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

International Nuclear Information System (INIS)

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

2000-01-01

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

Percutaneous Dilational Tracheotomy in Solid-Organ Transplant Recipients.

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Ozdemirkan, Aycan; Ersoy, Zeynep; Zeyneloglu, Pinar; Gedik, Ender; Pirat, Arash; Haberal, Mehmet

2015-11-01

Solid-organ transplant recipients may require percutaneous dilational tracheotomy because of prolonged mechanical ventilation or airway issues, but data regarding its safety and effectiveness in solid-organ transplant recipients are scarce. Here, we evaluated the safety, effectiveness, and benefits in terms of lung mechanics, complications, and patient comfort of percutaneous dilational tracheotomy in solid-organ transplant recipients. Medical records from 31 solid-organ transplant recipients (median age of 41.0 years [interquartile range, 18.0-53.0 y]) who underwent percutaneous dilational tracheotomy at our hospital between January 2010 and March 2015 were analyzed, including primary diagnosis, comorbidities, duration of orotracheal intubation and mechanical ventilation, length of intensive care unit and hospital stays, the time interval between transplant to percutaneous dilational tracheotomy, Acute Physiology and Chronic Health Evaluation II score, tracheotomy-related complications, and pulmonary compliance and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen. The median Acute Physiology and Chronic Health Evaluation II score on admission was 24.0 (interquartile range, 18.0-29.0). The median interval from transplant to percutaneous dilational tracheotomy was 105.5 days (interquartile range, 13.0-2165.0 d). The only major complication noted was left-sided pneumothorax in 1 patient. There were no significant differences in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen before and after procedure (170.0 [interquartile range, 102.2-302.0] vs 210.0 [interquartile range, 178.5-345.5]; P = .052). However, pulmonary compliance results preprocedure and postprocedure were significantly different (0.020 L/cm H2O [interquartile range, 0.015-0.030 L/cm H2O] vs 0.030 L/cm H2O [interquartile range, 0.020-0.041 L/cm H2O); P = .001]). Need for sedation significantly decreased after tracheotomy (from 17 patients [54.8%] to

Ruptured Splenic Abscess following Percutaneous Transluminal Angioplasty in a 40-Year-Old Man

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C. Rajasekharan

2012-05-01

Full Text Available The incidence of splenic abscesses is currently 0.14–0.7% with a reported mortality of 0–47%. The diagnosis of splenic abscess which has ruptured into the abdomen is often overlooked because of its rarity and its misleading clinical presentations. Percutaneous coronary interventions (PCIs and coronary stenting procedures increased from 184,000 to 885,000 (from 335 to 1,550 and from 3,000 to 770,000 (from 5 to 1,350 per one million inhabitants, respectively. A 40-year-old Asian male presented to our emergency department with upper abdominal pain 5 days after a percutaneous transluminal coronary angioplasty. Clinical examination raised the possibilities of acute pancreatitis and intraabdominal sepsis. An initial ultrasound of the abdomen and blood tests were negative. A computed tomography scan of the abdomen revealed a splenic abscess that had ruptured into the abdomen. Pus culture revealed a multidrug-resistant strain of Klebsiella pneumoniae that was sensitive to meropenem. The patient recovered quickly after open surgical drainage and antibiotic therapy. As this is the second case of splenic abscess and the first case report of a ruptured splenic abscess following a PCI, it will be rational to administer a short course of antibiotic prophylaxis for high-risk immunocompromised patients who are undergoing percutaneous transluminal coronary intervention.

Membranous obstruction of inferior vena cava(MOIVC): treatment with percutaneous transluminal angioplasty(PTA) and self expandable metallic stent

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Lee, Ki Yeol; Kim, Baek Hyun; Cha, In Ho; Lee, Nam Joon; Kim, Yun Hwan; Kim, Jung Hyuk [College of Medicine, Korea University, Seoul (Korea, Republic of)

1994-03-15

Percutaneous transluminal angioplasty(PTA) with a balloon catheter is a standard method of treatment for membranous obstruction of inferior vena cava(MOIVC). But, correct therapeutic approach has not been established for MOIVC patients whose lesion is associated with extensive thrombotic IVC occlusion. We tried to treat MOIVC associated with or without thrombus. We treated 13 cases of MOIVC(associated with thrombus in 7 cases, no thrombus in 6 cases) with PTA, thrombolysis and self-expandable metallic stents. PTA was successful in 8 cases, but failed in 5 cases. The recurred cases were retreated with PTA, but follow-up study revealed recoiling restenosis in 4 cases and intimal hyperplasia in 1 case at previous PTA site which could be overcome with a self-expandable metallic stent. The complication were occurred in 3 cases which were hemothorax, hemopericardium, and hemoperitoneum respectively. However, those were resolved by conservative treatment only. Recanalization and dilatation could be done in MOIVC patients with or without thrombosis for improvement of patient's symptom. Gianturco self-expandable metallic stent is useful in treatment of recurred MOIVC after balloon dilatation and preventing reocclusion of the IVC after PTA.

Percutaneous transluminal angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child after liver transplantation

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Yussim, Ethan; Belenky, Alexander; Atar, Eli [Department of Diagnostic Radiology, Rabin Medical Center, Vascular and Interventional Radiology Unit, Petah Tikva (Israel); Shapiro, Rivka [Schneider Children' s Medical Center, Institute of Pediatric Gastroenterology and Nutrition, Petah Tikva (Israel); Mor, Eytan [Rabin Medical Center, Department of Organ Transplantation, Petah Tikva (Israel)

2005-07-01

Percutaneous transluminal angioplasty is increasingly used in children. We present a case of successful balloon angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child who underwent liver transplantation because of biliary atresia. Percutaneous reopening of the shunt is a relatively safe procedure that may spare patients of surgical intervention. (orig.)

Percutaneous transluminal angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child after liver transplantation

International Nuclear Information System (INIS)

Yussim, Ethan; Belenky, Alexander; Atar, Eli; Shapiro, Rivka; Mor, Eytan

2005-01-01

Percutaneous transluminal angioplasty is increasingly used in children. We present a case of successful balloon angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child who underwent liver transplantation because of biliary atresia. Percutaneous reopening of the shunt is a relatively safe procedure that may spare patients of surgical intervention. (orig.)

Percutaneous dilatational tracheostomy following total artificial heart implantation.

Science.gov (United States)

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

2015-07-01

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

Case Report Percutaneous Dilational Tracheostomy A bed side ...

African Journals Online (AJOL)

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

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

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

2013-11-01

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

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.

Percutaneous transluminal angioplasty (PTA) of supra-aortic arteries especially the internal carotid artery

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Kachel, R.; Basche, S. (Medizinische Akademie, Erfurt (Germany, F.R.). Radiologische Klinik); Heerklotz, I.; Grossmann, K. (Medizinische Akademie, Erfurt (Germany, F.R.). Klinik fuer Innere Medizin); Endler, S. (Medizinische Akademie, Erfurt (Germany, F.R.). Klinik fuer Neurologie und Psychiatrie)

1991-06-01

We present our experience with 105 patients in whom percutaneous transluminal angioplasty was performed in 112 stenosed or occluded supra-aortic arteries. Symtoms of cerebrovascular and/or vertebrobasilar insufficiency were present in 104 of the 105 patients. The angioplasty was successful in 35 stenoses of the internal carotid artery, 2 stenoses of the common carotid artery, 1 stenosis of the external carotid artery, 15 stenoses of the vertebral artery, 3 stenoses of the innominate artery and 44 stenoses of the subclavian artery. There were only 4 minor-complications (2 haematomas, 1 transient ischemic attack, 1 small thrombus of the internal carotid artery which was detected by 111-indium platelet scintigraphy and treated by thrombendarterectomy before the appearance of neurological symptoms). All patients were symptom free after angioplasty. During the observations period of 3 to 109 months (average 58 months) there were only two cases with re-stenosis after subclavian angioplasty. The results of more than 700 personal and international published percutaneous transluminal angioplasties of supra-aortic arteries are presented. The results suggest that angioplasty of supra-aortic arteries is an effective method. On strict definition of the indications, the complication rate for angioplasty of the supra-aortic arteries is not likely to be higher than that for operative treatment. (orig.).

[Tracheotomy-endoscop for dilatational percutaneous tracheotomy (TED)].

Science.gov (United States)

Klemm, Eckart

2006-09-01

While surgical tracheotomies are currently performed using state-of-the-art operative techniques, percutaneous dilatational tracheostomy (PDT) is in a rapidly evolving state with regard to its technology and the number of techniques available. This has resulted in a range of new complications that are difficult to quantify on a scientific basis, given the fact that more than half of the patients who are tracheotomized in intensive care units die from their underlying disease. The new Tracheotomy Endoscope (TED) is designed to help prevent serious complications in dilatational tracheotomies and facilitate their management. The endoscope has been specifically adapted to meet the require-ments of percutaneous dilatational tracheotomies. It is fully compatible with all current techniques of PDT. The method is easy to learn. The percutaneous dilatational tracheotomy with the Tracheotomy Endoscope is a seven-step procedure: Advantages of the Tracheotomy Endoscope: Injuries to the posterior tracheal wall ar impossible (tracheoesophageal fistulas, pneumothorax). Minor bleeding sites on the tracheal mucosa can be controlled with a specially curved suction-coagulation tube introudeced through the Tracheotomy Endoscope. In cases with heavy bleeding and a risk of aspiration, the rigid indwelling Tracheotomy Endoscope provides a secure route for reintubating the patient with a cuffed endotracheal tube. It also allows for rapid conversion to an open surgical procedure if necessary. All the parts are easy to clean and are autoclavable. This type of endoscopically guided PDT creates an optimal link between the specialties of intensive care medicine and otorhinolaryngology. The Tracheotomy Endoscope (TED) increases the standard of safety in PDT.

Short-, medium-, and long-term follow-up after percutaneous transluminal coronary angioplasty for stable and unstable angina pectoris

NARCIS (Netherlands)

O. Kamp (Otto); K.J. Beatt (Kevin); P.J. de Feyter (Pim); M.J.B.M. van den Brand (Marcel); H. Suryapranata (Harry); H.E. Luijten; P.W.J.C. Serruys (Patrick)

1989-01-01

textabstractThe first 840 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA) performed in the same institution were retrospectively assessed at an average follow-up period of 25 months after the initial procedure. The study population consisted of 506 patients

Percutaneous dilatation of benign ureteral stricture -a case report-

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

1987-06-15

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

A Systematic Review of Outcomes Following Percutaneous Transluminal Angioplasty and Stenting in the Treatment of Transplant Renal Artery Stenosis

NARCIS (Netherlands)

Ngo, A. T.; Markar, S. R.; de Lijster, M. S.; Duncan, N.; Taube, D.; Hamady, M. S.

2015-01-01

To evaluate outcomes following treatment of transplant renal artery stenosis by percutaneous transluminal angioplasty and stent insertion. A literature search was performed using Pubmed, MEDLINE, Embase, Wiley Interscience and the Cochrane Library databases. Outcome measures were glomerular

A perspective of percutaneous transluminal angioplasty.

Science.gov (United States)

Stanson, A W

1983-01-01

PTA is a relatively new procedure which is still evolving. More technical improvements are needed. Stiffer balloon plastics and devices to measure arterial wall compliance during balloon inflation are predicted to lead to better long-term success rates. Increasing case numbers provide greater expertise and subsequent refinements in performance and case selection. These factors will lead to improved statistics. Other features of overall patient care must be considered also. The procedure is easy for patients to tolerate, and they can return to activities and work in three or four days. The overall cost is much cheaper than surgery, even at a conservative success rate of 65 percent. There is minimal risk and morbidity, and virtually no mortality. PTA can be repeated if the lesion recurs. Severe complications are rare and almost always surgically treatable. If PTA fails to achieve success, a traditional surgical procedure can be performed. Percutaneous transluminal angioplasty is an important therapeutic alternative to traditional medical and surgical treatment for occlusive arterial disease. It can save legs, veins, time, and money. We need to refine and accurately record the use of this procedure. Total cooperation among clinicians, surgeons, and radiologists is essential for proper utilization of PTA.

