy was successfully in 59 patients, and failed in 1 patient. 15 patients improved without other procedure. 16 patients underwent cholecystectomy after improvement of their general condition. Severe complications of PCCS are as follows; bile peritonitis(n=6), hemoperitoneum(n=1), subphrenic abscess(n=1). Mild complication, such as pain, occurred in most patients. Emergency operation was done in one patient who developed bile peritonitis. Cholecystostomy is effective and safe, especially in cases of inoperable patients who represent acute cholecystitis. Percutaneous cholecystostomy may substitute surgical cholecystostomy.

  13. Percutaneous cryotherapy for inoperable lung malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Park, Eun Hae; Jin, Gong Yong; Han, Young Min; Lee, Yong Chul; Kwon, Keun Sang [Chonbuk National Univ. Medical School and Hospital, Jeonju, (Korea, Republic of)

    2012-05-15

    To evaluate the therapeutic efficacy of percutaneous cryotherapy for inoperable patients with malignant pulmonary nodules. We enrolled 14 patients (7 males, 7 females, average age 68.8 years) who had inoperable lung malignancy in this study from August 2006 through July 2009. We evaluated the therapeutic efficacy of cryotherapy for complete or incomplete ablation by follow up chest CT. Using Kaplan Meier statistical methods, we estimated the survival of patients who had undergone cryotherapy and we investigated post cryotherapy complications. Five of the 14 patients underwent complete ablation (35.7%), while 9 of 14 patients underwent incomplete ablation (64.3%). The change in mean size before procedure and at last follow up CT in the complete and incomplete ablation were as follows: 13.2 {+-} 7.6 mm {yields} 3.8 {+-} 2.7 mm, and 18.1 {+-} 6.2 mm {yields} 33.7 {+-} 17.9 mm, respectively. The median survival of patients in the complete and the incomplete groups were 51.5 months and 24 months, respectively. One patient developed a small pneumothorax, which resolved spontaneously. Two patients developed hemoptysis after the procedure, which was controlled within a day. Percutaneous cryotherapy may be an effective and safe therapeutic method for inoperable patients with malignant pulmonary nodules.

  14. [Treatment of atherosclerosis. New percutaneous intraluminal techniques].

    Science.gov (United States)

    Lablanche, J M

    1990-10-06

    Balloon-catheter angioplasty was introduced by Gruntzig in 1977 and has since proved effective, but 3 problems are still encountered: immediate reobstruction, restenosis during the first 3 months and extension of the procedure to a greater number of cases. In an attempt to solve these problems, other percutaneous/technics, associated or not with balloon angioplasty, have been devised. They are: (1) intraluminal stents which perfectly keep the vessel open after balloon angioplasty; (2) vaporization of atheromatous plaques by laser, and notably excimer laser which results in immediate recanalization, later completed by balloon angioplasty; (3) heating balloons which stick dissections and improve the immediate success rate; (4) atheroma-cutting and storing systems, such as Simpson's atherocath, cutting and aspirating systems, such as Stack's transluminal extraction catheter, or erasing systems, such as Auth's rotablator; (5) other sources of energy, such as ultrasounds, microwaves and radiofrequencies, will perhaps, be used in the near future. None of these new technics has solved the restenosis problem, but all have proved effective in suppressing the obstacle, there by giving hopes of reducing immediate complications and gradually widening the indications of percutaneous revascularization.

  15. Midazolam sedation for percutaneous liver biopsy.

    Science.gov (United States)

    Alexander, J A; Smith, B J

    1993-12-01

    Control of patient respiration is needed to safely perform percutaneous liver biopsy (PLB) and may be adversely affected by sedation. The purpose of this study was to evaluate the safety of PLB with intravenous midazolam and to evaluate patient acceptance of PLB with and without sedation. Two hundred seventeen consecutive patients underwent 301 percutaneous liver biopsies. One hundred fifty-one of the biopsies were done after the patients were sedated with intravenous midazolam immediately before the biopsy. The last 61 patients were questioned after the biopsy to evaluate the discomfort of the procedure, their memory of the procedure, and their willingness to undergo another PLB. The major complication rate was similar in the midazolam-treated (0.7%) and untreated (0.7%) groups. The midazolam-treated patients had a numerically lower mean pain score (1.5 +/- 0.4 vs 4.0 +/- 0.7) (mean +/- SEM) (P = 0.07) and significantly lower mean memory score (4.8 +/- 0.7 vs 9.9 +/- 0.1) (P < 0.01) than the untreated patients. The treated and untreated groups had similar mean willingness for repeat PLB scores (9.3 +/- 0.3 vs 9.1 +/- 0.6). We conclude that: (1) there is no increased risk of PLB with midazolam and (2) patients have less memory of the procedure with midazolam.

  16. Percutaneous drainage of pelvic fluid collection

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Young; Sohn, Cheol Ho [School of Medicine Keimyung University, Daegu (Korea, Republic of)

    1995-10-15

    To evaluate safe access route and success rate of percutaneous drainage of pelvic fluid collection. The 35 percutaneous drainages of pelvic fluid collection under the CT and fluorosocpic guidance were done in 32 patients. The anterior transabdominal approach was done in 20 patients, while the nine patients used the transgluteal approach through greater sciatic foramen. Three patients, who had septated or noncommunicating abscesses, underwent drainage using both approaches. The catheter was removed when the patient's symptom and laboratory data were improved or the amount of drainage and the size of fluid collection were markedly reduced. Success, partial success and failure were classified. The causes of fluid collection were complication of intraabdominal operation in 27 patient. The diagnosis after drainage included abscess (21), loculated ascites (6), and hematoma (4). The 27 cases (30 procedure) were treated successfully and the mean duration of catheter insertion was 10 days. The partial successes were two cases (2 procedures), which had palliative purpose. Three cases (3 procedures) were failed, which were multiple loculated ascites of pancreatic origin (2) and recurrent abscess (1). The significant complication during the procedure or drainage was not noted.

  17. Kissing balloon inflation in percutaneous coronary interventions.

    Science.gov (United States)

    Sgueglia, Gregory A; Chevalier, Bernard

    2012-08-01

    Bifurcation lesions are the most frequently approached complex coronary lesions in everyday interventional practice. Bifurcations complexity relies essentially on their very specific anatomy that is imperfectly handled by current coronary devices and, despite dedicated techniques and drug-eluting stents, percutaneous coronary interventions directed toward the treatment of bifurcations are technically demanding and require proper execution. Kissing balloon (KB) inflation was the first specific bifurcation technique to have been developed for percutaneous bifurcation interventions and continues to currently play an important role. Indeed, KB has been proposed to optimize stent apposition, improve side branch access while correcting stent deformation or distortion. Over the years, the KB technique has been deeply investigated by many different methods, from bench testing and computer simulations to in vivo intravascular imaging and clinical studies, producing a large amount of data pointing out the benefits and limitations of the technique. We sought to provide here a comprehensive overview of all those aspects. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Accuracy of percutaneous lung biopsy for invasive pulmonary aspergillosis

    Energy Technology Data Exchange (ETDEWEB)

    Hoffer, F.A. [Dept. of Diagnostic Imaging, St. Jude Children' s Research Hospital, Memphis, TN (United States); Gow, K.; Davidoff, A. [Dept. of Surgery, St. Jude Children' s Research Hospital, Memphis, TN (United States); Flynn, P.M. [Dept. of Infectious Diseases, St. Jude Children' s Research Hospital, Memphis, TN (United States)

    2001-03-01

    Background. Invasive pulmonary aspergillosis is fulminant and often fatal in immunosuppressed patients. Percutaneous biopsy may select patients who could benefit from surgical resection. Objective. We sought to determine the accuracy of percutaneous biopsy for pediatric invasive pulmonary aspergillosis. Materials and methods. We retrospectively reviewed 28 imaging-guided percutaneous biopsies of the lungs of 24 children with suspected pulmonary aspergillosis. Twenty-two were being treated for malignancy and two for congenital immunodeficiency; 15 had received bone-marrow transplants. The accuracy of the percutaneous lung biopsy was determined by subsequent surgical resection, autopsy, or clinical course. Results. Histopathological studies showed ten biopsy specimens with septate hyphae, indicating a mold, and seven with Aspergillus flavus colonies in culture. The remaining 18 biopsies revealed no fungi. No patient had progressive aspergillosis after negative biopsy. Invasive pulmonary mold was detected by percutaneous biopsy with 100 % (10/10) sensitivity and 100 % (18/18) specificity. Percutaneous biopsy results influenced the surgical decision in 86 % (24 of 28) of the cases. Bleeding complicated the biopsy in 46 % (13/28) and hastened one death. Conclusion. Percutaneous biopsy of the lung is an accurate technique for the diagnosis of invasive pulmonary aspergillosis and correctly determines which immunosuppressed pediatric patients would benefit from therapeutic pulmonary resection. (orig.)

  19. Radiologic imaging and percutaneous treatment of pelvic lymphocele

    Energy Technology Data Exchange (ETDEWEB)

    Karcaaltincaba, Musturay [Department of Radiology, Division of Abdominal and Interventional Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara 06100 (Turkey); Akhan, Okan [Department of Radiology, Division of Abdominal and Interventional Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara 06100 (Turkey)]. E-mail: oakhan@hacettepe.edu.tr

    2005-09-01

    Pelvic lymphocele, also known as lymphocyst, is a cystic structure caused by lymphatic injury usually secondary to pelvic lymphadenectomy and renal transplantation. Lymphoceles can cause morbidity and rarely mortality by compression of adjacent structures and infectious complications. This review discusses etiology and treatment options for pelvic lymphoceles including surgical and percutaneous methods with emphasis on percutaneous techniques particularly in conjunction with sclerotherapy. Percutaneous catheter drainage with sclerotherapy procedure with various sclerosing agents is described in detail. Ethanol, povidone-iodine, tetracycline, doxycycline, bleomycin, talc and fibrin glue can be used as sclerosing agents. Combination of sclerosing agents to percutaneous catheter drainage significantly improves success rate in the treatment of pelvic lymphoceles. Infected lymphoceles are usually treated solely with percutaneous catheter drainage. Percutaneous treatment can be tailored according to volume of lymphoceles. We generally prefer single session sclerotherapy and 1 day catheter drainage in lymphoceles less than 150 mL, and larger ones are treated by multi-session sclerotherapy until daily drainage decreases below 10 mL. Percutaneous treatment preferably with sclerotherapy should be considered as the first-line treatment modality for pelvic lymphoceles due to its effectiveness, widespread applicability on an outpatient basis, ease of procedure and low complication rate.

  20. Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

    Directory of Open Access Journals (Sweden)

    Burgess SN

    2015-06-01

    Full Text Available Sonya N Burgess,1 John J Edmond,2 Craig P Juergens,1 John K French11Department of Cardiology, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; 2Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand Background: Coronary artery bypass graft surgery is arguably the most intensively studied surgical procedure, and percutaneous coronary intervention (PCI has been subjected to more randomized clinical trials than any other interventional procedure. Changes seen in revascularization techniques have been numerous. The rapid evolution of evidence-based revascularization procedures has occurred as a result of many pivotal large randomized clinical trials. Objective: This review compares and contrasts outcomes from two coronary revascularization techniques, coronary artery bypass grafting (CABG and PCI, with particular reference to the landmark trials that inform practice guidelines. Methods: We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the predrug-eluting stent and postdrug-eluting stent era. Results and discussion: Surgical and percutaneous revascularization strategies have different strengths and weaknesses, and neither strategy is superior in all patients, clinical presentations, or anatomical subgroups. Current data support the use of percutaneous intervention in ST elevation myocardial infarction and in single-vessel disease. In noncomplex multivessel disease and isolated left main stem PCI, the data support non-inferiority of PCI compared to CABG as reflected in the 2014 European Society of Cardiology guidelines. Landmark revascularization trials of multivessel disease comparing CABG to PCI found no survival benefit to CABG over PCI, except in patients with complex disease. In these trials, revascularization drove differences in primary endpoints and in all but the

  1. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications

    Directory of Open Access Journals (Sweden)

    Joshua Halpern

    2016-01-01

    Full Text Available There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.

  2. Percutaneous Procedures for the Treatment of Trigeminal Neuralgia.

    Science.gov (United States)

    Bender, Matthew T; Bettegowda, Chetan

    2016-07-01

    Three major percutaneous procedures are currently used to treat trigeminal neuralgia (TN). Percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation interrupt afferent pain fibers by injury to the trigeminal nerve root or ganglion. Each is capable of offering immediate and durable pain relief. Each is associated with relatively low, but variable rates of complications. Patient heterogeneity, technical variation, and nonstandard outcomes plague the existing outcomes literature and limit comparisons of treatments. Rendering treatment selection a function of individual physician preference and practice patterns. Randomized, prospective trials are needed; in the meantime, percutaneous rhizotomy remains an excellent treatment for selected patients.

  3. Giant small bowel diverticulum presenting after percutaneous gastrostomy: case report

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, G.J.; Clark, J.A.; Pugash, R.A. [St. Michael' s Hospital, Wellesley Central Site, Dept. of Medical Imaging, Toronto, Ontario (Canada)

    2000-10-01

    The standard technique for percutaneous gastrostomy requires insufflation of air into the stomach via a nasogastric tube before percutaneous gastric puncture. We present a previously undescribed complication in which the insertion of a percutaneous gastrostomy tube resulted in the distention of a previously undiagnosed giant small bowel diverticulum. This led to discomfort for the patient, further radiologic investigation and a delay in discharge. Symptoms resolved with conservative management. We suggest a strategy for avoiding this complication, as well as for reducing the incidence of post-procedure ileus. (author)

  4. Percutaneous pulmonary valve endocarditis: incidence, prevention and management.

    Science.gov (United States)

    Patel, Mehul; Malekzadeh-Milani, Sophie; Ladouceur, Magalie; Iserin, Laurence; Boudjemline, Younes

    2014-11-01

    The epidemiology of infective endocarditis is changing rapidly due to the emergence of resistant microorganisms, the indiscriminate use of antibiotics, and an increase in the implantation of cardiovascular devices including percutaneous valves. Percutaneous pulmonary valve implantation has achieved standard of care for the management of certain patients with right ventricular outflow tract dysfunction. With its expanding use, several cases of early and delayed infective endocarditis with higher morbidity and mortality rates have been reported. This review summarizes the trends in percutaneous pulmonary valve infective endocarditis, postulates proposed mechanisms, and elaborates on the prevention and management of this unique and potentially fatal complication.

  5. Effect of percutaneous radiofrequency thermocoagulation on different neuropathic pains

    Institute of Scientific and Technical Information of China (English)

    Youcai Shi; Xiaoxia Hu

    2006-01-01

    BACKGROUND: The clinical treatment of neuropathic pain is very troublesome ,and the physical method of radiofrequency thermocoagulation is a good choice for its treatment.OBJECTIVE: To observe the curative effact of percutaneous radiofrequency thermocoagulation on neuropathic neuralgia.DESIGN:A case follow-up analysis.SETTING: Minimally Invasive Surgery Room,Department of Neurosurgery,Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS: Totally 131 patients were selected from the Department of Neurosurgery,Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA from December 2000 to June 2006,including 73 males and 58 females,aging 37-72 years old,AND the disease course was 2-15 years.①Drug treatment failed to alleviate the pain or induced obvious side the pain or induced obvious side effects; ②With the same pathological changes as pain and effective in the nerve block test; Had signed the informed consents before treatment.Distribution of the neuropathic pain:①Trigeminal neuralgia,which were lighting attack,located at V2 in 28 cases,V3 in 46 cases,V1+V2 in 3 cases,V2+V3 in 28 cases,and V1+V2+V3 in 1 cases;②Migraine located at(except the frontal branch of trigeminal nerve)greater and lesser occipital nerves in 6 cases,auriculotemporal nerve in 3 cases,temporal and zygomatic nerves in 3 cases;③Unilateral neuralgia of C2 and C3 following herpes zoster in 1 case,and chest intercostals neuralgia in 2 cases;④Lasting burning pain in the operative area after thoracotomy was in 1 case of lung cancer.METHODS: ①All the enrolled patients were treated with percutaneous puncture at trigeminal ganglion or peripheral nerve,then nerve block was performed firstly for anesthesia,and the pain disappeared immediately at this moment,there was hypoesthesia or numbness in the area of innervation,which manifested the puncture apposition was correct.then electrostimulation of 50 Hz with the current of 0.1-0.5 V was given for

  6. Earlier application of percutaneous cardiopulmonary support rescues patients from severe cardiopulmonary failure using the APACHE III scoring system.

    Science.gov (United States)

    Song, Suk-Won; Yang, Hong-Suk; Lee, Sak; Youn, Young-Nam; Yoo, Kyung-Jong

    2009-12-01

    Percutaneous cardiopulmonary support (PCPS) is a widely accepted treatment for severe cardiopulmonary failure. This system, which uses a percutaneous approach and autopriming devices, can be rapidly applied in emergency situations. We sought to identify the risk factors that could help predict in-hospital mortality, and to assess its outcomes in survivors. During a 2-yr period, 50 patients underwent PCPS for the treatment of severe cardiopulmonary failure, and of those, 22 (44%) were classified as survivors and 28 (56%) as non-survivors. We compared the 2 groups for risk factors of in-hospital mortality and to establish proper PCPS timing. Twenty patients underwent PCPS for acute myocardial infarction, 20 for severe cardiopulmonary failure after cardiac surgery, 7 for acute respiratory distress syndrome, and 3 for acute myocarditis. Multivariate analysis showed that an acute physiology, age, and chronic health evaluation (APACHE) III score >or=50 prior to PCPS was the only significant predictor of in-hospital mortality (P=0.001). Overall 18-month survival was 42.2%. Cox analysis showed patients with APACHE III scores >or=50 had a poor prognosis (P=0.001). Earlier application of PCPS, and other preemptive strategies designed to optimize high-risk patients, may improve patient outcomes. Identifying patients with high APACHE scores at the beginning of PCPS may predict in-hospital mortality. Survivors, particularly those with higher APACHE scores, may require more frequent follow-up to improve overall survival.

  7. Percutaneous Microwave Ablation of Renal Angiomyolipomas

    Energy Technology Data Exchange (ETDEWEB)

    Cristescu, Mircea, E-mail: mcristescu@uwhealth.org [University of Wisconsin, Department of Radiology (United States); Abel, E. Jason, E-mail: abel@urology.wisc.edu [University of Wisconsin, Department of Urology (United States); Wells, Shane, E-mail: swells@uwhealth.org; Ziemlewicz, Timothy J., E-mail: tziemlewicz@uwhealth.org [University of Wisconsin, Department of Radiology (United States); Hedican, Sean P., E-mail: hedican@surgery.wisc.edu [University of Wisconsin, Department of Urology (United States); Lubner, Megan G., E-mail: mlubner@uwhealth.org; Hinshaw, J. Louis, E-mail: jhinshaw@uwhealth.org; Brace, Christopher L., E-mail: cbrace@uwhealth.org; Lee, Fred T., E-mail: flee@uwhealth.org [University of Wisconsin, Department of Radiology (United States)

    2016-03-15

    PurposeTo evaluate the safety and efficacy of US-guided percutaneous microwave (MW) ablation in the treatment of renal angiomyolipoma (AML).Materials and MethodsFrom January 2011 to April 2014, seven patients (5 females and 2 males; mean age 51.4) with 11 renal AMLs (9 sporadic type and 2 tuberous sclerosis associated) with a mean size of 3.4 ± 0.7 cm (range 2.4–4.9 cm) were treated with high-powered, gas-cooled percutaneous MW ablation under US guidance. Tumoral diameter, volume, and CT/MR enhancement were measured on pre-treatment, immediate post-ablation, and delayed post-ablation imaging. Clinical symptoms and creatinine were assessed on follow-up visits.ResultsAll ablations were technically successful and no major complications were encountered. Mean ablation parameters were ablation power of 65 W (range 60–70 W), using 456 mL of hydrodissection fluid per patient, over 4.7 min (range 3–8 min). Immediate post-ablation imaging demonstrated mean tumor diameter and volume decreases of 1.8 % (3.4–3.3 cm) and 1.7 % (27.5–26.3 cm{sup 3}), respectively. Delayed imaging follow-up obtained at a mean interval of 23.1 months (median 17.6; range 9–47) demonstrated mean tumor diameter and volume decreases of 29 % (3.4–2.4 cm) and 47 % (27.5–12.1 cm{sup 3}), respectively. Tumoral enhancement decreased on immediate post-procedure and delayed imaging by CT/MR parameters, indicating decreased tumor vascularity. No patients required additional intervention and no patients experienced spontaneous bleeding post-ablation.ConclusionOur early experience with high-powered, gas-cooled percutaneous MW ablation demonstrates it to be a safe and effective modality to devascularize and decrease the size of renal AMLs.

  8. Minimally invasive percutaneous posterior lumbar interbody fusion.

    Science.gov (United States)

    Khoo, Larry T; Palmer, Sylvain; Laich, Daniel T; Fessler, Richard G

    2002-11-01

    The wide exposure required for a standard posterior lumbar interbody fusion (PLIF) can cause unnecessary trauma to the lumbar musculoligamentous complex. By combining existing microendoscopic, percutaneous instrumentation and interbody technologies, a novel, minimally invasive, percutaneous PLIF technique was developed to minimize such iatrogenic tissue injury (MIP-PLIF). The MIP-PLIF technique was validated in three cadaveric torsos with six motion segments decompressed and fused. Preoperative variables measured from imaging included interpedicular distance, pedicular height and width, interspinous distance, lordosis, intervertebral height, Cobb angle, and foraminal height and volume. Using the METRx and MD spinal access systems (Medtronic Sofamor Danek, Memphis, TN), bilateral laminotomies were performed using a hybrid of microsurgical and microendoscopic techniques. The intervertebral disc spaces were then distracted and prepared with the Tangent (Medtronic Sofamor Danek) interbody instruments. Either a 10 or 12 by 22 mm interbody graft was then placed. Using the Sextant (Medtronic Sofamor Danek) system, percutaneous pedicle screw-rod fixation of the motion segment was completed. We then applied MIP-PLIF in three patients. For segments with preoperative intervertebral/foraminal height loss, MIP-PLIF was effective in restoring both heights in all cases. The amount of improvement (9.7 to 38% disc height increase; 7.7 to 29.9% foraminal height increase) varied directly with the size of the graft used and the original degree of disc and foraminal height loss. Segmental lordosis improved by 29% on average. Graft and screw placement was accurate in the cadavers, except for a single Grade 1 screw violation of one pedicle. The average operative time was 3.5 hours per level. In our three clinical cases, the MIP-PLIF procedure required a mean of 5.4 hours, estimated blood loss was 185 ml, and inpatient stay was 2.8 days, with no intravenous narcotic use after 2 days in

  9. Percutaneous surgery for plantar fasciitis due to a calcaneal spur

    National Research Council Canada - National Science Library

    Apóstol-González, Saúl; Herrera, Jesús

    2009-01-01

    .... This is an observational, descriptive, clinical series analyzing the outcomes of 10 patients with a diagnosis of talalgia due to plantar fasciitis with a calcaneal spur treated with percutaneous foot surgery...

  10. Percutaneous K-wire fixation in paediatric Supracondylar fractures ...

    African Journals Online (AJOL)

    Percutaneous K-wire fixation in paediatric Supracondylar fractures of humerus: A retrospective study. ... Nigerian Medical Journal ... conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2005 to July 2010.

  11. Impact of diabets on clinical outcomes following multivessel percutaneous interventions

    Institute of Scientific and Technical Information of China (English)

    乔岩

    2013-01-01

    Objective To compare the rates of mortality,mycardial infarction (MI) ,repeat revascularization and stent thrombosis after percutaneous coronary intervention (PCI) with implantation of stents for diabetics versus nondiabetics with multivessel disease to evaluate the im-

  12. Acute stent thrombosis after primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Wiberg, Sebastian; Van't Hof, Arnoud;

    2015-01-01

    OBJECTIVES: This study sought to determine clinical, procedural, and treatment factors associated with acute stent thrombosis (AST) in the EUROMAX (European Ambulance Acute Coronary Syndrome Angiography) trial. BACKGROUND: Bivalirudin started during transport for primary percutaneous coronary int...

  13. Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    deMuinck, ED; denHeijer, P; vanDijk, RB; Crijns, HJGM; Hillige, HL; Lie, KI

    1996-01-01

    Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty (PTCA)-with an autoperfusion balloon or active system-facilitates prolonged balloon inflation. Prolonged inflations may tack up intimal dissections and improve the primary angioplasty result in complex lesions. Addit

  14. Status quo of percutaneous nephrolithotomy in children.

    Science.gov (United States)

    Bogris, Sotirios; Papatsoris, Athanasios G

    2010-02-01

    Paediatric nephrolithiasis is quite challenging in terms of management because of the smaller size of the urinary tract and the bigger risk for stone recurrence. Children bear a higher risk of metabolic and infectious causes of stone disease and a longer lifetime risk for recurrence, especially in cases of residual fragments. Complete stone clearance should become the absolute objective and clinically insignificant residual fragments should be avoided. Nowadays, percutaneous nephrolithotomy (PCNL) arises as a logical first-line treatment option for considerable paediatric nephrolithiasis as miniaturization of endoscopes and advances in energy sources for stone fragmentation have facilitated stone-free rates. In this review we present the evolution of PCNL in children and we demonstrate its safety and efficacy. As appropriate instruments are available and relevant surgical experience is accumulating, age should no longer exist as a limiting factor for performing PCNL.

  15. Percutaneous Nephrolithotomy and Chronic Kidney Disease

    DEFF Research Database (Denmark)

    Sairam, Krish; Scoffone, Cesare M; Alken, Peter

    2012-01-01

    by glomerular filtration rate, including chronic kidney disease stages 0/I/II-greater than 60, stage III-30 to 59 and stages IV/V-less than 30 ml/minute/1.73 m(2). Patient characteristics, operative characteristics, outcomes and morbidity were assessed. RESULTS: Estimated glomerular filtration rate data were...... available on 5,644 patients, including 4,436 with chronic kidney disease stages 0/I/II, 994 with stage III and 214 with stages IV/V. A clinically significant minority of patients with nephrolithiasis presented with severe chronic kidney disease. A greater number of patients with stages IV/V previously...... underwent percutaneous nephrolithotomy, ureteroscopy or nephrostomy and had positive urine cultures than less severely affected patients, consistent with the higher incidence of staghorn stones in these patients. Patients with chronic kidney disease stages IV/V had statistically significantly worse...

  16. Percutaneous & Mini Invasive Achilles tendon repair

    Directory of Open Access Journals (Sweden)

    Carmont Michael R

    2011-11-01

    Full Text Available Abstract Rupture of the Achilles tendon is a considerable cause of morbidity with reduced function following injury. Recent studies have shown little difference in outcome between the techniques of open and non-operative treatment using an early active rehabilitation programme. Meta-analyses have shown that non-operative management has increased risk of re-rupture whereas surgical intervention has risks of complications related to the wound and iatrogenic nerve injury. Minimally invasive surgery has been adopted as a way of reducing infections rates and wound breakdown however avoiding iatrogenic nerve injury must be considered. We discuss the techniques and outcomes of percutaneous and minimally invasive repairs of the Achilles tendon.

  17. Percutaneous mechanical declotting of thrombosed dialysis graft

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Goo, Dong Erk; Kim, Dae Ho; Lee, Hae Kyung; Choi, Deuk Lin; Kwon, Kee Hyang; Hong, Hyun Sook; Moon, Chul [College of Medicine, Soonchunhyang University, Seoul (Korea, Republic of)

    2000-10-01

    To evaluate the effectiveness of percutaneous mechanical declotting. Using a 7-F Desilets-Hoffman sheath and the crossed-catheter technique, we aspirated the intragraft clot and pushed the residual clot into the central circulation with balloon catheters. The success rate, procedure time, complications and patency rates were evaluated. Technical success was achieved in 24 of 32 cases, with a procedure time of 30-240 (average, 111) minutes. In five of eight cases in which technical failure occurred, the guide wire failed to reach the stenotic site and in the other three, there was insufficient luminal dilatation. Complications included vein ruptures (n=2), arterial emboli (n=1) and arterial dissection (1), but there was no evidence of clinical symptoms of pulmonary embolism. The six-month patency rate was 67.8%. Mechanical declotting of thrombosed dialysis graft using a balloon catheter is relatively inexpensive, safe and fast, and is well tolerated. (author)

  18. Results of percutaneous transhepatic cholangiography drainages (PTCD)

    Energy Technology Data Exchange (ETDEWEB)

    Schoenemann, J.; Willems, M.; Wolf, G.; Fromme, M.

    1987-12-01

    From September 1980 to December 1986, 72 percutaneous transhepatic cholangiography drainages (PTCD) were performed in 64 patients (58 palliative in malignant obstructions, 14 temporary). The median duration of drainage was 26.8 days (2-183 days). The median survival time in 37 patients with palliative tumour drainage was 55.3 days (7-473 days). 9/37 patients survived longer than 3 months (max. 15.5 months). Complications occurred in 29.5% (10.3% severe). 3/64 patients (4.7%) died. Patients with palliative transpapillary drainages (23), especially with endoprostheses (14), survived longer, and the complication rate was lower. Therefore, we prefer the endoscopic transpapillary approach. PTCD patients must be selected carefully.

  19. Percutaneous endoscopic gastrostomy and early mortality.

    Science.gov (United States)

    Clarkston, W K; Smith, O J; Walden, J M

    1990-12-01

    To assess morbidity, mortality, and benefit associated with percutaneous endoscopic gastronomy (PEG), we retrospectively studied 42 patients who had had PEG. Mortality was exceptionally high during the first 60 days after PEG (43%), and then stabilized. In nearly half of the cases (20/42) the PEG tube was removed during the first 60 days because of either death or improvement. Patients with malignancy had a significantly higher morbidity and 60-day mortality than the neurologically impaired. We concluded that patients should be carefully selected for PEG because early mortality is high; a 60-day trial of soft nasogastric feedings should be considered before PEG, and could reduce by nearly half the number of patients failing to receive long-term benefit; and patients with malignancy have significantly greater morbidity and mortality after PEG and may not receive the same advantage from the procedure.

  20. Percutaneous transarterial embolization of extrahepatic arteroportal fistula

    Institute of Scientific and Technical Information of China (English)

    Gianluca Marrone; Settimo Caruso; Roberto Miraglia; Ilaria Tarantino; Riccardo Volpes; Angelo Luca

    2006-01-01

    Arteroportal fistula is a rare cause of prehepatic portalhypertension. A 44-year-old male with hepatitis virus C infection was admitted for acute variceal bleeding.Endoscopy showed the presence of large esophageal varices. The ultrasound revealed a mass near the head of pancreas, which was characterized at the colorDoppler by a turbulent flow, and arterialization of portal vein flow. CT scan of abdomen showed a large aneurysm of the gastroduodenal artery communicating into the superior mesenteric vein. The sinusoidal portal pressure measured as hepatic vein pressure gradient was normal, confirming the pre-hepatic origin of portal hypertension. The diagnosis of extrahepatic portal hypertension secondary to arteroportal fistula was established, and the percutaneous embolization was performed.Three months later, the endoscopy showed absence of esophageal varices and ascites. At the moment, the patient is in good clinical condition, without signs of portal hypertension.

  1. Percutaneous Screw Fixation of Crescent Fracture-Dislocation of the Sacroiliac Joint.

    Science.gov (United States)

    Shui, Xiaolong; Ying, Xiaozhou; Mao, Chuanwan; Feng, Yongzeng; Chen, Linwei; Kong, Jianzhong; Guo, Xiaoshan; Wang, Gang

    2015-11-01

    Crescent fracture-dislocation of the sacroiliac joint (CFDSIJ) is a type of lateral compression pelvic injury associated with instability. Open reduction and internal fixation is a traditional treatment of CFDSIJ. However, a minimally invasive method has never been reported. The purpose of this study was to assess the outcome of closed reduction and percutaneous fixation for different types of CFDSIJ and present their clinical outcome. The authors reviewed 117 patients diagnosed with CFDSIJ between July 2003 and July 2013. Closed reduction and percutaneous fixation was performed in 73 patients. Treatment selection was based on Day's fracture classification. For type I fractures, fixation perpendicular to the fracture line were performed. For type II fractures, crossed fixation was performed. For type III fractures, fixation was performed with iliosacral screws. Forty-four patients were treated by open reduction and plate fixation. Demographics, fracture pattern distribution, blood loss, incision lengths, revision surgeries, radiological results, and functional scores were compared. All 117 patients were followed for more than 6 months (mean, 14 months [range, 6-24 months]). Blood loss, extensive exposure, duration of posterior ring surgery, duration of hospital stay, and infection rates were lower in the closed group (P<.01). Patients in the closed group achieved better functional performance (P<.01). There were no significant differences in reduction quality (P=.32), revision surgery rates (P=.27), and iatrogenic neurologic injuries (P=.2) between the 2 groups. The authors' results indicate that closed reduction and percutaneous fixation is a safe and effective surgical method for CFDSIJ. Copyright 2015, SLACK Incorporated.

  2. Percutaneous atrial shunt closure using the novel Occlutech Figulla device: 6-month efficacy and safety.

    Science.gov (United States)

    Van Den Branden, Ben J L; Post, Martijn C; Plokker, Herbert W M; Ten Berg, Jurriën M; Suttorp, Maarten J

    2011-06-01

    The Occlutech Figulla Occluder is a new innovative device for percutaneous closure of a patent foramen ovale (PFO) and an atrial septum defect (ASD). We describe the safety and efficacy of this new device at 6-month follow-up. All 82 consecutive patients (51% female, mean age 49.0 ± 13.6 years) who underwent percutaneous PFO (n = 48) or ASD (n = 34) closure between October 2008 and October 2009 were included. Implantation success was 100%. The in-hospital complications were two new onset supraventricular tachycardia (SVT) (2.4%, both ASD patients), nine minimal groin hematoma's (11.0%, 4 PFO and 5 ASD patients), and one transient ST elevation during the procedure (1.2%, ASD patient). During 6 months follow-up (n = 79), no major complications or reoccurrences of cerebral thrombo-embolic events did occur. Seven patients (8.9%, 6 PFO and 1 ASD patient) experienced a new SVT. One patient developed a recurrent cerebral hemorrhage 5 months after ASD closure, which appeared not to be related to the procedure. Using contrast transthoracic echocardiography 6 months after PFO closure (n = 45), a residual shunt was present in 30.2% of the patients (small 25.6%, moderate 4.6%, severe 0%). In the ASD group (n = 34), a residual shunt was observed in 32.5% (small 17.7%, moderate 14.7%, severe 2.9%). The Occlutech Figulla Occluder appears to be easy to use, effective, and safe for percutaneous closure of PFO and ASD. We report a low complication rate but a relative high percentage of small residual shunts 6 months after closure. ©2010, Wiley Periodicals, Inc.