Association Between Disruption of Fibrin Sheaths Using Percutaneous Transluminal Angioplasty Balloons and Late Onset of Central Venous Stenosis

International Nuclear Information System (INIS)

Ni, Nina; Mojibian, Hamid; Pollak, Jeffrey; Tal, Michael

2011-01-01

To compare the rates of central venous stenosis in patients undergoing hemodialysis who underwent disruption of fibrin sheath with percutaneous transluminal angioplasty balloons and those who underwent over-the-wire catheter exchange. This study is a retrospective review of 209 percutaneous transluminal angioplasty balloon disruption and 1304 over-the-wire catheter exchange procedures performed in 753 patients. Approval from the Human Investigations Committee was obtained for this study. Up to 10-year follow-up was performed. A χ 2 test was used to compare the rates of central venous stenosis after balloon disruption versus catheter exchange. A t-test was used to compare time to central venous stenosis development. Of the 753 patients in the study, 127 patients underwent balloon disruption of fibrin sheath and 626 had catheter exchange. Within the balloon disruption group, 18 (14.2%) of 127 patients subsequently developed central venous stenosis, compared with 44 (7.0%) of 626 in the catheter exchange group (P 2 test). Time to central venous stenosis development was approximately 3 years in both groups and not significantly different (1371 and 1010 days, P = 0.20). A total of 25.2% of patients in the balloon disruption group had four or more subsequent catheter exchanges, versus 12.6% in the catheter exchange group (P 2 test). In conclusions, there is a possible association between percutaneous transluminal angioplasty balloon disruption of fibrin sheath and late-onset central venous stenosis. Because venography was not routinely performed in catheter exchange patients, future randomized studies are necessary to confirm these findings.

Percutaneous transluminal angioplasty with stenting for treatment of superior vena cava obstructive syndrome

International Nuclear Information System (INIS)

Chen Shiwei; Qiao Delin

2004-01-01

Objective: To evaluate the clinical value of percutaneous transluminal angioplasty with stenting (PTAS) for the treatment of superior vana cava obstructive syndrome (SVCOS). Methods: 15 cases of SVCOS including 10 cases of lung cancer with mediastinal lymphatic metastasis, 3 cases as malignant lymphoma and 2 cases of esophageal cancer with mediastinal lymphadenopathy, were undergone right subclavian vein or elbow vein catheterization for pressure measurement and DSA imaging of SVC with displaying the obstructive characteristics. A self-expanding stent was then implanted through right femoral vein catheterization. Results: 15 cases were all successfully under-taken angioplasty and stenting, except 1 case with a long stricture over 10 cm requiring 2 stents. After successful stent placement, DSA revealed smooth flow of contrast with almost normal diameter of SVC lumen, together with disappearance or relief of SVCOS. The SVC pressure decreased from 30.5±2.3 cmH 2 O down to 8.8 ± 1.5 cmH 2 O after recanalization, with a significant difference in statistics (P<0.01). All the patients were followed up for 6 months and obstructive symptom did not reappear except one case complicated with thrombosis which was treated by regional thrombolysis and balloon dilation leading to obviously improved symptom. Conclusion: PTAS for the treatment of SVCOS is effective, safe, simple and of less complications. (authors)

Percutaneous Transluminal Angioplasty of Renal Artery Fibromuscular Dysplasia: Mid-term Results

International Nuclear Information System (INIS)

Kim, Hyo Jin; Do, Young Soo; Shin, Sung Wook; Park, Kwang Bo; Cho, Sung Ki; Choe, Yeon Hyeon; Choo, Sung Wook; Choo, In Wook; Kim, Duk Kyung

2008-01-01

To evaluate mid-term imaging, clinical follow-up, and restenosis rates from patients that had undergone percutaneous transluminal renal artery angioplasty (PTRA) for symptomatic renal artery fibromuscular dysplasia (FMD). Between March 1999 and July 2006, 16 consecutive renal artery FMD patients underwent PTRA for poorly controlled hypertension. The patients were enrolled into this retrospective study after receiving 19 primary and four secondary PTRAs in 19 renal artery segments. Follow-up monitoring of blood pressure, use of antihypertensive medication, and the serum creatinine level after PTRA were assessed at 1, 3, 6, 9, 12 months, and each following year. The degree of restenosis was evaluated with computed tomographic angiography (CTA) after PTRA at 6, 12 months, and every year if possible. Technical and clinical success rates for the treatment of FMD, and restenosis rates for the renal artery were evaluated. The technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19). Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months. There was a cumulative 22% (4/18) restenosis rate during the follow-up period. All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA. Percutaneous transluminal renal artery angioplasty for clinically symptomatic renal FMD is technically and clinically successful and safe to perform. For all patients with restenosis, there was a good response after undergoing a second PTRA

[Synchronized anterograde perfusion during percutaneous transluminal coronary angioplasty: preliminary clinical study].

Science.gov (United States)

Farcot, J C; Berland, J; Derumeaux, G; Letac, B; Bourdarias, J P

1995-03-01

A new circulatory system, "physiologic anteroperfusion system", has been developed and tested in 6 patients with significant proximal coronary artery stenosis. Prolonged and safe balloon inflation was possible without any ischemic signs. The system consists of an electronic cardiac synchroperfusor which, by activating a pulsatile unit, permits increased diastolic anteroperfusion of autologous blood under physiologic pressure through low-profile standard angioplasty catheters. This study reports the results obtained in 6 patients during proximal prolonged percutaneous transluminal coronary angioplasty. Four men and two women suffering from severe exertional angina pectoris, with normal resting left ventricular function, no collaterals and excellent apical two-dimensional four-chamber echocardiographic views were studied. After a 90 +/- 10 seconds of control occlusion under continuous monitoring of hemodynamics, electrocardiograms (3 to 4 leads), two-dimensional echo and chest pain grading, a second balloon inflation protected by the physiologic anteroperfusion system at a flow rate of 44 +/- 12 ml/min was performed for fifteen minutes. The ischemic signs present in the myocardium depending on the occluded artery were totally abolished during prolonged inflation protected by physiologic anteroperfusion system. All the patients were successfully dilated and were discharged from hospital the following morning without cardiac enzyme elevation or signs of central or peripheral hemolysis. Conclusion, in 6 patients with severe proximal coronary artery stenosis, safe prolonged proximal angioplasty without signs of ischemia was performed using a new simple physiologic anteroperfusion system, which allows active diastolic flow-pressure controlled autologous arterial blood perfusion, through standard low profile catheters.

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

Percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease using a transluminal endatherectomy catheter (TEC): Initial results and angiographic follow-up

International Nuclear Information System (INIS)

Rilinger, Norbert; Goerich, Johannes; Scharrer-Pamler, Reinhard; Vogel, Jochen; Tomczak, Reinhard; Merkle, Elmar; Sokiranski, Roman; Brambs, Hans-Juergen

1997-01-01

Purpose. To evaluate the clinical results of percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease. Methods. Rotational atherectomy was performed in 39 patients aged 39-87 years (mean 66.6 years). A total of 71 lesions (43 stenoses and 28 occlusions) were treated in 40 limbs. Additional balloon angioplasty was required in 54% of lesions. Fifteen patients (37.5%) presented in Fontaine stage II, 10 patients (25%) in Fontaine stage III and 15 patients (37.5%) in Fontaine stage IV. Rotational atherectomy at 750 rpm was carried out over a 0.014-inch guidewire with continuous aspiration into a vacuum, bottle. Follow-up angiography and color flow Doppler examinations were performed in 22 patients (23 limbs) after a mean period of 6 months (range 2-14 months). Results. There was one primary technical failure. In 36 of 40 lesions there was a good angiographic result with residual stenoses in less than 30%. In 70 lesions treated by rotational atherectomy, however, 54% showed residual stenoses of 30%-50% and these cases required additional balloon angioplasty. The mean ankle-brachial index improved significantly (p<0.001), from 0.49 before the procedure to 1.01 after the procedure. A single distal embolus, related to primary recanalization, occurred and there were two large inguinal hematomas. Cumulative clinical patency after 6 months was 83.8% and cumulative angiographic patency after 6 months was 79.1%. Conclusion. Percutaneous rotational atherectomy is a promising approach for the treatment of chronic peripheral vascular disease. Further prospective, randomized studies are necessary to compare percutaneous transluminal angioplasty with this new technical approach

Cardiac troponin T and CK-MB mass release after visually successful percutaneous transluminal coronary angioplasty in stable angina pectoris

DEFF Research Database (Denmark)

Ravkilde, J; Nissen, H; Mickley, H

1994-01-01

The incidence of cardiac troponin T (Tn-T) and creatine kinase (CK) isoenzyme MB mass release was studied in 23 patients with stable angina pectoris undergoing visually successful percutaneous transluminal coronary angioplasty (PTCA). Serial blood samples were drawn for measurement of serum Tn...

[Effect of nattokinase on restenosis after percutaneous transluminal angioplasty of the abdominal artery in rabbits].

Science.gov (United States)

Gong, Min; Lin, Huan-bing; Wang, Qian; Xu, Jiang-ping

2008-08-01

To investigate the effect of nattokinase on intimal hyperplasia in rabbit abdominal artery after balloon injury and explore a novel strategy for the preventing restenosis after percutaneous transluminal angioplasty. Fifty-six New Zealand rabbits were randomly divided into 7 groups, namely the solvent control group, model group, natto extract lavage group, refined nattokinse lavage group, intravenous refined nattokinse injection group, clopidogrel group and clopidogrel-aspirin group. Balloon injury was induced by inserting the catheter through the femoral artery into the thoracic aorta of the rabbits. The platelet counts were notad and platelet aggregation was observed, and the abdominal artery was taken for pathological analysis. The expressions of MMP-2 and -9 in the abdominal artery were detected immunohistochemically. There was no significant difference in the platelet counts, platelet aggregation rate or MMP-2 and -9 expression between the model group and the nattokinse-treated groups (P>0.05). The stenosis index in each nattokinse-treated group was significantly greater and the neointimal proliferation index smaller than that of the model group (P<0.01 or 0.05). Nattokinse can inhibit restenosis of rabbit abdominal artery after percutaneous transluminal angioplasty, which is independent of its actions on the platelet or MMP-2 and -9 expressions.

[Analysis on influencing factor of the complications of percutaneous dilational tracheotomy].

Science.gov (United States)

Zhai, Xiang; Zhang, Jinling; Hang, Wei; Wang, Ming; Shi, Zhan; Mi, Yue; Hu, Yunlei; Liu, Gang

2015-01-01

To Analyze the influence factors on the complications of percutaneous dilational tracheotomy. Between August 2008 and February 2014, there were 3 450 patients with the indications of tracheotomy accepted percutaneous dilational tracheostomy, mainly using percutaneous dilational and percutaneous guide wire forceps in these cases. Statistical analysis was performed by SPSS 19.0 software on postoperative complications, the possible influence factors including age, gender, etiology, preoperative hypoxia, obesity, preoperative pulmonary infection, state of consciousness, operation method, operation doctor and whether with tracheal intubation. Among 3 450 patients, there were 164 cases with intraoperative or postoperative complications, including postoperative bleeding in 74 cases (2.14%), subcutaneous emphysema in 54 cases (1.57%), wound infection in 16 cases (0.46%), pneumothorax in 6 cases (0.17%), mediastinal emphysema in 5 cases (0.14%), operation failed and change to conventional incision in 4 cases (0.12%), tracheoesophageal fistula in 2 cases (0.06%), death in 3 cases(0.09%).Obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method were the main influence factors, with significant statistical difference (χ(2) value was 0.010, 0.000, 0.002, 0.000, 0.000, 0.000, all P Gender, age, operation doctor and whether there was the endotracheal intubation were not the main influence factors. There was no significant statistical difference (P > 0.05). Although percutaneous dilational tracheostomy is safe, but the complications can also happen. In order to reduce the complications, it is need to pay attention to the factors of obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method.

Percutaneous Dilatational Tracheostomy via Griggs Technique.

Science.gov (United States)

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

2017-01-01

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

[The usefullness of percutaneous transluminal balloon angioplasty in the management of budd-Chiari syndrome].

Science.gov (United States)

Kim, Se Hwan; Yu, Kyung Sool; Baek, Seung Min; Lee, Seung Yup; Kim, Hyun Su; Tak, Won Young; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan; Chung, Joon Mo

2002-06-01

Membranous obstruction is the most common cause of Budd-Chiari syndrome in Orientals. Recently, percutaneous transluminal balloon angioplasty (PTBA) has been successfully applied as a treatment of membranous obstruction. We evaluated etiologies and clinical manifestations in our cases and the usefulness of PTBA. Twelve cases of Budd-Chiari syndrome were analyzed. 50.3 years was the average age of the cases (ranging from 37 to 67 years). Major symptoms or signs were superficial collateral vessels on the chest or the abdomen in 6 cases, ascites in 3, abdominal pain in 4, hepatomegaly in 4, splenomegaly in 3, melena or hematemesis in 2, and leg edema in 2. Upper gastrointestinal endoscopy showed esophageal varices in 6 cases and two of these 6 cases had gastric varices. Of 8 cases with liver cirrhosis, 4 were classified as Child-Pugh class A and 4 as B. Four patients with cirrhosis had concurrent hepatocellular carcinoma including 1 patient who was HBs Ag positive. Etiologies were membranous obstruction in 11 cases and protein C deficiency in 1 case. The main site of obstruction was IVC in 8 and hepatic vein in 4. PTBA was successfully performed in 8 cases of membranous obstruction. During the mean follow-up period of 27.6 months (12-40 months), there were no reobstructions except in 2 cases. The most common cause of Budd-Chiari syndrome in our cases was membranous obstruction of IVC. Percutaneous transluminal balloon angioplasty is a very useful treatment method.

The usefulness of percutaneous transluminal angioplasty of the middle cerebral artery stenosis in patients with transient ischemic attack

Energy Technology Data Exchange (ETDEWEB)

Lee, Young Chul; Lim, Hyo Soon; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun [Chonnam National Univ. Medical School, Kwangju (Korea, Republic of)

2001-06-01

To determine the effectiveness of percutaneous transluminal angioplasty(PTA) of atherosclerotic middle cerebral artery(MCA) stenosis in patients with transient ischemic attack (TIA). Ten patients with TIA who had undergone PTA were retrospectively investigated. In all ten, angiography revealed stenosis of the MCA. Mechanical dilatation was performed at the stenotic portion, and the angiographic findings after PTA, as well as peri/post-angioplastic complications, were evaluated. Four to 64 (mean, 23.5) months later, neurologic symptoms and the nature and timing of recurrent attacks were also assessed. The degree of stenosis before PTA was 50-75% in six patients and greater than 75% in four. Complete or partial angiographic recanalization of the stenotic segment occurred in nine patients (90%). During follow-up, seven patients recovered without recurrent TIA or cerebral stroke; one reported a tingling sensation and one experienced vertebrobasilar insufficiency. Motor aphasia developed in one patient after PTA, but after systemic heparinization, improved within 24 hours. One patient who suffered intracranial hemorrhage due to vascular rupture during PTA did three days later. PTA for atherosclerotic MCA stenosis in patients with TIA is an effective therapeutic method.

The usefulness of percutaneous transluminal angioplasty of the middle cerebral artery stenosis in patients with transient ischemic attack

International Nuclear Information System (INIS)

Lee, Young Chul; Lim, Hyo Soon; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun

2001-01-01

To determine the effectiveness of percutaneous transluminal angioplasty(PTA) of atherosclerotic middle cerebral artery(MCA) stenosis in patients with transient ischemic attack (TIA). Ten patients with TIA who had undergone PTA were retrospectively investigated. In all ten, angiography revealed stenosis of the MCA. Mechanical dilatation was performed at the stenotic portion, and the angiographic findings after PTA, as well as peri/post-angioplastic complications, were evaluated. Four to 64 (mean, 23.5) months later, neurologic symptoms and the nature and timing of recurrent attacks were also assessed. The degree of stenosis before PTA was 50-75% in six patients and greater than 75% in four. Complete or partial angiographic recanalization of the stenotic segment occurred in nine patients (90%). During follow-up, seven patients recovered without recurrent TIA or cerebral stroke; one reported a tingling sensation and one experienced vertebrobasilar insufficiency. Motor aphasia developed in one patient after PTA, but after systemic heparinization, improved within 24 hours. One patient who suffered intracranial hemorrhage due to vascular rupture during PTA did three days later. PTA for atherosclerotic MCA stenosis in patients with TIA is an effective therapeutic method

Complications in percutaneous transluminal stenting for carotid artery stenosis

International Nuclear Information System (INIS)

Li Shenmao; Miao Zhongrong; Zhu Fengshui; Ji Xunming; Jiao Liqun; Qi Jianshu; Ling Feng

2007-01-01

Objective: To discuss the complications of endovascular stenting for carotid artery stenosis. Methods: Cerebral vascular angiography and cervical Doppler sonography were performed in 648 patients with carotid artery stenosis. Emboli-protected device was used in 365 patients and none in 283 patients. Results: All 648 patients were technically successful (100%). Symptoms disappeared or improved in 78.7% patients. Slow heart rate during operation existed in 26.4% patients. Embolism caused by dislodgment of emboli occurred in 5 patients, 3 of them recovered after treatment and 2 had unilateral dyskinesias. Intracranial hemorrhage occurred in 3 patients. Stroke or death within 30 days after operation occurred in 6 patients(1.24%). 322 patients (77.8%)were followed up. Restenosis occurred in 17 patients(3.3%). Conclusion: Percutaneous transluminal stenting is a safe option for carotid artery stenosis. Correct evaluation of clinical and angiographic data before operation, together with normative manipulation and nursing during and after operation are the key points to avoid complications. (authors)

Long-Term Follow-up of the PADI Trial : Percutaneous Transluminal Angioplasty Versus Drug-Eluting Stents for Infrapopliteal Lesions in Critical Limb Ischemia

NARCIS (Netherlands)

Spreen, Marlon I; Martens, Jasper M; Knippenberg, Bob; van Dijk, Lukas C; De Vries, Jean-Paul P. M.; Vos, Jan Albert; de Borst, Gert Jan; Vonken, Evert-Jan P A; Bijlstra, Okker D; Wever, Jan J; Statius van Eps, Randolph G; Mali, Willem P Th M; van Overhagen, Hendrik

2017-01-01

BACKGROUND: Clinical outcomes reported after treatment of infrapopliteal lesions with drug-eluting stents (DESs) have been more favorable compared with percutaneous transluminal angioplasty with a bailout bare metal stent (PTA-BMS) through midterm follow-up in patients with critical limb ischemia.

The exposure of radiologists and patients to radiation during coronary angiography and percutaneous transluminal coronary angioplasty (PTCA)

International Nuclear Information System (INIS)

Karppinen, J.; Parviainen, T.

1993-03-01

The exposure of radiologists and patients to radiation during coronary angiography and percutaneous transluminal coronary angioplasty (PTCA) in Finland was studied using phantom measurements. Additional tests were made concerning the performance of TV fluoroscopy systems, cine fluorographic units and film processing. These tests include sensitometric quality control of film processing, automatic exposure control in fluoroscopy and cinefluorography, and contrast and resolution in a cine frame and TV image

Comparison of the effect of stem cell therapy and percutaneous transluminal angioplasty on diabetic foot disease in patients with critical limb ischemia

Czech Academy of Sciences Publication Activity Database

Dubský, M.; Jirkovská, A.; Bém, R.; Fejfarová, V.; Pagacová, L.; Němcová, A.; Sixta, B.; Chlupáč, J.; Peregrin, J. H.; Syková, Eva; Jude, E. B.

2014-01-01

Roč. 16, č. 12 (2014), s. 1733-1738 ISSN 1465-3249 Grant - others:GA MZd(CZ) 00023001IKEM Institutional support: RVO:68378041 Keywords : critical limb ischemia * stem cell therapy * percutaneous transluminal angioplasty Subject RIV: FH - Neurology Impact factor: 3.293, year: 2014

Is the Watanabe heritable hyperlipidemic rabbit a suitable experimental model for percutaneous transluminal coronary angioplasty in humans? A light microscopic, immunohistochemical and ultrastructural study

NARCIS (Netherlands)

Wanibuchi, H.; Dingemans, K. P.; Becker, A. E.; Ueda, M.; Naruko, T.; Tanizawa, S.; Nakamura, K.

1993-01-01

This study was designed to assess an experimental model for the study of mechanisms that underlie restenosis after percutaneous transluminal coronary angioplasty. The Watanabe heritable hyperlipidemic (WHHL) rabbit lacks the receptor for low density lipoproteins, produces atherosclerotic lesions

Flow motion waves with high and low frequency in severe ischaemia before and after percutaneous transluminal angioplasty

OpenAIRE

Hoffmann, Ulrich; Schneider, Ernst; Bollinger, Alfred

2017-01-01

Study of objective - The aim was to evaluate skin flux and prevalence of low and high frequency flow motion waves in patients with severe ischaemia due to peripheral arterial occlusive disease before and after percutaneous transluminal angioplasty (PTA) with and without local thrombolysis. Design - Flow motion was recorded by the laser Doppler technique at the dorsum of the foot before, one day, and one month after PTA. The results were separately analysed in patients with successful and unsu...

Quantitative exercise thallium-201 scintigraphy for predicting angina recurrence after percutaneous transluminal coronary angioplasty

International Nuclear Information System (INIS)

Stuckey, T.D.; Burwell, L.R.; Nygaard, T.W.; Gibson, R.S.; Watson, D.D.; Beller, G.A.

1989-01-01

The aim of this prospective study was to determine the value of quantitative exercise thallium-201 scintigraphy for predicting short-term outcome in patients after percutaneous transluminal coronary angioplasty (PTCA). Quantitative exercise thallium-201 scintigraphy was performed 2.2 +/- 1.2 weeks after successful PTCA in 68 asymptomatic patients, 64 (94%) of whom had class III or IV angina before the procedure. Clinical follow-up was obtained in all patients at a mean of 10 +/- 2 months and all were followed for at least 6 months; 45 patients (66%) remained asymptomatic during follow-up and 23 (34%) developed recurrent class III or IV angina at a mean of 2.6 +/- 1.2 months. Multivariate analysis of 22 clinical, angiographic and exercise test variables revealed that thallium-201 redistribution, any thallium scan abnormality, presence of a distal stenosis and treadmill time were the only significant predictors of recurrent angina after PTCA. Using a stepwise discriminant function model, thallium-201 redistribution was the only significant independent predictor. Despite its prognostic value relative to other variables as a predictor, thallium redistribution at 2 weeks after PTCA was only detected in 9 of the 23 patients (39%) who subsequently developed recurrent angina, although only 2 of the 45 patients (9%) who remained asymptomatic during follow-up demonstrated thallium-201 redistribution at the time of early testing. After repeat angiography was performed in 17 of the 23 patients with recurrent angina, 14 (82%) demonstrated restenosis and 3 (18%) had worse narrowing distal to or remote from the site of dilatation

Clinical review: Percutaneous dilatational tracheostomy

Science.gov (United States)

Al-Ansari, Mariam A; Hijazi, Mohammed H

2006-01-01

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

Percutaneous transluminal angioplasty of renal artery: therapeutic experience of 31 patients

International Nuclear Information System (INIS)

Kim, Seung Cheol; Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Kim, Hong Dae; Jeong, Yoong Ki; Kim, Seung Hoon; Yeon, Kyung Mo

1995-01-01

The purpose of this study is to introduce the experience of 31 patients who had renovascular hypertension and underwent percutaneous transluminal angioplasty of renal artery (PTA). The subjects were 31 patients with hypertension and stenotic renal artery or arteries on angiography. The criteria of stenosis is more than 50% narrowing of the artery. The technical results were considered to be successful if residual stenosis is less than 50%. The clinical results were classified as cure, improvement and fail. And clinical results were analyzed according to the follow-up duration, short term (≤6 mo) and long term (> 6 mo). Technical success rate was 90.2% (37/41) and clinical success rate were 82.8% (24/29) on short term follow-up and 84.2% (16/19) on long term follow-up. Recurred cases were 7 cases. PTA is a safe and effective therapeutic modality on renovascular hypertension

The role of percutaneous transluminal coronary angioplasty in heart transplant recipients.

Science.gov (United States)

Schnetzler, B; Drobinski, G; Dorent, R; Camproux, A C; Ghossoub, J; Thomas, D; Gandjbakhch, I

2000-06-01

Review the acute and late results of percutaneous transluminal coronary angioplasty (PTCA) in heart transplant recipients and examine the factors predictive of restenosis. Coronary graft disease (CGD) is the main factor responsible for late graft loss. Medical treatment, surgical revascularization, or retransplantation gives only suboptimal results in this regard. Therefore, PTCA has been attempted in this situation. More than 332 heart transplantations in our institution have been performed since 1992, the date of the first PTCA in our patients. We are currently in charge of 450 patients. All the characteristics, procedure-related information, and clinical outcome of patients needing PTCA were assessed by review of each patient's clinical records. All coronary angiograms were reviewed by an independent cardiologist. Since 1992, 53 coronary sites have been dilated in the course of 39 procedures in 29 patients. Indication for PTCA was asymptomatic angiographic coronary graft disease in 35 sites (64.8%), angina in 9 (16.6%), silent ischemia in 2 (3.7%), acute myocardial infarction in 1 (1.8%), and CHF in 7 (12.9%). Primary success ( 50%) was 32.5% (14/43). Mean follow-up was 1.27 year +/- 1.2 (SD). Five deaths (17. 2%) occurred in follow-up and were all in relation to coronary graft disease. Mean time separating PTCA from death was 0.9 year +/- 1.3 (SD). We also sought to look at factors predictive of restenosis. By multivariate analysis, a positive recipient's serology for cytomegalovirus (CMV) before the graft was the only factor found protective against restenosis (odds ratio 22.4; confidence interval 1.1 to 443.4). PTCA in heart transplant recipients allows a high level of primary success with a low periprocedural-complication rate. Restenosis rate seems equivalent to restenosis rate in native coronary arteries. Mortality during follow-up is increased in this population and is the consequence of a high level of coronary events. Recipient positivity for CMV before

Assessment of percutaneous transluminal coronary angioplasty with 123IODO-heptadecanoic acid

International Nuclear Information System (INIS)

Stoddart, P.G.P.; Wilde, P.; Papouchado, M.; Jones, J.V.