  3. Immediate and mid-term clinical course after percutaneous closure of paravalvular leakage.

    Science.gov (United States)

    Sánchez-Recalde, Angel; Moreno, Raúl; Galeote, Guillermo; Jimenez-Valero, Santiago; Calvo, Luis; Sevillano, Joel Hernández; Arroyo-Ucar, Eduardo; López, Teresa; Mesa, José M; López-Sendón, José L

    2014-08-01

    Percutaneous closure of paravalvular leakage is an alternative to surgery in high-risk patients, but its use has been limited by a lack of specific devices. More appropriate devices-like the Amplatzer Vascular Plug III-have recently been developed, but information about their efficacy and safety is still scarce. The objective of the present study was to assess the mid-term results of paravalvular leakage closure with this device. We analyzed the clinical and echocardiographic course both in-hospital and mid-term (13 [9] months) in a series of 20 consecutive patients (age, 68 years; logistic EuroSCORE, 29) with paravalvular leakage and attempted percutaneous closure. Closure was attempted for 23 leaks (17 mitral and 6 aortic) during 22 procedures in 20 patients. Implantation was successful in 87% of the leaks and the procedure was successful in 83%-with success being defined as a reduction in regurgitation of ≥ 1 degree. Survival at 1 year was 64.7% and survival free of the composite event of death/surgery was 58.8%. The degree of residual regurgitation was not associated with mortality but was associated with functional status. Survivors showed significant improvement in functional class. Percutaneous closure of leakage with the Amplatzer Vascular Plug III is safe and efficient in the mid-term. However, mortality among high-risk patients is high independently of the degree of residual regurgitation, indicating that these procedures are performed when heart disease has reached an advanced stage. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  4. Diabetes Mellitus and Glucose as Predictors of Mortality in Primary Coronary Percutaneous Intervention

    Directory of Open Access Journals (Sweden)

    Renato Budzyn David

    2014-10-01

    Full Text Available Background: Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate. Objective: To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention. Methods: Prospective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score. Results: Among the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13, whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01. Conclusion: In ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients.

  5. Outcome of Percutaneous Release of Tennis Elbow: A Non-Randomized Controlled Trial Study

    Science.gov (United States)

    Khatri, Kishor; Kharel, Krishna; Byanjankar, Subin; Shrestha, Rahul; Sharma, Jay R; Vaishya, Raju; Agarwal, Amit kumar; Vijay, Vipul

    2017-01-01

    Background Tennis elbow is a common disorder of the upper extremity. It can be treated conservatively in the majority of patients, but some resistant cases eventually can be treated by percutaneous release with good functional outcome. Materials and methods This non-randomized control trial was conducted at the Department of Orthopaedics Surgery in a tertiary care hospital from July 2015 to June 2016 on 50 patients who underwent percutaneous release of the common extensor origin using an 18 gauge hypodermic needle. These patients did not respond to conservative treatment including rest, nonsteroidal anti-inflammatory drugs (NSAIDS) and local steroid injections. The outcome was graded as Excellent, Good, Fair, and Poor. Results Fifty patients (50 elbows) were included in the study. Thirty-two patients were female (64%), and 18 were male (36%). The right side was affected in 37 patients (74%) and left side in 13 (26%). The time taken to achieve a completely pain-free elbow ranged from one day to two months (average of 26.2 days). Those who did not achieve a pain-free elbow had a residual pain of 1.5 to six on the visual analogue scale (VAS) (average 2.32). Excellent outcome was noticed in 24 patients (48%); Good result in eight patients (36% ); Fair in four patients (eight percent) and Poor in four patients (eight percent). Conclusion Tennis elbow probably results from the degenerative tear of the common extensor origin, and a percutaneous tenotomy using an 18 gauge hypodermic needle is a simple, safe, patient-friendly, efficient, and easily reproducible method of treating tennis elbow in those who are resistant to conservative treatment, and it can be done as an outpatient procedure. PMID:28168130

  6. Closed reduction and percutaneous pinning of displaced supracondylar fractures of humerus in children with delayed presentation

    Directory of Open Access Journals (Sweden)

    Dua Aman

    2011-02-01

    Full Text Available 【Abstract】Objective: Supracondylar fractures of the humerus account for 60% of all the fractures around the pediatric elbow and even in developed countries 18% of patients undergo surgery 48 hours or longer following presentation in the hospital. Management guidelines are not clear yet for these patients who present late. The aim of this prospective study was to evaluate the clinical, radiological and functional outcome following closed reduction and percutaneous pinning of widely displaced supracondylar fractures of the humerus presenting 12 hours or more after injury. Methods: We reviewed the functional and radiological results of closed reduction and percutaneous pinning using crossed K-wires in 40 patients with displaced extension type supracondylar fracture of the humerus (Gartland type III with a delay of more than 12 hours in presentation. The average age of patients was 4.5 years and the mean delay in presentation was 17.55 hours. Results: Closed reduction and percutaneous pinning was successful in 90% of patients. The mean follow up period was 15 months. The Baumann’s angle was restored within 4 degrees of the unaffected side in all patients. Use of a small medial incision in patients with severe swelling helped us avoid ulnar nerve injury. Using Flynn’s criteria, 38 patients (95% had an excellent result. Two patients had mild myositis and both had a poor result. None of the patients developed cubitus varus. Conclusion: Closed reduction and crossed pinning of displaced supracondylar fractures of humerus in children is a safe and effective method even with delayed presentation. Key words: Fractures, bone; Humerus; Pediatrics; Fluoroscopy

  7. Complications of ultrasound-guided percutaneous microwave ablation of renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Dong XJ

    2016-09-01

    Full Text Available Xuejuan Dong, Xin Li, Jie Yu, Ming-an Yu, Xiaoling Yu, Ping Liang Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People’s Republic of China Purpose: To retrospectively review the complications of ultrasound (US-guided percutaneous microwave ablation (MWA of renal cell carcinoma.Patients and methods: In this study, 101 patients with 105 tumors seen from April 2006 to Feb 2014 were enrolled retrospectively. The patients were treated with US-guided percutaneous MWA and were followed up with contrast-enhanced US and computed tomography or magnetic resonance imaging at 1, 3, and 6 months and every 6 months thereafter.Results: Technical success was achieved in 99 of 105 tumors (94.3%. The median follow-up time was 25 (range 1.13–93.23 months. Among the 105 tumors, 26 complications in 24.8% of patients and 23 minor complications (Clavien–Dindo Grades I and II in 21.9% of patients were noted, accounting for 88.5% of all complications. All the minor complications were cured. Three major complications (Clavien–Dindo Grade ≥III occurred in 2.9% of the patients, accounting for 11.5% of all complications: hydrothorax in two patients and bowel injury in one. The two patients who had hydrothorax post-MWA had a history of cirrhosis and were treated with catheter drainage. The bowel injury was treated surgically. In all patients, the changes in serum creatinine and urea nitrogen levels from before to after the procedure were small.Conclusion: US-guided percutaneous MWA is a beneficial treatment for renal cell carcinoma in selected patients; however, if the renal tumor is close to the bowel, or the patient has serious comorbidities or has undergone abdominal surgery, the procedure must be performed more carefully. Keywords: microwave ablation, renal cell, complications, carcinoma

  8. Effects of handholding and providing information on anxiety in patients undergoing percutaneous vertebroplasty.

    Science.gov (United States)

    Kim, Bong-Hee; Kang, Hee-Young; Choi, Eun-Young

    2015-12-01

    This study evaluated the effects of handholding and spoken information provided on the anxiety of patients undergoing percutaneous vertebroplasty under local anaesthesia. A surgical intervention usually entails physical discomfort and psychological burden. Furthermore, patients under local anaesthesia are conscious during the surgical intervention, which leads to more anxiety, as patients are aware of their surroundings in the operating theatre. A quasi-experimental design with a nonequivalent control group was utilised. Amsterdam preoperative anxiety scale assessed psychological anxiety, while blood pressure and pulse were measured to evaluate physiological anxiety. Participants were 94 patients undergoing percutaneous vertebroplasty in a spine hospital in Gwangju Metropolitan City, South Korea. Thirty patients were assigned to Experimental Group I, 34 to the Experimental Group II and 30 to the control group. During a surgical intervention, nurses held the hands of those in Experimental Group I and provided them with spoken information. Patients in Experimental Group II experienced only handholding. Psychological anxiety in Experimental Group I was low compared to those in Experimental Group II and the control group. In addition, there were significant decreases in systolic blood pressure in both Experimental Groups compared to the control group. Handholding and spoken information provided during a surgical intervention to mitigate psychological anxiety, and handholding to mitigate physiological anxiety can be used in nursing interventions with patients undergoing percutaneous vertebroplasty. Handholding and providing nursing information are possibly very useful interventions that are easily implemented by circulating nurses during a surgical intervention. In particular, handholding is a simple, economical and appropriate way to help patient in the operating theatre. © 2015 John Wiley & Sons Ltd.

  9. [Pull percutaneous endoscopic gastrostomy: personal experience].

    Science.gov (United States)

    Geraci, G; Sciumè, C; Pisello, F; Li Volsi, F; Facella, T; Tinaglia, D; Modica, G

    2007-04-01

    To review the indications, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG), that are placed routinely in patients unable to obtain adequate nutrition from oral feeding for swallowing disorders (neurological diseases, head and neck cancer, oesophageal cancer, psychological disorders). Retrospective review of patients referred for PEG placement from 2003 to 2005. Endoscopic Surgery in Section of General and Thoracic Surgery, Faculty of Medicine and Surgery, Palermo, Italy. A total of 50 patients, 11 women and 39 men, referred our Section for PEG placement. Indications for PEG placement included various neurologic impairment (82%), oesophageal non-operable cancer (6%), cardia non-operable cancer (4%), cerebrovascular accident (2%), anorexia (2%), pharyngeal esophageal obstruction (2%), head and neck cancer (2%). All patients received preoperative antibiotics as short-term profilaxis. 51 PEGs were positioned in 50 patients. No major complications were registered; 45 patients (90%) were alive at 1 year follow-up and no mortality procedure-related was registered. Percutaneous endoscopic gastrotomy removal had been performed on 2 patients as end-point of treatment, and 43 patients continued to have PEGs in use at 2006. Outpatients PEG placement using conscious sedation is a safe and effective method for providing enteral nutrition. This technique constitutes the gold standard treatment for enteral nutrition in patients with neurologic impairment or as prophylactic in patients affected by head and neck cancer who needs demolitive surgery. Patients should be carefully assessed, and discussion with the patient and their families should be held to determine that the patient is an appropriate candidate. The Authors feel prophylactic antibiotics lessened the incidence of cutaneous perigastrostomy infection.

  10. Percutaneous treatment of benign bile duct strictures

    Energy Technology Data Exchange (ETDEWEB)

    Koecher, Martin [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)]. E-mail: martin.kocher@seznam.cz; Cerna, Marie [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Havlik, Roman [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Kral, Vladimir [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Gryga, Adolf [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Duda, Miloslav [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)

    2007-05-15

    Purpose: To evaluate long-term results of treatment of benign bile duct strictures. Materials and methods: From February 1994 to November 2005, 21 patients (9 men, 12 women) with median age of 50.6 years (range 27-77 years) were indicated to percutaneous treatment of benign bile duct stricture. Stricture of hepatic ducts junction resulting from thermic injury during laparoscopic cholecystectomy was indication for treatment in one patient, stricture of hepaticojejunostomy was indication for treatment in all other patients. Clinical symptoms (obstructive jaundice, anicteric cholestasis, cholangitis or biliary cirrhosis) have appeared from 3 months to 12 years after surgery. Results: Initial internal/external biliary drainage was successful in 20 patients out of 21. These 20 patients after successful initial drainage were treated by balloon dilatation and long-term internal/external drainage. Sixteen patients were symptoms free during the follow-up. The relapse of clinical symptoms has appeared in four patients 9, 12, 14 and 24 months after treatment. One year primary clinical success rate of treatment for benign bile duct stricture was 94%. Additional two patients are symptoms free after redilatation (15 and 45 months). One patient is still in treatment, one patient died during secondary treatment period without interrelation with biliary intervention. The secondary clinical success rate is 100%. Conclusion: Benign bile duct strictures of hepatic ducts junction or biliary-enteric anastomosis are difficult to treat surgically and endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long-term internal/external drainage is feasible in the majority of these patients. It is minimally invasive, safe and effective.

  11. [The use of laser for percutaneous nephrolithotomy].

    Science.gov (United States)

    Valdivia Uría, José Gabriel; Sánchez Zalabardo, José Manuel; Elizalde Benito, Angel; Navarro Gil, Joaquín; Hijazo Conejos, Ignacio; Subirá Ríos, Jorge; García-Magariño, Jesús; García Calero, David

    2008-11-01

    The non negligible number of residual stones after extracorporeal lithotripsy is leading to a revision of the indications of percutaneous nephrolithotomy (PCNL). The laser, managed with flexible nephroscopes, plays an important role in this field. Pulsed Nd: YAG, dye and alexandrite lasers have given way to the holmium:yag laser in the endourological treatment of urinary lithiasis. More than one lithotripter are often required for percutaneous nephrolithotomy of great volume stones, and ballistic and electrokinetic lithotripters are generally preferred due to their high performance. The best indications for Holmium laser is the treatment of caliceal stones far from the pelvis, only accessible through flexible nephroscopes. Midi and minipercs, renal lithiasis in children and some earthy calculi, of low consistency, are also good indications for it. Depending on the anatomical characteristics of the kidney and localization, number, size and hardness of the stone 200, 365, or 500 nanometer fibers may be employed. Due to the fact that the laser drills a hole in the stone like if it is a thermal barrier, it may break in different ways: applying the quartz fiber in between the layers, drilling all the interior before breaking the surface, or drilling multiple points to weaken it and creating broad fracture lines. To accelerate the breaking process one can choose to use larger fibers or to modify the settings of the equipment increasing the potency, although this has some potential risk for the kidney. The theoretical 100% of good results is reduced due to multiple technical and anatomical factors: size, number, localization, and hardness of the stone, as well as the possibility of reaching and seeing the calculus and being able to place the tip of the fiber against it. Although the holmium laser develops on excellent role at the time of avoiding leaving residual calculi or diminishing the number of them, sometimes the electrohydraulic lithotripsy is more effective.

  12. Percutaneous central line extravasation masquerading as an abscess.

    Science.gov (United States)

    Govind, Binu; Tete, Prakash Ignace; Thomas, Niranjan

    2014-04-01

    Percutaneous central line insertion is a common procedure in the neonatal intensive care unit. A preterm baby, who had a percutaneous central line inserted developed an erythematous swelling over the infraclavicular area. A diagnosis of abscess was made, and an incision and drainage done that revealed a white fluid with high triglyceride content, confirming lipid extravasation. The lesion healed completely few days after removal of the catheter. This case highlights the importance of proper placement and confirmation of central line position.

  13. Current status and perspective of percutaneous coronary intervention in China

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ The first percutaneous transluminal coronary angioplasty (PTCA) in China was performed in 1984. Since then the progresses in this field have been achieved gradually. The development process can be divided into 3 phases roughly. According to a national survey organized by Chinese Society of Cardiology,1-3 from 1984 to 1996, as the first phase, percutaneous coronary intervention (PCI) can only be performed in a few centers by a few cardiologists.

  14. Minimal Invasive Percutaneous Fixation of Thoracic and Lumbar Spine Fractures

    Directory of Open Access Journals (Sweden)

    Federico De Iure

    2012-01-01

    Full Text Available We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgical treatment by percutaneous transpedicular fixation and stabilization with minimally invasive technique. Patient followup ranged from 6 to 72 months (mean 38 months, and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous transpedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures.

  15. Training for percutaneous renal access on a virtual reality simulator.

    Science.gov (United States)

    Zhang, Yi; Yu, Cheng-fan; Liu, Jin-shun; Wang, Gang; Zhu, He; Na, Yan-qun

    2013-01-01

    The need to develop new methods of surgical training combined with advances in computing has led to the development of virtual reality surgical simulators. The PERC Mentor(TM) is designed to train the user in percutaneous renal collecting system access puncture. This study aimed to validate the use of this kind of simulator, in percutaneous renal access training. Twenty-one urologists were enrolled as trainees to learn a fluoroscopy-guided percutaneous renal accessing technique. An assigned percutaneous renal access procedure was immediately performed on the PERC Mentor(TM) after watching instruction video and an analog operation. Objective parameters were recorded by the simulator and subjective global rating scale (GRS) score were determined. Simulation training followed and consisted of 2 hours daily training sessions for 2 consecutive days. Twenty-four hours after the training session, trainees were evaluated performing the same procedure. The post-training evaluation was compared to the evaluation of the initial attempt. During the initial attempt, none of the trainees could complete the appointed procedure due to the lack of experience in fluoroscopy-guided percutaneous renal access. After the short-term training, all trainees were able to independently complete the procedure. Of the 21 trainees, 10 had primitive experience in ultrasound-guided percutaneous nephrolithotomy. Trainees were thus categorized into the group of primitive experience and inexperience. The total operating time and amount of contrast material used were significantly lower in the group of primitive experience versus the inexperience group (P = 0.03 and 0.02, respectively). The training on the virtual reality simulator, PERC Mentor(TM), can help trainees with no previous experience of fluoroscopy-guided percutaneous renal access to complete the virtual manipulation of the procedure independently. This virtual reality simulator may become an important training and evaluation tool in

  16. Percutaneous nephrolithotomy in very elderly patients (Age 75 and Over

    Directory of Open Access Journals (Sweden)

    Hüseyin Çelik

    2015-12-01

    Full Text Available Objective: Percutaneous nephrolithotomy (PNL is a minimally invasive method used safely in surgical treatment of kidney stones in the world. The first PNL surgery performed in our clinic in March 1998 and first PNL surgery was performed in June 2000 over the age of seventy which was bilaterally side. In our study, PNL operations performed for 75 years and older patients were examined. Methods: PNL operations were performed under the general anesthesia. After cystoscopy in the supine position, ureteral catheter was inserted accompanied by C-arm fluoroscopy. Afterwards, patients were taken prone position then we entered into the kidney with a metal needle with fluoroscopic on. We dilated the entrance with Amplatzer renal dilatators set until the 30 F. After the procedure, the nephrostomy catheter was placed in the renal sheath. 4 mm residual fragments after the PNL operation were accepted as clinically insignificant stone residues (CIRF. Results: 3003 PNL procedures were performed between dates March 1998 - December 2014 in total 16 years. 28 patients of total were 75 years and over. 29 PNL surgeries performed to these patients, including one bilateral PNL procedure. Mean age was 79.36 years (75-88. Twenty (74% of the patients were concluded stone free. 2 patients had tubeless PNL surgery. There was no another complication. Conclusion: PNL is a minimally invasive method has became advantageous according to open surgery because of higher safety, lower complication rates, shorter hospitalization stay, more patient comfort and higher stone free rates. PNL is a safe and effective method in the surgical treatment of urinary tract stone diseases.

  17. Problems Experienced by Family of Child with Percutaneous Endoscopic Gastrostomy

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    Figen Işık Esenay

    2016-12-01

    Full Text Available Introduction: Percutaneous endoscopic gastrostomy (PEG is the most commonly used form of enteral nutrition in the long-term diet of children with dysphagia, neurological, gastrointestinal and esophageal diseases. Families may experience physical, psychological, social and economic problems in home care. In this study, families whose children with PEG were followed-up in a pediatric surgery clinic were examined with respect to the problems experienced in the home care. Materials and Methods: This descriptive cross-sectional study was carried out in Ankara University Faculty of Medicine, Cebeci Hospital Pediatric Surgery clinic. The study sample was made up of 20 primary caregivers of children with PEG. Data were collected by interviews with a questionnaire prepared by the researchers in accordance with the literature. Descriptive statistics was used for evaluation of the data. Results: Primery caregivers of all children with PEG in the clinic were their mothers. 80% of mothers stated that they have problems with home care, 70% of them had economical problems and 60% of them had housework problems. Most stated problems about home care were about medical dressing (80%, formula (40% and supply of PEG materials (20%. Mothers expressed that they were afraid to hurt their children while dressing their wounds, and experienced difficulties in the selection and preparation of their formula. Expectations of the mothers from the clinical team for the solution of these problems were applied training on dressing, complications and formula (90% and more effective communication with the clinical team (5%. Conclusions: It is considered that effective applied training to parents about home care of PEG would help families cope with problems.

  18. Patients’ perspectives of living with a percutaneous endoscopic gastrostomy (PEG

    Directory of Open Access Journals (Sweden)

    Martin Lena

    2012-09-01

    Full Text Available Abstract Background Since enteral nutrition therapy is the preferred nutritional support for dysphagic patients with a range of diagnoses, PEG has become part of traditional care. However, enteral nutrition with PEG transfers treatment responsibility and activity to the patients and their carers, so the advantages should be discussed. The aim of this study was therefore to investigate patients’ experience of living with a percutaneous endoscopic gastrostomy (PEG in order to increase the understanding of patients’ need for support. Method In a prospective study at Karolinska University Hospital in Sweden, data were collected consecutively at the time of PEG and two months later using a study-specific questionnaire about each patient’s experience of living with a PEG. Fishers exact test was used to test for statistically significant difference at five per cent level. Results There were 104 responders (response rate of 70%. Women felt more limited in daily activity compared to men (p = 0.004. Older patients experienced a more limited ability to influence the number of feeding times compared to younger (p = 0.026. Highly educated patients found feeding more time-consuming (p = 0.004. Patients with a cancer diagnosis reported that the PEG feeding interfered with their oral feeding more than patients with a neurological disease (p = 0.009. Patients mostly contacted the PEG outpatient clinic with problems regarding their PEG, and were mainly assisted by their spouse rather than district nurses. Conclusions PEG feeding is time-consuming and interferes with daily life. Although 73% was satisfied, patients’ experiences of living with a PEG may be dependent on age, sex, education and diagnosis. Spouses are the main carers for PEG patients at home, and patients prefer to go to the PEG outpatient clinic for help if problems occur.

  19. Our initial experience with percutaneous nephrolithotomy in children

    Directory of Open Access Journals (Sweden)

    Mehmet Hanifi Okur

    2014-03-01

    Full Text Available Objective: To present our initial experience on percutaneous nephrolithotomy (PCNL in children between March 2012 and November 2013. Methods: 13 renal units of 12 patients underwent PCNL. Patients were evaluated in terms of age, preoperatively in terms of urine, blood count, urine culture, serum biochemical, and routine coagulation tests and radiological examinations, stone location, stone burden (according to plain radiograph, preoperative use of nephrostomy and average fluoroscopic manipulation time. To facilitate access, prior mechanical dilatation was performed nephrostomy access tract. After the PCNL procedure, we placed nephrostomy in all patients postoperatively. They were evaluated with regard to residual stone, complications (according to the Clavien classification and outcomes. Results: Average age was 11 years (6-15. There was no abnormality in Laboratory Screening. Location of 11 stones was renal pelvis and 2 stones was pelvis + calyx. The average stone size was 260 mm². Preoperative acces were provided in 3 patients, others were intraoperatively. Average fluoroscopic manipulation time was 4,8 minutes (2-11. At the first postoperative day, 11 (85 % patients achieved a completely stone-free state. Complications were seen in 3 patients; failure of renal access in one patient (Grade 3b, urine leakage was observed after surgery in one (Grade 3a, postoperative blood transfusion required in one patient (Grade 2. The hospital stay duration was 5,5 days (5-7 days. Conclusions: Pediatric PCNL is a minimal invasive procedure which provides high rate of stone free and good cosmetics. İf there is adequate facilities and equipment with experienced persons, this procedure can easily be used in pediatric surgery clinics.

  20. Percutaneous pulmonary and tricuspid valve implantations: An update

    Institute of Scientific and Technical Information of China (English)

    Robert; Wagner; Ingo; Daehnert; Philipp; Lurz

    2015-01-01

    The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology.Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status.Although techniquesof percutaneous pulmonary valve implantation have been described just a decade ago,two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide.In contrast,percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status.Taking into account that an "interdisciplinary challenging",heterogeneous population of patients previously treated by corrective,semi-corrective or palliative surgical procedures is growing inexorably,there is a rapidly increasing need of treatment options besides redo-surgery.Therefore,the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures,to update on current devices,to discuss indications and patient selection criteria,to report on clinical results and finally to consider future directions.

  1. hospital's perspective

    African Journals Online (AJOL)

    Cost effectiveness of autologous blood transfusion - A developing country hospital's ... 4Military Hospital, Lagos. Summary. An autologous blood donation program was set up at. National .... risk of infection for autologous patients was 5.06.

  2. Percutaneous coronary intervention for acute myocardial infarction in elderly patients with renal dysfunction: results from the Korea Acute Myocardial Infarction Registry.

    Science.gov (United States)

    Lim, Sang Yup; Bae, Eun Hui; Choi, Joon Seok; Kim, Chang Seong; Ma, Seong Kwon; Ahn, Youngkeun; Jeong, Myung Ho; Kim, Weon; Woo, Jong Shin; Kim, Young Jo; Cho, Myeong Chan; Kim, Chong Jin; Kim, Soo Wan

    2013-07-01

    This study aimed to evaluate the effects of percutaneous coronary intervention (PCI) on short- and long-term major adverse cardiac events (MACE) in elderly (>75 yr old) acute myocardial infarction (AMI) patients with renal dysfunction. As part of Korea AMI Registry (KAMIR), elderly patients with AMI and renal dysfunction (GFRrenal dysfunction, PCI therapy yields favorable in-hospital and short-term and long-term MACE-free survival.

  3. Low-density lipoprotein cholesterol target goal attainment rate and related factors in patients with acute coronary syndrome after percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    张波

    2014-01-01

    Objective To observe the low-density lipoprotein cholesterol(LDL-C)target goal attainment rate and related factors in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods From March 2011 to March 2012,a total of832 ACS patients were retrospectively evaluated in the Cardiology Department of the First Affiliated Hospital of Dalian Medical University.The target goal attainment

  4. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis.

    Science.gov (United States)

    Keric, Naureen; Eum, David J; Afghanyar, Feroz; Rachwal-Czyzewicz, Izabela; Renovanz, Mirjam; Conrad, Jens; Wesp, Dominik M A; Kantelhardt, Sven R; Giese, Alf

    2017-03-01

    Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the application of intervertebral cages. In this collective, we compare conventional open to a further minimalized percutaneous robot-assisted spinal instrumentation, avoiding a direct contact of implants and infectious focus. 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments with and without decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. 24 patients were treated by free-hand fluoroscopy-guided surgery (121 screws), and 66 patients were treated by percutaneous robot-assisted spinal instrumentation (341 screws). Accurate screw placement was confirmed in 90 % of robot-assisted and 73.5 % of free-hand placed screws. Implant revision due to misplacement was necessary in 4.95 % of the free-hand group compared to 0.58 % in the robot-assisted group. The average intraoperative X-ray exposure per case was 0.94 ± 1.04 min in the free-hand group vs. 0.4 ± 0.16 min in the percutaneous group (p = 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (p = 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis.

  5. Treatment of Severely Displaced Radial Neck Fractures in Children With Percutaneous K-wire Leverage and Closed Intramedullary Pinning

    Science.gov (United States)

    Zhang, Fu-Yong; Wang, Xiao-Dong; Zhen, Yun-Fang; Guo, Zhi-Xiong; Dai, Jin; Zhu, Lun-Qing

    2016-01-01

    Abstract To evaluate the efficacy and safety of percutaneous K-wire leverage (PKWL) reduction and closed intramedullary pinning (CIMP) for the treatment of pediatric radial neck fractures. From June 2010 to December 2013, a total of 50 children with Judet III and IV radial neck fractures were treated at our hospital. Manual closed reduction was first attempted to reduce the radial neck fractures. Upon successful closed reduction or the radial neck–shaft angle was reduced to  0.05), but were significantly larger than group A in the radial neck–shaft angle and fracture displacement (P < 0.05). Group A and B had significantly shorter operation time than group C (58.4 ± 14.5 minutes, 55.2 ± 11.2 minutes, versus 81.4 ± 7.5 minutes, P < 0.05). Forty-five patients were followed up for a mean of 2 years. Bone union was achieved in all patients within a mean time of 4.1 months. The patients treated with manual reduction or percutaneous leverage reduction showed excellent results. Three patients, however, treated with open reduction showed 10 to 20° limitation in range of motion of the elbow. No other complications were seen. Percutaneous K-wire leverage and CIMP are safe and effective for the treatment of pediatric Judet III and IV radial neck fractures. PMID:26735536

  6. Extrapedicular Infiltration Anesthesia as an Improved Method of Local Anesthesia for Unipedicular Percutaneous Vertebroplasty or Percutaneous Kyphoplasty

    Directory of Open Access Journals (Sweden)

    Liehua Liu

    2016-01-01

    Full Text Available Aim. This report introduces extrapedicular infiltration anesthesia as an improved method of local anesthesia for unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty. Method. From March 2015 to March 2016, 44 patients (11 males and 33 females with osteoporotic vertebral compression fractures with a mean age of 71.4±8.8 years (range: 60 to 89 received percutaneous vertebroplasty or percutaneous kyphoplasty. 24 patients were managed with conventional local infiltration anesthesia (CLIA and 20 patients with both CLIA and extrapedicular infiltration anesthesia (EPIA. Patients evaluated intraoperative pain by means of the visual analogue score and were monitored during the procedure for additional sedative analgesia needs and for adverse nerve root effects. Results. VAS of CLIA + EPIA and CLIA group was 2.5±0.7 and 4.3±1.0, respectively, and there was significant difference (P=0.001. In CLIA group, 1 patient required additional sedative analgesia, but in CLIA + EPIA group, no patients required that. In the two groups, no adverse nerve root effects were noted. Summary. Extrapedicular infiltration anesthesia provided good local anesthetic effects without significant complications. This method deserves further consideration for use in unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty.

  7. Extrapedicular Infiltration Anesthesia as an Improved Method of Local Anesthesia for Unipedicular Percutaneous Vertebroplasty or Percutaneous Kyphoplasty

    Science.gov (United States)

    2016-01-01

    Aim. This report introduces extrapedicular infiltration anesthesia as an improved method of local anesthesia for unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty. Method. From March 2015 to March 2016, 44 patients (11 males and 33 females) with osteoporotic vertebral compression fractures with a mean age of 71.4 ± 8.8 years (range: 60 to 89) received percutaneous vertebroplasty or percutaneous kyphoplasty. 24 patients were managed with conventional local infiltration anesthesia (CLIA) and 20 patients with both CLIA and extrapedicular infiltration anesthesia (EPIA). Patients evaluated intraoperative pain by means of the visual analogue score and were monitored during the procedure for additional sedative analgesia needs and for adverse nerve root effects. Results. VAS of CLIA + EPIA and CLIA group was 2.5 ± 0.7 and 4.3 ± 1.0, respectively, and there was significant difference (P = 0.001). In CLIA group, 1 patient required additional sedative analgesia, but in CLIA + EPIA group, no patients required that. In the two groups, no adverse nerve root effects were noted. Summary. Extrapedicular infiltration anesthesia provided good local anesthetic effects without significant complications. This method deserves further consideration for use in unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty. PMID:27766261

  8. Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations

    Directory of Open Access Journals (Sweden)

    Doniel Drazin

    2015-01-01

    Full Text Available Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior instrumentation is traditionally performed in two stages requiring repositioning. We describe a novel technique to complete the circumferential procedure simultaneously without patient repositioning. Twenty patients diagnosed with worsening back pain with/without radiculopathy who failed exhaustive conservative management were retrospectively reviewed. Ten patients with both procedures simultaneously from a single lateral approach and 10 control patients with lateral lumbar interbody fusion followed by repositioning and posterior percutaneous instrumentation were analyzed. Pars fractures, mobile grade 2 spondylolisthesis, and severe one-level degenerative disk disease were matched between the two groups. In the simultaneous group, avoiding repositioning leads to lower mean operative times: 130 minutes (versus control 190 minutes; p=0.009 and lower intraoperative blood loss: 108 mL (versus 93 mL; NS. Nonrepositioned patients were hospitalized for an average of 4.1 days (versus 3.8 days; NS. There was one complication in the control group requiring screw revision. Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position. In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning. Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.

  9. SURGICAL PERCUTANEOUS TREATMENT OF AN ACUTE RUPTURE OF ACHILLES TENDON IN ATHLETES

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    Zarko Dasic

    2005-01-01

    Full Text Available We have registered that with growing interest of the middle-aged in sport activities in our country the incidence of Achilles tendon ruptures has increased. It was usually preceded by its degenerative changes. Our aim was to examine the results of Achiles tendon rupture treatment in the group treated with our modified percutaneous technique with double - crossed suture.We compared these results with those obtained by the treatment with the nonsurgical method.Our study included 139 patients who gained injuries during their sports activities. They were active professionals or ex-active who continued training sports for recreation, and finally, amateurs who trained sports for the sake of recreation. We also analyzed differences in the results of those three groups after the treatment and checked them statistically.The results have showed superiority of this percutaneous operative treatment because of its simple operative technique, possibility of doing it in the local anaesthesia, continuous ultrasonographic following of the rupture during the process of healing up and shorter immobilisation time, practically without hospitalization and rare complications.

  10. Percutaneous coronary intervention following repair of type B aortic dissection: a report of 8 cases

    Institute of Scientific and Technical Information of China (English)

    Quanmin Jing; Xiaozeng Wang; Yaling Han; Bo Luan; Geng Wang; Xiaojiang Liu; Hongxu Jin

    2008-01-01

    Objective Patients with aortic dissection have a significant incidence of coronary artery disease.The purpose of this study is to evaluate the safety and feasibility of percutaneous coronary stent in patients who have undergone endovascular stent,and to assess the effect of anti-coagulant and anti-platelet treatment on patients' thrombosis process.Methods From January 2005 to July 2007,8 patients who had undergone endovascular stent-graft during the past 1 to 7 months for type B aortic dissection repair,underwent percutaneous coronary intervention (PCI) because of coexisting coronary artery disease.Anti-coagulant and anti-platelet treatments were administrated after PCI according to the standard protocol.Patients were followed up for a mean period of 23 months.Clinical and false lumen status data were collected during the follow-up.Results PCI were technically successful in all 8 patients and no severe complications such as death,paraplegia,renal failure occurred during hospitalization.Complete false lumen thrombosis was observed in 5 patients and incomplete false lumen thrombosis in the remained 3 patients at the end of follow up.There were no major complications such as death,dissection rupture or aneurysm development occurred during the follow-up period.Conclusion Our data implied that PCI can be safely performed in patients with type B aortic dissection who have undergone endovascular stent-graft,without interrupting the thrombosis process.

  11. Hospitality within hospital meals –

    DEFF Research Database (Denmark)

    Justesen, Lise; Gyimóthy, Szilvia; Mikkelsen, Bent Egberg

    2016-01-01

    Hospital meals and their role in nutritional care have been studied primarily from a life and natural science perspective. This article takes a different approach and explores the idea of hospitality inspired by Jacques Derrida’s work on the ontology of hospitality. By drawing on ethnographic...... fieldwork in a Danish hospital, hospitality practices were studied using a socio-material assemblage approach. The study showed that rethinking the meal event could change the wards into temporary “pop-up-restaurants,” transcending the hospital context and providing a scene for shifting host...... and management involved in hospital food service and in nutritional care to work more systematically with the environment for improved hospital meal experiences in the future...