1987-01-01

Ten patients underwent myocardial scintigraphy with 123 I-iodo-heptadecanoic acid (HDA), which was injected in the last minute of maximal exercise testing. Six of the patients were rescanned following percutaneous transluminal coronary angioplasty. All ten patients underwent full coronary angiography. There were visible perfusion defects on the static images in 74% of the myocardial areas which were supplied by an artery with a stenosis greater than 75%. The mean half life recorded from areas distal to an arterial stenosis of at least 90% (35.69 min±41.25 min), was longer than the expected normal mean (18.85 min±3.35 min). However, the difference was not statistically significant. The static images changed in some patients following angioplasty, however there was no consistent alteration in the half-lives. It was concluded that HDA is a suitable agent for investigating myocardial perfusion, but that the half life cannot be measured adequately for clinical purposes with a planar imaging sytsem. (orig.)

Optimization and audit of radiation dose during percutaneous transluminal coronary angioplasty

International Nuclear Information System (INIS)

Livingstone, Roshan S.; Timothy Peace, B.S.; Chandy, Sunil; Gorge, Paul V.; Pati, Purendra

2007-01-01

The percutaneous transluminal coronary angioplasty (PTCA) is one of the interventional procedures which impart high radiation doses to patients compared to the other cardiologic procedures. This study intends to audit and optimize radiation dose imparted to patients undergoing PTCA. Forty-four patients who underwent PTCA involving single or multiple stent placement guided under cardiovascular X-ray machine were included in the study. Radiation doses were measured using dose area product (DAP) meter for patients undergoing single and multiple stent placements during PTCA. A dose reduction of 27-47% was achieved using copper filters and optimal exposure parameters. The mean DAP values before optimization were 66.16 and 122.68 Gy cm 2 for single and multiple stent placement respectively. These values were 48.67 and 65.44 Gy cm 2 respectively after optimization. In the present scenario, due to the increase in the number of PTCAs performed and the associated risk from radiation, periodical audit of radiation doses for interventional procedures are recommended. (author)

Percutaneous angioscopy

International Nuclear Information System (INIS)

Beck, A.

1987-01-01

In dogs and 11 patients a new endoscopic method for arteries has been developed. The approach is transfemoral, and endoscopy is combined with angiography, percutaneous transluminal angioplasty (PTA), and local lysis. An ultrathin endoscope with a diameter of 2.4 mm is used, which also provides a working channel with a diameter of 0.4 mm. Guide wires, contrast media, and drugs for local lysis can be inserted through this channel. Under fluoroscopic control, the endoscope is placed in the region of interest, followed by a special method for decreasing blood flow. Endoscopy is documented by video or by a high-speed camera. No complications have occurred. In all patients, it was possible to demonstrate the results of dilatation, recanalization, or local lysis before and after the interventional procedure. (orig.) [de

Percutaneous Transluminal Angioplasty and Enclosed Thrombolysis Versus Percutaneous Transluminal Angioplasty in the Treatment of Femoropopliteal Occlusions: Results of a Prospective Randomized Trial

International Nuclear Information System (INIS)

Nicholson, Tony

1998-01-01

Purpose: To determine whether percutaneous transluminal angioplasty (PTA) and enclosed thrombolysis (ET) is superior to PTA alone in the treatment of femoropopliteal occlusions. Methods: Twenty-five patients with 5-15-cm-long occlusions in the femoropopliteal segments, with otherwise normal run-in arteries and at least one normal tibioperoneal artery to the foot, were randomized to ET/PTA or PTA alone. Ankle brachial systolic index (ABI) was measured before the procedure and at 24 hr and 12 months after the procedure, when a duplex scan was also carried out. End points in the study were patency at, or repeat intervention before, 12 months. Results: Procedures were successful in 23 of 25 patients. There was one immediate occlusion of tibioperoneal arteries, and one early reocclusion of a reopened segment in the ET/PTA group. There was one early reocclusion in the PTA group. At 12 months patency was 70% and 69.2% in the ET/PTA and PTA groups respectively. Covariant analysis showed no significant difference in ABI between the two groups at any of the three measurement times. Conclusion: This trial demonstrated no difference between ET/PTA and PTA alone in femoropopliteal occlusions associated with normal proximal arteries and at least one normal tibioperoneal artery

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

DEFF Research Database (Denmark)

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

2015-01-01

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

[A clinical observation of percutaneous balloon dilation and maintenance percutaneous transhepatic cholangial catheter drainage for treatment of 21 patients with benign biliary strictures and difficult endoscopy].

Science.gov (United States)

Pan, Jie; Shi, Hai-feng; Li, Xiao-guang; Zhang, Xiao-bo; Liu, Wei; Jin, Zheng-yu; Hong, Tao; Yang, Ai-ming; Yang, Ning

2012-06-01

To investigate the value of percutaneous balloon dilation and percutaneous transhepatic cholangial drainage (PTCD) catheter maintenance in the treatment of benign biliary strictures. The clinical data of 21 patients with benign biliary strictures at Peking Union Medical College Hospital from June 2005 to June 2011 were retrospectively studied, in which 12 patients in severe stricture (stenosis > 70%) were treated with percutaneous balloon dilation and PTCD catheter placed across the stricture, while another 9 patients in median stricture (stenosis stenosis was seen in 2 patients. A severe complication with biliary artery branch rupture and massive hemobilia was seen in 1 patient during balloon dilation. Of the 9 patients only treated with 1 - 12 months (median: 6 months) of PTCD catheter placement, 7 patients had the catheter successfully removed. In the follow-up of 5 - 18 months (median: 8 months), patency of bile duct was preserved in 5 of 7 patients, and recurrent stenosis was seen in 2 patients. No severe complication occurred. When endoscopy therapy is failed or the patient can't undergo endoscopy therapy, the percutaneous balloon dilation and PTCD catheter maintenance method is an effective alternative therapeutic approach in the treatment of benign biliary strictures. The moderate benign biliary stricture may be effectively treated only by the PTCD catheter maintenance method.

Adverse outcomes after percutaneous dilatational tracheostomy versus surgical tracheostomy in intensive care patients: case series and literature review

Directory of Open Access Journals (Sweden)

Jarosz K

2017-08-01

Full Text Available Konrad Jarosz,1 Bartosz Kubisa,2 Agata Andrzejewska,3 Katarzyna Mrówczyńska,3 Zbigniew Hamerlak,4 Alicja Bartkowska-Śniatkowska5 1Department of Clinical Nursing, Pomeranian Medical University, 2Thoracic Surgery and Transplantation Department, Pomeranian Medical University, 3Anaesthesiology and Intensive Care Department, Pomeranian Medical University, 4Stomatology Department, Pomeranian Medical University, 5Anaesthesiology and Pediatric Intensive Care Department, Poznan University of Medical Sciences, Szczecin, Poland Abstract: Tracheostomy is a routinely done procedure in the setting of intensive care unit (ICU in patients requiring prolonged mechanical ventilation. There are two ways of making a tracheostomy: an open surgical tracheostomy and percutaneous dilatational tracheostomy. Percutaneous dilatational tracheostomy is associated with fewer complications than open tracheostomy. In this study, we would like to compare both techniques of performing a tracheostomy in ICU patients and to present possible complications, methods of diagnosing and treating and minimizing their risk. Keywords: tracheostomy, percutaneous tracheostomy, percutaneous dilatational tracheostomy, bronchoscopy, surgical tracheostomy, tracheoesophageal fistula, tracheostomy complications

Percutaneous balloon dilatation and long-term drainage as treatment of anastomotic and nonanastomotic benign biliary strictures

NARCIS (Netherlands)

Janssen, Jan Jaap; van Delden, Otto M.; van Lienden, Krijn P.; Rauws, Erik A. J.; Busch, Olivier R. C.; van Gulik, Thomas M.; Gouma, Dirk J.; Laméris, Johan S.

2014-01-01

This study was designed to determine the effectiveness of percutaneous balloon dilation and long-term drainage of postoperative benign biliary strictures. Medical records of patients with postoperative benign biliary strictures, in whom percutaneous transhepatic biliary drainage (PTBD) and balloon

Percutaneous transluminal angioplasty in the region of the renal artery: indications, technique and results

Energy Technology Data Exchange (ETDEWEB)

Olbert, F; Ogris, E; Muzika, N; Schlegl, A; Vacariu, O; Diez, W

1985-01-01

The paper reports the results obtained by percutaneous transluminal angioplasty (PTA) in the treatment of renal artery stenosis in 25 patients with secondary hypertension and discusses indications and the technique used. The follow-up period ranged from 0.5 to 12 months. All interventions were performed with the Olbert catheter system. Following PTA a significant decrease in systolic, diastolic and mean arterial pressure was observed in nearly all patients. The response of the plasma renin activity (PRA) to orthostatic stimulation and pharmacological stimulation by furosemide was determined in a subset of 15 patients before and after PTA. A significant decrease in both basal and stimulated PRA values was observed subsequent to PTA. The decrease in PRA values after successful PTA did not, however, correlate with the extent of the blood pressure changes. (Author).

Percutaneous transluminal angioplasty in the region of the renal artery: indications, technique and results

International Nuclear Information System (INIS)

Olbert, F.; Ogris, E.; Muzika, N.; Schlegl, A.; Vacariu, O.; Diez, W.

1985-01-01

The paper reports the results obtained by percutaneous transluminal angioplasty (PTA) in the treatment of renal artery stenosis in 25 patients with secondary hypertension and discusses indications and the technique used. The follow-up period ranged from 0.5 to 12 months. All interventions were performed with the Olbert catheter system. Following PTA a significant decrease in systolic, diastolic and mean arterial pressure was observed in nearly all patients. The response of the plasma renin activity (PRA) to orthostatic stimulation and pharmacological stimulation by furosemide was determined in a subset of 15 patients before and after PTA. A significant decrease in both basal and stimulated PRA values was observed subsequent to PTA. The decrease in PRA values after successful PTA did not, however, correlate with the extent of the blood pressure changes. (Author)

Exercise electrocardiography and myocardial scintigraphy in the serial evaluation of the results of percutaneous transluminal coronary angioplasty

International Nuclear Information System (INIS)

Schall, J.M.; Chaitman, B.R.; David, P.R.; Dupras, G.; Brevers, G; Val, P.G.; Crepeau, J.; Lesperance, J.; Bourassa, M.G.

1982-01-01

The diagnostic value of exercise electrocardiography using 14 leads and thallium-201 scintigraphy were evaluated in 54 of 70 patients who underwent percutaneous transluminal coronary angioplasty (PTCA), both in the initial assessment and serial follow-up of patients after PTCA. Of the 45 patients who had successful PTCA, 36 had complete noninvasive studies performed before and 1 month after PTCA. The use of clinical symptoms in conjunction with the physiologic data, ECG and myocardial scintigram acquired during exercise provide important short-term data on the angiographic evolution of PTCA results. The noninvasive tests may be useful in determining guidelines for repeat angiography in patients who have had PTCA

Close to Transplant Renal Artery Stenosis and Percutaneous Transluminal Treatment

Directory of Open Access Journals (Sweden)

Leonardou Polytimi

2011-01-01

Full Text Available Purpose. To evaluate the efficacy of percutaneous transluminal angioplasty (PTA in the management of arterial stenosis located close to the allograft anastomosis (close-TRAS. Materials and Methods. 31 patients with renal transplants were admitted to our institution because of persistent hypertension and impairment of transplant renal function and underwent angiography for vascular investigation. 27 were diagnosed suffering from transplant renal artery stenosis (TRAS, whereas 4 had severe iliac artery stenosis proximal to the transplant anastomosis (Prox-TRAS. 3 cases of TRAS coexisted with segmental renal arterial stenosis, whereas 3 other cases of TRAS were caused by kinking and focal stenosis in the middle of the transplanted renal artery. Results. Angioplasty and stenting were successfully applied to all patients with iliac artery stenosis as well as to those with TRAS and segmental artery stenosis. Two of three patients with kinking were well treated with angioplasty and stenting, whereas one treated only with angioplasty necessitated surgery. No major procedure-related complications appeared, and the result was decrease of the serum creatinine level and of the blood pressure. Conclusions. PTA is the appropriate initial treatment of TRAS and close-TRAS, with low morbidity and mortality rates, achieving improvement of graft function and amelioration of hypertension.