  12. Multidisciplinary Assessment in Optimising Results of Percutaneous Patent Foramen Ovale Closure.

    Science.gov (United States)

    Davies, Allan; Ekmejian, Avedis; Collins, Nicholas; Bhagwandeen, Rohan

    2017-03-01

    Percutaneous patent foramen ovale (PFO) closure is a therapeutic option to prevent recurrent cerebral ischaemia in patients with cryptogenic stroke and transient cerebral ischaemia (TIA). The apparent lack of benefit seen in previous randomised trials has, in part, reflected inclusion of patients with alternate mechanisms of stroke. The role of formal neurology involvement in accurately delineating the likely aetiology of stroke or TIA is crucial in appropriate identification of patients for device closure. Furthermore, as the benefits of device closure may accrue over time, long-term follow-up is essential to define the role of device closure in management of presumed cryptogenic stroke. We retrospectively reviewed our experience with percutaneous PFO device closure since 2005. All subjects who underwent PFO closure at John Hunter and Lake Macquarie Private Hospitals were included in the study. All patients referred for device closure following cryptogenic stroke or TIA had first undergone formal neurology review with appropriate imaging and exclusion of paroxysmal atrial arrhythmia. Patients with a history of transient ischaemic attack (TIA) are frequently referred to a specialised clinic, aimed to identify patients with conditions not referable to cerebral ischaemia, with investigations initiated by the specialist clinic to elucidate an underlying aetiology. Outcome data was derived from the Hunter New England Area Local Health District Cardiac and Stroke Outcomes Unit, in addition to review of the medical record. The Cardiac and Stroke Outcomes Unit prospectively identified all patients presenting with stroke, TIA and atrial fibrillation. One hundred and twelve consecutive patients undergoing percutaneous patent foramen ovale closure between 2005 and 2015 were identified. The average age was 42.7 years and 57 (50.9%) patients were male. Cryptogenic stroke (68.8%) and transient cerebral ischaemia (23.2%) were the most common indications for PFO closure, with the

  13. Experience of percutaneous access under ultrasound guidance in renal transplant patients with allograft lithiasis

    Directory of Open Access Journals (Sweden)

    Silvano Palazzo

    2016-12-01

    Full Text Available Objective: Urolithiasis of the transplanted kidney has an incidence of 0.2 to 1.7%, it increases the risk of infection in immunosuppressed patients and it can lead to ureteral obstruction that is often associated with deterioration of renal function. Urolithiasis of the transplanted kidney has different characteristics compared to the native kidney, due to the absence of innervation, which does not lead to colic pain. Percutaneous approach is an optimal choice in transplant patients. Material and methods: Here we report our experience in two cadaveric transplant patients with urolithiasis. The first case was a patient of 68 years with a 20 mm stone located in the transplanted kidney pelvis and another smaller in a lower calyx. The second case was a patient of 65 years with a 15 mm stone in the distal part of the transplanted ureter. In both cases the patients were asymptomatic, but they had a reduction in urine output associated with worsening of the transplanted kidney function. The diagnosis was performed in both cases with ultrasound study, showing a severe hydronephrosis and it was confirmed by computed tomography scan. In both cases, we performed a Percutaneous Nephrolithotomy (PCNL. Access was made after targeting the stone, through a lower pole puncture under ultrasound guidance. The first case was treated with pneumatic and laser energy, breaking stones through a nephroscope. In the second case we performed a laser lithotripsy of the ureteral stone, using a flexible videoureteroscope. At the end of both procedures a Double-J stent and a 14 Fr Malecot nephrostomy were positioned, that were removed at 6 weeks and 10 days, respectively. Results: Both patients achieved a resolution of the worsening of renal function, recovering the spontaneous diuresis. The surgical procedure using ultrasound guidance was safe and allowed quick access to the renal pelvis. Both patients experienced no bleeding or infection during hospitalization. Conclusions

  14. Percutaneous microwave ablation combined with simultaneous transarterial chemoembolization for the treatment of advanced intrahepatic cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Yang GW

    2015-05-01

    Full Text Available Guo-Wei Yang,* Qing Zhao,* Sheng Qian, Liang Zhu, Xu-Dong Qu, Wei Zhang, Zhi-Ping Yan, Jie-Min Cheng, Qing-Xin Liu, Rong Liu, Jian-Hua Wang Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China *These authors contributed equally to this work Aim: To retrospectively evaluate the safety and efficacy of ultrasound-guided percutaneous microwave ablation (MWA combined with simultaneous transarterial chemoembolization (TACE in the treatment of patients with advanced intrahepatic cholangiocarcinoma (ICC.Methods: All patients treated with ultrasound-guided percutaneous MWA combined with simultaneous TACE for advanced ICC at our institution were included. Posttreatment contrast-enhanced computed tomography and/or magnetic resonance imaging were retrieved and reviewed for tumor response to the treatment. Routine laboratory studies, including hematology and liver function tests were collected and analyzed. Procedure-related complications were reviewed and survival rates were analyzed.Results: From January 2011 to December 2014, a total of 26 advanced ICC patients were treated at our single institute with ultrasound-guided percutaneous MWA combined with simultaneous TACE. There were 15 males and eleven females with an average age of 57.9±10.4 years (range, 43–75 years. Of 26 patients, 20 (76.9% patients were newly diagnosed advanced ICC without any treatment, and six (23.1% were recurrent and treated with surgical resection of the original tumor. The complete ablation rate was 92.3% (36/39 lesions for advanced ICC. There were no major complications observed. There was no death directly from the treatment. Median progression-free survival and overall survival were 6.2 and 19.5 months, respectively. The 6-, 12-, and 24-month survival rates were 88.5%, 69.2%, and 61.5%, respectively.Conclusion: The study suggests that ultrasound-guided percutaneous MWA combined with simultaneous TACE

  15. Comparing the Efficacy and Safety of Ultrasonic Versus Pneumatic Lithotripsy in Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

    Science.gov (United States)

    Radfar, Mohammad Hadi; Basiri, Abbas; Nouralizadeh, Akbar; Shemshaki, Hamidreza; Sarhangnejad, Reza; Kashi, Amir Hossein; Narouie, Behzad; Soltani, Amir Mohammad; Nasiri, Mahmoudreza; Sotoudeh, Mehdi

    2017-02-01

    Percutaneous nephrolitotomy (PCNL) is the preferred treatment for large renal stones. There is a need for more comparative data for different lithotripters used in PCNL. To evaluate the comparative safety and efficacy of ultrasonic and pneumatic lithotripsy in patients undergoing PCNL. This randomized clinical trial was conducted at Labbafinejad University Hospital, Tehran, Iran. A total of 180 patients were selected and divided randomly into two groups: 88 patients to pneumatic and 92 to ultrasonic lithotripsy. Standard fluoroscopy-guided PCNL was performed using pneumatic or ultrasonic lithotripsy. The primary outcome was the procedure success rate. We also evaluated other outcome measures including operation time, stone fragmentation and removal time (SFRT), length of hospital stay, and postoperative complications. We used SPSS software version 18.0 for data analysis. The two groups were similar in baseline characteristics. There were no significant differences between the groups in stone fragmentation and removal time (p=0.63), stone free rate (p=0.44), and hospital stay (p=0.66). SFRT for hard stones was shorter using pneumatic lithotripsy (ppneumatic and ultrasonic lithotripsy. SFRT was significantly shorter using pneumatic lithotripsy for hard stones, and ultrasonic lithotripsy for soft stones. We found no significant differences in the success rate and complications of percutaneous nephrolitotomy using pneumatic and ultrasonic lithotripsy. Ultrasonic and pneumatic lithotripsy differed in the time for stone fragmentation and removal for hard and soft stones. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  16. Successful percutaneous coronary intervention during cardiac arrest with use of an automated chest compression device: a case report

    Directory of Open Access Journals (Sweden)

    Libungan B

    2014-04-01

    Full Text Available Berglind Libungan, Christian Dworeck, Elmir OmerovicDepartment of Cardiology, Sahlgrenska University Hospital, Göteborg, SwedenAbstract: Ventricular tachycardia or fibrillation (VT/VF in patients with ST-elevation myocardial infarction (STEMI is associated with poor prognosis. Performing manual chest compressions is a serious obstacle for treatment with percutaneous coronary intervention (PCI. Here we introduce a case with refractory VT/VF where the patient was successfully treated with an automated chest compression device, which made revascularization with PCI possible.Keywords: PCI, LUCAS, STEMI, automatic chest compressions, ventricular fibrillation, mechanical CPR

  17. Percutaneous Needle Tenotomy for the Treatment of Muscle and Tendon Contractures in Adults With Brain Damage: Results and Complications.

    Science.gov (United States)

    Coroian, Flavia; Jourdan, Claire; Froger, Jérome; Anquetil, Claire; Choquet, Olivier; Coulet, Bertand; Laffont, Isabelle

    2017-05-01

    To study the results and complications of percutaneous needle tenotomy for superficial retracted tendons in patients with brain damage. Prospective observational study. University hospital. Patients with severe brain damage (N=38; mean age, 60.7y; age range, 24-93y; 21 women) requiring surgical management of contractures and eligible for percutaneous needle tenotomy were enrolled between February 2015 and February 2016. The percutaneous needle tenotomy gesture was performed by a physical medicine and rehabilitation physician trained by an orthopedic surgeon, under local or locoregional anesthesia. Treated tendons varied among patients. All patients were evaluated at 1, 3, and 6 months to assess surgical outcomes (joint range of motion [ROM], pain, and functional improvement) while screening for complications. Improvements in ROM (37/38) and contractures-related pain (12/12) were satisfactory. Functional results were satisfactory (Goal Attainment Scale score ≥0) for most patients (37/38): nursing (n=12), putting shoes on (n=8), getting in bed or sitting on a chair (n=6), verticalization (n=7), transfers and gait (n=8), and grip (n=2). Five patients had complications related to the surgical gesture: cast-related complications (n=2), hand hematoma (n=2), and cutaneous necrosis of the Achilles tendon in a patient with previous obliterative arteriopathy of the lower limbs (n=1). Percutaneous needle tenotomy yields good results in the management of selected superficial muscle and tendon contractures. The complications rate is very low, and this treatment can be an alternative to conventional surgery in frail patients with neurologic diseases. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  18. Effect of sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit.

    Science.gov (United States)

    Ryu, Min-Jung; Park, Jeong Sook; Park, Heeok

    2012-03-01

    The study compared the effect of earplug-delivered sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit. Diverse types of music have been claimed to improve sleeping elsewhere, but relatively little is known in South Korea. Most studies investigating the effect of sleep-inducing music on sleep have involved persons with insomnia, even though many persons with cardiovascular disease in the intensive care unit suffer from sleeping problems. There is a need to investigate the effect of sleep-inducing music on sleep disorders in persons with percutaneous transluminal coronary angiography in the cardiac care unit. An experimental research design was used. Data collection was conducted in the cardiac care unit of K University Hospital in D city, from 3 September-4 October 2010. Fifty-eight subjects participated and were randomly assigned to the experimental group (earplug-delivered sleep-inducing music for 52 min beginning at 10:00 pm, while wearing an eyeshield, n = 29) and the control group (no music, but earplugs and eyeshield worn, n = 29). The quantity and quality of sleep were measured using questionnaires at 7 am the next morning for each group. Participants in the experimental group reported that the sleeping quantity and quality were significantly higher than control group (t = 3·181, p = 0·002, t = 5·269, p music significantly improved sleep in patients with percutaneous transluminal coronary angiography at a cardiac care unit. Offering earplugs and playing sleep-inducing music may be a meaningful and easily enacted nursing intervention to improve sleep for intensive care unit patients. Nurses working at cardiac care unit can use music to improve sleeping in clients with percutaneous transluminal coronary angiography. © 2011 Blackwell Publishing Ltd.

  19. Analysis of complications of percutaneous X-Ray endoscopic surgical operations of patients with urolithiasis and nephrolithiasis with a single functioning kidney

    Directory of Open Access Journals (Sweden)

    S. S. Zenkov

    2015-01-01

    Full Text Available The presented article focuses on the important matters of development of intraoperative and postoperative complications in patients with urolithiasis undergoing percutaneous operative treatment for coral calculus of a solitary or sole functioning kidney. Complications of percutaneous X-ray-endoscopic operations in these patients always require careful medical and diagnostic approach, as they can lead to oppression of an already impaired solitary kidney function and, as a consequence, can have life-threatening nature. They are divided into two groups: intraoperative and postoperative complications. Intraoperative complications include: bleeding, damage of the renal pelvis in the course of creating of puncture access, perforation of internal organs, loss of stroke. Postoperative complications include: development of acute inflammation in a single kidney, bleeding, urinoma or hematoma development, progression of renal failure, leave of residual concretions, organ loss. There is a sufficient amount of data on the development of complications after percutaneous endoscopic surgeries in the literature, but very few works are devoted to a solitary kidney matter. The object of this study was the group of patients with urolithiasis, coral nephrolithiasis by a solitary or a single functioning kidney, who were on treatment in the urology department of the N.I. Pirogov City Clinical Hospital No. 1 from January 2007 to July 2014. All patients underwent percutaneous operative treatment for the removal of coral calculi. 

  20. Percutaneous dilatational tracheostomy without fiber optic bronchoscopy-Evaluation of 80 intensive care units cases

    NARCIS (Netherlands)

    J.A. Calvache (Jose Andrés); R.A. Molina García (Rodrigo); A.L. Trochez (Adolfo); J. Benitez (Javier); L.A. Flga (Lucía Arroyo)

    2013-01-01

    textabstractBackground: The development of percutaneous dilatational tracheostomy techniques (PDT) has facilitated the procedure in Intensive Care Units (ICU). Objective: To describe the early intra and post-operative complications in ICU patients requiring percutaneous dilatational tracheostomy usi

  1. Clinical and Angiographic Factors Associated With Asymptomatic Restenosis After Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    P.N. Ruygrok (Peter); M.W.I. Webster (Mark); V. de Valk (Vincent); G.A. van Es (Gerrit Anne); J.A. Ormiston (John); M-A.M. Morel (Marie-Angèle); P.W.J.C. Serruys (Patrick)

    2001-01-01

    textabstractBACKGROUND: Angiographic restenosis after percutaneous coronary interventional procedures is more common than recurrent angina. Clinical and angiographic factors associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention were compared. METHODS AND

  2. Percutaneous dilatational tracheostomy without fiber optic bronchoscopy-Evaluation of 80 intensive care units cases

    NARCIS (Netherlands)

    J.A. Calvache (Jose Andrés); R.A. Molina García (Rodrigo); A.L. Trochez (Adolfo); J. Benitez (Javier); L.A. Flga (Lucía Arroyo)

    2013-01-01

    textabstractBackground: The development of percutaneous dilatational tracheostomy techniques (PDT) has facilitated the procedure in Intensive Care Units (ICU). Objective: To describe the early intra and post-operative complications in ICU patients requiring percutaneous dilatational tracheostomy usi

  3. Percutaneous quadriceps tendon pie-crusting release of extension contracture of the knee

    National Research Council Canada - National Science Library

    Liu, H X; Wen, H; Hu, Y Z; Yu, H C; Pan, X Y

    2014-01-01

    ...: percutaneous quadriceps tendon pie-crusting release. Percutaneous pie-crusting release was performed using an 18-gauge needle to puncture the stiff fibrous band of the distal and lateral quadriceps tendon under maximum knee flexion...

  4. The CROES percutaneous nephrolithotomy global study: the influence of body mass index on outcome

    DEFF Research Database (Denmark)

    Fuller, Andrew; Razvi, Hassan; Denstedt, John D;

    2012-01-01

    In addition to more commonly forming stones, obese patients present a number of challenges when undergoing percutaneous nephrolithotomy. We evaluated percutaneous nephrolithotomy outcomes in 3,709 patients stratified by body mass index....

  5. Upper urinary tract stone disease: the changing management in a district general hospital.

    OpenAIRE

    Goble, N M; Hammonds, J C; Wells, I P

    1987-01-01

    The advent of percutaneous nephrolithotomy (PCN) and ureteroscopy, in combination with stone disruption techniques, has dramatically altered the management of upper urinary tract stone disease. These advances are not necessarily confined to the teaching centres. The problems encountered introducing these techniques in a District General Hospital and their impact on the surgical management of upper urinary tract stones is presented.

  6. PERCUTANEOUS REDUCTION WITH K-WIRES OF A BIMALLEOLAR SALTER HARRIS III: A CASE REPORT.

    Directory of Open Access Journals (Sweden)

    Luigi Meccariello

    2012-04-01

    Full Text Available A Salt Harris Fracture is a fracture involving the epiphyseal plate or growth plate of a bone. It is a common injury found in children; occurring in 15% of childhood long bone fractures. Injuries of the ankle joint are common. In our case report, we describe the case of a thirteen-year-old patient under our treatment at the Orthopaedic emergency depart-ment of Val D’Elsa Hospital (in Campostaggia Poggibonsi, Siena, who presented with a bimalleolar Salter Harris III fracture after a sport trauma. We reduced the bimalleolar Salter Harris III with percutaneous K-wires instead of an open access and two screws (one on the top and another on the bottom of the epiphyseal plate of distal tibia. We per-formed it according to a revision of scientific literature. The result was a satisfactory re-duction of the bimalleolar Salter Harris III.

  7. Hepatic Encephalopathy due to Congenital Multiple Intrahepatic Portosystemic Venous Shunts Successfully Treated by Percutaneous Transhepatic Obliteration

    Directory of Open Access Journals (Sweden)

    Shinsuke Takenaga

    2016-11-01

    Full Text Available Hepatic encephalopathy due to intrahepatic portosystemic venous shunts (IPSVS in a non-cirrhotic condition is rare. Here we report a rare case of a patient with congenital multiple IPSVS successfully treated by percutaneous transhepatic obliteration. The patient was a 67-year-old woman who presented to our hospital with progressive episodes of consciousness disorder and vomiting. Laboratory tests revealed hyperammonemia (192.0 μg/dL, and computed tomography revealed multiple IPSVS in both lobes. There was no evidence of underlying liver disease or hepatic trauma. Transcatheter embolization for IPSVS was performed because conservative therapy was not sufficiently effective. After endovascular shunt closure, hepatic encephalopathy improved. The serum ammonia level normalized during the 5-year follow-up period. Thus, transcatheter embolization may be an effective therapy for patients with symptomatic and refractory IPSVS. Careful follow-up is necessary for portal hypertension-related complications after transcatheter embolization for IPSVS.

  8. Percutaneous blood exposure among Danish doctors: exposure mechanisms and strategies for prevention

    DEFF Research Database (Denmark)

    Nelsing, S; Nielsen, T L; Nielsen, Jens Ole

    1997-01-01

    The objective of this study was to describe the mechanisms of percutaneous blood exposure (PCE) among doctors and discuss rational strategies for prevention. Data were obtained as part of a nation-wide questionnaire survey of occupational blood exposure among hospital employed doctors in Denmark.......5% of all PCE. Use of fingers rather than instruments was a major cause of injury in surgical specialities and was a contributing cause of 36.9% PCE on suture needles. Common contributing causes when fingers were used (n = 199) were poor space in (30.2%) or view of (18.6%) the operation field. It was often...... and 'acute situation' were common, especially in the case of PCE on i.v.-catheter-stylets. It is concluded that the exposure mechanisms of PCE reflect both unsafe routines, difficult working conditions and unsafe devices. Education in safer working routines are needed in all specialties. Introduction...

  9. Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

    Energy Technology Data Exchange (ETDEWEB)

    Courtney, Malachi; Ayyagari, Raj R. [Yale School of Medicine, Yale New Haven Hospital, New Haven, CT (United States); Division of Interventional Radiology, Department of Radiology, 789 Howard Avenue, P.O. Box 208042, New Haven, CT (United States)

    2015-06-15

    Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

  10. The clinical research office of the endourological society percutaneous nephrolithotomy global study

    DEFF Research Database (Denmark)

    Desai, Mahesh; De Lisa, Antonello; Turna, Burak

    2011-01-01

    PURPOSE: The study compared characteristics and outcomes in patients with staghorn or nonstaghorn stones who were treated with percutaneous nephrolithotomy (PCNL) within the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study. PATIENTS AND METHODS: Data over a 1-year...... period from consecutively treated patients from 96 centers worldwide were collated. The following variables in patients with staghorn or nonstaghorn stones were compared: National prevalence, patient characteristics, access method, puncture frequency and outcomes, including bleeding rates, operative time...... punctures more frequently than those with nonstaghorn stones (16.9% vs 5.0%). Postoperative fever, bleeding, and the need for blood transfusion were more frequent, the median operative time and duration of hospital stay were longer, while the proportion of patients remaining stone free was lower (56.9% vs...

  11. Complications of percutaneous renal tumor biopsy: An analysis of 340 consecutive biopsies

    DEFF Research Database (Denmark)

    René Rasmussen, Lars; Loft, Martina; Høyer, Søren;

    Purpose Ultrasound Guided Percutaneous Kidney Biopsy (UGPKB) plays a major role in diagnosis of renal tumours. There seems to be little consensus regarding post-biopsy observation period. We aim to identify complications in UGPKB among outpatients with a suspected malignant renal lesion as well...... as the timing of onset of these complications, helping to clarify the optimal observation period. Many studies in this field suggest a lower complication risk for outpatients compared to hospitalized patients. In the latter group, an observation period of 24h after biopsy is often recommended. Material...... discrepancy. Results As for one third of the patients, analysed up until now, we find a total of one major complication and a few minor, all arisen within less than 6 hours after biopsy. Conclusions Rates of both major and minor complications in UGPKB are very low suggesting a shorter observation period...

  12. Hospitality Industry

    Directory of Open Access Journals (Sweden)

    Marian Ionel

    2017-03-01

    Full Text Available Development of accommodation, as basic services offered to tourists, led to the creation of a genuine hospitality industry. Currently, the hospitality industry is no longer just the accommodation service itself but also requires an atmosphere that ensures leisure tourists in the hotel. Thus, hospitable unit manager offers its service in addition to accommodation and catering services, leisure services, treatment services, business services required.. The existence of factors such as revenue growth, increasing leisure time, the development of transport services, the emergence of new tourist attractions have caused increasing international flows of tourists, with consequent development of units hospitable, and therefore a strong hospitality industry. In Romania, after 1990, the tourism sector experienced a true expansion, both through the development of the hotel sector, but also by developing rural hospitality units.

  13. Percutaneous balloon valvuloplasty in mitral stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Oh, Byung Hee; Park, Kyung Ju; Kim, Seung Hyup; Lee, Young Woo; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1989-02-15

    Percutaneous balloon valvuloplasty(PBV) was successfully performed in 8 mitral stenosis patients for recent 3 months. Five patients have aortic insufficiencies also and two patients have mitral regurgitations below grade II/IV. All patients showed sinus rhythm on EKG, and had no mitral valvular calcification on echocardiography and fluoroscopy. PBV resulted in an increase in mitral valve area from 1.22{+-}0.22 to 2.57{+-}0.86 cm{sup 2}, a decrease in mean left atrial pressure from 23.4{+-}9.6 to 7.5{+-}3.4 mmHg and a decrease in mean mitral pressure gradient from 21.3{+-}9.4 to 6.8{+-}3.1 mmHg. There were no significant complications except 2 cases of newly appeared and mildly aggravated mitral regurgitation. We believe that PBV will become a treatment modality of choice replacing surgical commissurotomy or valve replacement in a group of mitral stenosis patients, because of its effectiveness and safety.

  14. Percutaneous nephrolithotomy through an intercostal approach

    Energy Technology Data Exchange (ETDEWEB)

    Narasimham, D.L.; Jacobsson, B.; Vijayan, P.; Bhuyan, B.C.; Nyman, U.; Holmquist, B. (Hamad General Hospital (Qatar). Dept. of Diagnostic Radiology Hamad General Hospital (Qatar). Dept. of Urology)

    1991-03-01

    During a 5-year period percutaneous nephrolithotripsy through an intercostal space was performed in 56 of 231 procedures. Minimal thoracic complications were seen in 3 of 53 patients with 11th intercostal space tracts into a lower, middle, or upper pole calyx. A working sheath and a pyelostomy drainage catheter were used in all these cases. Hydro- and pneumothorax requiring treatment occurred in 2 of 3 patients with a 10th intercostal space approach into an upper pole calyx combined with improper use of the working sheath and/or the pyelostomy catheter. Review of the literature also indicates that an intercostal approach appears safe when performed via the 11th intercostal space into a lower or middle pole calyx. Thoracic complications occurred when punctures were made towards an upper pole calyx or above the 11th rib. The complications may be limited by identifying the posterior inferior lung border by fluoroscopy during puncture, and performing it under general anesthesia with controlled breath-holding. The use of a working sheath to seal the pleural opening during the procedure and an efficient pyelostomy drainage catheter to allow free drainage of uring and to tamponade the tract postoperatively are also recommended. (orig.).

  15. Percutaneous aspiration thromboembolectomy: a preliminary experience.

    Science.gov (United States)

    Murray, J G; Brown, A L; Wilkins, R A

    1994-08-01

    Percutaneous aspiration thromboembolectomy (PAT) is a radiological alternative to surgical embolectomy or thrombolysis in the treatment of acute arterial thromboembolic disease. We report our experience in eight patients aged 63-83 years (mean 71 years). Indications were graft thrombosis (1) or emboli from atrial fibrillation (3), abdominal aneurysm (2) or proximal angioplasty (2). PAT was performed at 10 arterial sites; common iliac (1), profunda femoris (1), superficial femoral (2), femoro-popliteal graft (1), popliteal (2) and arteries of the trifurcation (3). PAT was used as an adjunct to thrombolysis or angioplasty in five patients and as the sole procedure in three patients. It was successful in six patients (seven sites) with mean ABI rising from 0.4 pre- to 0.8 post-procedure. Two of the failures required amputations. One of these was a completely thrombosed dacron femoro-popliteal graft with poor run-off, and the second case had a failed surgical embolectomy prior to amputation. There were no major complications, and no mortality on follow-up at 1 month. PAT is a useful adjunct to thrombolysis and balloon angioplasty in the radiological treatment of acute thromboembolic disease. In patients in whom thrombolysis is contraindicated, it offers an alternative to surgical embolectomy.

  16. Percutaneous microballoon compression for trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    LIU Hong-bing; MA Yi; ZOU Jian-jun; LI Xin-gang

    2007-01-01

    Background Percutaneous microballoon compression (PMC) for trigeminal neuralgia is an important therapeutic method. The aim of this study was to review the effects of PMC for trigeminal neuralgia in 276 patients.Methods From December 2000 to May 2003, 276 patients with trigeminal neuralgia were treated with PMC. The course of the disease ranged from 3 months to 38 years. Under the guidance of C-arm X-ray, 14# needle was placed into the foramen ovale using the classical Hakanson's technique. Fogarty balloon catheter was navigated into the Meckel's cave tenderly. A small amount of Omnipaque was slowly injected to inflate the balloon and compress the trigeminal ganglion for 3 to10 minutes.Results A total of 290 PMC were performed on the 276 patients. Among them, 252 had immediate relief from pain. The patients were followed up for a mean of 18.7 months (range, 4 to 32), 14 of them had a recurrence. Of the 14 patients, 12 were re-operated with PMC, and the pain was all controlled successfully.Conclusions PMC is an effective and technically simple method for trigeminal neuralgia. For older patients with trigeminal neuralgia, it may be the first choice.

  17. Percutaneous vertebroplasty: Current concepts and local experience

    Directory of Open Access Journals (Sweden)

    Hee Hwan

    2005-01-01

    Full Text Available With the aging population in our country, symptomatic osteoporotic compression fractures are increasingly common. Osteolytic compression fractures from spinal metastasis are also becoming more frequently seen because of the longer life expectancy from improvements in chemotherapy. Percutaneous vertebroplasty with PMMA has been shown to be an efficient procedure to treat pain due to these fractures. It is a minimally invasive procedure performed under local anesthesia and sedation. Injection of PMMA provides immediate stability when it hardens, and permits the patient to ambulate without pain. Appropriate patient selection is the key to clinical success. However, this procedure must be treated with respect, and has to be performed by physicians with the necessary training. Otherwise, increased pain, paralysis, and even death may occur from this seemingly innocuous procedure. In this article, I will deal with the background issues of osteoporotic and osteolytic vertebral compression fractures, patient selection, surgical technique, complications, and review of current literature on vertebroplasty. Key areas of development in this field include the use of kyphoplasty, defining the role of prophylactic augmentation, and improvements in biomaterials.

  18. Minimizing radiation exposure during percutaneous nephrolithotomy.

    Science.gov (United States)

    Chen, T T; Preminger, G M; Lipkin, M E

    2015-12-01

    Given the recent trends in growing per capita radiation dose from medical sources, there have been increasing concerns over patient radiation exposure. Patients with kidney stones undergoing percutaneous nephrolithotomy (PNL) are at particular risk for high radiation exposure. There exist several risk factors for increased radiation exposure during PNL which include high Body Mass Index, multiple access tracts, and increased stone burden. We herein review recent trends in radiation exposure, radiation exposure during PNL to both patients and urologists, and various approaches to reduce radiation exposure. We discuss incorporating the principles of As Low As reasonably Achievable (ALARA) into clinical practice and review imaging techniques such as ultrasound and air contrast to guide PNL access. Alternative surgical techniques and approaches to reducing radiation exposure, including retrograde intra-renal surgery, retrograde nephrostomy, endoscopic-guided PNL, and minimally invasive PNL, are also highlighted. It is important for urologists to be aware of these concepts and techniques when treating stone patients with PNL. The discussions outlined will assist urologists in providing patient counseling and high quality of care.

  19. Chemosaturation Percutaneous Hepatic Perfusion: A Systematic Review.

    Science.gov (United States)

    Vogel, Arndt; Gupta, Sanjay; Zeile, Martin; von Haken, Rebecca; Brüning, Roland; Lotz, Gösta; Vahrmeijer, Alexander; Vogl, Thomas; Wacker, Frank

    2017-01-01

    The Hepatic CHEMOSAT(®) Delivery System is an innovative medical device for the treatment of patients with unresectable primary liver tumors or unresectable hepatic metastases from solid organ malignancies. This system is used to perform chemosaturation percutaneous hepatic perfusion (CS-PHP), a procedure in which a high dose of the chemotherapeutic agent melphalan is delivered directly to the liver while limiting systemic exposure. In a clinical trial program, CS-PHP with melphalan significantly improved hepatic progression-free survival in patients with unresectable hepatic metastases from ocular or cutaneous melanoma. Clinically meaningful hepatic responses were also observed in patients with hepatocellular carcinoma or neuroendocrine tumors. Furthermore, the results of published studies and case reports demonstrated that CS-PHP with melphalan resulted in favorable tumor response rates in a range of tumor histologies (ocular or cutaneous melanoma, colorectal cancer, and hepatobiliary tumors). Analyses of the safety profile of CS-PHP revealed that the most common adverse effects were hematologic events (thrombocytopenia, anemia, and neutropenia), which were clinically manageable. Taken together, these findings indicate that CS-PHP is a promising locoregional therapy for patients with primary and secondary liver tumors and has a acceptable safety profile.

  20. Percutaneous Aspiration Thrombectomy for the Treatment of Arterial Thromboembolic Occlusions Following Percutaneous Transluminal Angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Schleder, Stephan, E-mail: stephan.schleder@ukr.de [University Hospital Regensburg, Department of Radiology (Germany); Diekmann, Matthias [Radiology Center Rahlstedt (Germany); Manke, Christoph [General Hospital Fulda, Department of Radiology (Germany); Heiss, Peter [University Hospital Regensburg, Department of Radiology (Germany)

    2015-02-15

    PurposeThis study was designed to evaluate the technical success and the early clinical outcome of patients undergoing percutaneous aspiration thrombectomy (PAT) for the treatment of arterial thromboembolism following percutaneous infrainguinal transluminal angioplasty (PTA).MethodsIn this single-center study, during a period of 7 years retrospectively, 47 patients (22 male, 47 %) with a mean age of 73 (range 53–96) years were identified in whom PAT was performed for the treatment of thromboembolic complications of infrainguinal PTA. Primary technical success was defined as residual stenosis of <50 % in diameter after sole PAT, whereas secondary technical success was defined as residual stenosis of <50 % in diameter after PAT and additional PTA and/or stenting. Clinical outcome parameters (e.g., need for further intervention, minor/major amputation) were evaluated for the 30-day postinterventional period.ResultsPrimary technical success was achieved in 64 % of patients (30/47); secondary technical success was obtained in 96 % of patients (45/47). Clinical outcome data were available in 38 patients. In 87 % of patients (33/38), there was no need for further intervention within the 30-day postinterventional period. In three patients, minor amputations were conducted due to preexisting ulcerations (Rutherford Category 5 respectively).ConclusionsPAT enables endovascular treatment of iatrogenic thromboembolic complications after PTA with good technical and early clinical results and minimal morbidity.

  1. Rehospitalization following percutaneous coronary intervention for commercially insured patients with acute coronary syndrome: a retrospective analysis

    Directory of Open Access Journals (Sweden)

    Meadows Eric S

    2012-07-01

    Full Text Available Abstract Background While prior research has provided important information about readmission rates following percutaneous coronary intervention, reports regarding charges and length of stay for readmission beyond 30 days post-discharge for patients in a large cohort are limited. The objective of this study was to characterize the rehospitalization of patients with acute coronary syndrome receiving percutaneous coronary intervention in a U.S. health benefit plan. Methods This study retrospectively analyzed administrative claims data from a large US managed care plan at index hospitalization, 30-days, and 31-days to 15-months rehospitalization. A valid Diagnosis Related Group code (version 24 associated with a PCI claim (codes 00.66, 36.0X, 929.73, 929.75, 929.78–929.82, 929.84, 929.95/6, and G0290/1 was required to be included in the study. Patients were also required to have an ACS diagnosis on the day of admission or within 30 days prior to the index PCI. ACS diagnoses were classified by the International Statistical Classification of Disease 9 (ICD-9-CM codes 410.xx or 411.11. Patients with a history of transient ischemic attack or stroke were excluded from the study because of the focus only on ACS-PCI patients. A clopidogrel prescription claim was required within 60 days after hospitalization. Results Of the 6,687 ACS-PCI patients included in the study, 5,174 (77.4% were male, 5,587 (83.6% were Conclusions For ACS patients who underwent PCI, revascularization procedures represented a large portion of rehospitalizations. Revascularization procedures appear to be the most frequent, most costly, and earliest cause for rehospitalization after ACS-PCI.

  2. Percutaneous cholecystostomy to treat acute cholecystitis in patients with high risk for surgery.

    Science.gov (United States)

    Cortázar García, R; Sánchez Rodríguez, P; Ramos García, M

    2016-01-01

    To evaluate the results of percutaneous cholecystostomy for urgent treatment of acute cholecystitis, with the aim of identifying factors that predict survival. To analyze the recurrence of cholecystitis after catheter withdrawal in patients considered unsuitable candidates for delayed surgery, with the aim of identifying factors that predict recurrence. We reviewed 40 patients who underwent percutaneous cholecystostomy in a two-year period. We analyzed survival during hospitalization in relation with fever, abdominal pain, leukocytosis, and C-reactive protein before and after the procedure. We analyzed the recurrence of cholecystitis after catheter withdrawal in patients considered unsuitable candidates for delayed surgery, as well as the influence of obstruction seen on cholangiography, age, sex, and comorbidities on the recurrence rate. During the hospital stay, 4 (10%) patients died of septic shock. Cholecystostomy improved fever, leukocytosis, and abdominal pain within five days of the procedure, but these improvements did not have a statistically significant effect on survival and were not therefore considered useful prognostic factors. Among the 15 patients considered unsuitable candidates for delayed surgery, 6 (40%) had recurrences of cholecystitis during a mean follow-up period of 6.7 months after catheter withdrawal. We found no association between recurrence and any of the parameters analyzed. Outcomes in our series of patients with high risk for surgery who underwent cholecystostomy for urgent treatment of acute cholecystitis were similar to those reported in other series. Withdrawing the catheter in patients considered unsuitable candidates for delayed surgery is not recommended due to the high risk of recurrence of cholecystitis in comparison with other series. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  3. Periprocedural temporary pacing in primary percutaneous coronary intervention for patients with acute inferior myocardial infarction

    Directory of Open Access Journals (Sweden)

    Hwang YM

    2016-03-01

    Full Text Available You Mi Hwang,1 Chul-Min Kim,2 Keon-Woong Moon2 1Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 2Department of Internal Medicine, St Vincent’s Hospital, The Catholic University of Korea, Suwon, South KoreaObjective: High-degree atrioventricular block (AVB, including complete AVB in acute inferior ST-elevation myocardial infarction (STEMI, is not uncommon. However, there is no study evaluating the clinical differences between patients who have undergone temporary pacing (TP and patients who have not. The present study was designed to investigate whether TP has any prognostic significance in inferior STEMI complicated by complete AVB.Methods: From January 2009 to December 2014, 295 consecutive patients diagnosed with inferior wall STEMI in a university hospital were reviewed. All of them underwent primary percutaneous coronary intervention (PCI. Among the 295 patients, there were 72 patients with complete AVB. The clinical characteristics, procedural data, and long-term major adverse cardiocerebrovascular events were compared in patients with and without TP.Results: Baseline clinical and procedural characteristics were similar between patients with and without TP. Patients with TP were more likely to present with cardiogenic shock; thus, additional interventions were attempted via a femoral approach, as patients received further treatment with intra-aortic balloon pumps and were subjected to additional cardiopulmonary resuscitation. Most cases of complete AVB were primarily caused by right coronary artery occlusion. After a median follow-up period of 344 (range, 105.5–641 days, major adverse cardiocerebrovascular events did not differ between the groups (P=0.528.Conclusion: We conclude that primary PCI without TP is acceptable in complete AVB-complicated acute inferior STEMI. To avoid delay in reperfusion, we suggest that primary PCI should be the first priority therapy rather than treating

  4. 21 CFR 880.5970 - Percutaneous, implanted, long-term intravascular catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Percutaneous, implanted, long-term intravascular... and Personal Use Therapeutic Devices § 880.5970 Percutaneous, implanted, long-term intravascular catheter. (a) Identification. A percutaneous, implanted, long-term intravascular catheter is a device...