Radiation dose to patients from the coronary angiography and percutaneous transluminal coronary angioplasty in interventional radiology procedures

International Nuclear Information System (INIS)

Zheng, Jun-Zheng; Bai, Mei; Liu, Bin

2008-01-01

Full text: Objective: To survey and assess radiation dose to patients from coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) in Beijing Xuanwu Hospital of Capital University of Medical Sciences. Methods: The dose-area product (DAP) values to the patient and cumulative dose (CD) were recorded from 84 coronary angiographies and 51 percutaneous transluminal coronary angioplasty. A Monte-Carlo based program PCXMC was used to calculate the effective dose from DAP values for each patient. Organ doses were also measured by thermoluminescent dosimeters (TLD) using a human-shaped phantom to compare the calculated organ dose from DAP. Results: The difference between the organ doses measured by TLDs and those from PCXMC software (P>0.05) were tolerable. The DAP value ranged from 7611∼60538 mGy·cm 2 for CA and 16423∼161973 mGy·cm 2 for PTCA. The effective dose for all procedures was determined to be in the range of 1.1∼6.9 mSv for CA and 2.3∼20.1 mSv for PTCA. CD ranged from 120.0 to 1016.0 mGy for CA and 287 to 2883 mGy for PTCA. Conversion factors between effective dose and DAP were 0.114∼0.139 mSv·Gy - 1·cm -2 for CA and 0.124∼0.142 mSv·Gy -1 ·cm -2 for PTCA; Conversion factors between organ dose and CD were derived for CA and PTCA, respectively. Conclusions: DAP and CD can be used as the dose indicator to calculate the organ dose and effective dose of patient based on Monte Carlo simulation. Using this method can provide important information of patient absorbed dose and enhance the radiation protection of patient in interventional radiology procedures. (author)

Correction of subclinical coagulation disorders before percutaneous dilatational tracheotomy. A randomised controlled trial

NARCIS (Netherlands)

Veelo, Denise P.; Vlaar, Alexander P.; Dongelmans, Dave A.; Binnekade, Jan M.; Levi, Marcel; Paulus, Frederique; Berends, Fenny; Schultz, Marcus J.

2012-01-01

Background. There is evidence that percutaneous dilatational tracheotomy (PDT) can be safely performed in patients with severe coagulation disorders if these are carefully corrected immediately before the procedure. However, it is currently unclear whether PDT can be performed safely in patients in

Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts

International Nuclear Information System (INIS)

Weber, Andreas; Gaa, Jochen; Rosca, Bogdan; Born, Peter; Neu, Bruno; Schmid, Roland M.; Prinz, Christian

2009-01-01

Percutaneous transhepatic biliary drainage (PTBD) have been described as an effective technique to obtain biliary access. Between January 1996 and December 2006, a total of 419 consecutive patients with endoscopically inaccessible bile ducts underwent PTBD. The current retrospective study evaluated success and complication rates of this invasive technique. PTBD was successful in 410/419 patients (97%). The success rate was equal in patients with dilated and nondilated bile ducts (p = 0.820). In 39/419 patients (9%) procedure related complications could be observed. Major complications occurred in 17/419 patients (4%). Patients with nondilated intrahepatic bile ducts had significantly higher complication rates compared to patients with dilated intrahepatic bile ducts (14.5% vs. 6.9%, respectively [p = 0.022]). Procedure related deaths were observed in 3 patients (0.7%). In conclusion, percutaneous transhepatic biliary drainage is an effective procedure in patients with dilated and nondilated intrahepatic bile ducts. However, patients with nondilated intrahepatic bile ducts showed a higher risk for procedure related complications.

Percutaneous dilatational tracheostomy for ICU patients with severe brain injury

Directory of Open Access Journals (Sweden)

Guo Dongyuan

2014-12-01

Full Text Available 【Abstract】Objective: To sum up our experience in percutaneous dilatational tracheostomy (PDT in ICU patient with severe brain injury. Methods: Between November 2011 and April 2014, PDTs were performed on 32 severe brain injury patients in ICU by a team of physicians and intensivists. The success rate, effi cacy, safety, and complications including stomal infection and bleeding, paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, as well as clinically significant tracheal stenosis were carefully monitored and recorded respectively. Results: The operations took 4-15 minutes (mean 9.1 minutes±4.2 minutes. Totally 4 cases suffered from complications in the operations: 3 cases of stomal bleeding, and 1 case of intratracheal bloody secretion, but none required intervention. Paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, or clinically signifi cant tracheal stenosis were not found in PDT patients. There was no procedure-related death occurring during or after PDT. Conclusion: Our study demonstrats that PDT is a safe, highly effective, and minimally invasive procedure. The appropriate sedation and airway management perioperatively help to reduce complication rates. PDT should be performed or supervised by a team of physicians with extensive experience in this procedure, and also an intensivist with experience in diffi cult airway management. Key words: Brain injuries; Percutaneous dilatational tracheostomy; ICU

Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

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Song, Jang Hyeon; Lee, Seung Jin; Jung, Hye Doo; Lim, Jae Hoon; Chang, Nam Kyu; Yim, Nam Yeol; Kim, Jae Kyu [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Lee, Keun Bae [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)

2011-09-15

To assess the efficacy of percutaneous transluminal angioplasty (PTA) in patients with infrapopliteal arterial disease, and to determine the influencing factor for prognosis. A total of 55 patients (60 limbs) with infrapopliteal arterial stenosis or occlusion underwent PTA. Atherosclerotic risk factors, clinical symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and vascular wall calcification were evaluated before PTA. The number of patent infrapopliteal arteries was estimated, and the outcome was evaluated by symptom relief and limb salvage. Technical success was achieved in 53/60 limbs (88.3%) and 81/93 arteries (87.1%), TASC classification (p = 0.038) and vascular calcification (p = 0.002) influenced on technical failure. During follow-up, 26 of 55 limbs (47%) achieved symptom relief and 42/55 limbs (76%) underwent limb salvage. Non-diabetic patients (9/12, 75%) were superior to diabetic patients (17/43, 40%) in terms of symptom relief (p = 0.024). TASC classification and vascular wall calcification influenced on symptom relief and limb salvage. The number of patent infrapopliteal arteries after PTA influenced symptom relief (p < 0.001) and limb amputation (p = 0.003). PTA in patients with chronic critical limb ischemia is worthwhile as a primary treatment. The influence factors should be considered before PTA, and PTA should be performed in as many involved arteries as possible.

Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

International Nuclear Information System (INIS)

Song, Jang Hyeon; Lee, Seung Jin; Jung, Hye Doo; Lim, Jae Hoon; Chang, Nam Kyu; Yim, Nam Yeol; Kim, Jae Kyu; Lee, Keun Bae

2011-01-01

To assess the efficacy of percutaneous transluminal angioplasty (PTA) in patients with infrapopliteal arterial disease, and to determine the influencing factor for prognosis. A total of 55 patients (60 limbs) with infrapopliteal arterial stenosis or occlusion underwent PTA. Atherosclerotic risk factors, clinical symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and vascular wall calcification were evaluated before PTA. The number of patent infrapopliteal arteries was estimated, and the outcome was evaluated by symptom relief and limb salvage. Technical success was achieved in 53/60 limbs (88.3%) and 81/93 arteries (87.1%), TASC classification (p = 0.038) and vascular calcification (p = 0.002) influenced on technical failure. During follow-up, 26 of 55 limbs (47%) achieved symptom relief and 42/55 limbs (76%) underwent limb salvage. Non-diabetic patients (9/12, 75%) were superior to diabetic patients (17/43, 40%) in terms of symptom relief (p = 0.024). TASC classification and vascular wall calcification influenced on symptom relief and limb salvage. The number of patent infrapopliteal arteries after PTA influenced symptom relief (p < 0.001) and limb amputation (p = 0.003). PTA in patients with chronic critical limb ischemia is worthwhile as a primary treatment. The influence factors should be considered before PTA, and PTA should be performed in as many involved arteries as possible.

Percutaneous balloon dilatation of stenotic calyceal diverticular infundibula in patients with recurrent urinary tract infections.

LENUS (Irish Health Repository)

Keeling, Aoife N

2012-02-01

AIM: Renal calyceal diverticula are usually detected as incidental findings on intravenous pyelograms (IVPs) and rarely manifest any clinical signs or symptoms. However, they can interfere with patient\\'s quality of life in a number of instances causing pain, recurrent urinary tract infections (UTIs), abscess, systemic sepsis and calculus formation. The purpose of this study was to review the clinical indications, procedure technique and clinical outcome in all patients referred to Interventional Radiology for the percutaneous management of renal calyceal diverticula. MATERIALS AND METHODS: A retrospective review of all patients treated with percutaneous balloon dilatation of calyceal diverticular infundibula in the Interventional Radiology Department over a 10-year period was performed. Data collected included clinical details, laboratory indices, IVP and CT findings, procedure details and clinical outcome. RESULTS: A total of three patients were treated over the course of the study period. All patients were young females who presented as a result of recurrent urinary tract infections. The calyceal diverticula were diagnosed incidentally on routine IVPs, with CT eloquently confirming the plain film findings in two cases. Technical procedure success was achieved in all cases, avoiding surgical intervention. Clinical follow-up revealed no further UTIs following dilatation. CONCLUSION: Fluoroscopic guided percutaneous balloon dilatation of renal calyceal diverticular infundibula following direct diverticular puncture is a safe and well tolerated method to reduce UTI and potentially avoid future stone formation.

Percutaneous balloon dilatation of stenotic calyceal diverticular infundibula in patients with recurrent urinary tract infections

Energy Technology Data Exchange (ETDEWEB)

Keeling, Aoife N. [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland); Wang, Tim T. [Department of Biosurgery and Surgical Technology, Surgical Epidemiology and Quality Unit, Imperial College London, St. Mary' s Hospital, London W2 1NY (United Kingdom); Lee, Michael J., E-mail: mlee@rcsi.ie [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland)

2011-02-15

Aim: Renal calyceal diverticula are usually detected as incidental findings on intravenous pyelograms (IVPs) and rarely manifest any clinical signs or symptoms. However, they can interfere with patient's quality of life in a number of instances causing pain, recurrent urinary tract infections (UTIs), abscess, systemic sepsis and calculus formation. The purpose of this study was to review the clinical indications, procedure technique and clinical outcome in all patients referred to Interventional Radiology for the percutaneous management of renal calyceal diverticula. Materials and methods: A retrospective review of all patients treated with percutaneous balloon dilatation of calyceal diverticular infundibula in the Interventional Radiology Department over a 10-year period was performed. Data collected included clinical details, laboratory indices, IVP and CT findings, procedure details and clinical outcome. Results: A total of three patients were treated over the course of the study period. All patients were young females who presented as a result of recurrent urinary tract infections. The calyceal diverticula were diagnosed incidentally on routine IVPs, with CT eloquently confirming the plain film findings in two cases. Technical procedure success was achieved in all cases, avoiding surgical intervention. Clinical follow-up revealed no further UTIs following dilatation. Conclusion: Fluoroscopic guided percutaneous balloon dilatation of renal calyceal diverticular infundibula following direct diverticular puncture is a safe and well tolerated method to reduce UTI and potentially avoid future stone formation.

Percutaneous balloon dilatation of stenotic calyceal diverticular infundibula in patients with recurrent urinary tract infections

International Nuclear Information System (INIS)

Keeling, Aoife N.; Wang, Tim T.; Lee, Michael J.

2011-01-01

Aim: Renal calyceal diverticula are usually detected as incidental findings on intravenous pyelograms (IVPs) and rarely manifest any clinical signs or symptoms. However, they can interfere with patient's quality of life in a number of instances causing pain, recurrent urinary tract infections (UTIs), abscess, systemic sepsis and calculus formation. The purpose of this study was to review the clinical indications, procedure technique and clinical outcome in all patients referred to Interventional Radiology for the percutaneous management of renal calyceal diverticula. Materials and methods: A retrospective review of all patients treated with percutaneous balloon dilatation of calyceal diverticular infundibula in the Interventional Radiology Department over a 10-year period was performed. Data collected included clinical details, laboratory indices, IVP and CT findings, procedure details and clinical outcome. Results: A total of three patients were treated over the course of the study period. All patients were young females who presented as a result of recurrent urinary tract infections. The calyceal diverticula were diagnosed incidentally on routine IVPs, with CT eloquently confirming the plain film findings in two cases. Technical procedure success was achieved in all cases, avoiding surgical intervention. Clinical follow-up revealed no further UTIs following dilatation. Conclusion: Fluoroscopic guided percutaneous balloon dilatation of renal calyceal diverticular infundibula following direct diverticular puncture is a safe and well tolerated method to reduce UTI and potentially avoid future stone formation.