  5. Emergency coronary artery bypass surgery for failed percutaneous coronary angioplasty. A 10-year experience.

    Science.gov (United States)

    Craver, J M; Weintraub, W S; Jones, E L; Guyton, R A; Hatcher, C R

    1992-01-01

    Six hundred ninety-nine patients have required emergency coronary artery bypass after failed elective percutaneous coronary angioplasty during the decade September 1980 through December 1990. This represents 4% of 9860 patients having 12,146 elective percutaneous coronary angioplasty procedures during this interval. Emergency coronary artery bypass was required for acute refractory myocardial ischemia in 82%. Hospital mortality rate for all patients was 3.1%; 3.7% in patients with refractory myocardial ischemia but 0.8% in patients without refractory myocardial ischemia, p = 0.08. Postprocedural Q-wave myocardial infarctions were observed in 21% versus 2.4%, p less than 0.0001, and intra-aortic balloon pumping was required in 19% with versus 0.8% without refractory myocardial ischemia, p less than 0.0001. Multivessel disease, p = 0.004, age older than 65 years, p = 0.005, and refractory myocardial ischemia, p = 0.08, interacted to produce the highest risk of in-hospital death. Follow-up shows that there have been 28 additional late deaths, including 23 of cardiac causes for a 91% survival at 5 years. Freedom from both late death and Q-wave myocardial infarction at 5 years was 61%. In the group going to emergency coronary artery bypass with refractory myocardial ischemia, the late cardiac survival was 90%, and in those without ischemia, 92% at 5 years, p = not significant. The MI--free survival in the group with refractory ischemia, however, was 56% versus 83% in the group without ischemia, p less than 0.0001. Multivariate analysis showed the highest late event rates for patients with Q-wave myocardial infarction at the initial emergency coronary artery bypass, age older than 65 years, angina class III or IV, and prior coronary bypass surgery. In spite of a continuing high incidence of early acute myocardial infarction and an increasing operative mortality rate (7%) in the latest 3 years cohort of patients, excellent late survival and low subsequent cardiac event

  6. Sex differences in clinical characteristics, hospital management practices, and in-hospital outcomes in patients hospitalized in a Vietnamese hospital with a first acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Hoa L Nguyen

    Full Text Available BACKGROUND: Cardiovascular disease is one of the leading causes of morbidity and mortality in Vietnam. We conducted a pilot study of Hanoi residents hospitalized with acute myocardial infarction (AMI at the Vietnam National Heart Institute in Hanoi. The objectives of this observational study were to examine sex differences in clinical characteristics, hospital management, in-hospital clinical complications, and mortality in patients hospitalized with an initial AMI. METHODS: The study population consisted of 302 Hanoi residents hospitalized with a first AMI at the largest tertiary care medical center in Hanoi in 2010. RESULTS: The average age of study patients was 66 years and one third were women. Women were older (70 vs. 64 years and were more likely than men to have had hyperlipidemia previously diagnosed (10% vs. 2%. During hospitalization, women were less likely to have undergone percutaneous coronary intervention (PCI compared with men (57% vs. 74%, and women were more likely to have developed heart failure compared with men (19% vs. 10%. Women experienced higher in-hospital case-fatality rates (CFRs than men (13% vs. 4% and these differences were attenuated after adjustment for age and history of hyperlipidemia (OR: 2.64; 95% CI: 1.01, 6.89, and receipt of PCI during hospitalization (OR: 2.09; 95% CI: 0.77, 5.09. CONCLUSIONS: Our pilot data suggest that among patients hospitalized with a first AMI in Hanoi, women experienced higher in-hospital CFRs than men. Full-scale surveillance of all Hanoi residents hospitalized with AMI at all Hanoi medical centers is needed to confirm these findings. More targeted and timely educational and treatment approaches for women appear warranted.

  7. Percutaneous peritoneovenous shunt positioning: technique and preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Orsi, Franco; Grasso, Rosario Francesco; Bonomo, Guido; Marinucci, Irene [Division of Radiology, European Institute of Oncology, Milan (Italy); Monti, Cinzia [Institute of Radiology, University of Milan (Italy); Bellomi, Massimo [Division of Radiology, European Institute of Oncology, Milan (Italy); Institute of Radiology, University of Milan (Italy)

    2002-05-01

    Nine peritoneovenous shunts were positioned by percutaneous technique in seven patients with advanced malignancy causing severe refractory ascites, and in two patients with hepatic cirrhosis (one with hepatocarcinoma). In all patients the shunts were percutaneously placed through the subclavian vein in the angiographic suite under digital fluoroscopic guide. No complications directly related to the procedure occurred. The shunt was successfully positioned in all patients in 60 min average time. No patient showed symptoms related to pulmonary overload or to disseminated intravascular coagulation. All patients had a significant improvement of the objective symptoms related to ascites such as respiratory symptoms, dyspepsia, and functional impairment to evacuation describing an improvement of their quality of life. Maximum shunt patency was 273 days. Percutaneous placement of peritoneovenous shunt is a safe, fast, and inexpensive procedure, extremely useful in resolution of refractory ascites, reducing symptoms, and allowing effective palliation, with a great improvement in quality of life. (orig.)

  8. Post-operative duodenal fistula: percutaneous treatment and review

    Directory of Open Access Journals (Sweden)

    D.Huerta

    2015-04-01

    Full Text Available Duodenal fistula is a complex condition, relatively frequent presentation, being in most cases of postoperative origin. Among the latter, 6% to 11% are secondary to surgical treatment of perforated duodenal ulcer, and more unusual, as a complication of cholecystectomy. Two cases treated percutaneous at the Polyclinic Bank city of Buenos Aires are presented. The first, a female patient with a duodenal fistula as a postoperative complication of a perforated duodenal ulcer and the second one patient male with the same pathology but as a complication of cholecystectomy. Percutaneous treatment of this disease has been reported sporadically without having proven its usefulness. Once diagnosed the same Fistulography and obliteration were performed percutaneously achieving complete remission of the disease.

  9. Treatment of osteoporotic vertebral body compression fractures by percutaneous vertebroplasty

    Institute of Scientific and Technical Information of China (English)

    Hongmin Zang; Yiheng Liu; Junchang Chen

    2005-01-01

    Objective: To explore the effect of percutaneous vertebroplasty to treat osteoporotic vertebral body compression fractures. Methods: Seventeen patients with compression fractures at 27 different levels came in for percutaneous vertebroplasty. Under the guidance of C-arm image intensifier, bone needle was inserted into the fracture vertebral bodies via a unilateral transpedicular approach.Polymethyl methacrylate (PMMA) was injected slowly under continuous fluoroscopic control. Then the effect was evaluated after operation.Results: Follow-up results among 15 patients were studied, other two patients lost contact. The follow-up period was from three to seven months. No patient had relapse of compression fracture. Leakage of the cement outside the vertebral body was seen in four bodies. All patients had a complete relief after Percutaneous vertebroplasty(PVP). Conclusion: PVP is an efficient minimally invasive technique to treat osteoporotic vertebral body compression fractures.

  10. 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.

  11. Preparation and Behaviour of New Materials for Percutaneous Access

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    The reinforcing effects on hydroxyapatite ( abbreviated HA ) of phosphate glass additives were researched. The samples of reinforced HA ( abbreviated RHA ) and control material were prepared and then percutaneously implanted in the skin of experiment animal. The histomorphology of the part skin tissue were observed.By a biomimetic process, the method and conditions of forming HA coating on the surface of medical silicon rubber(abbreviated MSR) were studied. The results illustrate that the phosphate glass additives have obvious reinforcing effects on HA. In the percutaneous implantation test, neither clear infiltration of inflammatory cells nor marked downgrowth of epidermis was observed for the part tissue surrounded RHA. The surface modification of MSR for percutaneous access could be attained by biomimetic synthesis of HA coating.

  12. Complications of percutaneous thoracostomy in neonates and infants.

    Science.gov (United States)

    Reed, R C; Waters, B L; Siebert, J R

    2016-04-01

    Percutaneous thoracostomy tubes are widely used in neonates, infants and children. The technique has a low complication rate. Lung perforation by a pigtail catheter is described in a single case report. This is a multi-center case series of neonates and infants who experienced thoracic organ injury following percutaneous chest tube placement between 2006 and 2015. Eleven patients had chest tube-related thoracic organ injury. In six, tubes were placed during resuscitation. Gestational ages ranged from 24+6 weeks to term. Most of the chest tubes were pigtail catheters, and the most common injury was lung lobe perforation. Pericardium and mediastinum were also sites of injury. Some patients had small pleural effusions, with no other complications identified. Thoracic organ injury by percutaneous catheters may be more common than previously appreciated. Clinical and radiological findings are non-specific, and the diagnosis may not be apparent until autopsy.

  13. [Use of percutaneous anesthesia in cardiac pacemaker implantation].

    Science.gov (United States)

    Trigano, J A; Paganelli, F; Taramasco, V; Levy, S; Lorec, A M; Blin, O; Bruguerolle, B

    Assess the efficacy of an anesthesic cream for pacemaker implantations. Percutaneous anesthesia was studied in a series of permanent pacemaker transvenous implantations. The anesthesic cream composed of a mixture of lidocaine and prilocaine was applied precisely over operative areas after marking the skin. Percutaneous anesthesia should be applied 2 hours before entering the operating room. This percutaneous local anesthesia was perfectly effective for simple replacement procedures. At first implantations, it was used alone in 4 out of 10 cases while intradermal injections were needed to anesthetize the deep layers in the other patients. Serum concentrations indicate very low levels which are tolerated very well. Alone or combined with lidocaine infiltration, the use of an anesthesic cream is safe and effective in transvenous pacemaker surgery.

  14. Unusual complication of percutaneous nephrostomy in a renal transplant recipient

    Directory of Open Access Journals (Sweden)

    Martina Paetzel

    2010-11-01

    Full Text Available Context: Ureteral obstruction, resulting in impaired graft function, is a well-known problem following renal transplantation. Management of ureteral complications includes percutaneous nephrostomy, which is considered to be a safe and effective measure. Case Report: Here, we demonstrate a case of a 35-year old renal allograft recipient with primary graft function but stagnating serum creatinine following extraction of the double-J catheter. Ureteral stenosis was suspected by ultrasound imaging and magnetic resonance tomography, and urinary flow was preserved with a percutaneous nephrostomy. However, early displacement of the percutaneous nephrostomy catheter resulted in distinct clinical discomfort. CT imaging suggested an intra-abdominal position of the catheter’s tip, requiring immediate surgical action. Conclusion: The present case demonstrates that performing PCN following renal transplantation may have unexpected risks.

  15. Percutaneous radiofrequency thermocoagulation of osteoid osteomas: factors affecting therapeutic outcome

    Energy Technology Data Exchange (ETDEWEB)

    Cribb, G.L.; Goude, W.H.; Cool, P.; Tins, B.; Cassar-Pullicino, V.N.; Mangham, D.C. [Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry (United Kingdom)

    2005-11-01

    To examine factors which affect local recurrence of osteoid osteomas treated with percutaneous CT-guided radiofrequency thermocoagulation. A prospective study was carried out on 45 patients with osteoid osteoma who underwent percutaneous radiofrequency thermocoagulation with a minimum follow-up of 12 months There were seven local recurrences (16%); all occurred within the first year. Local recurrence was significantly related to a non-diaphyseal location (P<0.01). There was no significant relationship (P=0.05) between local recurrence and age of the patient, duration of symptoms, previous treatment, size of the lesion, positive biopsy, radiofrequency generator used or the number of needle positions. There were no complications. Osteoid osteomas in a non-diaphyseal location are statistically more likely to recur than those in a diaphyseal location when treated with CT-guided percutaneous radiofrequency thermocoagulation. This relationship between local recurrence and location has not been previously reported. (orig.)

  16. Totally percutaneous thoracic endovascular aortic repair with the preclosing technique: a case-control study

    Institute of Scientific and Technical Information of China (English)

    NI Zhong-han; LUO Jian-fang; HUANG Wen-hui; LIU Yuan; XUE Ling; FAN Rui-xin; CHEN Ji-yan

    2011-01-01

    Background The conventional thoracic endovascular aortic repair (TEVAR) involves groin incisions under general or epidural anesthesia. As technology moves towards less invasive procedures, a total percutaneous approach is desirable.In this study, we describe a Preclosing technique and investigate its safety and efficacy for femoral access sites management, and evaluate its advantages as compared to those of traditional surgical cutdown approaches.Methods The Preclosing technique involves two or multiple 6 F Perclose Proglide devices deployed in the femoral artery before upsizing to a 20-25 F sheath. The sutures were secured to close the arteriotomy at the end of the procedure. The medical records of patients who underwent thoracic endovascular aortic repairs using the Preclosing technique between December 2009 and November 2010 (group A) were compared with those using surgical femoral cutdown from January 2008 to November 2009 (group B). Outcome measures included rates of technical success, early complications, anesthesia method, procedure time, cardiac care unit (CCU) stay, time from procedure to discharge,hospital stay, procedure expense, hospital cost.Results Between the two groups, there were no significant differences in baseline characteristics, in the endograft models or profiles. The technical success rate was 100.0% (85/85) in group A vs. 97.4% (147/151) in group B (P <0.05).There was no access-related mortality in both groups. Compared with group B, the incidence of early complications were fewer in group A, 9.4% (8/85) vs. 22.5% (34/151) (P <0.01). Local anesthesia with conscious sedation was used more often in group A, 68.2% (58/85) vs. 51.7% (78/151) in group B (P<0.01). The procedure duration was shorter, (96±33)minutes in group Avs. (127±41) minutes in group B (P<0.01). The length of the CCU stay, the duration from procedure to discharge, and the hospital stay were both reduced in group A, (117.3±88.3) hours, (7.5±5.3) days and (15.3±6

  17. Percutaneous vertebroplasty in osteoporotic vertebral body compression fracture

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyuk Jung; Lee, Seon Kyu; Hwang, Hee Young; Kim, Hyung Sik; Ko, Joon Seok; Park Si Hyun; Park, Cheol Hee [Gacheon Medical College, Incheon (Korea, Republic of)

    2001-02-01

    To determine the clinical efficacy of percutaneous vertebroplasty in cases of painful and medically intractable osteoporotic vertebral compression fracture. Ninety-eight patients (20 men and 78 women: mean age, 69 years) underwent 122 percutaneous vertebroplasty procedures for the treatment of osteoporotic vertical compression fracture. For the evaluation of bone mass, bone densitometry was performed in 45 patients, and to assess the recent evolution of the fracture, all 98 underwent MRI. Percutaneous vertebroplasty involves percutaneous transpedicular puncture of the involved verteb666rae followed by the injection of a polymethylmethacrylate(PMMA)-Barium mixture into the vertebral body. To assess leakage of the mixture into the epidural tissue, neural foramina, venous plexus and paravertebral tissue, we then immediately obtained a computerized tomographic (CT) scan, assessing the clinical efficacy of the procedure on the basis of time required for pain relief (defined as more than 60% reduction of initial pain), and time required for ambulation without significant pain. Percutaneous vertebroplasty was successful in all patients. Pain relief was accomplished within 1-5 (mean, 1.8) days and early ambulation without significant pain was possible within 2-15 (mean, 3.3) days. Post-procedural CT scanning revealed leakage of the PMMA-barium mixture into paravertebral tissue(n=41).the paravertebral venous plexus (n=34) and epidural tissue (n=4). No neural foraminal leakage was identified, and no procedure-related complication requiring surgical treatment occurred. Percutaneous vertebroplasty is an effective new interventional procedure for the treatment of osteoporotic vertebral compression fracture. It relieves pain, provides early mobilization, and strengthens involved vertebral bodies.

  18. Early readmission in a high complexity public hospital in cardiology

    Directory of Open Access Journals (Sweden)

    Herminia Ricci

    2016-01-01

    Full Text Available Objective: to evaluate the early readmission of patients in a high complexity public hospital in cardiology. Methods: this is a descriptive, documental and retrospective study, carried out in a public hospital. Results: in 2012, 729 of the 9,218 hospitalized patients were readmitted, 47.9% of them were readmitted within 30 days after discharge, 61% were men, with a mean age of 57 years old, with the main medical diagnosis of heart disease (heart failure, treatment of acute coronary syndrome, among others on admission (44.7% and readmission (45.8%. Most were readmitted for the same medical reason that led to their first hospitalization. Conclusion: considering the profile of the population admitted and readmitted to the institution, it is believed that the rate of readmission is mainly due to the profile of the patients, considering the high prevalence of non-communicable chronic diseases, and coronary artery disease considered unapproachable for percutaneous or surgical when hospitalized.

  19. Percutaneous transluminal renal angioplasty with stent is effective for blood pressure control and renal function improvement in atherosclerotic renal artery stenosis patients

    Institute of Scientific and Technical Information of China (English)

    LIAO Chuan-jun; YANG Bao-zhong; WANG Zhong-gao

    2012-01-01

    Background Percutaneous transluminal renal angioplasty with stent is an effective procedure for atherosclerotic renal artery stenosis.However,the decision to perform this procedure has recently raised considerable debate.The aim of this study was to assess the effects of percutaneous transluminal renal angioplasty with stent in atherosclerotic renal artery stenosis patients,especially as it relates to blood pressure control and renal function improvement.Methods A retrospective analysis was made of the clinical data from 125 atherosclerotic renal artery stenosis patients who underwent percutaneous transluminal renal angioplasty from July 2004 to June 2008 in the Department of Vascular Surgery of Beijing Chaoyang Hospital.We compared blood pressure,number of oral antihypertensive medications,and renal function changes pre and post-procedure at 24 months follow-up.Results A total of 125 atherosclerotic renal artery stenosis patients underwent percutaneous transluminal renal angioplasty and 143 stents were placed.At 24 months follow-up,both systolic and diastolic blood pressure and the number of oral antihypertensive medications were significantly reduced (P <0.05).Overall,the estimated glomerular filtration rate did not change significantly (P >0.05); however,a significant increase in estimated glomerular filtration rate was observed in the subgroup of patients with a lower baseline estimated glomerular filtration rate and in the subgroup of patients with bilateral renal artery stenosis (P <0.05).Conclusion Percutaneous transluminal renal angioplasty is a safe procedure for atherosclerotic renal artery stenosis patients,providing a significant improvement in blood pressure control and reduction in the number of oral antihypertensive medications.

  20. Percutaneous transluminal angioplasty of infrarenal arteries in intermittent claudication

    DEFF Research Database (Denmark)

    Henriksen, L O; Jørgensen, B; Holstein, P E;

    1988-01-01

    Percutaneous transluminal angioplasty was performed on 55 iliac and 31 femoropopliteal arteries in 71 patients with intermittent claudication (23 women, 48 men). The two-year patency rate was 80% after iliac and 41% after femoropopliteal angioplasty. In 17 femoropopliteal cases with lesions greater...... than or equal to 5 cm the 2-year patency rate was only 32%, but the corresponding figure for shorter lesions was 53%. Complicating haematoma appeared in 10% of the cases and the arterial state deteriorated in one patient. There was no distal embolization. Percutaneous transluminal angioplasty...

  1. Atlantoaxial joint synovial cyst: diagnosis and percutaneous treatment.

    Science.gov (United States)

    Velán, Osvaldo; Rabadán, Alejandra; Paganini, Lisandro; Langhi, Luciano

    2008-01-01

    Synovial cysts at the atlantoaxial level are found uncommonly. Lumbar symptomatic cases are treated by percutaneous cyst aspiration with or without corticoid injection or by surgical resection, but synovial cysts at the C1-C2 level are usually treated by surgery. We report here a 92-year-old woman with a retro-odontoid synovial cyst producing spinal cord compression that was treated by percutaneous aspiration of the cyst under CT guidance. To our knowledge, this is the first reported case of an atlantoaxial synovial cyst successfully treated with a minimally invasive procedure.

  2. Sedation Monitoring and Management during Percutaneous Endoscopic Lumbar Discectomy

    Directory of Open Access Journals (Sweden)

    Menekse Oksar

    2016-01-01

    Full Text Available Percutaneous endoscopic laser discectomy (PELD is a painful intervention that requires deep sedation and analgesia. However, sedation should be light at some point because cooperation by the patient during the procedure is required for successful surgical treatment. Light sedation poses a problem for endotracheal intubation, while patients placed in the prone position during percutaneous endoscopic discectomy pose a problem for airway management. Therefore, under these conditions, sedation should be not deeper than required. Here we report the sedation management of three cases that underwent PELD, with a focus on deep and safe sedation that was monitored using bispectral index score and observer’s assessment of alertness/sedation score.

  3. Percutaneous Ventricular Assist Devices: New Deus Ex Machina?

    Directory of Open Access Journals (Sweden)

    Diego Arroyo

    2011-01-01

    Full Text Available The development of ventricular assist devices has broadened the means with which one can treat acute heart failure. Percutaneous ventricular assist devices (pVAD have risen from recent technological advances. They are smaller, easier, and faster to implant, all important qualities in the setting of acute heart failure. The present paper briefly describes the functioning and assets of the most common devices used today. It gives an overview of the current evidence and indications for left ventricular assist device use in cardiogenic shock and high-risk percutaneous coronary intervention. Finally, extracorporeal life support devices are dealt with in the setting of hemodynamic support.

  4. Training for percutaneous renal access on a virtual reality simulator

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yi; YU Cheng-fan; LIU Jin-shun; WANG Gang; ZHU He; NA Yan-qun

    2013-01-01

    Background The need to develop new methods of surgical training combined with advances in computing has led to the development of virtual reality surgical simulators.The PERC MentorTM is designed to train the user in percutaneous renal collecting system access puncture.This study aimed to validate the use of this kind of simulator,in percutaneous renal access training.Methods Twenty-one urologists were enrolled as trainees to learn a fluoroscopy-guided percutaneous renal accessing technique.An assigned percutaneous renal access procedure was immediately performed on the PERC MentorTM after watching instruction video and an analog operation.Objective parameters were recorded by the simulator and subjective global rating scale (GRS) score were determined.Simulation training followed and consisted of 2 hours daily training sessions for 2 consecutive days.Twenty-four hours after the training session,trainees were evaluated performing the same procedure.The post-training evaluation was compared to the evaluation of the initial attempt.Results During the initial attempt,none of the trainees could complete the appointed procedure due to the lack of experience in fluoroscopy-guided percutaneous renal access.After the short-term training,all trainees were able to independently complete the procedure.Of the 21 trainees,10 had primitive experience in ultrasound-guided percutaneous nephrolithotomy.Trainees were thus categorized into the group of primitive experience and inexperience.The total operating time and amount of contrast material used were significantly lower in the group of primitive experience versus the inexperience group (P=0.03 and 0.02,respectively).Conclusions The training on the virtual reality simulator,PERC MentorTM,can help trainees with no previous experience of fluoroscopy-guided percutaneous renal access to complete the virtual manipulation of the procedure independently.This virtual reality simulator may become an important training and evaluation tool

  5. A case of micro-percutaneous nephrolithotomy with macro complication.

    Science.gov (United States)

    Dede, Onur; Utangaç, Mazhar; Dağguli, Mansur; Hatipoğlu, Namık Kemal; Sancaktutar, Ahmet Ali; Bodakçı, Mehmet Nuri

    2015-06-01

    Percutaneous nephrolithotomy is accepted as the standard management approach for kidney stones that are either refractory to extracorporeal shock wave lithotripsy or are >2 cm in diameter. The recently developed micro-percutaneous nephrolithotomy (microperc) technique provides intrarenal access under full vision using an optic instrument with a smaller calibration. A lesser amount of bleeding has been reported with the use of this method. Here we present a case of a bleeding complication on postoperative day 15 after a microperc procedure used to treat a left kidney stone. The complication led to retention of bloody urine in the bladder and required transfusion of 5 units of whole blood.

  6. Device entrapment: a rare complication of percutaneous coronary intervention.

    Science.gov (United States)

    Rehman, Abdul; Rehman, Abdur; Khan, Javaid Arif; Sial, Javaid A; Baloch, Zafar Haleem

    2011-10-01

    Device entrapment is a rare complication of percutaneous coronary intervention. It has hazardous potentials for the patient. Emergent cardiac surgery is the only option after failure of retrieval devices. We have described here a case of a 55 years old male. During percutaneous coronary intervention, the balloon inflated only partially at its ends and entrapped in the lesion along with the stent. Multiple attempts at inflation failed and the patient developed severe chest pain for few minutes. Surgery was contemplated but final attempt at inflation was successful and the patient stabilized. It was an emergent situation and could have led to fatal outcome, although this patient escaped narrowly from any fatal outcome.

  7. Primary Percutaneous Coronary Intervention in a Patient with Haemophilia A

    Directory of Open Access Journals (Sweden)

    S. Ashwin Reddy

    2013-01-01

    Full Text Available Haemophilia A is a rare genetic condition leading to coagulation factor VIII deficiency and thus predisposing to bleeding diathesis. Due to advances in treatment, life expectancy of haemophilia A sufferers is increasing, and the incidence and prevalence of coronary artery disease are rising. There have been many reported cases of acute myocardial infarction in such patients, who subsequently undergo elective percutaneous coronary intervention. We present the case of a 55-year-old gentleman presenting with an acute anterior full-thickness myocardial infarction who required emergency primary percutaneous coronary intervention.

  8. Life-threatening paraspinal muscle hematoma after percutaneous vertebroplasty

    Directory of Open Access Journals (Sweden)

    Chang-Hoon Jeon

    2016-01-01

    Full Text Available Bleeding and hematoma formation is rarely reported in percutaneous vertebroplasty procedure. An 84 year old male presented with a large paraspinal muscle hematoma after a percutaneous vertebroplasty. The patient had neither any prior bleeding disorder nor any anticoagulant treatment. Vital signs of the patient were unstable, and his hemoglobin level decreased daily. After a month of conservative treatment, including transfusion, cryotherapy, pain control and bed rest, his hemoglobin level remained stable and he showed relief from pain. Four months later, hematoma resolved spontaneously and he could walk without back pain.

  9. Percutaneous radiofrequency ablation in painful bone metastases

    Directory of Open Access Journals (Sweden)

    German Garabano

    2015-09-01

    Full Text Available Backgraund There are different treatment for painful bone metastases (mtts, with different results. CT-guided Percutaneous Radiofrequency Ablation (CT-PRA is one of them. The pupose of this retrospective study was to assess the initial results using this methods, focusing on pain relief, showing details of the surgical technique. Methods 18 patients with an average age of 59.2 years and 15 months follow-up were treated. Nine mtts were located in the femur, 4 dorsal / lumbar spine, 3 in scapula and 2 in Iliac. The Mtts origin were Breast Ca 7 cases, lung in 4, Kidney in 4 and 3 in Thyroid. The rachis mtts were found at more than 10mm of the medullary cavity and mtts of long bones showed low risk of fracture. Lesions >3cm were treated whit CT-PRA  using Valleylab Rita needle and these <3cm with CoolTip needle. Pain was assessed by Visual Analog Scale (VAS preoperatively, at 2, 7 and 30 days, and then at 3 and 6 months. Results Preoperative pain score was 8.33 on average. At 7 days of ablatión de VAS score was 5 on average and at 30 days was 2 points. After at 3 and 6 months de VAS average was 1. This method had excellent patients tolerance and no complications. There were two recurrences which underwent endoprosthesis unconventional proximal femur and knee respectively, evolving favorably. Conclusion CT-guided APRF impresses a promising, simple and effective tool in the treatment of painfull bone mtts, achieving excellent pain control with good tolerance by the patient.

  10. Third-generation percutaneous vertebral augmentation systems

    Science.gov (United States)

    Galzio, Renato; Kazakova, Anna; Pantalone, Andrea; Grillea, Giovanni; Bartolo, Marcello; Salini, Vincenzo; Magliani, Vincenzo

    2016-01-01

    Currently, there is no general consensus about the management of osteoporotic vertebral fractures (OVF). In the past, conservative treatment for at least one month was deemed appropriate for the majority of vertebral fractures. When pain persisted after conservative treatment, it was necessary to consider surgical interventions including: vertebroplasty for vertebral fractures with less than 30% loss of height of the affected vertebral body and kyphoplasty for vertebral fractures with greater than 30% loss of height. Currently, this type of treatment is not feasible. Herein we review the characteristics and methods of operation of three of the most common percutaneous vertebral augmentation systems (PVAS) for the treatment of OVF: Vertebral Body Stenting® (VBS), OsseoFix® and Spine Jack®. VBS is a titanium device accompanied by a hydraulic (as opposed to mechanical) working system which allows a partial and not immediate possibility to control the opening of the device. On the other hand, OsseoFix® and Spine Jack® are accompanied by a mechanical working system which allows a progressive and controlled reduction of the vertebral fracture. Another important aspect to consider is the vertebral body height recovery. OsseoFix® has an indirect mechanism of action: the compaction of the trabecular bone causes an increase in the vertebral body height. Unlike the Vertebral Body Stenting® and Spine Jack®, the OsseoFix® has no direct lift mechanism. Therefore, for these characteristics and for the force that this device is able to provide. In our opinion, Spine Jack® is the only device also suitable for the treatment OVF, traumatic fracture (recent, old or inveterate) and primary or secondary bone tumors. PMID:27683690

  11. Percutaneous Nephrolithotomy under Spinal Anesthesia with Marcaine

    Directory of Open Access Journals (Sweden)

    S.M.R. Rabani

    2010-01-01

    Full Text Available Introduction & Objective: The efficacy of Percutaneous Nephrolithotomy (PCNL in the treatment of renal stones has been proven in its indications. The main method of anesthesia in this procedure is general anesthesia. We used spinal anesthesia (SA as an alternative method of anesthesia with many benefits. This study was intended to show the possibility of SA as a more comfortable method of anesthesia for the surgeon , the anesthesiologist and the patient via more cooperation of the patient during changing the position and prevention of some complications mostly in upper extremities and neck. Materials & Methods: In a prospective clinical trial study, a total of 112 patients underwent PCNL under SA with marcaine , from Nov 2004 till Feb 2009. Their mean age was 36 years (22-48, at first the syringe was stained by epinephrine and then 2 -3.5 ml marcaine was used for SA and addition of analgesics , sedatives or both., if needed. The rest of the procedure was done as routine.Results: Stone clearance was achieved in 82% of the patients and the rest were managed by ESWL. The mean operation time was 126 minutes (90-220, 36% of the patients needed sedation, analgesia, or both, specially those with bigger stones. 6% of the patients had upper pole stones .Blood transfusion was needed only in one patient. No significant complication was observed in this study.Conclusion: PCNL under SA afforded the surgeon and the anesthesiologist the opportunity of more patient cooperation during position changes and precludes some morbidities that may happen under general anesthesia because the patient is awake and able to portend.

  12. Effectiveness of Percutaneous Celiac Plexus Ablation in the Treatment of Severe Cancer Pain in Upper Abdomen and Evaluation of Health Economics.

    Science.gov (United States)

    Cao, Jun; He, Yang; Liu, Hongqiang; Wang, Saibo; Zhao, Baocheng; Zheng, Xiaohui; Yang, Kai; Xie, Donghao

    2017-03-01

    To compare the effectiveness, adverse effects, and cost-effectiveness of percutaneous neurolytic celiac plexus block (NCPB) versus traditional medication strategies for the treatment of patients with advanced cancer having severe upper abdominal cancer pain. This retrospective study included 81 patients with advanced upper abdominal cancer admitted to The Sixth People's Hospital Affiliated to Shanghai Jiaotong University between January 2013 and July 2014. The patients were divided into percutaneous NCPB (treatment) and medication for pain (control) groups. The outcomes were measured in terms of Numeric Rating Scale (NRS) score and Karnofsky Performance Status (KPS) score before treatment and on the 3rd, 7th, 14th, and 28th days posttreatment. The effectiveness and cost-effectiveness of the therapy were assessed using analysis of the health economics. The improvements in NRS score (1.42 ± 1.09 vs 4.03 ± 0.96, P economics evaluation revealed that the medicine-specific costs and total health care costs were significantly reduced in the treatment group compared to the control group ( P .05) were seen in the costs of hospitalization, examinations, and treatment. The percutaneous NCPB method shows promising results and better cost-effectiveness for treating patients with advanced cancer having severe upper abdominal pain.

  13. Application of a flexible lightwand in percutaneous dilatational tracheotomy.

    Science.gov (United States)

    Zhao, Zhuang; Pan, Shu; Wang, Dunwei; Wang, Chengyu; Li, Zhiwen

    2017-06-23

    By comparing flexible lightwand-assisted and conventional endotracheal tube (ETT) withdrawal in percutaneous dilatational tracheotomy (PDT), this paper aims to provide guidance for precise ETT withdrawal by anesthesiologists and accurate determination of the incision site by surgeons. Sixty patients who underwent PDT in our hospital were randomly divided into the lightwand group (Group L, n=30) and the withdrawal group (Group W, n=30) using the envelope method. For Group L patients, a flexible lightwand was inserted into an ETT (based on the patient's size), the light source was positioned at the root of the cuff, and the depth from the root of the cuff to the end of the ETT was marked. The flexible lightwand was inserted into the patient's ETT to the marked depth. The ETT along with the flexible lightwand was withdrawn until the highlighted spot was located at the level of the thyroid cartilage. The incision site was approximately 3 finger widths (approximately 4.8cm) below the highlighted spot. For Group W patients, the ETT was withdrawn to a tube depth of 17cm at the upper incisors in males and 15cm in females, and surgeons determined incision sites without assistance. The following metrics were recorded for the two groups: occurrences of inadvertent extubation, ETT puncture and cuff rupture; success rate of first puncture; hypoxia rate; SpO2 at the time of tracheostomy cannula intubation (T1); and postoperative hemorrhage rate. Inadvertent extubation, ETT puncture and cuff rupture occurred significantly less frequently in Group L than in Group W, and the success rate of first puncture and SpO2 at T1 were markedly higher in Group L than in Group W. Moreover, significant between-group differences in hypoxia rate and postoperative hemorrhage rate were observed. The use of a flexible lightwand in PDT is a safe and effective approach. This approach can effectively and directly guide precise ETT repositioning and provide incision site confirmation with few intra- and

  14. Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan

    Science.gov (United States)

    Suzuki, Yutaka; Tamez, Seryna; Murakami, Akihiko; Taira, Akihiko; Mizuhara, Akihiro; Horiuchi, Akira; Mihara, Chie; Ako, Eiji; Muramatsu, Hirohito; Okano, Hitoshi; Suenaga, Hitoshi; Jomoto, Kazuaki; Kobayashi, Junya; Takifuji, Katsunari; Akiyama, Kazuhiro; Tahara, Koh; Onishi, Koji; Shimazaki, Makoto; Matsumoto, Masami; Ijima, Masashi; Murakami, Masato; Nakahori, Masato; Kudo, Michiaki; Maruyama, Michio; Takahashi, Mikako; Washizawa, Naohiro; Onozawa, Shigeru; Goshi, Satoshi; Yamashita, Satoyoshi; Ono, Shigeki; Imazato, Shin; Nishiwaki, Shinji; Kitahara, Shuichirou; Endo, Takao; Iiri, Takao; Nagahama, Takeshi; Hikichi, Takuto; Mikami, Tatsuya; Yamamoto, Tetsuo; Ogawa, Tetsushi; Ogawa, Tomoko; Ohta, Tomoyuki; Matsumoto, Toshifumi; Kura, Toshiroh; Kikuchi, Tsutomu; Iwase, Tsuyoshi; Tsuji, Tsuyotoshi; Nishiguchi, Yukio; Urashima, Mitsuyoshi

    2010-01-01

    AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan. METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient’s characteristics at PEG using log-rank tests and Cox proportional hazard models. RESULTS: Nine hundred and thirty one patients were followed up for a median of 468 d. A total of 502 deaths were observed (mortality 53%). However, 99%, 95%, 88%, 75% and 66% of 931 patients survived more than 7, 30, 60 d, a half year and one year, respectively. In addition, 50% and 25% of the patients survived 753 and 1647 d, respectively. Eight deaths were considered as PEG-related, and were associated with lower serum albumin levels (P = 0.002). On the other hand, among 28 surviving patients (6.5%), PEG was removed. In a multivariate hazard model, older age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.00-1.03; P = 0.009], higher C-reactive protein (HR, 1.04; 95% CI: 1.01-1.07; P = 0.005), and higher blood urea nitrogen (HR, 1.01; 95% CI: 1.00-1.02; P = 0.003) were significant poor prognostic factors, whereas higher albumin (HR, 0.67; 95% CI: 0.52-0.85; P = 0.001), female gender (HR, 0.60; 95% CI: 0.48-0.75; P < 0.001) and no previous history of ischemic heart disease (HR, 0.69; 95% CI: 0.54-0.88, P = 0.003) were markedly better prognostic factors. CONCLUSION: These results suggest that more than half of geriatric patients with PEG may survive longer than 2 years. The analysis elucidated prognostic factors. PMID:20976846

  15. Percutaneous Coronary Intervention Utilization and Appropriateness across the United States.

    Directory of Open Access Journals (Sweden)

    Michael P Thomas

    Full Text Available Substantial geographic variation exists in percutaneous coronary intervention (PCI use across the United States. It is unclear the extent to which high PCI utilization can be explained by PCI for inappropriate indications. The objective of this study was to examine the relationship between PCI rates across regional healthcare markets utilizing hospital referral regions (HRRs and PCI appropriateness.The number of PCI procedures in each HRR was obtained from the 2010 100% Medicare limited data set. HRRs were divided into quintiles of PCI utilization with increasing rates of utilization progressing to quintile 5. NCDR CathPCI Registry® data were used to evaluate patient characteristics, appropriate use criteria (AUC, and outcomes across the HRR quintiles defined by PCI utilization with the study population restricted to HRRs where ≥ 80% of the PCIs were performed at institutions participating in the registry. PCI appropriateness was defined using 2012 AUC by the American College of Cardiology (ACC/American Heart Association (AHA/The Society for Cardiovascular Angiography and Interventions (SCAI.Our study cohort comprised of 380,981 patients treated at 178 HRRs. Mean PCI rates per 1,000 increased from 4.6 in Quintile 1 to 10.8 in Quintile 5. The proportion of non-acute PCIs was 27.7% in Quintile 1 increasing to 30.7% in Quintile 5. Significant variation (p < 0.001 existed across the quintiles in the categorization of appropriateness across HRRs of utilization with more appropriate PCI in lower utilization areas (Appropriate: Q1, 76.53%, Q2, 75.326%, Q3, 75.23%, Q4, 73.95%, Q5, 72.768%; Inappropriate: Q1 3.92%, Q2 4.23%, Q3 4.32%, Q4 4.35%, Q5 4.05%; Uncertain: Q1 8.29%, Q2 8.84%, Q3 8.08%, Q4 9.01%, Q5 8.93%; Not Mappable: Q1 11.26%, Q2 11.67%, Q3 12.37%, Q4 12.69%, Q5 14.34%. There was no difference in risk-adjusted mortality across quintiles of PCI utilization.Geographic regions with lower PCI rates have a higher proportion of PCIs performed

  16. Percutaneous Coronary Intervention Utilization and Appropriateness across the United States

    Science.gov (United States)

    Thomas, Michael P.; Parzynski, Craig S.; Curtis, Jeptha P.; Seth, Milan; Nallamothu, Brahmajee K.; Chan, Paul S.; Spertus, John A.; Patel, Manesh R.; Bradley, Steven M.; Gurm, Hitinder S.

    2015-01-01

    Background Substantial geographic variation exists in percutaneous coronary intervention (PCI) use across the United States. It is unclear the extent to which high PCI utilization can be explained by PCI for inappropriate indications. The objective of this study was to examine the relationship between PCI rates across regional healthcare markets utilizing hospital referral regions (HRRs) and PCI appropriateness. Methods The number of PCI procedures in each HRR was obtained from the 2010 100% Medicare limited data set. HRRs were divided into quintiles of PCI utilization with increasing rates of utilization progressing to quintile 5. NCDR CathPCI Registry® data were used to evaluate patient characteristics, appropriate use criteria (AUC), and outcomes across the HRR quintiles defined by PCI utilization with the study population restricted to HRRs where ≥ 80% of the PCIs were performed at institutions participating in the registry. PCI appropriateness was defined using 2012 AUC by the American College of Cardiology (ACC)/American Heart Association (AHA)/The Society for Cardiovascular Angiography and Interventions (SCAI). Results Our study cohort comprised of 380,981 patients treated at 178 HRRs. Mean PCI rates per 1,000 increased from 4.6 in Quintile 1 to 10.8 in Quintile 5. The proportion of non-acute PCIs was 27.7% in Quintile 1 increasing to 30.7% in Quintile 5. Significant variation (p < 0.001) existed across the quintiles in the categorization of appropriateness across HRRs of utilization with more appropriate PCI in lower utilization areas (Appropriate: Q1, 76.53%, Q2, 75.326%, Q3, 75.23%, Q4, 73.95%, Q5, 72.768%; Inappropriate: Q1 3.92%, Q2 4.23%, Q3 4.32%, Q4 4.35%, Q5 4.05%; Uncertain: Q1 8.29%, Q2 8.84%, Q3 8.08%, Q4 9.01%, Q5 8.93%; Not Mappable: Q1 11.26%, Q2 11.67%, Q3 12.37%, Q4 12.69%, Q5 14.34%). There was no difference in risk-adjusted mortality across quintiles of PCI utilization. Conclusions Geographic regions with lower PCI rates have a higher

  17. In-hospital delay to primary angioplasty for patients with ST-elevated myocardial infarction between cardiac specialized hospitals and non-specialized hospitals in Beijing, China

    Institute of Scientific and Technical Information of China (English)

    XUN Yi-wen; YANG Jin-gang; SONG Li; SUN Yi-hong; LU Chang-lin; YANG Yue-jin; HU Da-yi

    2010-01-01

    Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention (PPCI) for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 (interquartile range 105 to 180) minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals (147 minutes vs. 120 minutes, P<0.001; 55 minutes vs. 45 minutes, P=0.035). After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.

  18. Evaluation of algorithms for registry-based detection of acute myocardial infarction following percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Egholm G

    2016-10-01

    Full Text Available Gro Egholm,1,2,* Morten Madsen,2,* Troels Thim,1 Morten Schmidt,2,3 Evald Høj Christiansen,1 Hans Erik Bøtker,1 Michael Maeng1 1Department of Cardiology, 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, 3Department of Internal Medicine, Regional Hospital of Randers, Denmark *These authors contributed equally to this work Background: Registry-based monitoring of the safety and efficacy of interventions in patients with ischemic heart disease requires validated algorithms.Objective: We aimed to evaluate algorithms to identify acute myocardial infarction (AMI in the Danish National Patient Registry following percutaneous coronary intervention (PCI.Methods: Patients enrolled in clinical drug-eluting stent studies at the Department of Cardiology, Aarhus University Hospital, Denmark, from January 2006 to August 2012 were included. These patients were evaluated for ischemic events, including AMI, during follow-up using an end point committee adjudication of AMI as reference standard.Results: Of 5,719 included patients, 285 patients suffered AMI within a mean follow-up time of 3 years after stent implantation. An AMI discharge diagnosis (primary or secondary from any acute or elective admission had a sensitivity of 95%, a specificity of 93%, and a positive predictive value of 42%. Restriction to acute admissions decreased the sensitivity to 94% but increased the specificity to 98% and the positive predictive value to 73%. Further restriction to include only AMI as primary diagnosis from acute admissions decreased the sensitivity further to 82%, but increased the specificity to 99% and the positive predictive value to 81%. Restriction to patients admitted to hospitals with a coronary angiography catheterization laboratory increased the positive predictive value to 87%.Conclusion: Algorithms utilizing additional information from the Danish National Patient Registry yield different sensitivities, specificities, and predictive

  19. Decade-long trends in the timeliness of receipt of a primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Chen HY

    2016-06-01

    Full Text Available Han-Yang Chen,1 Joel M Gore,1,2 Kate L Lapane,1 Jorge Yarzebski,1 Sharina D Person,1 Catarina I Kiefe,1 Robert J Goldberg1,3 1Department of Quantitative Health Sciences, 2Department of Medicine, 3Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA Objectives: The purpose of this study was to examine decade-long trends (2001–2011 in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI who received a primary percutaneous coronary intervention (PCI. Methods: Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629. Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department (ED arrival. Results: The average age of this patient population was 61.9 years; 30.5% were women, and 91.7% were White. During the years under study, 50.9% of patients received a primary PCI within 90 minutes of ED arrival; this proportion increased from 2001/2003 (17.2% to 2009/2011 (70.5% (P<0.001. Having previously undergone coronary artery bypass graft surgery, arriving at the ED by car/walk-in and during off-hours were significantly associated with a higher risk of failing to receive a primary PCI within 90 minutes of ED arrival. Conclusion: The likelihood of receiving a timely primary PCI in residents of central Massachusetts hospitalized with STEMI at the major teaching/community medical centers increased dramatically during the years under study. Several groups were identified for purposes of heightened surveillance and intervention efforts to reduce the likelihood of failing to receive a timely primary PCI among patients acutely

  20. Contrast-induced nephropathy in postmenopausal women undergoing percutaneous coronary intervention for acute myocardial infarction.

    Science.gov (United States)

    Ma, Guizhou; Yu, Danqing; Cai, Zhixiong; Ni, Chumin; Xu, Ronghe; Lan, Bin; Chen, Ping; Zhu, Zhidan

    2010-07-01

    Contrast-induced nephropathy (CIN) is a complex syndrome of acute kidney injury induced by exposure to intravascular contrast media. CIN occurs frequently in patients undergoing urgent percutaneous coronary intervention (PCI) and is associated with poor outcomes, making it a major challenge faced by interventional cardiologists. It has been suggested that female sex is a risk factor for development of CIN following PCI. However, no data exist in the literature concerning the risks of postmenopausal women with acute myocardial infarction (AMI) developing CIN after undergoing urgent PCI. To explore the incidence, risk factors and in-hospital outcomes of CIN in this special population, we analyzed 69 postmenopausal women with AMI treated with urgent PCI. CIN was defined as a relative increase of >25% or an absolute increase of >or=0.5 mg/dL in serum creatinine concentration from the baseline value 72 h after exposure to contrast medium. We found 1) the incidence of CIN was 37.68%; 2) patients with CIN had worse in-hospital outcomes, including longer hospital stay and more in-hospital adverse events; and 3) in multivariate logistic analysis, independent risk factors for CIN included a longer menopausal duration and the implantation of an intra-aortic balloon pump (an indirect indicator of hemodynamic instability). These results indicate that CIN is a frequent complication associated with worse in-hospital outcomes in postmenopausal women with AMI who are undergoing urgent PCI, particularly those with longer menopausal duration and hemodynamic instability. It is therefore necessary to pay more attention to preventive strategies for renal protection in this special population.

  1. Hospital Inspections

    Data.gov (United States)

    U.S. Department of Health & Human Services — Welcome to hospitalinspections.org, a website run by the Association of Health Care Journalists (AHCJ) that aims to make federal hospital inspection reports easier...

  2. Hospital Inspections

    Data.gov (United States)

    U.S. Department of Health & Human Services — Welcome to hospitalinspections.org, a website run by the Association of Health Care Journalists (AHCJ) that aims to make federal hospital inspection reports easier...

  3. Hospital marketing.

    Science.gov (United States)

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

  4. Early rethrombosis in femoropopliteal occlusions treated with percutaneous transluminal angioplasty

    DEFF Research Database (Denmark)

    Jørgensen, B; Meisner, S; Holstein, P;

    1990-01-01

    One hundred and thirty-seven consecutive percutaneous transluminal angioplasties (PTA) were performed for femoropopliteal vascular disease including 58 stenoses and 79 total occlusions. Nine occlusions could not be crossed with the guidewire, but in the remaining 128 the haemodynamic and clinical...

  5. Segmentally enclosed thrombolysis in percutaneous transluminal angioplasty for femoropopliteal occlusions

    DEFF Research Database (Denmark)

    Jørgensen, B; Tønnesen, K H; Nielsen, J D;

    1991-01-01

    Segmentally enclosed thrombolysis (SET) was performed immediately following 34 percutaneous transluminal angioplasties (PTAs) for femoropopliteal occlusions. The dilated segment was sealed off with a double balloon catheter, and recombinant tissue plasminogen activator (rt-PA) 1 mg/ml and heparin...

  6. Future of Percutaneous Coronary Intervention From an Asian Perspective

    Institute of Scientific and Technical Information of China (English)

    Yean-Leng LIM

    2002-01-01

    @@ We have come a long-way since Andreas Gruentzig performed the first percutaneous transluminal coronary angioplasty (PTCA) in man in 1977. It is timely to assess what we have actually achieved for patients with coronary heart disease with the advent of this treatment modality and where we are heading from now.

  7. Percutaneous injuries in doctors in the School of Medicine ...

    African Journals Online (AJOL)

    (48.8%), and “was not aware of the reporting procedures” (7%). Only 13.7% of the respondents .... Surgery, General Surgery, Neurosurgery, Obstetrics and Gynaecology, ... There could possibly have been recall bias, since .... Greene ES, Berry AJ, Arnold WP, Jagger J. Percutaneous injuries in anesthesia personnel. Anesth ...

  8. Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention.

    Science.gov (United States)

    ten Berg, Jurriën M; Plokker, HW Thijs; Verheugt, Freek WA

    2001-01-01

    Thrombosis plays a major role in acute vessel closure both after coronary balloon angioplasty and after stenting. This review will address the role of antiplatelet and anticoagulant therapy in preventing early thrombotic complications after percutaneous coronary intervention. The focus will be on agents that are routinely available and commonly used.

  9. Clinical outcome after percutaneous flexor tenotomy in forefoot surgery.

    Science.gov (United States)

    Debarge, Romain; Philippot, Rémy; Viola, Jérémy; Besse, Jean Luc

    2009-10-01

    The aim of this study was to evaluate the outcome of the percutaneous flexor tenotomy. We compared the results of two groups. The first group included 23 patients who underwent forefoot surgery without percutaneous flexor tenotomy, and the second group included 50 patients who underwent the same procedure combined with percutaneous flexor tenotomy for claw toe deformities, secondary to shortening metatarsal Scarf osteotomy. The average follow-up was 11.6 months. Three algoneurodystrophies were noted. No delayed wound healing was observed. Functional dissatisfaction rate (18% vs.17.4%) and toe pulp contact defect (12% vs. 8.7%) were not significantly different in the two groups. Toe grasping defect rate (10% vs. 4.3%) was superior in the tenotomy group. Five recurring claw toe deformities of the second toe were noted in the tenotomy group. Percutaneous flexor tenotomy is a simple, rapid, and efficient method to correct reducible secondary claw toe deformities. However, despite a significant postoperative loss of toe grasping function, no patient reported major dissatisfaction.

  10. QT Dispersion: Does It Change after Percutaneous Coronary Intervention?

    Directory of Open Access Journals (Sweden)

    Mahsa Asadi Moghaddam

    2011-02-01

    Full Text Available Background: Myocardial ischemia is one of several causes of prolonged QT dispersion. The aim of this study was to evaluate the effect that percutaneous coronary intervention has on the depolarization and repolarization parameters of surface electrocardiography in patients with chronic stable angina.Methods: We assessed the effects of full revascularization in patients with chronic stable angina and single-vessel disease who underwent percutaneous coronary intervention. Twelve-lead electrocardiograms were recorded before intervention and 24 hours subsequently. We measured parameters including QRS duration, QT and corrected QT durations, and JT and corrected JT duration in both electrocardiograms and compared the values.Results: There were significant differences between the mean QRS interval (0.086 ± 0.01sec vs. 0.082 ± 0.01 second; p value = 0.01, mean corrected QT dispersion (0.080 ± 0.04 sec vs. 0.068 ± 0.04 sec; p value = 0.001, and mean corrected JT dispersion (0.074 ± 0.04 sec vs. 0.063 ± 0.04 sec; p value = 0.001 before and after percutaneous coronary intervention. No significant differences were found between the other ECG parameters.Conclusion: Our data indicate that the shortening of corrected QT dispersion and corrected JT dispersion in patients undergoing percutaneous coronary intervention is prominent.

  11. Percutaneous biliary drainage in acute suppurative cholangitis with biliary sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyung Lyul; Cho, June Sik; Kwon, Soon Tae; Lee, Sang Jin; Rhee, Byung Chull [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    1993-11-15

    Acute suppurative cholangitis is a severe inflammatory process of the bile duct occurred as result of partial or complete obstruction of the bile duct, and may manifest clinically severe form of disease, rapidly deteriorating to life-threatening condition. We analyzed emergency percutaneous transhepatic biliary drainage in 20 patients of acute suppurative cholangitis with biliary sepsis to evaluate the therapeutic effect and complication of the procedure. The underlying cause were 12 benign disease(stones) and eight malignant tumors and among eight malignant tumors, bile duct stones(n=4) and clonorchiasis(n=1) were combined. Percutaneous transhepatic biliary drainage was performed successfully in 17 of 20 patients resulting in improvement of general condition and failed in three patients. The procedure were preterminated due to the patient's condition in two and biliary-proto fistula was developed in one. After biliary decompression by percutaneous transhepatic biliary drainage, effective and successful elective surgery was performed in nine cases, which were seven biliary stones and two biliary cancer with stones. Our experience suggest that emergency percutaneous transhepatic biliary drainage is an initial and effective treatment of choice for acute suppurative cholangitis with sepsis and a safe alternative for nonsurgical treatment.

  12. Percutaneous Gastronomy and Jejunostomy: Lessons from the First Decade

    Directory of Open Access Journals (Sweden)

    John S Goff

    1992-01-01

    Full Text Available Percutaneous gastrostomies and jejunostomies have increasingly been used for long term enteral feeding in patients with functioning gastrointestinal tracts but who are unable, for a variety of reasons, to use the standard oropharyngeal route. Since these devices can be placed without the use of general anesthesia, the morbidity and mortality generally are less than for placement of a surgical gastrostomy. A permanent gastrostomy tube is easy to manage in most patients who require prolonged tube feeding. There are four basic types of percutaneous gastrostomy techniques; three employ an endoscope and one uses only radiographic or ultrasonic guidance. All gastrostomy tubes may be convened to feeding jejunostomies if the clinical situation warrants. Jejunal feeding tubes are prone to many technical problems and do not always solve the problems of gastric dysfunction and reflux that make gastrostomy tubes less desireable. Percutaneous endoscopic gastrostomics are technically simple to perform and have become the main method for access to the gastrointestinal tract in many patients. If judiciously used, the percutaneous enterostomy offers many benefits over a nasogastric tube for long term enteral feeding.

  13. Successful management of dislodged stents during percutaneous coronary intervention.

    Science.gov (United States)

    Farman, Muhammad Tariq; Sial, Jawaid Akbar; Saghir, Tahir; Rizvi, Syed Nadeem Hasan; Rasool, Syed Ishtiaq; Jamal, Syed Zahid

    2010-02-01

    Stent dislodgement is a very rare but recognized and potentially serious complication of percutaneous coronary intervention (PCI). This case series describe the incidence and etiology of such cases at National Institute of Cardiovascular Diseases, Karachi during the year 2008 and the method of treatment of this complication.

  14. Manually controlled steerable needle for MRI-guided percutaneous interventions

    NARCIS (Netherlands)

    Henken, Kirsten R; Seevinck, Peter R; Dankelman, Jenny; van den Dobbelsteen, John J

    2017-01-01

    This study aims to develop and evaluate a manually controlled steerable needle that is compatible with and visible on MRI to facilitate full intra-procedural control and accurate navigation in percutaneous interventions. The steerable needle has a working channel that provides a lumen to a cutting s

  15. Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Verheugt Freek WA

    2001-05-01

    Full Text Available Abstract Thrombosis plays a major role in acute vessel closure both after coronary balloon angioplasty and after stenting. This review will address the role of antiplatelet and anticoagulant therapy in preventing early thrombotic complications after percutaneous coronary intervention. The focus will be on agents that are routinely available and commonly used.

  16. 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.

  17. Predicting Respiratory Motion for Active Canceling During Percutaneous Needle Insertion

    Science.gov (United States)

    2007-11-02

    Lecture Notes in Computer Science , Springer...robotic system for image guided percutaneous procedures,� Lecture Notes in Computer Science , Springer-Verlag, vol. 1496, pp. 404-410, 1998. [5] A...L.L. Whitcomb, and L.R. Kavoussi, �A passive positioning and supporting device for surgical robots and instrumentation,� Lecture Notes in Computer Science ,

  18. Percutaneous catheter drainage of intraabdominal abscesses and fluid

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Tae; Kwon, Tae Hee; Yoo, Hyung Sik; Suh, Jung Ho [Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Young Ho [Cheil General Hospital, Seoul (Korea, Republic of)

    1986-10-15

    Percutaneous catheter drainage has been reported to be an effective method in the management of selected patients with abscess and fluid collection. Its high success rate and relatively low complications make the procedure an alternative to surgery in the individual cases. During past two years percutaneous catheter drainage in 25 patients with intraabdominal abscesses and fluid collection was performed at the Department of Radiology, Yonsei University College of medicine. Here the technique and author's results were summarized. 1. The total 25 patients who had percutaneous catheter drainage are 10 liver abscesses, 3 subphrenic, one subhepatic, 4 renal and perirenal, 2 pelvic, one psoas, one anterior pararenal fluid from acute pancreatitis, one pancreas pseudocyst and 2 malignant tumor necrosis. 2. The modified Seldinger technique used for all cases of abscess and fluid drainage under guidance of ultrasound scan. The used catheters were 10F. Pigtail and 14F. Malecot (Cook c/o) catheters. 3. The abscesses and fluid of 17 patients among 25 were cured by the percutaneous catheter drainage and 4 patients were clinically improved. The catheter drainage was failed in 2 patients and 3 complication were developed. 4. The success rate of this procedure was 91.3%, failure rate was 8.7% and complication rate was 12%.

  19. Genetic inflammatory factors predict restenosis after percutaneous coronary interventions

    NARCIS (Netherlands)

    Monraats, PS; Pires, NMM; Agema, WRP; Zwinderman, AH; Schepers, A; de Maat, MPM; Doevendans, PA; de Winter, RJ; Tio, RA; Waltenberger, J; Frants, RR; Quax, PHA; van Vlijmen, BJM; Atsma, DE; van der Laarse, A; van der Wall, EE; Jukema, JW

    2005-01-01

    Background - Restenosis is a negative effect of percutaneous coronary intervention (PCI). No clinical factors are available that allow good risk stratification. However, evidence exists that genetic factors are important in the restenotic process as well as in the process of inflammation, a pivotal

  20. Intrarenal pseudoaneurysm after percutaneous nephrolithotomy: angiotomographic assessment and endovascular management

    Directory of Open Access Journals (Sweden)

    M. F. Massulo-Aguiar

    2006-08-01

    Full Text Available We report a case of intrarenal pseudoaneurysm of the right kidney after percutaneous nephrolithotomy (PCNL in supine position. Diagnosis was established by angiotomography with a 3-D reconstruction. Treatment was successfully achieved by endovascular occlusion using N-butyl-2-cyanoacrylate.

  1. Clinical Application of Percutaneous Nephrostomy in Some Urologic Diseases

    Institute of Scientific and Technical Information of China (English)

    Hongbo LUO; Xiuheng LIU; Tianpeng WU; Xiaobin ZHANG

    2008-01-01

    Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy (PNL) was performed in patients with various renal, perinephric and bladder diseases (n=79). The tract establishment, operation duration and complications were observed and the efficacy was assessed. The results showed that the tracts were successfully established in 79 cases. The operation lasted 4-20 min. 12F-16F single tract was established in nephrohydrop patients and 16F-20F single or multiple tracts were established in patients with pyonephrosis, renal cortical abscess, renal cyst and perinephric abscess. During dilation, no leakage of liquor puris was noted. Establishment of 18F single tract was achieved in one urinoma patient. In two patients with foreign body in kidney, the foreign bodies were removed via established 14F single tract. 18F tracts were established in 2 patients with bladder contracture, which was followed by the placement of 16F balloon urethral catheter for drainage. No complications, such as massive bleeding, intestinal injury and spreading of infection took place in our series. All the patients were followed up for 2-12 months. No long-term complications such as dropping of drainage tube occurred. It is concluded that as a minimally invasive technique, percutaneous nephrostomy has the advantages of convenience, simplicity and causing less complications and can be used for various urologic diseases.

  2. Effects of percutaneous needle liver biopsy on dairy cow behaviour

    DEFF Research Database (Denmark)

    Mølgaard, Lene; Damgaard, Birthe Marie; Bjerre-Harpøth, Vibeke;

    2012-01-01

    behavioural changes for up to 19 h – and particularly for behaviour previously associated with pain. Even though the exact welfare impact of percutaneous needle liver biopsies in cows is not known, and the magnitude of the behavioural changes was limited, pain always has negative effects on animal welfare...

  3. Percutaneous osteosynthesis of Galeazzi fracture-dislocation.

    Science.gov (United States)

    Gadegone, Wasudeo M; Salphale, Yogesh; Magarkar, Ds

    2010-10-01

    A Galeazzi fracture is defined as a fracture of the radius associated with dislocation of the distal radio-ulnar joint (DRUJ). The conventional surgical technique of nailing does not give enough stability and open reduction, internal fixation with the plate is associated with numerous complications. The stacked nailing for the management of these injuries provides adequate stability, maintains the relationship of the DRUJ and promotes uneventful union by closed technique. The purpose of this study is to evaluate the results of simple, user-friendly, low cost elastic stacked nailing for the management of Galeazzi fracture dislocation. We treated 22 young adults with fresh Galeazzi fracture-dislocation of the forearm, from January 2004 to January 2008, by percutaneous fixation of fracture by stacked elastic nailing at our institute. There were 19 males and three females and the age group ranged from 20-56 years (average 35 years). Surgery was performed within 48 to 72 hours under the guidance of image intensifier. Medullary cavity was filled with two elastic titanium nails having unequal lengths and diameter. One nail acts as a reduction nail and the other acts as a stabilizing nail. The results were evaluated using Mikic criteria based on union, alignment, relationship of the DRUJ, and movements at the inferior radio ulnar joint, elbow and wrist. In six cases, following radiological union, nails in the radius were extracted between six to nine months after operation because of discomfort complained by the patient at site of insertion. After one year follow-up, 18 patients had excellent, four had fair results. Closed reduction and internal fixation of Galeazzi fracture by two elastic rods re-establishes the normal relationship of the fractured fragments and the DRUJ without repair of the ligaments. The stability is achieved by the flexibility and elasticity of the nails, crowding of the medullary canal and anchorage they gain in the radial diaphysis. Elastic nailing

  4. Effect of low-frequency pulse percutaneous electric stimulation on peripheral nerve injuries at different sites

    Institute of Scientific and Technical Information of China (English)

    Jinwu Wang; Liye Chen; Qi Li; Weifeng Ni; Min Zhang; Shangchun Guo; Bingfang Zeng

    2006-01-01

    BACKGROUND: The postoperative recovery of nerve function in patients with peripheral nerve injury is always an important problem to solve after treatment. The electric stimulation induced electromagnetic field can nourish nerve, postpone muscular atrophy, and help the postoperative neuromuscular function.OBJECTIVE: To observe the effects of low-frequency pulse percutaneous electric stimulation on the functional recovery of postoperative patients with peripheral nerve injury, and quantitatively evaluate the results of electromyogram (EMG) examination before and after treatment.DESIGN: A retrospective case analysis.SETTING: The Sixth People's Hospital affiliated to Shanghai Jiaotong University.PARTICIPANTS: Nineteen postoperative inpatients with peripheral nerve injury were selected from the Department of Orthopaedics, the Sixth People's Hospital affiliated to Shanghai Jiaotong University from June 2005 to January 2006, including 13 males and 6 females aged 24-62 years with an average of 36 years old.There were 3 cases of brachial plexus nerve injury, 3 of median nerve injury, 7 of radial nerve injury, 3 of ulnar nerve injury and 3 of common peroneal nerve injury, and all the patients received probing nerve fiber restoration. Their main preoperative manifestations were dennervation, pain in limbs, motor and sensory disturbances. All the 19 patients were informed with the therapeutic program and items for evaluation.METHODS : ① Low-frequency pulse percutaneous electric stimulation apparatus: The patients were given electric stimulation with the TERESA cantata instrument (TERESA-0, Shanghai Teresa Health Technology, Co.,Ltd.). The patients were stimulated with symmetric square waves of 1-111 Hz, and the intensity was 1.2-5.0 mA, and it was gradually adjusted according to the recovered conditions of neural regeneration following the principle that the intensity was strong enough and the patients felt no obvious upset. They were treated for 4-24 weeks, 10-30 minutes

  5. Percutaneous vertebral augmentation for painful osteolytic vertebral metastasis: a case report

    Directory of Open Access Journals (Sweden)

    Anselmetti GC

    2012-03-01

    Full Text Available Giovanni C Anselmetti1, Sean M Tutton2, Francis R Facchini3, Larry E Miller4,5, Jon E Block51Institute for Cancer Research and Treatment, Turin, Italy; 2Medical College of Wisconsin in Milwaukee, Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA; 3Interventional Radiology, Interventional Oncology, VIR Chicago, Hinsdale, IL, USA; 4Miller Scientific Consulting, Inc, Arden, NC, USA; 5The Jon Block Group, San Francisco, CA, USAIntroduction: Vertebral metastases are associated with significant pain, disability, and morbidity. Open surgery for fracture stabilization is often inappropriate in this population due to a poor risk-benefit profile, particularly if life expectancy is short. Percutaneous vertebroplasty and kyphoplasty are appealing adjunctive procedures in patients with malignancy for alleviation of intractable pain. However, these patients have higher risk of serious complications, notably cement extravasation. Described in this report is a case of a painful osteolytic vertebral metastasis that was successfully treated by a novel percutaneous vertebral augmentation system.Case presentation: A 42-year-old Caucasian female presented with a history of metastatic lung cancer unresponsive to radiation and chemotherapy with symptoms inadequately controlled by opiates over the previous 6 months. Magnetic resonance imaging and spiral computed tomography with two-dimensional reconstruction showed an osteolytic vertebral metastasis with complete involvement of the T10 vertebral body, extending to the cortical vertebral wall anteriorly and posteriorly. The patient was treated with percutaneous vertebral augmentation (Kiva® VCF Treatment System, Benvenue Medical, Inc, Santa Clara, CA utilizing a novel coil-shaped polyetheretherketone implant designed to minimize the risk of cement extravasation. After the minimally invasive procedure, bone cement distribution within the vertebral body was ideal, with no observed cement extravasation. No

  6. TREATMENT OF RENAL STONES WITH PERCUTANEOUS NEPHROLITHOTOMY IMPROVES RENAL FUNCTIONS IN CHRONIC KIDNEY DISEASE PATIENTS

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    Ekrem Akdeniz

    2016-01-01

    Full Text Available Objective:In this study, we aimed to investigate the impact of percutaneous nephrolitotomy on kidney functions in stage III or higher chronic renal failure patients using glomerular filtration rate and serum creatinine level. Material and Method:Between 2010 and 2014, percutaneous nephrolithotomy was applied to patients who had glomerular filtration rate below 60 mL/min/1.73m2. Pre-operative demographic features, stone burden and localization, urine analysis and microbial test, serum creatinine level, direct urinary system graphy, and spiral non-enhanced computerized tomography were obtained. Intraoperative renal unit counts, anesthesia and surgery time, and X-ray exposure time were calculated. Early and late post-operative complications, hospitalization time, stone-free rate, and glomerular function rate were evaluated, retrospectively. Findings:Pre-operatively, mean creatinine value was 2,42±0.76 mg/dL, mean glomerular filtration rate was 45.3±13mL/min/1.73m2, mean stone burden was 393±40 mm², mean intervention time was 79±34 min and 12 patients were stone free (70.5%. Decrease of hemoglobin 1,6 g/dL and transfusion was done only two patients (11.8% due to excessive bleeding. In early and long term follow-up, mean creatinine values and glomerular filtration rate were 1.98±0.72mg/dL, 2.16±0.78mL/dL and 54.1±14 mL/min/1.73m2and 51.8±15 mL/min/1.73m2, respectively. Comparison of pre-operative and post-operative creatinine and glomerular filtration rates revealed significant decrease in creatinine level and increase in glomerular filtration rate. Results:Percutaneous nephrolithotomy which eliminates urinary obstruction is safely used in the treatment of kidney stones with minimal damage on kidney functions. Stage III or higher renal failure patients who have obstructive kidney stones or recurrent urinary tract infections can effectively be treated and this may help patients to prevent progression to end-stage renal failure.

  7. Comparison of the trauma degree after retroperitoneoscopy and percutaneous nephtoscopy treatment of complicated upper ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    Shu-Run Zhao; Zhan-Peng Lu

    2016-01-01

    Objective:To compare the trauma degree after retroperitoneoscopy and percutaneous nephtoscopy treatment of complicated upper ureteral calculi.Methods:A total of 82 cases of patients with complicated upper ureteral calculi who received surgical treatment in our hospital from July 2013 to January 2015 were included for study. According to the different surgical methods, included subjects were randomly divided into observation group 41 cases and control group 41 cases. Control group received percutaneous nephtoscopy treatment, observation group received retroperitoneoscopy treatment, and then differences in early postoperative coagulation indicators, blood glucose and insulin levels, stress protein levels as well as PI3K/Akt and p38MAPK signaling pathway expression were compared between two groups.Results:Early postoperative PLCR, PDW, APTT and D-D values of observation group were lower than those of control group while Ca2+ value was higher than that of control group; early postoperative GLU, fasting lactate, fasting lactate/pyruvic acid and HOMA-IR values of observation group were lower than those of control group while HOMA-β value was higher than that of control group; early postoperative HSP70, DNA ligaseⅣ, JAB1 and ATF4 expression levels of observation group were higher than those of control group whileβ-tubulin and IFIT1 expression levels were lower than those of control group; early postoperative p38MAPK mRNA and protein expression levels of observation group were lower than those of control group while PI3K and Akt mRNA and protein expression levels were higher than those of control group.Conclusion: Retroperitoneoscopy treatment of patients with complicated upper ureteral calculi causes less injury to patients and less effect on internal environment, and helps to patients’ early postoperative rehabilitation.