Percutaneous transluminal mitral commissurotomy for rheumatic mitral stenosis in a 5-year-old child.

Science.gov (United States)

Ullah, Maad; Sultan, Mehboob; Akbar, Hajira; Sadiq, Nadeem

2012-06-01

We report a 5-year-old boy weighing 11 kg, with severe mitral valve stenosis of rheumatic aetiology, who underwent successful percutaneous transluminal mitral commissurotomy (PTMC) with valvuloplasty balloon. Postprocedural mean pressure gradient across the mitral valve decreased to 6 mmHg from an initially recorded value of 22 mmHg. In addition to symptomatic improvement, the mitral valvular area increased from 0.4 to 0.8 cm(2) without significant change in mitral regurgitation. At 1- and 3-month follow up, transthoracic echocardiography revealed further improvement with an increase in mitral valve area to 1.0 cm(2), a decrease in pulmonary arterial pressure, and a mean mitral valve pressure gradient of 8 mmHg with trivial mitral regurgitation. To best of our knowledge, this is the first successful PTMC procedure performed in the youngest and smallest ever reported child with rheumatic mitral stenosis (MS). We conclude that PTMC with valvuloplasty balloon could be a logical alternative to surgery in young patients with rheumatic MS.

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

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

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

NARCIS (Netherlands)

Fikkers, B.G.; Heerbeek, N. van; Krabbe, P.F.M.; Marres, H.A.M.; Hoogen, F.J.A. van den

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

Percutaneous angioplasty of carotid artery stenoses

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Freitag, G.; Freitag, J.; Koch, R.D.; Wagemann, W.

1986-03-01

Percutaneous transluminal angioplasty (PTA) is a well-established method to remedy stenoses and short occlusions in the femoro-popliteal region and has also proved worthwhile in dilating stenoses of pelvic, renal and coronary arteries. Following successful experiments in animals, Mathias et al. employed angioplasty to treat carotid artery stenoses in the same way. To date, successful treatment of carotid artery stenoses has been described only in isolated recent reports. For fear of embolism, angioplasty has not yet become standard practice in this region. Because of the limited number of carotid artery stenoses treated so far, the risk involved cannot be reliably assessed. It is remarkable that no embolism has been reported for the greater number of dilated stenoses of the subclavian artery. Moreover, the report by Mathias et al. indicated that for 350 angioplasties of pelvifemoral arteries 1.1% embolisms occured after artery occlusions only, while no embolism was observed after stenoses. Having gained experience of applying PTA to the treatment of vascular obstructions of extremities, we have adopted this technique in the carotid area as well.

Percutaneous transluminal angioplasty and stent placement for iliofemoral arterial atherosclerotic occlusive disease

International Nuclear Information System (INIS)

Zheng Yanbo; Jiang Wenjin; Liu Sheng; Song Xuepeng; Sheng Qirui

2006-01-01

Objectives: To assess the safety and efficacy of percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of iliofemoral arterial atherosclerotic occlusive diseases. Methods From April 1999 to August 2004, 13 cases of iliofemoral arterial occlusions were recanalized with contact thrombolytic therapy combined with guide wire mechanical recanalization method, followed by angioplasty and stent placement. A total of 25 self-expanding Wallstents were deployed. All patients were followed up by means of duplex ultrasound, angiography, or both. Results: All 13 cases were successfully recanalized, with technical successful rate of 100%. Available follow-up for all patients from 8 months-5 years (mean 26.2 months) included one patient undergoing again with successful contact thrombolysis because of early thrombosis; another patient with recurrent symptoms at 19 month after operation undertaking surgical bypass because of later reocclusion; all of the rest stents showing patency by the end of the study. Conclusions: Contact thrombolysis combined with guide wire mechanical recanalization for iliofemoral arterial occlusion is safe and effective, whereas PTA and stent placement would have the nearly same efficacy for the disease with mild injury and low restenosis. (authors)

The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: tract dilation comparisons in 5537 patients

NARCIS (Netherlands)

Lopes, Tomé; Sangam, Kandasami; Alken, Peter; Barroilhet, Benjamin Silva; Saussine, Christian; Shi, Lei; de la Rosette, Jean

2011-01-01

The study focused on the use of balloon or telescopic/serial dilation methods in percutaneous nephrolithotomy (PCNL) in the Global PCNL Study. Centers worldwide provided data from consecutive patients who were treated with PCNL during a 1-year period. Tract dilation was performed using a balloon or

Percutaneous transluminal forceps biopsy in patients suspected of having malignant biliary obstruction: factors influencing the outcomes of 271 patients

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Park, Jung Gu; Jung, Gyoo-Sik; Yun, Jong Hyouk [Kosin University College of Medicine, Department of Radiology, Seo-gu, Busan (Korea, Republic of); Yun, Byung Chul; Lee, Sang Uk; Han, Byung Hoon [Kosin University College of Medicine, Department of Internal Medicine, Busan (Korea, Republic of); Ko, Ji Ho [Busan Medical Center, Department of Radiology, Busan (Korea, Republic of)

2017-10-15

To evaluate predictive factors for false-negative diagnosis of percutaneous forceps biopsies in patients suspected of having a malignant biliary obstruction Two hundred seventy one consecutive patients with obstructive jaundice underwent percutaneous forceps biopsy. In each patient, three to five specimens (mean, 3.5 specimens) were collected from the lesion. The final diagnosis for each patient was confirmed with pathologic findings at surgery, additional histocytologic data, or clinical and radiologic follow-up. Univariate and multivariate logistic regression analysis was used to identify risk factors associated with false-negative diagnosis. One hundred ninety four of 271 biopsies resulted in correct diagnoses of malignancy, while 20 biopsy diagnoses were proved to be true-negative. There were 57 false-negative diagnoses and no false-positive diagnoses. The diagnostic performance of transluminal forceps biopsy in malignant biliary obstructions was as follows: sensitivity, 77.2%; specificity, 100%; and accuracy, 78.9%; positive predictive value, 100%, negative predictive value; 25.9%. Periampullary segment of common bile duct, intrahepatic bile duct and metastatic disease were the significant risk factors of false-negative diagnosis. Percutaneous forceps biopsy provides relatively high accuracy in the diagnosis of malignant biliary obstructions. The predictive factors of false-negative biopsy were determined to be biopsy site and origin of primary tumour. (orig.)

Percutaneous dilational tracheostomy--a 3 year experience in a general hospital in Malaysia.

Science.gov (United States)

Tan, C C; Lee, H S; Balan, S

2004-12-01

All percutaneous tracheostomies performed in the general intensive care unit (ICU), Hospital Sultanah Aminah, Johor Bahru, Malaysia, from July 1999 to June 2002 were studied. The tracheostomies were performed as an elective bedside technique in the ICU. A total of 352 percutaneous tracheostomies were performed. Eighty-eight percent of the tracheostomies were completed within 15 minutes. The most common complication was bleeding which occurred in 52 patients (14.7%). The rest of the complications encountered were:- transient hypoxia twelve (3.4%), inability/ difficulty to insert tracheostomy tube eight (2.3%), false passage four (1.1%), transient hypotension two (0.6%), pneumothorax two (0.6%), peristomal infection two (0.6%), subcutaneous emphysema one (0.3%), cuff rupture one (0.3%), oesophageal cannulation one (0.3%), and granuloma formation one (0.3%). Conversion to conventional tracheostomies were performed on 7 patients (2%). There was one unfortunate death related to percutaneous tracheostomy. In conclusion, percutaneous dilational tracheostomy can be used safely to manage the airway of critically ill patients.

Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation

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Uflacker, A., E-mail: andreuflacker@gmail.com; Sheeran, D., E-mail: dsheeran9@gmail.com; Khaja, M., E-mail: mkhaja@mac.com [University of Virginia/Interventional Radiology (United States); Patrie, J., E-mail: jp4h@virginia.edu [UVA Health System/Radiology (United States); Elias, G., E-mail: gae2y@virginia.edu [VCU Medical Center/Radiology (United States); Saad, W., E-mail: wspikes@yahoo.com [University of Michigan Health System (United States)

2015-06-15

PurposeThis study was designed o evaluate outcomes of percutaneous management of anastomotic ureteral strictures in renal transplants using nephroureteral stents with or without balloon dilatation.MethodsA retrospective audit of 1,029 consecutive renal transplants was performed. Anastomotic ureteral strictures were divided into two groups: nephroureteral stent only (NUS) and NUS+PTA (nephroureteral stent plus percutaneous transluminal angioplasty), with each cohort subdivided into early versus late presentation (obstructive uropathy occurring <90 day or >90 days from transplant, respectively). Overall and 6-month technical success were defined as removal of NUS any time with <30 % residual stenosis (any time lapse less or more than 6 months) and at >6 months, respectively. Patency was evaluated from NUS removal to last follow-up for both groups and compared.ResultsSixty-seven transplant patients with 70 ureteric anastomotic strictures (6.8 %, n = 70/1,029) underwent 72 percutaneous treatments. 34 % were late (>90 days, n = 24/70), and 66 % were early (<90 days, n = 46/70). Overall technical success was 82 % (n = 59/72) and 6-month success was 58 % (n = 42/72). Major and minor complications were 2.8 % (n = 2/72), and 12.5 % (n = 9/72). NUS+PTA did not improve graft survival (p = 0.354) or patency (p = 0.9) compared with NUS alone. There was no difference in graft survival between treated and nontreated groups (p = 0.74).ConclusionsThere is no advantage to PTA in addition to placement of NUS, although PTA did not negatively impact graft survival or long-term patency and both interventions were safe and effective. Neither the late or early groups benefited from PTA in addition to NUS. Earlier obstructions showed greater improvement in serum creatinine than later obstructions.

Percutaneous transhepatic balloon dilation of biliary-enteric anastomotic strictures after surgical repair of iatrogenic bile duct injuries.

Directory of Open Access Journals (Sweden)

Andrew Y Lee

Full Text Available PURPOSE: To evaluate the efficacy of percutaneous balloon dilation of biliary-enteric anastomotic strictures resulting from surgical repair of laparoscopic cholecystectomy-related bile duct injuries. MATERIAL AND METHODS: A total of 61 patients were referred to our institution from 1995 to 2010 for treatment of obstruction at the biliary-enteric anastomosis following surgical repair of laparoscopic cholecystectomy-related bile duct injuries. Of these 61 patients, 27 underwent surgical revision upon stricture diagnosis, and 34 patients were managed using balloon dilation. Of these 34 patients, 2 were lost to follow up, leaving 32 patients for analysis. The primary study objective was to determine the clinical success rate of balloon dilation of biliary-enteric anastomotic strictures. Secondary study objectives included determining anastomosis patency, rates of stricture recurrence following treatment, and morbidity. RESULTS: Balloon dilation of biliary-enteric anastomotic strictures was clinically successful in 21 of 32 patients (66%. Anastomotic stricture recurred in one of 21 patients (5% after an average of 13.1 years of follow-up. Patients who were unsuccessfully managed with balloon dilation required significantly more invasive procedures (6.8 v. 3.4; p = 0.02 and were left with an indwelling biliary catheter for a significantly longer period of time (8.8 v. 2.0 months; p = 0.02 than patients whose strictures could be resolved by balloon dilation. No significant differences in the number of balloon dilations performed (p = 0.17 or in the maximum balloon diameter used (p = 0.99 were demonstrated for patients with successful or unsuccessful balloon dilation outcomes. CONCLUSION: Percutaneous balloon dilation of anastomotic biliary strictures following surgical repair of laparoscopic cholecystectomy-related injuries may result in lasting patency of the biliary-enteric anastomosis.

Usefulness of percutaneous transluminal coronary angioplasty in silent myocardial ischemia

International Nuclear Information System (INIS)

Hou, Mami

1996-01-01

The usefulness of percutaneous transluminal coronary angioplasty (PTCA) was assessed in patients with exercise-induced asymptomatic myocardial ischemia (silent ischemia) and compared with exercise-induced symptomatic myocardial ischemia (symptomatic ischemia). Patients with single vessel coronary artery disease (51 with angina pectoris, 40 with old myocardial infarction) and evidence of stress-induced ischemia on thallium-201 single photon emission computed tomography (SPECT) underwent successful PTCA. Thirty-seven percent of angina patients and 60% of infarction patients showed asymptomatic exercise-induced ischemia. There was no significant difference in population characteristics between silent and symptomatic patients. Patients with silent angina had significantly higher percentage thallium uptake and washout rate than symptomatic patients. After PTCA, both percentage diameter stenosis and percentage thallium uptake were improved in all patients with angina irrespective of the presence or absence of symptoms. There were no significant differences in percentage thallium uptake and washout rate between patients with silent and symptomatic infarction. After PTCA, percentage diameter stenosis, percentage thallium uptake, and washout rate improved in all infarction patients irrespective of the symptoms. Zero percent of silent angina patients, 12% of symptomatic angina patients, 12% of silent infarction patients, 19% of symptomatic infarction patients had cardiac events during about 4.5 years after PTCA. The incidence of cardiac events did not significantly differ in any patient group. PTCA improved myocardial perfusion in all patients, and the incidence of cardiac events did not differ between the silent and symptomatic groups. Revascularization with PTCA is suitable for patients with silent as well as symptomatic ischemia. (author)

Percutaneous transluminal angioplasty of supraaortic vessel

International Nuclear Information System (INIS)

Belli, L.; Puricelli, G.; Cerasano, A.; Cornalba, P.; Rota, L.; Facchinetti, P.