  8. Percutaneous Retrieval of Foreign Bodies Around Vital Vessels Aided with Vascular Intervention: A Technical Note

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Xiu-Jun, E-mail: woothingyang2008@126.com [Shanghai Eighth People’s Hospital, Department of Radiology (China); Xing, Guang-Fu, E-mail: xgf8848@126.com [Shanghai Eighth People’s Hospital, Department of General Surgery (China)

    2015-10-15

    ObjectiveTo describe a new interventional technique to remove foreign bodies (FBs) embedded in soft tissues around vital vessels.MethodsUnder fluoroscopic guidance and using local anesthesia, percutaneous removal of FBs was performed using forceps in nine patients. All patients suffered from a metallic soft tissue FB located in close proximity to important vessels and one also had a small traumatic pseudoaneurysm adjacent to the FB. Prior to removal of the FB, the position of the nearest vessel was identified using a guide wire or catheter placed into the vessel. Balloon catheter was also simultaneously used to temporarily stop the blood flow of the nearest artery during the FB removal in three of the nine patients.ResultsAll of the nine FBs with 0–2 mm interval to the nearest vessel were successfully removed in the nine patients without any serious complications. The removed FBs measured 3–12 mm in length and 1–3 mm in width. The total fluoroscopic time of retrieval of each FB was 5–9 min (mean, 6.4 min). The volume of intraoperative bleeding ranged from 5 to 12 ml (mean, 7.5 ml). The length of hospital stay for each patient ranged from 4 to 8 days (mean, 5.5 days).ConclusionVascular intervention-aided percutaneous FB removal is minimally invasive and an effective method for removal of FBs around vital vessels.

  9. Persistence of cardiovascular risk factors in patients with coronary artery diseases after percutaneous coronary interventions

    Directory of Open Access Journals (Sweden)

    Fariba Heidari

    2016-02-01

    Full Text Available Introduction: Coronary artery disease (CAD is as a leading cause of death and disability all around the world. Multiple risk factors have a role in the development and progression of coronary heart disease (CHD. It is necessary to control risk factors, to achieve optimal results of treatment. The aim of present study was to evaluate the persistence of cardiovascular risk factors in patients with CADs after percutaneous cardiac interventions. Methods: In an analytical-descriptive study, 150 patient with CAD and percutaneous coronary intervention (PCI were performed for them, and referred to Cardiology Clinic of Shahid Madani Hospital of Tabriz University of Medical Sciences, Tabriz, Iran, from September 2013 to September 2015, were studied. The persistence of coronary risk factors, 12-24 months after performing PCI, was evaluated. Results: The mean age of patients at time of PCI performing was 57.90 ± 12.26 years. 72.7% of patients were male and 27.3% were female and male to female ratio was 1 to 0.37. Dyslipidemia in 52.0% of patients, hypertension in 51.3% patients, and diabetes mellitus (DM in 41.3% patients were the most common underlying comorbidities. In both before and after doing PCI, 26.7% were a smoker, and smoking rates after doing PCI also showed no significant change (P = 0.055, and also there were no significant changes in the physical activity of patients compared before and after performing PCI. Conclusion: Based on the findings of the present study, dyslipidemia, hypertension, and DM, was the most frequent underlying diseases in patients with CAD respectively. Risk factors such as smoking, and lack of exercise, had no significant changes after performing PCI.

  10. Hemostatic agents for access tract in tubeless percutaneous nephrolithotomy: Is it worth?

    Science.gov (United States)

    Sepulveda, Francisco; Aliaga, Alfredo; Fleck, Daniela; Fernandez, Mario; Mercado, Alejandro; Vilches, Roberto; Moya, Francisco; Ledezma, Rodrigo; Reyes, Diego; Marchant, Fernando

    2016-01-01

    Introduction: The role of hemostatic agents as an adjunct for closure of the nephrostomy tract in tubeless percutaneous surgery (tubeless percutaneous nephrolithotomy [tPNL]) has been previously evaluated, observing a potential benefit in terms of reduced bleeding and urinary leakage. We assessed the rate of postoperative complications after the use of hemostatic agents for sealing the nephrostomy tract in patients undergoing tPNL at our institution. Subjects and Methods: We performed a retrospective analysis of 52 consecutive patients undergoing tPNL at our center between January 2010 and December 2013. No substance was placed within the tract in 25 patients (Group 1). A cylinder of Surgicel® in addition to 1 unit of Gelita® were placed within the access tract in 27 patients (Group 2). We accounted for demographic variables, stone size, operative time, postoperative pain, development of hematoma, postoperative hematocrit drop, urinary leakage, residual lithiasis, and hospital stay length. Results: Age and sex differed significantly between the two groups (P = 0.0002 and P = 0.048 respectively). However, there were no significant differences in terms of body mass index and stone burden. No significant differences between groups were found with regards to operative time, postoperative hematocrit drop, postoperative pain and presence of residual lithiasis. Conclusion: The use of Gelita® and Surgicel® as hemostatic agents in tPNL is safe, but we were not able to demonstrate any significant benefit in terms of postoperative morbidity after comparing the use of these agents in tPNL. We concluded that the uses of hemostatic agents needed to be evaluated in prospective randomized trials to define its benefits. PMID:27141194

  11. Percutaneous abscess drainage in the UK: A national survey and single centre study

    Energy Technology Data Exchange (ETDEWEB)

    Buckley, B.T. [Radiology Department, John Radcliffe Hospital, Oxford (United Kingdom)]. E-mail: BrendanB@adhb.govt.nz; Goodwin, M. [Radiology Department, John Radcliffe Hospital, Oxford (United Kingdom); Boardman, P. [Radiology Department, John Radcliffe Hospital, Oxford (United Kingdom); Uberoi, R. [Radiology Department, John Radcliffe Hospital, Oxford (United Kingdom)

    2006-01-15

    AIM: To establish the current practice for management of radiologically placed percutaneous drains for abdominal sepsis in the UK and prospectively study the management of radiologically placed drains at our institution. METHOD: A questionnaire on the management of radiologically placed drains was sent to all radiology departments on a Royal College of Radiologists database. We prospectively followed all drains placed by our radiology department for drainage of abdominal collections, over a 7-month period. RESULTS: A total of 210 questionnaires were sent for the national survey, of these 117 were returned (55.7%). The majority of departments (70.5%) reported that after drain insertion the clinical team took over daily management. Just over 5% of departments either formally managed the drain or obtained final outcome data. From October 2003 to April 2004 we followed 63 consecutive drains placed in 45 patients, for abdominal sepsis. Thirty-nine drains (61.9%) were curative and 17 (26.9%) drains failed. Three drains (4.8%) were placed for palliation, and four drains (6.4%) were placed in order to temporise prior to surgery. Forty-three (68.3%) drains had a successful primary outcome: success after secondary percutaneous abscess drainage (PAD) improved to 46 (73.0%) drains. Two (3%) major complications occurred. CONCLUSIONS: The current approach in the UK to management of radiologically placed drains differs significantly from that practised in the USA. The most common type of support offered by radiology departments in the UK is of informal advice and follow-up, with the clinical team managing the patient's drain. Observations in our hospital highlighted problems relating to drain management that may impact on the success of PAD. We suggest that more formal radiological support after PAD would improve communication and potentially improve outcomes.

  12. Percutaneous nephrolithotomy with and without retrograde pyelography: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Ali Tabibi

    2007-02-01

    Full Text Available OBJECTIVE: Since the introduction of percutaneous nephrolithotomy (PCNL, many changes have been added regarding the entrance to pyelocalyceal system such as insertion of the needle pointed to an opaque stone as a guided landmark. We aim at comparing the outcomes of managing renal calculi with and without retrograde pyelography. MATERIALS AND METHODS: In a randomized clinical trial, 55 cases with opaque renal calculi candidates for PCNL with stone in one calyce, in the pelvis or both in one calyce and the pelvis simultaneously were included in a nine-month study. They were randomized into 2 groups, noncatheterized (n = 28 and catheterized (n = 27, called intervention and control groups, respectively. RESULTS: The 2 groups had similar distributions regarding gender, age, duration of operation, length of hospital stay, past history of any surgical procedures on kidney, and stone size. Outcome (residual stone based on aforementioned management was evaluated with plain X-ray on the morning following the operation. Postoperative hemoglobin decrease was significantly higher in controls than in the intervention group (p < 0.001 (with no clinical significance. No difference in outcome, postoperative fever, duration of surgery, duration of hospital stay and radiation exposure was observed between the 2 groups. CONCLUSION: Our findings showed no differences in major clinical outcomes between the 2 groups (with and without catheter insertion for retrograde pyelography.

  13. Long Term Outcome of Unprotected Left Main Stem Percutaneous Coronary Intervention, a Single Centre Experience

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    Egred M

    2014-11-01

    Full Text Available Percutaneous coronary intervention (PCI is increasingly used for unprotected left main coronary artery disease (UPLMS revascularization. Data regarding long-term mortality in this subset of patients remain sparse. We aim to present our outcome data on all comers who had UPLMS PCI. Methods: Retrospective dataset analysis of prospectively collected data evaluating all UPLMS PCI performed in a large tertiary cardiac centre, between September 2003 and December 2012. Long-term mortality data were available over a median duration of 21 months (IQR 10 months to 43 months. Results: In total there were 483 procedures performed. The cohort consisted of 58% with non ST elevation myocardial infarction (NSTEMI, 17% with STEMI and 25% with stable angina (SA. The overall in-hospital and long-term mortality were 7% and 22% respectively. The in-hospital mortality was 23%, 6%, and 1.6% in STEMI, NSTEMI, and SA respectively. Long-term mortality was 31% in STEMI patients, 26% in NSTEMI and 10% in SA. The use of drug eluting stents (DES [adjusted RR 0.40 (95% CI, 0.23-0.69] and Intravascular ultrasound (IVUS [adjusted RR 0.17 (95% CI 0.04-0.72] were independently associated with improved long-term survival. Conclusion: UPLMS PCI is associated with favourable long-term survival. The use of DES and IVUS guided PCI appear to be associated with improved long-term outcome and should be considered in the routine management of this cohort of patients.

  14. Gender Differences in Associations Between Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention and Adverse Outcomes

    DEFF Research Database (Denmark)

    Schoos, Mikkel; Mehran, Roxana; Dangas, George D

    2016-01-01

    Women are frequently reported to have increased morbidity after presentation with acute coronary syndromes and myocardial infarction; however, whether a greater thrombotic tendency contributes to gender differences in clinical outcomes of urgent percutaneous coronary intervention is unknown...... quantitative coronary angiography (QCA) analysis, from the ACUITY and HORIZONS-AMI trials. We compared major adverse cardiac events (MACE) at in-hospital, 30-day, and 1-year follow-up and major bleeding at 30 days according to gender and the presence or absence of IPTE. IPTE was identified in 507 patients (7.......7%), with 119 of 1,744 (6.8%) occurring in women and 388 of 4,847 (8.0%) in men (p = 0.12). IPTE, but not gender, was independently associated with MACE at in-hospital and 30-day follow-up. At 1-year follow-up, the adjusted hazard of MACE was higher in women and in patients with IPTE; however, the risk of MACE...

  15. Propofol-Based Sedation Does Not Increase Rate of Complication during Percutaneous Endoscopic Gastrostomy Procedure

    Directory of Open Access Journals (Sweden)

    Somchai Amornyotin

    2011-01-01

    Full Text Available Objectives. To evaluate and compare the complication rate of sedation with or without propofol regimen for percutaneous endoscopic gastrostomy (PEG in a hospital in Thailand. Subjects and Methods. A total of 198 patients underwent PEG procedures by using intravenous sedation (IVS from Siriraj Hospital, Thailand from August 2006 to January 2009. The primary outcome variable was the overall complication rate. The secondary outcome variables were sedation and procedure related complications, and mortality rate. Results. After matching ASA physical status and indications of procedure, there were 92 PEG procedures in propofol based sedation group (A and 20 PEG procedures in non-propofol based sedation group (B. All sedation was given by residents or anesthetic nurses directly supervised by staff anesthesiologist in the endoscopy room. There were no significant differences in patients' characteristics, sedation time, indication, complications, anesthetic personnel and mortality rate between the two groups. All complications were easily treated, with no adverse sequelae. Mean dose of fentanyl and midazolam in group A was significantly lower than in group B. Conclusion. Propofol-based sedation does not increase rate of complication during PEG procedure. Additionally, IVS of PEG procedure is relatively safe and effective when performed by physicians in training. Serious complications are none.

  16. A time-series study of percutaneous closure of patent foramen ovale: premature adoption?

    Science.gov (United States)

    Lew, Kian Nian; Angelini, Gianni D; Hollingworth, William

    2016-01-01

    To evaluate the impact of National Institute for Health and Care Excellence (NICE) guidance in January 2005 and subsequent trial evidence on the adoption of percutaneous closure of patent foramen ovale (PCPFO). A retrospective time series study was conducted using the Inpatient Hospital Episode Statistics (HES) England. A total of 3801 patients, aged ≥18 and ≤60 years, who had PCPFO from 1 April 2006 to 31 March 2012 in England. Percentage change annualised (PCA) in PCPFO procedure rates between initial NICE guidance and publication of trial results was analysed. Between Quarter 2, 2006 and Quarter 4, 2009, 2163 PCPFO procedures were performed, with an increasing PCA of 48.4%. The procedure rate peaked before the presentation of equivocal results from the first randomised controlled trial (RCT) in late 2010, and declined between Quarter 4, 2009 and Quarter 4, 2011 (PCA=-15.3%). Of more than 2300 patients recruited to three RCTs, only 71 were recruited in English hospitals. PCPFO was rapidly adopted after the publication of initial NICE guidance despite the absence of RCT evidence of efficacy. Very few English patients participated in international RCTs of PCPFO, suggesting that NICE recommendations also failed to encourage the generation of RCT evidence.

  17. Study of CK-MB activity in patients with acute myocardial infarction after percutaneous coronary intervention.

    Science.gov (United States)

    Emukhvari, N M; Tsetsekhladze, E D; Khijakadze, Kh A; Mamatsashvili, I O; Napetvaridze, R G

    2015-02-01

    The research has been carried out in patients of TSMU Cardiovascular Department of A.Aladashvili University Clinic. 105 patients with acute myocardial infarction have been involved in the study, wich undergoing percutaneous coronary intervention (PCI). For several years coronary angioplasty has been proposed to be an effective method, but in spite of its well developed technique, probability of myocardial injury is still high which appears to have no clinical or electrocardiographic manifestations and is diagnosed only by elevation of cardiac marker level. According to our study data after successful PCI elevation of CK-MB mass was observed in 34.4% patients, majority of those patients had STEMI. In II group the age of patients was higher compared to I group. There were more patients with diabetes mellitus (38.8%), dyslipidemia (86.1%) and patients with low left ventricular ejection fraction (50%). Also there were more patients with previous MI and damage of 3 coronary arteries. Hence age, diabetes mellitus, dyslipidemia, left ventricular ejection fraction MB elevation after successful PCI. Solid elevation of CK-MB after procedure was also associated with increased hospital complications rate, 30-day and 6 months hospitalization rate and 6 months mortality rate. It should be noted that from 36 patients who developed solid (24 h) elevation of CK-MB after PCI CK-MB mass was increased in all cases, while the concentration was elevated only in 16 cases. It proves that CK-MB mass is more significant criteria of myocardial injury.

  18. A randomized trail comparing primary percutaneous coronary intervention with a strategy of short-acting thrombolysis and immediate planned primary percutaneous coronary intervention in acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    傅向华

    2003-01-01

    A randomized trail comparing primary percutaneous coronary intervention with a strategy of short-acting thrombolysis and immediate planned primary percutaneous coronary intervention in acute myocardial infarction!050000$河北医科大学第二医院河北医科大学心脏介入中心@傅向华

  19. Clinical study of ultrasound-guided percutaneous radiofrequency ablation for primary hepatic carcinoma adjacent to the diaphragm

    Directory of Open Access Journals (Sweden)

    LI Meng

    2015-04-01

    Full Text Available ObjectiveTo investigate the safety and efficacy of ultrasound (US-guided percutaneous radiofrequency ablation (RFA for primary hepatic carcinoma adjacent to the diaphragm. MethodsThis study included 277 patients with 362 lesions of primary hepatic carcinoma managed with US-guided percutaneous RFA in 302 Hospital of PLA from January 2011 to October 2014. Sixty-six patients with 71 hepatocellular carcinomas (HCCs located less than 5 mm from the diaphragm were in study group, and 95 patients with 114 HCCs located more than 10 mm from the hepatic surface were in control group. The patients′ symptoms and complications were observed after the therapy. The complete ablation rate, local tumor progression rate, and complication rate were compared between the two groups. Comparison of continuous data between the two groups was made by independent-samples t test, while comparison of categorical data was made by chi-square test. ResultsAt one month after operation, 65 (91.5% of 71 tumors in the study group and 107 (93.9% of 114 tumors in the control group achieved complete ablation, according to contrast-enhanced CT and MRI, and there was no significant difference between the two groups (χ2=0.36, P=0.55. The postoperative follow-up showed that the local tumor progression rates in the study group and control group were 16.9% and 13.2%, respectively, without significant difference between the two groups (χ2=0.49, P=0.48. In the study group, 22 patients developed adverse reactions, versus 37 patients in the control group (χ2=2.60, P=0.11. ConclusionUS-guided percutaneous RFA is a safe and effective means for the treatment of primary hepatic carcinoma adjacent to the diaphragm.

  20. Bivalirudin is superior to heparins alone with bailout GP IIb/IIIa inhibitors in patients with ST-segment elevation myocardial infarction transported emergently for primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Zeymer, Uwe; van 't Hof, Arnoud; Adgey, Jennifer

    2014-01-01

    AIMS: In the HORIZONS trial, in-hospital treatment with bivalirudin reduced bleeding and mortality in primary percutaneous coronary intervention (PCI) compared with heparin and routine glycoprotein IIb/IIIa inhibitors (GPI). It is unknown whether this advantage of bivalirudin is observed in compa......AIMS: In the HORIZONS trial, in-hospital treatment with bivalirudin reduced bleeding and mortality in primary percutaneous coronary intervention (PCI) compared with heparin and routine glycoprotein IIb/IIIa inhibitors (GPI). It is unknown whether this advantage of bivalirudin is observed...... in comparison with heparins only with GPI used as bailout. METHODS AND RESULTS: In the EUROMAX study, 2198 patients with ST-segment elevation myocardial infarction (STEMI) were randomized during transport for primary PCI to bivalirudin or to heparins with optional GPI. Primary and principal outcome...

  1. Academic Hospitality

    Science.gov (United States)

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  2. Hospitality Management.

    Science.gov (United States)

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  3. Percutaneous Endovascular Treatment for Hepatic Artery Stenosis after Liver Transplantation: The Role of Percutaneous Endovascular Treatment

    Science.gov (United States)

    Vidjak, Vinko; Novačić, Karlo; Matijević, Filip; Kavur, Lovro; Slavica, Marko; Mrzljak, Anna; Filipec-Kanižaj, Tajana; Leder, Nikola Ivan; Škegro, Dinko

    2015-01-01

    Summary Background To retrospectively analyze the outcomes of interventional radiology treatment of patients with hepatic artery stenosis (HAS) after liver transplantation at our Institution. Material/Methods Hepatic artery stenosis was diagnosed and treated by endovascular technique in 8 (2.8%) patients, who underwent liver transplantation between July 2007 and July 2011. Patients entered the follow-up period, during which we analyzed hepatic artery patency with Doppler ultrasound at 1, 3, 6, and 12 months after percutaneous endovascular treatment (PTA), and every six months thereafter. Results During the 12-month follow-up period, 6 out of 8 patients (75%) were asymptomatic with patent hepatic artery, which was confirmed by multislice computed tomography (MSCT) angiography, or color Doppler (CD) ultrasound. One patient had a fatal outcome of unknown cause, and one patient underwent orthotopic liver retransplantation (re-OLT) procedure due to graft failure. Conclusions Our results suggest that HAS angioplasty and stenting are minimally invasive and safe endovascular procedures that represent a good alternative to open surgery, with good 12-month follow-up patency results comparable to surgery. PMID:26150902

  4. Routine diversion of patients with STEMI to high-volume PCI centres: modelling the financial impact on referral hospitals

    OpenAIRE

    Pathak, Elizabeth Barnett; Comins, Meg M; Forsyth, Colin J.; Strom, Joel A

    2015-01-01

    Objective To quantify possible revenue losses from proposed ST-elevation myocardial infarction (STEMI) patient diversion policies for small hospitals that lack high-volume percutaneous coronary intervention (PCI) capability status (ie, ‘STEMI referral hospitals’). Background Negative financial impacts on STEMI referral hospitals have been discussed as an important barrier to implementing regional STEMI bypass/transfer protocols. However, there is little empirical data available that directly ...

  5. [Percutaneous endoscopic gastrostomy and gastrojejunostomy. Experience and its role in domiciliary enteral nutrition].

    Science.gov (United States)

    Pereira, J L; Velloso, A; Parejo, J; Serrano, P; Fraile, J; Garrido, M; Pizarro, A; Romero, H; García-Luna, P P

    1998-01-01

    Percutaneous Endoscopic Gastrostomy (PEG) and its variation Percutaneous Endoscopic Gastrojejunostomy (PEGJ), has become the method of choice to achieve an enteral access route in patients who require long term enteral nutrition, especially in the area of the At Home Enteral Nutrition (AHEN). We present our experience on the first PEG's and PEGJ's carried out in our hospital. We studied 48 patients (14 women and 34 men) in whom a PEG/Percutaneous Endoscopic Gastrojejunostomy (PEGJ) was indicated, as they required enteral nutrition for prolonged periods of time (> 4 weeks) and/or they presented obstructive dysphagia, neuromotor dysphagia, or incorrigible vomiting in the two cases in whom PEGJ was carried out. 34 patients underwent the Ponsky-Gauderer technique, 6 patients underwent the Sacks-Vine technique, and 2 patients underwent a PEGJ. 24 hours after the PEGJ enteral nutrition (EN) was begun in a progressive manner. During the hospitalization period there was a daily follow up of the patient. In those cases in which At Home Enteral Nutrition was programmed, the patients/families were trained in the techniques and the care of the PEG and the EN, and the control was carried out through the Nutrition out patient department. PEG was successfully carried out in 42 patients (88%). 35 patients had previously been given EN through a naso-gastric tube (NGT), while in 7 cases the PEG was the first enteral access route. The average duration of the PEG was 212 days, and 27 patients (64%) needed the PEG for more than 3 months. The mean caloric supply was 1921 +/- 200 kcal/day. The mode of administration was by means of an intermittent infusion by gravity in 31 cases, and by continuous infusion using a volumetric pump in 11 patients. Two patients with pregnancy induced hyperemesis underwent a PEGJ in the 3rd and the 4th month of pregnancy, with the pregnancy being successfully brought to term and ending in vaginal deliveries. Carrying out a PEG permitted release from hospital

  6. Four Cases of a Cerebral Air Embolism Complicating a Percutaneous Transthoracic Needle Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Um, Soo Jung; Lee, Soo Keol; Yang, Doo Kyung; Son, Choon Hee; Kim, Ki Nam; Lee, Ki Nam [Dong-A University College of Medicine, Busan (Korea, Republic of); Kim, Yun Seong [Busan National University College of Medicine, Busan (Korea, Republic of)

    2009-02-15

    A percutaneous transthoracic needle biopsy is a common procedure in the practice of pulmonology. An air embolism is a rare but potentially fatal complication of a percutaneous transthoracic needle biopsy. We report four cases of a cerebral air embolism that developed after a percutaneous transthoracic needle biopsy. Early diagnosis and the rapid application of hyperbaric oxygen therapy is the mainstay of therapy for an embolism. Prevention is the best course and it is essential that possible risk factors be avoided.

  7. Percutaneous treatment of patients with heart diseases: selection, guidance and follow-up. A review

    Directory of Open Access Journals (Sweden)

    Contaldi Carla

    2012-03-01

    Full Text Available Abstract Aortic stenosis and mitral regurgitation, patent foramen ovale, interatrial septal defect, atrial fibrillation and perivalvular leak, are now amenable to percutaneous treatment. These percutaneous procedures require the use of Transthoracic (TTE, Transesophageal (TEE and/or Intracardiac echocardiography (ICE. This paper provides an overview of the different percutaneous interventions, trying to provide a systematic and comprehensive approach for selection, guidance and follow-up of patients undergoing these procedures, illustrating the key role of 2D echocardiography.

  8. Treatment of Spinal Osseous Metastasis with Combined Percutaneous Radiofrequency Ablation and Vertebroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Sik; Hong, Suk Joo; Kim, Ye Lim; Bae, Hyoung Ju; Kang, Eun young [Dept. of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Joo Han [Dept. of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2011-04-15

    Recent introduction of image-guided percutaneous methods to treat unresectable bone tumors including metastases that do not respond to conventional radiotherapy or chemotherapy has proven to be effective. Here we present three successfully treated cases of metastatic bone lesions: two cases of malignant bone metastases in the lumbar spine and one in the sacral bone, using combined percutaneous radiofrequency ablation and percutaneous vertebroplasty/compassionately. A brief review of literature is also included.

  9. Manual Thrombus Aspiration and the Improved Survival of Patients With Unstable Angina Pectoris Treated With Percutaneous Coronary Intervention (30 Months Follow-Up).

    Science.gov (United States)

    Yildiz, Bekir S; Bilgin, Murat; Zungur, Mustafa; Alihanoglu, Yusuf I; Kilic, Ismail D; Buber, Ipek; Ergin, Ahmet; Kaftan, Havane A; Evrengul, Harun

    2016-02-01

    The clinical effect of intracoronary thrombus aspiration during percutaneous coronary intervention in patients with unstable angina pectoris is unknown. In this study, we aimed to assess how thrombus aspiration during percutaneous coronary intervention affects in-hospital and 30-month mortality and complications in patients with unstable angina pectoris.We undertook an observational cohort study of 645 consecutive unstable angina pectoris patients who had performed percutaneous coronary intervention from February 2011 to March 2013. Before intervention, 159 patients who had culprit lesion with thrombus were randomly assigned to group 1 (thrombus aspiration group) and group 2 (stand-alone percutaneous coronary intervention group). All patients were followed-up 30 months until August 2015.Thrombus aspiration was performed in 64 patients (46%) whose cardiac markers (ie, creatinine kinase [CK-MB] mass and troponin T) were significantly lower after percutaneous coronary intervention than in those of group 2 (CK-MB mass: 3.80 ± 1.11 vs 4.23 ± 0.89, P = 0.012; troponin T: 0.012 ± 0.014 vs 0.018 ± 0.008, P = 0.002). Left ventricular ejection fraction at 6, 12, and 24 months postintervention was significantly higher in the group 1. During a mean follow-up period of 28.87 ± 6.28 months, mortality rates were 6.3% in the group 1 versus 12.9% in the group 2. Thrombus aspiration was also associated with significantly less long-term mortality in unstable angina pectoris patients (adjusted HR: 4.61, 95% CI: 1.16-18.21, P = 0.029).Thrombus aspiration in the context of unstable angina pectoris is associated with a limited elevation in cardiac enzymes during intervention that minimises microembolization and significantly improves both of epicardial flow and myocardial perfusion, as shown by angiographic TIMI flow grade and frame count. Thrombus aspiration during percutaneous coronary intervention in unstable angina pectoris patients has better

  10. Outcomes of a single-port laparoscopic appendectomy using a glove port with a percutaneous organ-holding device and commercially-available multichannel single-port device.

    Science.gov (United States)

    Lee, Jieun; Lee, Sung Ryol; Kim, Hyung Ook; Son, Byung Ho; Choi, Wonjun

    2014-02-01

    A laparoscopic appendectomy is now commonly performed. The push in recent years toward reducing the number of ports required to perform this surgery has led to the development of a single-port laparoscopic appendectomy (SPA). We compared postoperative pain after an SPA using a glove port with a percutaneous organ-holding device (group 1) with that of an SPA using a commercially-available multichannel single-port device (group 2). Between March 2010 and July 2011, a retrospective study was conducted of a total of 77 patients who underwent an SPA by three surgeons at department of surgery, Kangbuk Samsung Medical Center. Thirty-eight patients received an SPA using a glove port with a percutaneous organ-holding device. The other 39 patients received an SPA using a commercially-available multichannel single port (Octo-Port or SILS Port). Operative details and postoperative outcomes were collected and evaluated. There were no differences in the mean operative times, times to pass gas, postoperative hospital stays, or cosmetic satisfaction scores between the two groups. The pain score in the first 24 hours after surgery was higher in group 2 than group 1 patients (P expensive than that used in group 1. An SPA using a glove port with a percutaneous organ-holding device was associated with a lower pain score during the first 24 hours after surgery because of the shorter fascia incision length and a cheaper cost than an SPA using a commercially-available multichannel single-port device.

  11. Percutaneous Nephrolithotomy under Ultrasound Guidance in Patients with Renal Calculi and Autosomal Dominant Polycystic Kidney Disease: A Report of 11 Cases

    Directory of Open Access Journals (Sweden)

    Xiao Wang

    2017-01-01

    Full Text Available Nephrolithiasis accelerates the renal failure in the patients with ADPKD. In order to evaluate the role of percutaneous nephrolithotomy in management of calculus in these patients, 11 patients with autosomal dominant polycystic kidney disease and renal stones were included in the study. Two patients had bilateral renal stones. All patients were treated by percutaneous nephrolithotomy under ultrasound guidance. 13 percutaneous nephrolithotomy procedures were performed in 1 stage by the urology team under ultrasound guidance. 5 people received second operation with flexible nephroscopy in lateral position. The success rate and morbidity and mortality of the technique and hospital stay were recorded. Results. The puncture procedure was fully successful in all cases. The renal function improved in these patients. 5 patients had moderate fever after the surgery. 5 patients received flexible nephroscopy to take out the residual calculi. 2 persons had ESWL therapy after the surgery. Conclusion. PCNL is an ideal, safe, and effective method to remove the stones from those patients with no definite increase in the risk of complication. The outcome and stone-free rate are satisfactory comparable to the PCNL in the patients without ADPKD.

  12. Assessment of myocardial injury markers and neurohumoral indicators in serum after STEMI patients received percutaneous coronary intervention combined with thrombus aspiration

    Institute of Scientific and Technical Information of China (English)

    Ling Gong

    2016-01-01

    Objective:To study the myocardial injury markers and neurohumoral indicators in serum after STEMI patients received percutaneous coronary intervention combined with thrombus aspiration.Methods:Patients with acute ST-segment elevation myocardial infarction who received percutaneous coronary intervention in our hospital from May 2010 to December 2015 were selected for study, 48 cases of patients who received PCI combined with thrombus aspiration and 50 cases of patients who received direct PCI were screened and included in experimental group and control group respectively. The degree of myocardial injury and neurohumoral indicators of two groups were compared.Results:Intraoperative TIMI grade of experimental group was significantly higher than that of control group, peak values of CK-MB, cTnT and cTnI 24 h after operation were significantly lower than those of control group, and ST-segment fallback ratio within 1h after operation was significantly higher than that of control group; 24h after operation, serum renin, angiotensin II, aldosterone, sodium and endothlin-1 content of experimental group were significantly lower than those of control group, potassium and nitric oxide content were significantly higher than those of control group, and the number of CD31+/CD42b- EMPs in peripheral blood was significantly lower than that of control group. Conclusion:Percutaneous coronary intervention combined with thrombus aspiration treatment of STEMI can improve coronary perfusion, reduce myocardial cell injury, inhibit RAS system activation and protect endothelial function.

  13. Percutaneous Nephrolithotomy under Ultrasound Guidance in Patients with Renal Calculi and Autosomal Dominant Polycystic Kidney Disease: A Report of 11 Cases

    Science.gov (United States)

    Wang, Xiao; Yang, Xuecheng; Zhong, Xiulong; Wang, Zhenlin; Xue, Senyao; Yu, Weifeng

    2017-01-01

    Nephrolithiasis accelerates the renal failure in the patients with ADPKD. In order to evaluate the role of percutaneous nephrolithotomy in management of calculus in these patients, 11 patients with autosomal dominant polycystic kidney disease and renal stones were included in the study. Two patients had bilateral renal stones. All patients were treated by percutaneous nephrolithotomy under ultrasound guidance. 13 percutaneous nephrolithotomy procedures were performed in 1 stage by the urology team under ultrasound guidance. 5 people received second operation with flexible nephroscopy in lateral position. The success rate and morbidity and mortality of the technique and hospital stay were recorded. Results. The puncture procedure was fully successful in all cases. The renal function improved in these patients. 5 patients had moderate fever after the surgery. 5 patients received flexible nephroscopy to take out the residual calculi. 2 persons had ESWL therapy after the surgery. Conclusion. PCNL is an ideal, safe, and effective method to remove the stones from those patients with no definite increase in the risk of complication. The outcome and stone-free rate are satisfactory comparable to the PCNL in the patients without ADPKD. PMID:28321250

  14. Subcutaneous Transitional Cell Cancer After Percutaneous Nephrolithotomy: A Case Report

    Directory of Open Access Journals (Sweden)

    Lokman Ižrkilata

    2013-10-01

    Full Text Available Transitional cell carcinomas of the upper urinary tract are rare but, highly predisposing to tumoral seeding. Percutaneous lithotripsy (PNL recently has expanded the therapeutic choices for patients with kidney stones and gained popularity by urologic surgeons. Although unusual, renal collecting system tumours may be encountered during PNL. We present and discuss the clinical course of a 48 years old male patient who underwent PNL surgery for kidney stone in whom transitional cell carcinoma in the renal collecting system obscured by stone left undiagnosed. Three months later following PNL he admitted with a bulge on lumbar region. Excisional biopsy revealed carcinoma and therefore, he was directed to chemoradiotherapy and died 21 months later. Renal collecting system tumors undiagnosed during surgery may progress and demonstrate local invasion in a short period of time. Therefore, we recommend to take more caution during any percutaneous access and to exclude the possible existence of tumor.

  15. Percutaneous antegrade ureteric stent removal using a rigid alligator forceps.

    LENUS (Irish Health Repository)

    Given, M F

    2008-12-01

    To evaluate the safety and efficacy of percutaneous antegrade ureteric stent removal using a rigid alligator forceps. Twenty patients were included in our study. Indications for ureteric stent insertion included stone disease (n = 7), malignancy (n = 8) and transplant anastomotic strictures (n = 5). Stent retrieval was carried out for proximal stent placement\\/migration in seven patients and encrustation in the remaining 13. Twenty-two stents were successfully retrieved in 20 patients. There was one technical failure (5%). There were no major complications. We had four minor complications, which included nephrostomy site pain (n = 2), periprocedural sepsis (n = 1) and a small urinoma (n = 1). All patients settled with conservative management. Percutaneous radiologically guided antegrade ureteric stent removal with an alligator forceps is safe and effective, particularly when initial surgical removal has failed.

  16. APPLICATION OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN ENT PATIENTS

    Directory of Open Access Journals (Sweden)

    Gil-Carcedo García, LM

    2011-09-01

    Full Text Available INTRODUCTION: Gastrostomy is a very useful technique to maintain an adequate nutritional status in patients with head and neck cancer. It presents very good acceptability and complete adherence of treatments.DISCUSSION: PEG is a good nutritional option for our oncological patients. It is a minimally invasive method with low morbility and mortality rates, low economical cost and very good social acceptability.We summarize the main ENT indications of this technique. CONCLUSION: Our department indicate the percutaneous endoscopic gastrostomy in patients with head and neck cancer who are unable to maintain an adequate nutritional status and need enteral nutrition for more than 8 weeks. Its acceptability is very good and complications are generally minor ones.Percutaneous endoscopic gastrostomy should replace to nasogastric feeding tubes and to open gastrostomy in patients with short life expectancy.

  17. Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Robert Marcovich

    2003-06-01

    Full Text Available Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial anatomy of the renal collecting system, presence of hydronephrosis, and other anatomic variables, such as the presence of calyceal diverticula and renal anomalies; and clinical or patient factors like morbid obesity, the presence of a solitary kidney, and renal insufficiency. The morbidity of each procedure in relation to its efficacy should be taken in to account. This article will review current knowledge and suggest an algorithm for the rational management of renal calculi with shock wave lithotripsy and percutaneous nephrolithotomy.

  18. Percutaneous mitral valve repair with MitraClip.

    Science.gov (United States)

    Cilingiroğlu, Mehmet; Salinger, Michael

    2012-03-01

    Over the last decade, several technologies have been developed for percutaneous repair of the mitral valve for patients with severe mitral regurgitation (MR) and at high-risk for the traditional open-heart mitral valve repair or replacement. Among them, MitraClip has emerged as the only clinically safe and effective method for percutaneous mitral valve repair. It is adapted from the surgical technique that was initially described by Dr. Alfieri and his group by placement of a suture approximating the edges of the mitral leaflets at the origin of the MR jet, leading to creation of so-called bow-tie or double orifice with significant reduction in the MR jet. Here, we review the details of the technology, its procedural perspective as well as currently available data for its safety and effectiveness on a case-based report.

  19. [Percutaneous transluminal angioplasty in vascular by-passes].

    Science.gov (United States)

    Rodríguez, J E; Fernández Guinea, O; López, V; Suárez Pereiro, M J; Reimunde, E; Cosío, J M; Barreiro, A

    1993-01-01

    Results from 21 cases of percutaneous transluminal angioplasties as a treatment of stenosed vascular by-pass from 16 patients, are presented. The technique took place in 10 cases at the aorto-femoral area, in others 10 cases at the popliteal-femoral area and, in the last one, at the carotid-subclavian area. Preliminary results were successful in all cases (100%). Follow-up showed a better long-term results at the aorto-femoral level. Considering the satisfactory results and also considering that, in case of negative results or re-stenosis, other surgical techniques could be performed, we conclude that the percutaneous transluminal angioplasty should be the first treatment for such of injuries.

  20. High-density percutaneous chronic connector for neural prosthetics

    Science.gov (United States)

    Shah, Kedar G.; Bennett, William J.; Pannu, Satinderpall S.

    2015-09-22

    A high density percutaneous chronic connector, having first and second connector structures each having an array of magnets surrounding a mounting cavity. A first electrical feedthrough array is seated in the mounting cavity of the first connector structure and a second electrical feedthrough array is seated in the mounting cavity of the second connector structure, with a feedthrough interconnect matrix positioned between a top side of the first electrical feedthrough array and a bottom side of the second electrical feedthrough array to electrically connect the first electrical feedthrough array to the second electrical feedthrough array. The two arrays of magnets are arranged to attract in a first angular position which connects the first and second connector structures together and electrically connects the percutaneously connected device to the external electronics, and to repel in a second angular position to facilitate removal of the second connector structure from the first connector structure.

  1. Immediate complications of percutaneous central venous cannulation in children

    Science.gov (United States)

    Dheer, Geetika; Chaudhry, Gurmeet Kaur; Singh, Tejinder

    2011-01-01

    Objective: To study the incidence of immediate complications associated with percutaneous central venous catheterization. Materials and Methods: A total of 103 central venous catheters were inserted in 70 children over a period of 18 months, governed by a uniform protocol. Sixty-three percent of the catheters were inserted in neonates, 23.3% in infants and 13.6% in children between 1 and 12 years of age. Statistical Analysis Used: Software SPSS version 15. Results: There were a total of 41 insertion-related immediate complications, of which 75.6% were in neonates. Neonatal age, hemodynamic instability and more number of attempts to catheterize the vein had a higher risk of insertion-related problems. There was no mortality directly as a result of the procedure. Conclusion: In our practice, it was observed that complications were fewer with increasing familiarity with the procedure. Hence, percutaneous central venous catheterization is a safe procedure when performed in experienced hands. PMID:22121313

  2. Immediate complications of percutaneous central venous cannulation in children

    Directory of Open Access Journals (Sweden)

    Geetika Dheer

    2011-01-01

    Full Text Available Objective: To study the incidence of immediate complications associated with percutaneous central venous catheterization. Materials and Methods: A total of 103 central venous catheters were inserted in 70 children over a period of 18 months, governed by a uniform protocol. Sixty-three percent of the catheters were inserted in neonates, 23.3% in infants and 13.6% in children between 1 and 12 years of age. Statistical Analysis Used: Software SPSS version 15. Results: There were a total of 41 insertion-related immediate complications, of which 75.6% were in neonates. Neonatal age, hemodynamic instability and more number of attempts to catheterize the vein had a higher risk of insertion-related problems. There was no mortality directly as a result of the procedure. Conclusion: In our practice, it was observed that complications were fewer with increasing familiarity with the procedure. Hence, percutaneous central venous catheterization is a safe procedure when performed in experienced hands.

  3. Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Pabon-Ramos, Waleska M., E-mail: waly.pr@duke.edu [Duke University Hospital, Department of Radiology (United States); Niemeyer, Matthew M. [Washington University Medical Center, Mallinckrodt Institute of Radiology (United States); Dasika, Narasimham L., E-mail: narasimh@med.umich.edu [University of Michigan Health System, Department of Radiology (United States)

    2013-10-15

    Purpose: To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach. Methods: The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated. Results: Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 days (range 26-313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40-659 days). Conclusion: This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.

  4. Percutaneous drainage as a first therapeutic step prior to surgery in liver hydatid cyst abscess: Is it worth it?

    Science.gov (United States)

    Lopez-Marcano, Aylhin J; Ramia, Jose M; Arteaga, Vladimir; De la Plaza, Roberto; Gonzales, Jhonny D; Medina, Anibal

    2017-01-01

    AIM To delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity. METHODS Using this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the clinical presentation was fever without a clear source of infection; all had nonspecific symptoms such as general malaise, dyspnea, and abdominal discomfort in the previous 15 d. They came to the emergency room at our hospital due to deterioration of their general condition. Analytical tests showed leukocytosis, neutrophilia and increased polymerase chain reaction. In all cases an abdominal computed tomography (CT) was performed and liver hydatid abscess (LHA) was detected. The mean size of the LHA was 12 cm. RESULTS All patients underwent CT-guided percutaneous drainage. The purulent material obtained was cultured, and Klebsiella pneumoniae, Streptococcus viridans and Streptococcus salivarius were identified. Antibiotic treatment was given adapted to antibiotic sensitivity testing. Surgery was performed two weeks after admission, once the patient’s condition had improved. All three patients underwent an almost total cystectomy, cholecystectomy and omentoplasty in the residual cavity. Complications were: Clavien I (atelectasis and pleural effusion) and Clavien II (transfusion). The average length of stay (pre and postoperative) was 23 d. At the follow-up, no relapses were recorded. CONCLUSION LHA management is not standardized. Emergency surgery offers suboptimal results. Percutaneous drainage plus antibiotics allows improving patient’s general condition. This enables treating patients in greater safety and also reduces complications. PMID:28144393

  5. Early Postoperative Results of Percutaneous Needle Fasciotomy in 451 Patients with Dupuytren Disease.

    Science.gov (United States)

    Molenkamp, Sanne; Schouten, Tanneke A M; Broekstra, Dieuwke C; Werker, Paul M N; Moolenburgh, J Daniel

    2017-06-01

    Percutaneous needle fasciotomy is a minimally invasive treatment modality for Dupuytren disease. In this study, the authors analyzed the efficacy and complication rate of percutaneous needle fasciotomy using a statistical method that takes the multilevel structure of data, regarding multiple measurements from the same patient, into account. The data of 470 treated rays from 451 patients with Dupuytren disease that underwent percutaneous needle fasciotomy were analyzed retrospectively. The authors described the early postoperative results of percutaneous needle fasciotomy and applied linear mixed models to compare mean correction of passive extension deficit between joints and efficacy of primary versus secondary percutaneous needle fasciotomy. Mean preoperative passive extension deficits at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 37, 40, and 31 degrees, respectively. Mean preoperative total passive extension deficit was 54 degrees. Results were excellent, with a mean total passive extension deficit correction of 85 percent. Percutaneous needle fasciotomy was most effective for metacarpophalangeal joints and less effective for proximal interphalangeal and distal interphalangeal joints. Secondary percutaneous needle fasciotomy was as effective as primary percutaneous needle fasciotomy. Complications were rare and mostly minor. The results of this study confirm that percutaneous needle fasciotomy is an effective and safe treatment modality for patients with mild to moderate disease who prefer a minimally invasive procedure. Therapeutic, IV.

  6. Percutaneous absorption of crotamiton in man following single and multiple dosing.

    Science.gov (United States)

    Dika, E; Tosti, A; Goldovsky, M; Wester, R; Maibach, H I

    2006-01-01

    Crotamiton is a topical drug used in the treatment of scabies and pruritus. We determined its percutaneous absorption following single and multiple dosing in normal skin. We used in vivo measurement of percutaneous absorption of [14C] crotamiton in a multidose regimen by measuring urinary excretion and liquid scintillation counting in three groups of four healthy volunteers. The Feldmann urinary excretion method was utilized to ascertain percutaneous absorption. Our results showed that tape stripping does not increase percutaneous absorption of crotamiton; upon repeated application.

  7. Percutaneous Ablation for Small Renal Masses—Complications

    OpenAIRE

    Kurup, A. Nicholas

    2014-01-01

    Although percutaneous ablation of small renal masses is generally safe, interventional radiologists should be aware of the various complications that may arise from the procedure. Renal hemorrhage is the most common significant complication. Additional less common but serious complications include injury to or stenosis of the ureter or ureteropelvic junction, infection/abscess, sensory or motor nerve injury, pneumothorax, needle tract seeding, and skin burn. Most complications may be treated ...

  8. Percutaneous gastrostomy tube placement in patients with ventriculoperitoneal shunts

    Energy Technology Data Exchange (ETDEWEB)

    Sane, S.S.; Towbin, A.; Bergey, E.A.; Kaye, R.D.; Fitz, C.R.; Albright, L.; Towbin, R.B. [Department of Radiology, Children`s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213 (United States)

    1998-07-01

    Objective. The purpose of this study is to determine the risk of CNS and/or peritoneal infection in children with ventriculoperitoneal shunts in whom a percutaneous gastrostomy tube is placed. Materials and methods. We placed 205 gastrostomy or gastrojejunostomy tubes from January of 1991 to December 1996. Twenty-three patients (10 boys, 13 girls) had ventriculoperitoneal shunts at the time of placement. All shunts were placed at least 1 month prior to placement of the gastrostomy tube. The patients ranged in age from 8 months to 16 years with a mean age of 6 years, 9 months. Patient weight ranged from 2 kg to 60 kg. All 23 children required long-term nutritional support due to severe neurologic impairment. No prophylactic antibiotics were given prior to the procedure. Of the patients, 21/23 had a 14-F Sacks-Vine gastrostomy tube with a fixed terminal retention device inserted, using percutaneous fluoroscopic antegrade technique. Two of the 23 patients had a Ross 14-F Flexi-flo gastrostomy tube which required a retrograde technique due to a small caliber esophagus in these children. Results. All 23 children had technically successful placements of percutaneous gastrostomy (7) or gastrojejunostomy (16) tubes. Of the children, 21/23 (91 %) had no complications from the procedure. Two of 23 (9 %) patients demonstrated signs of peritonitis after placement of their gastrostomy tubes and subsequently had shunt infections. In both, children CSF culture grew gram-positive cocci. The antegrade technique was used in both children who developed peritonitis. Conclusion. Our study indicates children with ventriculoperitoneal shunts who undergo percutaneous gastrostomy are at greater risk for infection and subsequent shunt malfunction. Therefore, we recommend prophylactic antibiotic therapy to cover for skin and oral flora. (orig.) With 1 fig., 7 refs.

  9. Percutaneous approach for sialolith removal in a donkey.

    Science.gov (United States)

    Rodrigues, João B; Mora, Sara; Bastos, Estela; Viegas, Carlos; San Roman, Fidel

    2013-01-01

    Salivary duct lithiasis is a condition characterized by the partial or total obstruction ofa salivary gland or its excretory duct due to the formation of sialoliths. A 9-year-old female donkey, belonging to the unique and endangered indigenous breed of donkey in Portugal, was diagnosed with a sialolith in the rostral portion of the right parotid duct based on clinical, oral, dental, and radiographic examination results. Surgical removal of the sialolith was done through a percutaneous approach.

  10. Distal protection devices during percutaneous coronary and carotid interventions

    OpenAIRE

    2001-01-01

    Abstract Distal embolization of particulate matter complicates percutaneous coronary and peripheral interventions more often than had been recognized until recently. A number of distal protection devices are under development. The PercuSurge GuardWire™ is a balloon occlusion thrombectomy device approved by the United States Food and Drug Administration for saphenous vein graft intervention. A number of filter devices utilize an expandable filter mounted on the angioplasty guidewire to facilit...

  11. Manually controlled steerable needle for MRI-guided percutaneous interventions

    OpenAIRE

    Henken, Kirsten R.; Seevinck, Peter R.; Dankelman, Jenny; van den Dobbelsteen, John J.

    2016-01-01

    This study aims to develop and evaluate a manually controlled steerable needle that is compatible with and visible on MRI to facilitate full intra-procedural control and accurate navigation in percutaneous interventions. The steerable needle has a working channel that provides a lumen to a cutting stylet or a therapeutic instrument. A steering mechanism based on cable-operated compliant elements is integrated in the working channel. The needle can be steered by adjusting the orientation of th...

  12. Biliary peritonitis following percutaneous nephrolithotomy: Minimally invasive management

    OpenAIRE

    Yadav, Siddharth; Singh, Animesh; Singh, Prabhjot

    2015-01-01

    Percutaneous nephrolithotomy (PCNL) is a standard procedure for large renal calculi but has potential for complications. Rarely, biliary tract injury can occur during PCNL that can lead to biliary peritonitis with sepsis. Such cases are usually managed by emergent cholecystectomy. We present a case of biliary peritonitis resulting from gall bladder injury during PCNL, managed minimally invasively with an abdominal drain and endoscopic retrograde cholangiography with common bile duct stenting.

  13. Biliary peritonitis following percutaneous nephrolithotomy: Minimally invasive management.

    Science.gov (United States)

    Yadav, Siddharth; Singh, Animesh; Singh, Prabhjot

    2015-01-01

    Percutaneous nephrolithotomy (PCNL) is a standard procedure for large renal calculi but has potential for complications. Rarely, biliary tract injury can occur during PCNL that can lead to biliary peritonitis with sepsis. Such cases are usually managed by emergent cholecystectomy. We present a case of biliary peritonitis resulting from gall bladder injury during PCNL, managed minimally invasively with an abdominal drain and endoscopic retrograde cholangiography with common bile duct stenting.

  14. Comparative Study between Standard and Totally Tubeless Percutaneous Nephrolithotomy

    OpenAIRE

    Yun, Sung Il; Lee, Yoon Hyung; Kim, Jae Soo; Cho, Sung Ryong; Kim, Bum Soo; Kwon, Joon Beom

    2012-01-01

    Purpose Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PNL). Postoperatively, tubeless PNL patients have an indwelling ureteral stent placed, which is often associated with stent-related morbidity. We have performed totally tubeless (tubeless and stentless) PNL in which no nephrostomy tube or ureteral stent is placed postoperatively. We evaluated the safety, effectiveness, and feasibility of totally tubeless PNL. Materials and Methods From March 20...

  15. Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

    OpenAIRE

    Robert Marcovich; Smith, Arthur D.

    2003-01-01

    Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial...

  16. Echocardiographic assessment and percutaneous closure of multiple atrial septal defects

    Directory of Open Access Journals (Sweden)

    Timperley Jonathan

    2004-07-01

    Full Text Available Abstract Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. Centrally located, secundum defects are ideal for device closure but there is considerable morphological variation in size and location of the defects. A small proportion of atrial septal defects may have multiple fenestrations and these are often considered unsuitable for device closure. We report three cases of multiple atrial septal defects successfully closed with two Amplatzer septal occluders.

  17. Percutaneous ultrasonic lithotripsy of symptomatic renal calculi in children

    Energy Technology Data Exchange (ETDEWEB)

    Papanicolaou, N.; Pfister, R.C.; Yoder, I.C.; Young, H.H. II; Herrin, J.T.

    1986-01-01

    Percutaneous ultrasonic lithotripsy of upper urinary tract lithiasis is a well-established procedure in adults. We successfully applied this technique to completely remove symptomatic renal calculi in two children with idiopathic hypercalciuria. The procedure was well tolerated and no complications occurred. Both patients were discharged within 4 days of the lithotripsy. This method is an alternative to surgery for the removal of large or impacted calculi from the upper urinary tracts of pediatric patients. (orig.).

  18. Percutaneous aspiration of fluid for management of peritonitis in space

    Science.gov (United States)

    Kirkpatrick, A. W.; Nicolaou, S.; Campbell, M. R.; Sargsyan, A. E.; Dulchavsky, S. A.; Melton, S.; Beck, G.; Dawson, D. L.; Billica, R. D.; Johnston, S. L.; Hamilton, D. R.

    2002-01-01

    BACKGROUND: As a medical emergency that can affect even well-screened, healthy individuals, peritonitis developing during a long-duration space exploration mission may dictate deviation from traditional clinical practice due to the absence of otherwise indicated surgical capabilities. Medical management can treat many intra-abdominal processes, but treatment failures are inevitable. In these circumstances, percutaneous aspiration under sonographic guidance could provide a "rescue" strategy. Hypothesis: Sonographically guided percutaneous aspiration of intra-peritoneal fluid can be performed in microgravity. METHODS: Investigations were conducted in the microgravity environment of NASA's KC-135 research aircraft (0 G). The subjects were anesthetized female Yorkshire pigs weighing 50 kg. The procedures were rehearsed in a terrestrial animal lab (1 G). Colored saline (500 mL) was introduced through an intra-peritoneal catheter during flight. A high-definition ultrasound system (HDI-5000, ATL, Bothell, WA) was used to guide a 16-gauge needle into the peritoneal cavity to aspirate fluid. RESULTS: Intra-peritoneal fluid collections were easily identified, distinct from surrounding viscera, and on occasion became more obvious during weightless conditions. Subjectively, with adequate restraint of the subject and operators, the procedure was no more demanding than during the 1-G rehearsals. CONCLUSIONS: Sonographically guided percutaneous aspiration of intra-peritoneal fluid collections is feasible in weightlessness. Treatment of intra-abdominal inflammatory conditions in spaceflight might rely on pharmacological options, backed by sonographically guided percutaneous aspiration for the "rescue" of treatment failures. While this risk mitigation strategy cannot guarantee success, it may be the most practical option given severe resource limitations.

  19. Modular training for percutaneous nephrolithotripsy: The safe way to go

    OpenAIRE

    2015-01-01

    Objectives should be describe a modular training scheme (MTS) which aims to provide training in percutaneous nephrolithotripsy (PCNL) and ensure the safety of the patients. Subjects and methods Two trainees with no experience in PCNL attended the MTS under the supervision of an experienced mentor. The MTS included five modules, comprising an initial animal laboratory course (using pigs), to acquire basic skills (Module 1), and Modules 2–5 included making the puncture, tract dilatation, single...

  20. Percutaneous suturing of the ruptured Achilles tendon with endoscopic control.

    Science.gov (United States)

    Doral, Mahmut Nedim; Bozkurt, Murat; Turhan, Egemen; Ayvaz, Mehmet; Atay, Ozgür Ahmet; Uzümcügil, Akin; Leblebicioğlu, Gürsel; Kaya, Defne; Aydoğ, Tolga

    2009-08-01

    A prospective study of modified percutaneous Achilles tendon repair performed between 1999 and 2005 under local infiltration anesthesia is presented; the study evaluated the results of percutaneous repair technique by visualization of the synovia under endoscopic control, followed by early functional postoperative treatment for surgical intervention of acute Achilles tendon ruptures. Sixty-two patients (58 males, 4 females, mean age 32) were treated by percutaneous suturing with modified Bunnel technique under endoscopic control within 10 days after acute total rupture. Physiotherapy was initiated immediately after the operation and patients were encouraged to weight-bearing ambulation with a walking brace-moon boot as tolerated. Full weight-bearing was allowed minimum after 3 weeks postoperatively without brace. The procedure was tolerated in all patients. There were no significant ROM limitation was observed. Two patients experienced transient hypoesthesia in the region of sural nerve that spontaneously resolved in 6 months. Fifty-nine patients (95%) including professional athletes returned to their previous sportive activities, while 18 of them (29%) had some minor complaints. The interval from injury to return to regular work and rehabilitation training was 11.7 weeks (10-13 weeks). At the latest follow-up (mean: 46 months; range: 12-78 months), all the patients had satisfactory results with a mean American Orthopedic Foot and Ankle Society's ankle-hindfoot score of 94.6. No re-ruptures, deep venous thrombosis or wound problems occurred. The proposed method offers a reasonable treatment option for acute total Achilles tendon rupture with a low number of complications. The rerupture rate and return to preinjury activities are comparable to open and percutaneous without endoscopic control procedures.

  1. Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study.

    Science.gov (United States)

    Barnes, Darryl E; Beckley, James M; Smith, Jay

    2015-01-01

    Elbow tendinopathy is the most common cause of elbow pain affecting active populations. Surgical excision is reserved for patients with refractory symptoms. Percutaneous ultrasonic tenotomy performed under local anesthesia also removes degenerated tissue and therefore provides an alternative treatment option to surgical excision. This investigation prospectively documented the safety and 1-year efficacy of ultrasonic percutaneous tenotomy performed by a single operator. Nineteen patients, aged 38 to 67 years, in whom >6 months of conservative management for medial (7) or lateral (12) elbow tendinopathy had failed were prospectively studied. All patients were treated with percutaneous ultrasonic tenotomy of the elbow by a single operator. Visual analog scale (VAS) for pain, the 11-item version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) index, and the Mayo Elbow Performance Score (MEPS) were assessed by an independent observer before treatment and at 6 weeks, 3 months, 6 months, and 12 months after treatment. No procedural complications occurred. Total treatment time was <15 minutes, and ultrasonic energy time averaged 38.6 ± 8.8 seconds per procedure. Average VAS scores were significantly improved from 6.4 to 2.6 at 6 weeks and were 0.7 at 12 months (P < .0001). Similar improvement occurred with the Quick DASH (pretreatment, 44.1; 12 months, 8.6, P < .0001) and MEPS (pretreatment, 59.1; 12 months, 83.4; P < .0001). Percutaneous ultrasonic tenotomy performed under local anesthesia appears to be a safe and effective treatment option for chronic, refractory lateral or medial elbow tendinopathy up to 1 year after the procedure. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  2. Image-guided percutaneous internal fixation of sacral fracture.

    Science.gov (United States)

    Kinon, Merritt D; Desai, Rupen; Loriaux, Daniel; Houten, John K

    2016-01-01

    Percutaneous iliosacral screw placement is a technically challenging procedure with a significant complication profile for misplaced screws. The use of stereotactic image guidance has been shown to provide superior accuracy in the placement of spinal instrumentation. Here, the authors describe a novel application of O-arm technology (Medtronic Sofamor Danek, Memphis, TN, USA) to help safely place iliosacral screws for the treatment of a traumatic sacral fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term mortality

    Directory of Open Access Journals (Sweden)

    Barywani SB

    2015-09-01

    Full Text Available Salim Bary Barywani,1 Shijun Li,1,2 Maria Lindh,1 Josefin Ekelund,1 Max Petzold,3 Per Albertsson,4 Lars H Lund,5,6 Michael LX Fu1 1Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden; 2Department of Geriatrical Cardiology, PLA General Hospitals, Beijing, People’s Republic of China; 3Centre for Applied Biostatistics, University of Gothenurg, Gothenburg, 4Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, 5Department of Medicine, Karolinska Institute, 6Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden Aim: Evidence of improved survival after use of percutaneous coronary intervention (PCI in elderly patients with acute coronary syndrome (ACS is limited. We assessed the association between PCI and long-term mortality in octogenarians with ACS. Methods and results: We followed 353 consecutive patients aged ≥80 years hospitalized with ACS during 2006–2007. Among them, 182 were treated with PCI, whereas 171 were not. PCI-treated patients were younger and more often male, and had less stroke and dependency in activities of daily living, but there were no significant differences in occurrence of diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and uncured malignancies between the two groups. The association between PCI and all-cause mortality was assessed in the overall cohort and a 1:1 matched cohort based on propensity score (PS. In overall cohort, 5-year all-cause mortality was 46.2% and 89.5% in the PCI and non-PCI groups, respectively. Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2–0.5. In propensity-matched cohort, 5-year all-cause mortality was 54.9% and 83.1% in the PCI and non

  4. Posterior Ischemic Optic Neuropathy Following Percutaneous Nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Mohammad Pakravan

    2008-12-01

    Full Text Available

    PURPOSE: To report a case of posterior ischemic optic neuropathy (PION following percutaneous nephrolithotomy (PCNL. CASE REPORT: A 57-year-old man with history of diabetes mellitus, hyperlipidemia and mild anemia underwent PCNL for treatment of nephrolithiasis. He noticed painless visual loss in both eyes immediately after the procedure. Visual acuity was light perception, however ophthalmologic examinations were unremarkable and the optic discs were pink with no swelling. Visual fields were severely affected, but neuro-imaging was normal. Within three months, visual acuity and visual fields improved dramatically but the optic discs became slightly pale. CONCLUSION: This is the first report of PION following PCNL. PION is a rare cause of severe visual loss following surgery. Severe blood loss, hypotension, anemia and body position during surgery are the most important risk factors. Ophthalmologists, urologists and anesthesiologists should be aware of this condition and this rare possibility should be considered prior to surgery.

  1. Impact of frailty on outcomes after percutaneous coronary intervention: a prospective cohort study

    Science.gov (United States)

    Murali-Krishnan, Rachel; Iqbal, Javaid; Rowe, Rebecca; Hatem, Emer; Parviz, Yasir; Richardson, James; Sultan, Ayyaz; Gunn, Julian

    2015-01-01

    Background Average life expectancy is rising, resulting in increasing numbers of elderly, frail individuals presenting with coronary artery disease and requiring percutaneous coronary intervention (PCI). PCI can be of value for this population, but little is known about the balance of benefit versus risk, particularly in the frail. Objective To determine the relationship between frailty and clinical outcomes in patients undergoing PCI. Methods Patients undergoing PCI, for either stable angina or acute coronary syndrome, were prospectively assessed for frailty using the Canadian Study of Health and Ageing Clinical Frailty Scale. Demographics, clinical and angiographic data were extracted from the hospital database. Mortality was obtained from the Office of National Statistics. Results Frailty was assessed in 745 patients undergoing PCI. The mean age of patients was 62±12 years and 70% were males. The median frailty score was 3 (IQR 2–4). A frailty score ≥5, indicating significant frailty, was present in 81 (11%) patients. Frail patients required longer hospitalisation after PCI. Frailty was also associated with increased 30-day (HR 4.8, 95% CI 1.4 to 16.3, p=0.013) and 1 year mortality (HR 5.9, 95% CI 2.5 to 13.8, p<0.001). Frailty was a predictor of length of hospital stay and mortality, independent of age, gender and comorbidities. Conclusions A simple assessment of frailty can help predict mortality and the length of hospital stay, and may therefore guide healthcare providers to plan PCI and appropriate resources for frail patients. PMID:26380099

  2. Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction.

    Science.gov (United States)

    Helft, Gérard; Georges, Jean-Louis; Mouranche, Xavier; Loyeau, Aurélie; Spaulding, Christian; Caussin, Christophe; Benamer, Hakim; Garot, Philippe; Livarek, Bernard; Teiger, Emmanuel; Varenne, Olivier; Monségu, Jacques; Mapouata, Mireille; Petroni, Thibaut; Hammoudi, Nadjib; Lambert, Yves; Dupas, François; Laborne, François; Lapostolle, Frederic; Lefort, Hugues; Juliard, Jean-Michel; Letarnec, Jean-Yves; Lamhaut, Lionel; Lebail, Gaëlle; Boche, Thévy; Jouven, Xavier; Bataille, Sophie

    2015-08-01

    Few data are available on primary percutaneous coronary intervention (pPCI) in nonagenarians. In a large prospective registry on pPCI for STEMI we compared the demographics, procedural and in-hospital outcomes between nonagenarians (age ≥ 90 years) and patients aged < 90 years. We included 26,157 consecutive patients with pPCI in the Greater Paris Area region between 2003 and 2011. Of these, 418 (1.6%) were ≥ 90 years old. Nonagenarians (versus patients < 90 years) were more likely to be female (62.3% versus 22.5%, p < 0.0001), nonsmokers (81.6% versus 36.7%, p < 0.0001), in cardiogenic shock (Killip IV) upon admission (10.5% versus 4.8%, p < 0.001), and had significant co-morbidities. Over two-thirds of patients underwent procedures via the radial artery (61% versus 72.1%, p = 0.007). Both groups had high and similar angiographic success rates (98.1% versus 98.7%, p = 0.33). Drug-eluting stents were used less often in nonagenarians (4.4% versus 16.7%, p < 0.0001). Hospital mortality was significantly much higher in patients over 90 years old (24.9% versus 5.1%, p < 0.001) in univariate analysis. After adjustment for sex, cardiogenic shock, diabetes, triple vessel disease, drug-eluting stent use and glycoprotein IIb/IIIa inhibitors use, mortality remains higher in nonagenarian patients (OR: 4.31; 95% CI: 3.26-5.71, p < 0.0001). In a real-world setting, we found important demographic differences in nonagenarian compared to younger patients. Despite achieving a high rate of reperfusion with pPCI using mainly radial access, similar to that achieved in younger patients, hospital mortality was higher in nonagenarians. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Management of calyceal diverticular calculi: a comparison of percutaneous nephrolithotomy and flexible ureterorenoscopy.

    Science.gov (United States)

    Bas, Okan; Ozyuvali, Ekrem; Aydogmus, Yasin; Sener, Nevzat Can; Dede, Onur; Ozgun, Serhat; Hizli, Fatih; Senocak, Cagri; Bozkurt, Omer Faruk; Basar, Halil; Imamoglu, Abdurrahim

    2015-04-01

    To compare the outcomes in patients who have been treated with flexible ureterorenoscopy (f-URS) and percutaneous nephrolithotomy (PNL) in managing stone-bearing caliceal diverticula. Between April 2007 and October 2013, we performed a retrospective analysis of 54 evaluable patients (28 women and 26 men) with symptomatic stone-bearing caliceal diverticula, who underwent PNL (n = 29) or F-URS (n = 25) in four referral hospitals in Turkey. The groups were compared with respect to demographics, stone location/size, success rate, stone-free status, symptom-free status, complication rates, and hospital stay. The average stone burden preoperatively was significantly larger in patients who were treated with PNL, with the average size for f-URS being 154 ± 77 mm(2) and that for PNL being 211 ± 97 mm(2) (p = 0.023). Symptom-free rates, success rates, stone-free rates and clinically insignificant residual fragments were similar between the groups (p = 0.880 vs. p = 0.537 vs. p = 0.539, and p = 0.877, respectively). There was no statistical difference between the groups for minor complications (p = 0.521) but no major complication (Clavien III-V) occured in the f-URS group; although there were three major complications (10.3 %) (Clavien III) in the PNL group (p PNL group (p PNL. The f-URS procedure is advantageous with respect to a shorter hospital stay and absence of major complications. Therefore, it should be emphasized that the location of the stone and diverticula is an important factor for the selection of the procedure.

  4. Efficacy and safety of totally tubeless standard percutaneous nephrolithotomy in patients with kidney stones

    Directory of Open Access Journals (Sweden)

    Cemil Aydın

    2014-09-01

    Full Text Available Objective: Percutaneous nephrolithotomy (PNL is the first- line treatment for large and complex renal calculi. In this study, we aimed to compare the efficacy and safety of the totally tubeless PNL versus the standard PNL. Methods:Between January 2012 and July 2013, 73 selected patients were treated standard or totally tubeless PNL, nephrostomy tube and ureteral stent was not placed at the end of the operation in 35 (39.7% (Group 1 of them and 38 (43.1% (Group 2 patient underwent standard PNL. Stone disintegration was performed with a pneumatic lithotripter. We retrospectively compared patient and stone characteristics, operation time, duration of hospitalization, analgesia requirements, stone-free rate, operative findings, blood loss, and perioperative complications between two groups. Results:The mean operation time, excluding the preparation course, was 38,3±15,4 minutes vs 51,2±12,9 minutes and mean fluoroscopy time was 4,5±2,4 minutes vs 4,8±2,1 minutes, respectively. No significant intraoperative complication or indication additional access or second-look PNL due to residual stones was observed. In both groups none of the patients demonstrated a urinoma, hemorrhage or residual stones in postoperative ultrasonography and plain radiograph. Blood transfusion was needed only in a patient vs two patients for group 1 and 2, respectively. There were no significant differences in preoperative patient characteristics, postoperative complications between two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with other group. Conclusion: Absence of the nephrostomy tube and ureteral stent may help in keeping the patient comfortable after the operation and reduction in the analgesia requirement and length of hospital stay. We believe totally tubeless PNL is safe and effective management option in properly selected cases.

  5. CT fluoroscopy-guided percutaneous gastrostomy with loop gastropexy and peel-away sheath trocar technique in 31 amyotrophic lateral sclerosis patients

    Energy Technology Data Exchange (ETDEWEB)

    De Bucourt, Maximilian; Collettini, Federico; Althoff, Christian; Streitparth, Florian; Greupner, Johannes; Hamm, Bernd (Dept. of Radiology, Charite - Univ. Medicine, Berlin (Germany)), Email: mdb@charite.de; Teichgraeber, U.K. (Dept. of Radiology, Jena Univ. (Germany))

    2012-04-15

    Background: In amyotrophic lateral sclerosis (ALS) patients with respiratory impairment and/or advanced disease, performing even mild sedation - as is usually necessary for percutaneous endoscopic gastrostomy (PEG) placements - is fraught with risk. These patients are often referred to Interventional Radiology for alternative percutaneous gastrostomy tube placement options. Purpose: To report our experience with CT fluoroscopy-guided percutaneous gastrostomy with a novel loop gastropexy and peel-away sheath trocar technique in ALS patients as an alternative to endoscopic techniques. Material and Methods: A consecutive series of 31 amyotrophic lateral sclerosis patients in whom endoscopic gastrostomy was considered too dangerous or impossible to perform underwent CT-guided percutaneous gastropexy and gastrostomy and prospective follow-up. All procedures were performed with a 15 FR Freka Pexact gastrostomy kit, a 16-row CT scanner (Aquilion 16) and single shot CT fluoroscopy mode. Results: The procedure was performed successfully in 30 of 31 patients (20 men, 11 women; median age 60 years, range 38-80 years). In the remaining case the stomach was punctured under CT fluoroscopy and CO2 insufflation was initiated thereafter, leading to successful gastrostomy without prior gastropexy and without further adverse events during follow-up. Two patients reported unproblematic exchange of a balloon tube due to skin irritations with no further adverse events. One patient reported accidental displacement of an exchanged new balloon tube in domestic environment due to balloon leakage: A new balloon tube was easily re-inserted in a hospital the same day. No serious adverse events such as peritonitis, persistent local bleeding, systemic blood loss, or any local infection requiring surgical intervention were observed. Until August 11, 2011 follow-up resulted in 7473 cumulative gastrostomy-days from the date of first placement. Conclusion: Initial results suggest that the described

  6. Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; design of a prospective randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Koes Bart W

    2009-05-01

    Full Text Available Abstract Background The usual surgical treatment of refractory sciatica caused by lumbar disc herniation, is open discectomy. Minimally invasive procedures, including percutaneous therapies under local anesthesia, are increasingly gaining attention. One of these treatments is Percutaneous Laser Disc Decompression (PLDD. This treatment can be carried out in an outpatient setting and swift recovery and return to daily routine are suggested. Thus far, no randomized trial into cost-effectiveness of PLDD versus standard surgical procedure has been performed. We present the design of a randomized controlled trial, studying the cost-effectiveness of PLDD versus conventional open discectomy in patients with sciatica from lumbar disc herniation. Methods/design The study is a randomized prospective multi-center trial, in which two treatment strategies are compared in a parallel group design. Patients (age 18–70 years visiting the neurosurgery department of the participating hospitals, are considered for inclusion in the trial when sciatica due to lumbar disc herniation has lasted more than 8 weeks. Patients with disc herniation smaller than 1/3 of the spinal canal diameter, without concomitant lateral recess stenosis or sequestration, are eligible for participation, and are randomized into one of two treatment arms; either Percutaneous Laser Disc Decompression or conventional discectomy. The functional outcome of the patient, as assessed by the Roland Disability Questionnaire for Sciatica at 8 weeks and 1 year after treatment, is the primary outcome measure. The secondary outcome parameters are recovery as perceived by the patient, leg and back pain, incidence of re-intervention, complications, quality of life, medical consumption, absence of work and secondary costs. Discussion Open discectomy is still considered to be the golden standard in the surgical treatment of lumbar disc herniation. Whether Percutaneous Laser Disc Decompression has at least as

  7. Percutaneous transvenous mitral commissurotomy (PTMC) and percutaneous coronary intervention (PCI) successfully applied in one patient in same sitting.