1988-01-01

Sixteen cases are reported of dilatation of supra-aortic vessels; in 14/16 patients the vessel involved was either the subclavian artery or the brachio-cephalich trunk. Special attention is paid to the choice of patients - the ideal one presenting with a single uncalcified lesion, with stenosis more than 50% of diameter; the symptoms have recently appeared, with a significant difference (more than 20 mmHg) in the pressure of the two arms. The technical aspects of the angioplastic procedure are discussed, especially in order to preserve the intracriminal circulation and to limit possible complications. The presence of reversed blood flow in the vertebral artery is extremely important to preserve intracranial circulation from possible embolism; normal flow obtained at the end of the procedure is therefore an useful proof of successful dilatation. The advantages are stressed of dilatation over the surgical technique used in the past. Finally, the importance is emphasized of a correct follow-up and doppler control of supra-aortic circulation

Randomized trial of Legflow® paclitaxel eluting balloon and stenting versus standard percutaneous transluminal angioplasty and stenting for the treatment of intermediate and long lesions of the superficial femoral artery (RAPID trial): Study protocol for a randomized controlled trial

NARCIS (Netherlands)

A. Karimi; S.W. de Boer (Sanne W.); D.A.F. Van Den Heuvel; B. Fioole (Bram); D. Vroegindeweij (Dammis); J.M.M. Heyligers (Jan); P.N.M. Lohle (Paul N.M.); O.E. Elgersma (Otto E.); R.P.T. Nolthenius (Rudolf ); J.A. Vos (Jan Albert); J.-P.P.M. de Vries (Jean-Paul)

2013-01-01

textabstractBackground: Restenosis after percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) may occur in 45% of patients at 2 years follow-up. Paclitaxel-coated balloons have been found to reduce neointimal hyperplasia, and thus reduce restenosis. Recently, the

Balloon angioplasty in acute and chronic coronary artery disease

International Nuclear Information System (INIS)

Holmes, D.R. Jr.; Vlietstra, R.E.

1989-01-01

Percutaneous transluminal coronary angioplasty has grown exponentially since its introduction. Currently, selection criteria include single-vessel and multivessel disease, stable and unstable angina, and acute infarction. The outcome depends on specific patient and antiographic characteristics. In ideal lesions, success rates should be greater than 90%, with low morbidity and mortality. With more severe and diffuse multivessel disease, success rates are lower and complication rates are higher. In these cases, percutaneous transluminal coronary angioplasty still offers a reasonable option, provided complete revascularization can be achieved or the angina-producing lesion dilated. Numerous issues remain unresolved, including (1) the role of percutaneous transluminal coronary angioplasty vs coronary surgery (currently being tested), (2) restenosis, which occurs in approximately 30% of treated lesions, and (3) organizational adjustments such as training and certification to maintain high standards of care

Improved left ventricular function and perfusion at rest after successful transluminal coronary angioplasty

International Nuclear Information System (INIS)

Klepzig, H.; Kaltenbach, M.; Standke, R.; Maul, F.D.; Hoer, G.

1991-01-01

The purpose of this study was to evaluate left ventricular function and perfusion at rest before and after percutaneous transluminal coronary angioplasty. In consecutive 69 patients in whom coronary stenoses were dilated, the radionuclide left ventricular ejection fraction at rest increased significantly. In 26 of these patients, the ejection fraction increased by at least 4%. In these patients, exercise-induced ischemic ST depression had been more pronounced than in the others. 36 other patients underwent 201 Tl myocardial scintigraphy before and after angioplasty. Twelve patients in whom pre-PTCA images had revealed regions with irreversible 201 Tl uptake defects, showed normal 201 Tl distribution patterns on post-PTCA scintigrams. Post-exercise 201 Tl uptake (representing myocardial perfusion and metabolic activity) during pre-PTCA exercise stress tests was significantly lower in these cases. It is concluded that PTCA can improve left ventricular function and perfusion at rest. This improvement is most obvious in patients with pronounced exercise-induced myocardial ischemia as diagnosed by typical ST segment depression and reduced thallium uptake. (orig.) [de

Randomized trial of Legflow((R)) paclitaxel eluting balloon and stenting versus standard percutaneous transluminal angioplasty and stenting for the treatment of intermediate and long lesions of the superficial femoral artery (RAPID trial): study protocol for a randomized controlled trial

NARCIS (Netherlands)

Karimi, A.; Boer, S.W. de; Heuvel, D.A. Van Den; Fioole, B.; Vroegindeweij, D.; Heyligers, J.M.M; Lohle, P.N.; Elgersma, O.; Nolthenius, R.P.T.; Vos, J.A.; Vries, J.P. de

2013-01-01

BACKGROUND: Restenosis after percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) may occur in 45% of patients at 2 years follow-up. Paclitaxel-coated balloons have been found to reduce neointimal hyperplasia, and thus reduce restenosis. Recently, the Legflow((R))

Angiographic Characteristics of Symptomatic Recurrent Disease After Infrainguinal Percutaneous Transluminal Angioplasty

International Nuclear Information System (INIS)

Soeder, Heini K.; Manninen, Hannu I.; Matsi, Pekka J.

1999-01-01

Purpose: To evaluate the angiographic patterns of clinically manifest recurrent disease after infrainguinal percutaneous transluminal angioplasty (PTA) of stenoses and total occlusions. Methods: Among 326 infrainguinal PTAs on 263 consecutive patients, selective angiography was performed on 61 limbs of 52 patients 1-60 months after the primary intervention because of clinically suspected recurrent disease. Lesion-specific and patient-related factors were analyzed for 75 angiographically confirmed recurrent lesions in 57 limbs of 48 patients. Results: Recurrent disease was more frequently a stenosis when the original target lesion was a stenosis (92%, 44/48) than when the original lesion was a total occlusion (59%, 16/27; p < 0.001). When the original target lesion was a stenosis, the total length of the recurrent disease was longer than that of the original lesion [3.9 ± 3.9 cm (mean ± standard deviation) vs 2.8 ± 2.7 cm; p= 0.03], while in the subgroup of original total occlusions the length of the recurrent lesion was shorter than that of the original occlusion (7.1 ± 5.0 cm vs 9.9 ± 6.9 cm; p0.02). Half the restenoses (22/44) extended beyond one or both ends of the original stenosis and 38% (6/16) of the reocclusions extended beyond the distal end of the original occlusion. Conclusions: The type of recurrent disease depends on the original lesion type and the restenotic lesion frequently extends beyond one or both ends of the original target lesion

A Prospective Randomized Study Comparing Mini-surgical Percutaneous Dilatational Tracheostomy With Surgical and Classical Percutaneous Tracheostomy

Science.gov (United States)

Hashemian, Seyed Mohammad-Reza; Digaleh, Hadi

2015-01-01

Abstract Although percutaneous dilatational tracheostomy (PDT) is more accessible and less time-demanding compared with surgical tracheostomy (ST), it has its own limitations. We introduced a modified PDT technique and brought some surgical knowledge to the bedside to overcome some standard percutaneous dilatational tracheostomy relative contraindications. PDT uses a blind route of tracheal access that usually requires perioperational imaging guidance to protect accidental injuries. Moreover, there are contraindications in certain cases, limiting widespread PDT application. Different PDT modifications and devices have been represented to address the problem; however, these approaches are not generally popular among professionals due to limited accessibility and/or other reasons. We prospectively analyzed the double-blinded trial, patient and nurse head evaluating the complications, and collected data from 360 patients who underwent PDT, ST, or our modified mini-surgical PDT (msPDT, Hashemian method). These patients were divided into 2 groups—contraindicated to PDT—and randomization was done for msPDT or PDT in PDT-indicated group and msPDT or ST for PDT-contraindicated patients. The cases were compared in terms of pre and postoperational complications. Data analysis demonstrated that the mean value of procedural time was significantly lower in the msPDT group, either compared with the standard PDT or the ST group. Paratracheal insertion, intraprocedural hypoxemia, and bleeding were also significantly lower in the msPDT group compared with the standard PDT group. Other complications were not significantly different between msPDT and ST patients. The introduced msPDT represented a semiopen incision, other than blinded PDT route of tracheal access that allowed proceduralist to withdraw bronchoscopy and reduced the total time of procedure. Interestingly, the most important improvement was performing msPDT on PDT-contraindicated patients with the complication rate

Selection of patients with infrainguinal arterial occlusive disease for percutaneous transluminal angioplasty with duplex scanning

International Nuclear Information System (INIS)

Bostroem Ardin, A.; Hellberg, A.; Ljungman, C.; Logason, K.; Karacagil, S.; Loefberg, A.M.; Andren, B.

2002-01-01

Aim: To evaluate the role of duplex scanning in the selection of patients with infrainguinal arterial occlusive disease for percutaneous transluminal angioplasty (PTA). Material and Methods: From January 1995 through May 2000, 702 patients (952 limbs), with chronic lower extremity ischemia due to infrainguinal atherosclerotic disease diagnosed by duplex scanning, were retrospectively studied. Diagnostic angiography (130 limbs) or infrainguinal PTA (108 limbs) was performed in 238 limbs. Two investigators retrospectively analyzed the duplex examinations and angiographies in a blinded manner and used similar criteria for the interpretation of lesions suitable or not suitable for PTA. Results: The superficial femoral, popliteal and crural artery lesions were correctly selected for PTA in 85%, 66% and 32%, respectively. The accuracy, sensitivity, specificity, negative predictive value and positive predictive value of duplex scanning to appropriately categorize femoropopliteal lesions as suitable or unsuitable for PTA were 89%, 83%, 92%, 94% and 78%, respectively. The accuracy of duplex scanning for predicting the performance of infrainguinal PTA was 83%. Conclusion: Duplex scanning has an important impact on the selection of treatment modalities in limbs with infrainguinal arterial occlusive disease. Femoropopliteal lesions can be reliably selected to PTA according to duplex scan findings

Stent underexpansion in angiographic guided percutaneous coronary intervention, despite adjunctive balloon post-dilatation, in drug eluting stent era

Directory of Open Access Journals (Sweden)

Mehrdad Taherioun

2014-01-01

Full Text Available BACKGROUND: Stent underexpansion is the most powerful predictor of long-term stent patency and clinical outcome. The purpose of this study was to evaluate the incidence and predictors of stent underexpansion despite adjunctive post-dilatation with non-compliant balloon. METHODS: After elective coronary stent implantation and adjunctive post-dilatation with non-compliant balloon and optimal angiographic result confirmed by the operator, intravascular ultrasound (IVUS was performed for all the treated lesions. If the treated lesions fulfilled the IVUS criteria, they are considered as the optimal stent group; if not, they are considered as the suboptimal group. RESULTS: From 50 patients enrolled in this study 39 (78% had optimal stent deployment and 11 (22% had suboptimal stent deployment. In the suboptimal group 7 (14% had underexpansion, 2 (4% malposition, and 2 (4% had asymmetry. There were no stent edge dissections detected by IVUS. We did not find any correlation between lesion calcification, ostial lesions, stent length, and stent underexpansion. Stent diameter ≤ 2.75 mm had a strong correlation with stent underexpansion. CONCLUSION: Despite adjunctive post-dilatation with noncompliant balloon, using a relatively small stent diameter was a strong predictor for underexpansion. IVUS guided percutaneous coronary intervention (PCI may be considered for drug eluting stent (DES implantation in relatively small vessels.   Keywords: Stent, Percutaneous Coronary Intervention, Ultrasound, Post-dilatation 

Treatment of renovascular hypertension by transluminal angioplasty

DEFF Research Database (Denmark)

Øvrehus, Kristian A; Andersen, Poul E; Jacobsen, Ib A

2007-01-01

: with improved control of blood pressure; group III: unchanged blood pressure control. Grouping was performed immediately after treatment, at 1 month, 6 months and at the latest follow-up. One hundred-and-twenty-two patients (124 atherosclerotic and 12 fibromuscular lesions) were treated during 13 years......OBJECTIVE: The study is a follow-up on treatment of renovascular hypertension (RVH) with percutaneous transluminal renal angioplasty (PTRA). METHODS: Patients were screened on the basis of clinical criteria of increased probability of RVH with renography and in selected cases with renal vein renin...