    Science.gov (United States)

    Sial, Jawaid Akbar; Farman, Muhammad Tariq; Saghir, Tahir; Zaman, Khan Shah

    2011-01-01

    Sixty years old male with severe rheumatic mitral stenosis (MS), presented with dyspnoea New York Heart Association (NHYA) class III to IV. Coronary angiogram revealed severe occlusive coronary artery disease in left anterior coronary artery (LAD). Percutaneous Transvenous Mitral Commissurotomy (PTMC) and Percutaneous Coronary Intervention (PCI) of Left Anterior Descurery (LAD) were done in same sitting. Both procedures were successful and ended without complication. After, half an hour while shifting to coronary care unit (CCU) patient developed cardiac tamponade, which was managed successfully. Patient was followed up for three month, he is doing well and recent echocardiogram showed mild mitral stenosis with normal left ventricular function. This case demonstrates the feasibility of the combined appliance on interventional techniques in selected patients as an alternative to cardiac surgery.

  8. Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy.

    Science.gov (United States)

    Ozgor, Faruk; Kucuktopcu, Onur; Sarılar, Omer; Toptas, Mehmet; Simsek, Abdulmuttalip; Gurbuz, Zafer Gokhan; Akbulut, Mehmet Fatih; Muslumanoglu, Ahmet Yaser; Binbay, Murat

    2015-11-01

    In this study, we aim to evaluate the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients and to compare impact of previous open renal surgery and PNL on the success and complications of subsequent PNL. Charts of patients, who underwent PNL at our institute, were analyzed retrospectively. Patients were divided into three groups according to history of renal stone surgery. Patients without history of renal surgery were enrolled into Group 1. Other patients with previous PNL and previous open surgery were categorized as Group 2 and Group 3. Preoperative characteristic, perioperative data, stone-free status, and complication rates were compared between the groups. Stone-free status was accepted as completing clearance of stone and residual fragment smaller than 4 mm. Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between the groups. Highest stone clearance was achieved in primary PNL patients (81.62%) compared to the other groups (77.10% in Group 2 and 75.61% in Group 3). Stone-free rate was not significantly different between Group 2 and Group 3. Fever, pulmonary complications, and blood transfusion requirement were not statically different between groups but angioembolization was significantly higher in Group 2. Percutaneous nephrolithotomy is a safe and effective treatment modality for patients with renal stones regardless history of previous PNL or open renal surgery. However, history of open renal surgery but not PNL significantly reduced PNL success.

  9. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology.

    Science.gov (United States)

    Hamon, Martial; Pristipino, Christian; Di Mario, Carlo; Nolan, James; Ludwig, Josef; Tubaro, Marco; Sabate, Manel; Mauri-Ferré, Josepa; Huber, Kurt; Niemelä, Kari; Haude, Michael; Wijns, William; Dudek, Dariusz; Fajadet, Jean; Kiemeneij, Ferdinand

    2013-03-01

    Radial access use has been growing steadily but, despite encouraging results, still varies greatly among operators, hospitals, countries and continents. Twenty years from its introduction, it was felt that the time had come to develop a common evidence-based view on the technical, clinical and organisational implications of using the radial approach for coronary angiography and interventions. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has, therefore, appointed a core group of European and non-European experts, including pioneers of radial angioplasty and operators with different practices in vascular access supported by experts nominated by the Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology (ESC). Their goal was to define the role of the radial approach in modern interventional practice and give advice on technique, training needs, and optimal clinical indications.

  10. Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation.

    Science.gov (United States)

    Li, Jian; Yan, Deng-lu; Zhang, Zai-Heng

    2008-12-01

    Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors' clinic and treated by PCN. The patients' gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 +/- 10.2 years). The levels of involvement were 21 cases at C3-4, 30 cases at C4-5, 40 cases at C5-6, and 35 cases at C6-7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) > or =11 degrees or horizontal displacement (HD) > or =3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P PCN procedure. There was no significant difference in stability either preoperatively or

  11. Preliminary clinical trial in percutaneous nephrolithotomy using a real-time navigation system for percutaneous kidney access

    Science.gov (United States)

    Rodrigues, Pedro L.; Moreira, António H. J.; Rodrigues, Nuno F.; Pinho, A. C. M.; Fonseca, Jaime C.; Lima, Estevão.; Vilaça, João. L.

    2014-03-01

    Background: Precise needle puncture of renal calyces is a challenging and essential step for successful percutaneous nephrolithotomy. This work tests and evaluates, through a clinical trial, a real-time navigation system to plan and guide percutaneous kidney puncture. Methods: A novel system, entitled i3DPuncture, was developed to aid surgeons in establishing the desired puncture site and the best virtual puncture trajectory, by gathering and processing data from a tracked needle with optical passive markers. In order to navigate and superimpose the needle to a preoperative volume, the patient, 3D image data and tracker system were previously registered intraoperatively using seven points that were strategically chosen based on rigid bone structures and nearby kidney area. In addition, relevant anatomical structures for surgical navigation were automatically segmented using a multi-organ segmentation algorithm that clusters volumes based on statistical properties and minimum description length criterion. For each cluster, a rendering transfer function enhanced the visualization of different organs and surrounding tissues. Results: One puncture attempt was sufficient to achieve a successful kidney puncture. The puncture took 265 seconds, and 32 seconds were necessary to plan the puncture trajectory. The virtual puncture path was followed correctively until the needle tip reached the desired kidney calyceal. Conclusions: This new solution provided spatial information regarding the needle inside the body and the possibility to visualize surrounding organs. It may offer a promising and innovative solution for percutaneous punctures.

  12. Percutaneous transhepatic cholangiography in obstructive jaundice

    Energy Technology Data Exchange (ETDEWEB)

    Chun, Kang Uoo; Choi, Young Dae; Park, Jin Hoon; Min, Byung Chae; Yoon, Jong Sup [Han Gang Sacred Heart Hospital Hallym College, Seoul (Korea, Republic of)

    1983-03-15

    Although many invasive studies in the biliary tract disease are replaced by noninvasive techniques such as ultrasonography and computed tomography, PTC does still play an important role in diagnosis of obstructive jaundice. Authors had performed 42 patients of PTC with Chiba needle at the department of radiology, Han Gang Sacred Heart Hospital for 4 years from January 1978 to April 1982. And we reviewed literatures. The results were as follows: 1. Forty two patients of PTC were 22 males and 20 females. The success rate was 90.5% (38/42). The failed 4 cases of PTC were nonobstructive hepatobiliary diseases. 2. The PTC diagnosis of 38 cases were biliary stone (21 cases), cholangiocarcinoma (7 cases), pancreatic carcinoma (2 cases), hepatoma (2 cases), ascariasis (2 cases), and clonorchiasis (1 case), and the remainders were normal. 3. We made 2 cases of misdiagnosis on the basis of PTC findings. They were one case of distal CBD stone with severe cholangitis diagnosed as ampullary carcinoma and another case of proximal CBD stone with cholangitis diagnosed as pancreas carcinoma. 4. We experienced 2 cases of complication such as sepsis and severe hypotension, but they were recovered.

  13. To understand percutaneous endoscopic lumbar discectomy%正确认识经皮椎间孔镜技术

    Institute of Scientific and Technical Information of China (English)

    周跃

    2013-01-01

    Percutaneous endoscopic lumbar discectomy ( PELD ) technique provides high-quality images and clear spine anatomical structure to help surgeons analyze the pathological reason of pain in patients. For minimally invasive surgical treatment of lumbar disc herniation, PELD technique should be recommended except for some special cases. For a good surgeon of minimally invasive spine technique, he should not only understand and master new techniques of minimally invasive spinal surgery, but also the proper selection and application to achieve a multiplier effect. In the choosing of PELD or MED technique, every surgeon should make decision based on the technical level and the condition of medical equipments in the hospital. The most common risk factors of PELD are postoperative intervertebral infection, nerve root injury, dural tear, spinal bleeding and scar adhesions. Although these complications may occur in any spinal surgery, but the occurrence rate of these complications in PELD is the lowest comparing with other minimally invasive spine techniques.

  14. Sex-related differences after contemporary primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Barthélémy, Olivier; Degrell, Philippe; Berman, Emmanuel; Kerneis, Mathieu; Petroni, Thibaut; Silvain, Johanne; Payot, Laurent; Choussat, Remi; Collet, Jean-Philippe; Helft, Gerard; Montalescot, Gilles; Le Feuvre, Claude

    2015-01-01

    Whether outcomes differ for women and men after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains controversial. To compare 1-year outcomes after primary PCI in women and men with STEMI, matched for age and diabetes. Consecutive women with STEMI of0.05 for all). After exclusion of patients with shock (10.7%) and out-of-hospital cardiac arrest (6.6%), death rates were even more similar (11.3% vs 11.8%; P=0.10). Female sex was not independently associated with death (odds ratio 1.01, 95% confidence interval 0.55-1.87; P=0.97). In our consecutive unselected patient population, women had similar 1-year outcomes to men matched for age and diabetes, after contemporary primary PCI for STEMI, despite having a higher risk profile at baseline. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  15. Unplanned pregnancy after ultrasound-guided percutaneous microwave ablation of uterine fibroids: A follow-up study.

    Science.gov (United States)

    Bing-song, Zhang; Jing, Zhang; Zhi-Yu, Han; Chang-tao, Xu; Rui-fang, Xu; Xiu-mei, Li; Hui, Liu

    2016-01-06

    A follow-up study was performed with 169 women of childbearing age who underwent ultrasound-guided percutaneous microwave ablation (UPMWA) therapy for symptomatic uterine fibroids in the Chinese PLA General Hospital from June 2007 to December 2014. This study aimed to observe the incidence of unplanned pregnancies in these women after UPMWA treatment in order to evaluate its effect on natural conception. Ten unplanned pregnancies in nine women were occurred. Of the nine patients, six did not want the pregnancy and chose for induced abortion to end the pregnancy at an early stage. Three chose to continue with the pregnancy and gave birth to a healthy term infant delivered by cesarean section (of these three patients, two had been previously diagnosed as infertility). None of the patients had any serious obstetric complications. After UPMWA treatment for uterine fibroids, patients may conceive naturally, the impact of the procedure on fertility and pregnancy outcomes is worthy of further prospective study in larger sample.

  16. Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation

    DEFF Research Database (Denmark)

    De Backer, Ole; Arnous, Samer; Sandholt, Benjamin

    2015-01-01

    -induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48...... were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn...... stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency...

  17. Clinical effect of selective thrombus aspiration during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Hai-wei LIU

    2015-06-01

    Full Text Available Objective To assess impact of selective thrombus aspiration (TA during primary percutaneous coronary intervention (pPCI on long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI. Methods  Between Jan. 2008 and Jan. 2014, a total of 2357 STEMI patients [429 in thrombus aspiration (TA group and 1928 in routine percutaneous coronsry intorventim (PCI group (control group] were eligible for the study criteria and candidates for pPCI were enrolled in this study. The reflow of the involved vessel in pPCI procedure, stent thrombosis and major adverse cardiac events (MACE were comparatively analyzed in the two groups during hospital stay and 12-month follow-up period. Results Although the success rate of TA procedure was significantly lower in TA group compared with that in control group (P<0.001, both the TIMI flow grade ≥2 after TA procedure and stent implantation occurred more frequently in TA group than in control group (P<0.05. The rates of MACE and stent thrombosis showed no difference between two groups during in-hospital and 12-month follow-up period (P>0.05. But the rates of total MACE and target vessel revascularization were significantly higher in control group than in TA group (P=0.04. Conclusion Selective TA procedure before primary PCI could improve final myocardial reperfusion, reduce the incidence of MACE and improve the 1-year clinical result for STEMI patients. DOI: 10.11855/j.issn.0577-7402.2015.04.04

  18. Reducing Door to- Balloon- Time for Acute ST Elevation Myocardial Infarction In Primary Percutaneous Intervention: Transformation using Robust Performance Improvement.

    Science.gov (United States)

    Ellahham Md, Samer; Aljabbari, Samir; Harold Mananghaya, Tristan; J Raji, Salama; Al Zubaidi, Abdulmajeed

    2015-01-01

    Cardiovascular diseases (CVDs) are the leading causes of death in the UAE. Prompt reperfusion access is essential for patients who have Myocardial Infarction (MI) with ST-segment elevation as they are at a relatively high risk of death.This risk may be reduced by primary percutaneous coronary intervention (PCI), but only if it is performed in a timely manner. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon (D2B) time) during primary PCI should be 90 minutes or less. The earlier therapy is initiated, the better the outcome. Our aim was to decrease the door-to-balloon time for patients with ST segment elevation myocardial infarction (STEMI) who come through the emergency department (ED) in Sheikh Khalifa Medical City,a tertiary hospital in UAE, to meet the standard of less than 90 minutes. A multidisciplinary team was formed including interventional cardiologists, catheterization laboratory personnel, emergency department caregivers and quality staff. The project utilized the Lean Six Sigma Methodology which provided a powerful approach to quality improvement. The process minimized waste and variation, and a decreased median door-to-balloon time from 75.9 minutes to 60.1 minutes was noted. The percentage of patients who underwent PCI within 90 minutes increased from 73% to 96%. In conclusion, implementing the Lean Six Sigma methodology resulted in having processes that are leaner, more efficient and minimally variable. While recent publication failed to provide evidence of better outcome, the lessons learned were extrapolated to other primary percutaneous coronary intervention centers in our system.This would have marked impact on patient safety, quality of care and patient experience.

  19. Reducing Door to- Balloon- Time for Acute ST Elevation Myocardial Infarction In Primary Percutaneous Intervention: Transformation using Robust Performance Improvement

    Science.gov (United States)

    Ellahham, MD, Samer; Aljabbari, Samir; Harold Mananghaya, Tristan; J. Raji, Salama; Al Zubaidi, Abdulmajeed

    2015-01-01

    Cardiovascular diseases (CVDs) are the leading causes of death in the UAE. Prompt reperfusion access is essential for patients who have Myocardial Infarction (MI) with ST-segment elevation as they are at a relatively high risk of death.This risk may be reduced by primary percutaneous coronary intervention (PCI), but only if it is performed in a timely manner. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon (D2B) time) during primary PCI should be 90 minutes or less. The earlier therapy is initiated, the better the outcome. Our aim was to decrease the door-to-balloon time for patients with ST segment elevation myocardial infarction (STEMI) who come through the emergency department (ED) in Sheikh Khalifa Medical City,a tertiary hospital in UAE, to meet the standard of less than 90 minutes. A multidisciplinary team was formed including interventional cardiologists, catheterization laboratory personnel, emergency department caregivers and quality staff. The project utilized the Lean Six Sigma Methodology which provided a powerful approach to quality improvement. The process minimized waste and variation, and a decreased median door-to-balloon time from 75.9 minutes to 60.1 minutes was noted. The percentage of patients who underwent PCI within 90 minutes increased from 73% to 96%. In conclusion, implementing the Lean Six Sigma methodology resulted in having processes that are leaner, more efficient and minimally variable. While recent publication failed to provide evidence of better outcome, the lessons learned were extrapolated to other primary percutaneous coronary intervention centers in our system.This would have marked impact on patient safety, quality of care and patient experience. PMID:26734321

  20. Accuracy of CT-guided percutaneous core needle biopsy for assessment of pediatric musculoskeletal lesions

    Energy Technology Data Exchange (ETDEWEB)

    Hryhorczuk, Anastasia L. [University of Michigan, Department of Radiology, C. S. Mott Children' s Hospital, Ann Arbor, MI (United States); Harvard University School of Medicine, Department of Radiology, Boston Children' s Hospital, Boston, MA (United States); Strouse, Peter J. [University of Michigan, Department of Radiology, C. S. Mott Children' s Hospital, Ann Arbor, MI (United States); Biermann, J.S. [University of Michigan, Department of Orthopaedic Surgery, Ann Arbor, MI (United States)

    2011-07-15

    CT-guided percutaneous core needle biopsy has been shown in adults to be an effective diagnostic tool for a large number of musculoskeletal malignancies. To characterize our experience with CT-guided percutaneous core needle biopsy of pediatric bone lesions and determine its utility in diagnosing pediatric osseous lesions, in a population where such lesions are commonly benign. From 2000 to 2009, 61 children underwent 63 CT-guided percutaneous biopsies. Radiological, pathological and clinical records were reviewed. Fourteen biopsies (22%) were performed on malignant lesions, while 49 biopsies (78%) were performed on benign lesions. Forty-nine of the 63 biopsies (78%) were adequate; these children underwent no further tissue sampling. Fourteen of the 63 biopsies (22%) were inadequate or non-conclusive. Of these patients, 12 underwent open biopsy. Retrospective analysis of percutaneous biopsies in these patients demonstrates that 9/12 provided clinically relevant information, and 4/12 patients received final diagnoses that confirmed initial core biopsy findings. No malignancies were diagnosed as benign on percutaneous biopsy. Overall, percutaneous core needle biopsy provided accurate diagnostic information in 84% (53/63) of biopsies. Our results demonstrate that CT-guided percutaneous biopsy is safe and beneficial in children. This study supports the use of CT-guided percutaneous core needle biopsy for primary diagnosis of pediatric bone lesions. (orig.)

  1. [Studies on percutaneous absorption of ruyi jinhuang san patcher with radioisotope tracer].

    Science.gov (United States)

    Zhao, H W; Shen, Z; Zhou, B; Lin, X; Ye, M

    1993-04-01

    Berberine is one of the active ingredients in Ruyi Jinhuang San Patcher. With 3H-berberine as the tracer, a radio-labelled method was used for determining percutaneous rate and drug concentration of berberine in plasma in vivo and in vitro. A study on the percutaneous rate of different technological plasters and various animal skins was also carried out.

  2. Bile peritonitis after inadvertant puncture of the gallbladder as a rare complication of percutaneous transhepatic cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Farkas, I.; Marik, J.

    1983-01-01

    A report is given about a rare complication after percutaneous transhepatic cholangiography: after inadvertant puncture of the gallbladder, bile peritonitis developed. Surgery was done immediately and the gallbladder, which was filled with stones, as well as stones from the choledochus were removed. The literature dealing with complications of percutaneous cholangiography is reviewed.

  3. Health-related quality of life in the elderly three years after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Panasewicz, Anna; Pedersen, Susanne S.; Veenhuis, Stefanie J G;

    2013-01-01

    Long-term health-related quality of life (HRQOL) in the elderly after percutaneous coronary intervention (PCI) is unknown. We 1) compared HRQOL of elderly (≥70 years) with younger patients (......Long-term health-related quality of life (HRQOL) in the elderly after percutaneous coronary intervention (PCI) is unknown. We 1) compared HRQOL of elderly (≥70 years) with younger patients (...

  4. Percutaneous vertebroplasty in the treatment of vertebral body compression fracture secondary to osteogenesis imperfecta

    Energy Technology Data Exchange (ETDEWEB)

    Rami, Parag M.; Heatwole, Eric V.; Boorstein, Jeffrey M. [Center for Vascular and Interventional Radiology, St. Vincent Mercy Medical Center, Toledo, OH (United States); McGraw, Kevin J. [Riverside Methodist Hospital, Columbus, OH (United States)

    2002-03-01

    Percutaneous vertebroplasty, a minimally invasive interventional radiological procedure, has recently been used effectively for the treatment of symptomatic vertebral body compression fractures. Primary indications for vertebroplasty include osteoporotic compression fracture, osteolytic vertebral metastasis and myeloma, and vertebral hemangioma. We present a case and extend the indication of percutaneous vertebroplasty in a patient with a vertebral body compression fracture secondary to osteogenesis imperfecta. (orig.)

  5. Clinical study of percutaneous transhepatic balloon dilation: a novel procedure for common bileduct stone

    Institute of Scientific and Technical Information of China (English)

    李玉亮

    2014-01-01

    Objective To investigate the safety and efficacy of percutaneous transhepatic balloon dilation for the removal of common bile duct stone.Methods Sixty-eight cases with common bile duct stone treated with percutaneous transhepatic balloon dilation in our department from July2008 to April 20l1 were analyzed retrospectively.Record CA19-9,total bilirubin,

  6. Interactions of skin thickness and physicochemical properties of test compounds in percutaneous penetration studies

    NARCIS (Netherlands)

    Wilkinson, S.C.; Maas, W.J.M.; Nielsen, J.B.; Greaves, L.C.; Sandt, J.J.M. van de; Williams, F.M.

    2006-01-01

    Objectives: To determine the effect of skin thickness on the percutaneous penetration and distribution of test compounds with varying physicochemical properties using in vitro systems. Studies were carried out in accordance with OECD guidelines on skin absorption tests. Methods: Percutaneous penetra

  7. Percutaneous Catheter Drainage of Periappendiceal abscess due to Appendicolith : A case report

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Dae Sik; Kim, Heung Chueol; Han, Tae Kyun; Hur, Hun; Yum, Kung Tae; Namkung, Sook; Park, Man Soo; Hwang, Woo Chueol [Hallym University College of Medicine, Chuncheon (Korea, Republic of)

    1996-12-15

    Percutaneous catheter drainage of periappendiceal abscess is an effective and safe method of treatment. It is known that CT guided approach is the first choice of method. We experienced a successful percutaneous catheter drainage under ultrasound guidance for periappendiceal abscess with appendicolith

  8. Case report: percutaneous cryoablation of a small renal lesion necessitating modified lateral decubitus position.

    Science.gov (United States)

    McClung, Chris; Wright, Andrew; Pierce, Ken; Posniak, Harold; Perry, Kent

    2007-11-01

    When performing percutaneous cryoablation for renal masses, the standard patient positioning has been the prone position. We present a case in which placing the patient in a modified lateral decubitus position aided in the access of probe placement for percutaneous cryoablation.

  9. PERCUTANEOUS VERTEBROPLASTY IN PATIENTS WITH KIDNEY CANCER METASTASES TO THE VERTEBRAL COLUMN

    OpenAIRE

    S. V. Kostritsky; D. V. Semenov; V. I. Shirokorad; B. K. Komyakov; D. A. Ptashnikov; S. A. Zamyatnin; P. A. Karlov

    2014-01-01

    Data on 19 patients with kidney cancer with metastatic involvement of the vertebral column, who had undergone percutaneous vertebroplasty, were retrospectively analyzed. The role of percutaneous vertebroplasty was assessed in patients with bony metastases from kidney cancer to the vertebral column and this surgical treatment was found to achieve satisfactory results in improving the quality of life in patients.

  10. Subclavian artery to internal jugular vein fistula following percutaneous internal jugular vein catheterization.

    Science.gov (United States)

    Merino-Angulo, J; Cortazar, J L; Saez-Garmendia, F; Montejo, M

    1984-01-01

    The percutaneous internal jugular vein approach is now a commonly performed procedure for central venous catheterization. Iatrogenic arteriovenous fistulae are a very infrequent complication. We report an asymptomatic subclavian artery to internal jugular vein fistula following two percutaneous internal jugular vein catheterization attempts.

  11. Clinical and Angiographic Factors Associated With Asymptomatic Restenosis After Percutaneous Coronary Intervention

    OpenAIRE

    Ruygrok, Peter; Webster, Mark; de Valk, Vincent; Es, Gerrit Anne; Ormiston, John; Morel, Marie-Angèle; Serruys, Patrick

    2001-01-01

    textabstractBACKGROUND: Angiographic restenosis after percutaneous coronary interventional procedures is more common than recurrent angina. Clinical and angiographic factors associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention were compared. METHODS AND RESULTS: All patients with angiographic restenosis from the BENESTENT I, BENESTENT II pilot, BENESTENT II, MUSIC, WEST 1, DUET, FINESS 2, FLARE, SOPHOS, and ROSE studies were analyzed. Multivariat...

  12. Percutaneous CT-guided interventional procedures in musculoskeletal system (our experience)

    Energy Technology Data Exchange (ETDEWEB)

    Thanos, Loukas E-mail: loutharad@yahoo.com; Mylona, Sophia; Kalioras, Vasilios; Pomoni, Maria; Batakis, Nikolaos

    2004-06-01

    Percutaneous interventional procedures include a broad spectrum of minimal invasive techniques, which are a useful diagnostic and therapeutic tool. In this study we present our experience in CT-guided percutaneous musculoskeletal biopsies, drainages of musculoskeletal abscesses, facet and sacroiliac joint injection and radiofrequency thermal ablation of painful metastases or osteoid osteomas.

  13. Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience

    Energy Technology Data Exchange (ETDEWEB)

    Chen, M.; Huang, C.; Chou, Y.; Huang, Ch.; Chiang, C.; Liu, G. [Chung-Ho Memorial Hospital, Kaohsiung Medical College, Taiwan (China)

    1997-11-01

    CT is an efficient imaging method for diagnosis, guiding the drainage procedures and monitoring response to percutaneous drainage of emphysematous pyelonephritis. Antibiotic therapy combined with CT guided percutaneous drainage of emphysematous pyelonephritis is an acceptable alternative to antibiotic therapy with surgical intervention. (authors)

  14. Supine Versus Prone Position During Percutaneous Nephrolithotomy: A Report from the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study

    DEFF Research Database (Denmark)

    G. Vadivia, José; M. Scarpa, Roberto; Duvdevani, Mordechai

    2011-01-01

    To determine differences in patients' characteristics, operative time and procedures, and perioperative outcomes between prone and supine positioning in percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database....

  15. Assessing hospital performance for acute myocardial infarction: how should emergency department transfers be attributed.

    Science.gov (United States)

    Samadashvili, Zaza; Hannan, Edward L; Cozzens, Kimberly; Walford, Gary; Jacobs, Alice K; Berger, Peter B; Holmes, David R; Venditti, Ferdinand J; Curtis, Jeptha

    2015-03-01

    The Centers for Medicare and Medicaid Services publicly reports risk-standardized mortality rates (RSMRs) to assess quality of care for hospitals that treat acute myocardial infarction patients, and the outcomes for inpatient transfers are attributed to transferring hospitals. However, emergency department (ED) transfers are currently ignored and therefore attributed to receiving hospitals. New York State administrative data were used to develop a statistical model similar to the one used by Centers for Medicare and Medicaid Services to risk-adjust hospital 30-day mortality rates. RSMRs were calculated and outliers were identified when ED transfers were attributed to: (1) the transferring hospital and (2) the receiving hospital. Differences in hospital outlier status and RSMR tertile between the 2 attribution methods were noted for hospitals performing and not performing percutaneous coronary interventions (PCIs). Although both methods of attribution identified 3 high outlier non-PCI hospitals, only 2 of those hospitals were identified by both methods, and each method identified a different hospital as a third outlier. Also, when transfers were attributed to the referring hospital, 1 non-PCI hospital was identified as a low outlier, and no non-PCI hospitals were identified as a low outlier with the other attribution method. About one sixth of all hospitals changed their tertile status. Most PCI hospitals (89%) that changed status moved to a higher (worse RSMR) tertile, whereas the majority of non-PCI hospitals (68%) that changed status were moved to a lower (better) RSMR tertile when ED transfers were attributed to the referring hospital. Hospital quality assessments for acute myocardial infarction are affected by whether ED transfers are assigned to the transferring or receiving hospital. The pros and cons of this choice should be considered.

  16. Percutaneous paraumbilical embolization as an unconventional and successful treatment for bleeding jejunal varices

    Institute of Scientific and Technical Information of China (English)

    Lee-Guan Lim; Yin-Mei Lee; Lenny Tan; Stephen Chang; Seng-Gee Lim

    2009-01-01

    A 48-year-old Indian male with alcoholic liver cirrhosis was admitted after being found unresponsive. He was hypotensive and had hematochezia. Esophagogastroduodenoscopy (EGD) showed small esophageal varices and a clean-based duodenal ulcer. He continued to have hematochezia and anemia despite blood transfusions. Colonoscopy was normal. Repeat EGD did not reveal any source of recent bleed. Twelve days after admission, his hematochezia ceased. He refused further investigation and was discharged two days later. He presented one week after discharge with hematochezia. EGD showed non-bleeding Grade 1 esophageal varices and a clean-based duodenal ulcer. Colonoscopy was normal. Abdominal computed tomography (CT) showed liver cirrhosis with mild ascites, paraumbilical varices, and splenomegaly. He had multiple episodes of hematochezia, requiring repeated blood transfusions. Capsule endoscopy ident i f ied the bleeding s i te in the jejunum. Concurrently, CT angiography showed paraumbilical varices inseparable from a loop of small bowel, which had herniated through an umbilical hernia. The lumen of this loop of small bowel opacified in the delayed phase, which suggested variceal bleeding into the small bowel. Portal vein thrombosis was present. As he had severe coagulopathy and extensive paraumbilical varices, surgery was of high risk. He was not suitable for transjugular intrahepatic porto-systemic shunt as he had portal vein thrombosis. Percutaneous paraumbilical embolization via caput medusa was performed on day 9 of hospitalization. Following the embolization, the hematochezia stopped. However, he defaulted subsequent follow-up.

  17. Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

    Science.gov (United States)

    Hu, Henglong; Lu, Yuchao; Zhang, Jiaqiao; Qin, Baolong; Wang, Yufeng; Zhang, Zongbiao

    2017-01-01

    Object To compare the safety and efficacy of rigid ureteroscopic lithotripsy (rigid URSL) and percutaneous nephrolithotomy (PCNL) in treating large proximal ureteral stones. Methods A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed to find out relevant studies. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies was extracted and then a meta-analysis was conducted via RevMan 5.3 software. Results Five randomized controlled trials (RCTs), one prospective and four retrospective cohort studies involving 837 patients were included. Patients underwent rigid URSL were associated with shorter operation time (WMD, -23.66min; 95%CI, −45.00 to -2.32; p = 0.03), shorter hospital stay (WMD, -2.76d; 95%CI, −3.51 to −2.02; phematuria (RR, 0.38; 95%CI, 0.25 to 0.57; p < 0.0001). No significant difference was observed in terms of incidence of embolization, pain and ureterostenosis. When cohort studies or studies in which flexible ureteroscopy was used as an intraoperative auxiliary procedure were excluded, we both found that most of the results kept stable. Conclusions Both PCNL and rigid URSL are safe for patients with large proximal ureteral stones while PCNL is more effective in stone clearance. PMID:28182718

  18. Percutaneous vertebroplasty: optimizing the procedure after treatment of 250 vertebral levels under fluoroscopic guidance.

    Science.gov (United States)

    Pedicelli, A; Rollo, M; Piano, M; Grattacaso, G; Colosimo, C; Bonomo, L

    2009-10-01

    Percutaneous vertebroplasty (PVP) is a minimally invasive treatment for symptomatic vertebral compression fractures (VCFs). The aim of this study was to assess the effectiveness, complications and progress of results of PVP optimized in terms of technique, costs, time and strategic protocol after 3 years of procedures performed under fluoroscopic guidance alone. We treated 250 VCFs in 120 consecutive patients after assessing clinical and radiological indications. The effectiveness of the procedure was determined by statistical analysis of numerical scores for pain, mobility and drug consumption before and after treatment. No major complications and only three minor complications occurred. Clinically relevant improved mobility and reduction of pain and analgesics were observed, with overall significant results (p<0.0001) in all patients at 24 h after PVP and in 83 available patients at 6 months. A total of five asymptomatic refractures of cemented vertebrae and 14 new symptomatic vertebral fractures at different levels were observed between 1 and 10 months after the procedure. PVP is a safe, rapid, effective and costeffective therapy for VCFs, requiring only brief hospital admission and with long-lasting clinical results, when performed under good-quality radiological guidance, when correct indications are respected and when it is associated with rehabilitation therapy in the follow-up. It is a valid alternative to conservative therapy, which is burdened by high healthcare costs and often requires long-term immobilisation of frail and elderly patients at risk of clinical complications.

  19. Primary percutaneous transluminal coronary angioplasty in the acute infarction of the right ventricle

    Directory of Open Access Journals (Sweden)

    Gligić Branko

    2003-01-01

    Full Text Available Background. Predilection site for the acute myocardial infarction of the right ventricle, (AMI-RV is the upper third of the right coronary artery and for this reason such an infarction is followed by numerous complications, primarily by conduction disorders and very often by sudden and rapid cardiogenic shock development. Methods. Primary percutaneous transluminal coronary angioplasty (PPTCA was performed on three patients in whom the acute infarction of the right ventricular was diagnosed and who had been hospitalized six hours after the beginning of chest pain. In all three patients intracoronary stent was implanted. On the admission patients had been in the threatening cardiogenic shock, with the prominent chest pain and with the elevation of ST-segment in V4R>2 mV. In the course of intervention patients were administered low-molecular intracoronary heparin with direct platelet glycoprotein IIb/IIIa inhibitors (abciximab, according to the established procedure applied in such cases. Results. The complete dilatation of the infarcted artery was established with the signs of reperfusion and the further clinical course was completely normal, there was no heart failure and patients had no subjective difficulties. Conclusion. Invasive approach in the treatment of AMI-RV is justifiable, and possibly the therapy of choice of these patients, providing well trained and equipped team is available.

  20. Percutaneous aspiration and drainage with adjuvant medical therapy for treatment of hepatic hydatid cysts

    Institute of Scientific and Technical Information of China (English)

    Mohammed I Yasawy; Abdelrahman E Mohammed; Sammak Bassam; Mohammed A Karawi; Sohail Shariq

    2011-01-01

    AIM: To determine the efficacy and success of percutaneous aspiration irrigation and reaspiration (PAIR) in the management of hepatic hydatidosis.METHODS: Twenty-six patients with 32 hepatic hydatid cysts had PAIR. Twenty-two patients received at least 2 wk of drug therapy before the procedure was carried out to reduce the risk of recurrence from spillage during the procedure. The procedure was performed under local anesthesia with a 19-gauge 20 cm long needle,the cyst was punctured, cystic content (approximately 30 mL) was aspirated by a 12-14 F pigtail catheter and aspirated fluids were sent for analysis. Once the cyst was almost empty, two-thirds of the net amount of ma materialaspirated was replaced by hypertonic saline and left in the cavity for about 30 min, with the catheter left in place for reaspiration of most of the fluid. When the amount of fluid drained was less than 10 mL per 24 h,the drainage catheter was removed.RESULTS: All 32 cysts showed evidence of immediate collapse after completion of the procedure, and before discharge from hospital, ultrasound examination showed fluid reaccumulation in all cysts. Serial follow-up showed a progressive decrease in the size and change in the appearance of cysts. To confirm the sterility of these cystic cavities, seven cysts were reaspirated on average 3 mo after the procedure. Investigations revealed no viable scolices.CONCLUSION: PAIR using hypertonic saline is very effective and safe with proper precautions.