Fatal air embolism as complication of percutaneous dilatational tracheostomy on venovenous extracorporeal membrane oxygenation, two case reports.

Science.gov (United States)

Lother, Achim; Wengenmayer, Tobias; Benk, Christoph; Bode, Christoph; Staudacher, Dawid L

2016-07-11

Tracheostomy is recommended in case of prolonged mechanical ventilation. Therefore, most patients with an indication for venovenous extracorporeal membrane oxygenation (ECMO) will also have an indication for tracheostomy. We report 2 cases of fatal air embolism into the ECMO system as complication of percutaneous dilatational tracheostomy. Both patients had an AVALON ELITE® bi-caval cannula implanted draining blood from the vena cava superior and inferior. Since there is limited safety data on this specific group of patients, a routine early dilatational tracheostomy might be associated with a significant risk.

Comparison of two percutaneous tracheostomy techniques, guide wire dilating forceps and Ciaglia Blue Rhino: a sequential cohort study.

NARCIS (Netherlands)

Fikkers, B.G.; Staatsen, M; Lardenoije, S.G.; Hoogen, F.J.A. van den; Hoeven, J.G. van der

2004-01-01

INTRODUCTION: To evaluate and compare the peri-operative and postoperative complications of the two most frequently used percutaneous tracheostomy techniques, namely guide wire dilating forceps (GWDF) and Ciaglia Blue Rhino (CBR). METHODS: A sequential cohort study with comparison of short-term and

[Meta-analysis of percutaneous transluminal atherectomy in the treatment for in-stent restenosis of lower extremity peripheral artery disease].

Science.gov (United States)

Li, Weihao; Zhang, Tao; Liu, Yunfeng; Zhang, Yongbao; Li, Qingle; Zhang, Xiaoming; Shen, Chenyang

2015-11-24

To evaluate the clinical safety and efficacy of percutaneous transluminal atherectomy for in-stent restenosis (ISR) in patients with low extremity peripheral arterial diseases (PAD). PubMed, Elsevier, EBSCO, Spring databases and Cochrane Library were searched for relevant articles. Based on the different mechanisms of atherectomy, the patients were divided into mechanic atherectomy group and laser atherectomy group. The safety end points included the rate of distal embolism and severe arterial wall injuries. And the efficacy end points included primary patency rate and freedom from target vessel revascularization (TVR-free) 6 months and 12 months after surgery. A total of 9 studies and 620 patients (published between 2006 and 2014) were accepted. The rate of distal embolism was 4.2% (95% confidence interval (CI): 1.7%-6.7%), while that of severe arterial wall injuries was 1.9% (95%CI: 0.9%-3.0%), respectively. Laser atherectomy was responsible for more distal embolism (6.8%) compared to mechanic atherectomy (2.0%), which was significantly different (Q=21.66, P=0.010). At 6-month follow-up, primary patency rate and rate of TVR-free were 63.0% (95% CI: 55.5%-70.6%) and 80.4% (95% CI: 70.5%-90.3%), while at 12-month follow-up were 43.5% (95%CI: 32.2%-54.9%) and 58.0% (95% CI: 52.1%-63.9%), respectively. The free-TVR rate at 6 months follow-up in mechanical atherectomy group was 77.9%, and was inferior to that in laser atherectomy group (80.8%, Q=13.49, P=0.009). Published bias was discovered at the analysis of 12-month TVR-free rate by means of Begg Test (P=0.039). Meta analysis concerned about the 3 randomized controlled trials demonstrated that there was no significant improvement using atherectomy for ISR comparing to standard balloon at 6-month TVR-free rate (OR=1.34, 95% CI: 0.86-2.07, P=0.196). To treat ISR lesion in lower extremities, laser atherectomy has a lower free-TVR rate in the middle term follow-up.A higher rate of distal embolism is noted though. On

The clinical research office of the endourological society percutaneous nephrolithotomy global study: tract dilation comparisons in 5537 patients

DEFF Research Database (Denmark)

Lopes, Tomé; Sangam, Kandasami; Alken, Peter

2011-01-01

Abstract Purpose: The study focused on the use of balloon or telescopic/serial dilation methods in percutaneous nephrolithotomy (PCNL) in the Global PCNL Study. Patients and Methods: Centers worldwide provided data from consecutive patients who were treated with PCNL during a 1-year period. Tract...

A comparison among four tract dilation methods of percutaneous nephrolithotomy: a systematic review and meta-analysis.

Science.gov (United States)

Dehong, Cao; Liangren, Liu; Huawei, Liu; Qiang, Wei

2013-11-01

The purpose of this study was to evaluate the efficacy and safety of the Amplatz dilation (AD), metal telescopic dilation (MTD), balloon dilation (BD), and one-shot dilation (OSD) methods for tract dilation during percutaneous nephrolithotomy (PCNL). Relevant eligible studies were identified using three electronic databases (Medline, EMBASE, and Cochrane CENTRAL). Database acquisition and quality evaluation were independently performed by two reviewers. Efficacy (stone-free rate, surgical duration, and tract dilatation fluoroscopy time) and safety (transfusion rate and hemoglobin decrease) were evaluated using Review Manager 5.2. Four randomized controlled trials and eight clinical controlled trials involving 6,820 patients met the inclusion criteria. The pooled result from a meta-analysis showed statistically significant differences in tract dilatation fluoroscopy time and hemoglobin decrease between the OSD and MTD groups, which showed comparable stone-free and transfusion rates. Significant differences in transfusion rate were found between the BD and MTD groups. Among patients without previous open renal surgery, those who underwent BD exhibited a lower blood transfusion rate and a shorter surgical duration compared with those who underwent AD. The OSD technique is safer and more efficient than the MTD technique for tract dilation during PCNL, particularly in patients with previous open renal surgery, resulting in a shorter tract dilatation fluoroscopy time and a lesser decrease in hemoglobin. The efficacy and safety of BD are better than AD in patients without previous open renal surgery. The OSD technique should be considered for most patients who undergo PCNL therapy.

Patients' feelings and experiences during and after peripheral percutaneous transluminal angioplasty

International Nuclear Information System (INIS)

Lundén, Maud; Lundgren, Solveig M.; Persson, Lars-Olof; Lepp, Margret

2015-01-01

Background: Peripheral Arterial Disease (PAD) often caused by atherosclerosis is a major health care issue worldwide. Percutaneous Transluminal Angioplasty (PTA) on the lower limb is a common procedure used to enhance peripheral circulation. With an increasing number of individuals acquiring peripheral PTA treatment and with an increased focus on patient centred care, there is a need to find out more about patients' feelings and thoughts of undergoing PTA. Aim: The aim was to identify patients who are predominantly anxious or calm during and after peripheral PTA and to explore reasons for these feelings. Method: The study includes 51 patients who received PTA treatment in western Sweden. Findings: Seventy-eight percent of the patients rated themselves as calm after the PTA. The analysed interviews resulted in two themes: reasons for feelings of calmness and reasons for feelings of anxiety. Conclusion: In order to feel calm during and after the PTA, information given prior to the PTA needs to be comprehensive and consistent with the actual situation at the angiography suite. The dialogue with the physician and the radiographers was considered valuable, as was the ability to follow the procedure on the image screen. It is concluded that a thorough dialogue with the physician in a calm setting after the PTA is important for the patients' ability to foresee and plan for the future. Moreover, there is a need to find ways to improve analgesic routines regarding assessment and evaluation in connection with PTA treatment as pain is shown to increase anxiety

Percutaneous balloon dilation of pulmonary stenosis

International Nuclear Information System (INIS)

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

2003-01-01

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

Effect of percutaneous transluminal angioplasty on the stenosis of autogenous radiocephalic ateriovenous fistula for hemodialysis

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Jeong, Sun Min; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin MMo; Choi, Sang Tae; Kim, Jong Woo; Kim, Hyung Sik; Choi, Hye Young [Gachon University Gil Medical Center, Incheon (Korea, Republic of); Park, Jae Hyung [Dept. of Radiology, Seonam University College of Medicine, Myongji Hospital, Goyang (Korea, Republic of)

2016-02-15

The purpose of this study was to evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) on stenosis of autogenous radiocephalic arteriovenous fistula (RCF) for hemodialysis and to determine the factors influencing patency. This retrospective study included 136 patients referred for PTA of RCF stenosis between March 2005 and July 2014. The technical success rate, complications, and patency rate were evaluated. The following factors were analyzed as they might influence patency: age, gender, site and duration of arteriovenous fistula, underlying disease, body mass index, hypercholesterolemia, smoking, peripheral artery or coronary artery occlusive disease, stenosis length/grade, cutting balloon, and balloon size. The initial technical success rate was 91.9% (125/136). Complications included vessel rupture (n = 2) and vessel dissection (n = 2). The patency rates at 6, 12, 24, and 48 months after PTA were 81.9, 67.1, 52.7, and 42.3%, respectively. The patency rate was higher in cases with longer (> 3 cm) stenosis (p = 0.04). Use of cutting balloon and larger size of balloon catheter made the patency longer, but this difference was not statistically significant (p = 0.637, 0.258). PTA is a safe and effective way to manage stenosis in RCF. The length of stenosis was the only factor which affected the patency rate in this study.

Efficacy of 24-Hour Blood Pressure Monitoring in Evaluating Response to Percutaneous Transluminal Renal Angioplasty.

Science.gov (United States)

Jujo, Kentaro; Saito, Katsumi; Ishida, Issei; Furuki, Yuho; Ouchi, Taisuke; Kim, Ahsung; Suzuki, Yuki; Sekiguchi, Haruki; Yamaguchi, Junichi; Ogawa, Hiroshi; Hagiwara, Nobuhisa

2016-08-25

Percutaneous transluminal renal angioplasty (PTRA) improves patency in atherosclerotic renal artery stenosis (ARAS), but improvement in clinic blood pressure (BP) is seen in only 20-40% of patients who undergo PTRA. This study investigated the effects of PTRA on BP lowering, assessed on 24-h ambulatory BP monitoring (ABPM), and identified preoperative features predictive of satisfactory BP improvement after PTRA. Of 1,753 consecutive patients undergoing coronary angiography, 31 patients with angiographically significant ARAS and translesional pressure gradient (TLPG) >20 mmHg underwent PTRA. ABPM was performed before, at 1 month and at 1 year after PTRA; patients with average systolic ABPM-BP decrease >10 mmHg at 1 month from baseline were categorized as responders. There was no obvious relationship between clinic BP and ABPM-BP at baseline. ABPM-BP was significantly higher in responders at baseline (SBP: 148 vs. 126 mmHg, PABPM-BP achieved a larger decrease in ABPM-BP, but the severity of stenosis reflected by TLPG; renal duplex findings; and neurohumoral parameters other than baseline renal function, did not differ between the groups. Clinic BP does not represent daily hemodynamic status, whereas high ABPM-BP is a potent predictor of satisfactory BP response to PTRA. (Circ J 2016; 80: 1922-1930).

Collagen turnover in arterial disease

NARCIS (Netherlands)

Sluijter, J.P.G.

2004-01-01

Increased atherosclerotic plaque formation can lead to lumen reduction and finally to lumen obstruction. Percutaneous transluminal angioplasty (PTA) or balloon angioplasty (dilation) are approaches generally used to treat coronary, but also peripheral atherosclerotic disease. Their goal is to

High-Flow Nasal Cannula Therapy in a Patient with Reperfusion Pulmonary Edema following Percutaneous Transluminal Pulmonary Angioplasty

Directory of Open Access Journals (Sweden)

Kiyoshi Moriyama

2014-01-01

Full Text Available A 62-year-old woman with Wolff-Parkinson-White syndrome was with recent worsening of dyspnea to New York Heart Association functional status Class III. The patient was diagnosed as having central type chronic thromboembolic pulmonary hypertension. By cardiac catheterization, her mean pulmonary artery pressure was 53 mmHg with total pulmonary resistance 2238 dynes·sec·cm−5. After medical therapies with tadalafil, furosemide, ambrisentan, beraprost, and warfarin were initiated, percutaneous transluminal pulmonary angioplasty (PTPA was performed. Following PTPA, life-threating hypoxemia resulting from postoperative reperfusion pulmonary edema developed. High-flow nasal cannula therapy (HFNC was applied, and 100% oxygen at 50 L/min of flow was required to keep oxygenation. HFNC was continued for 3 days, and the patient was discharged on 8th postoperative day with SpO2 of 97% on 3 L/min of oxygen inhalation. Because of the simplicity of the technique, the lower cost of equipment, and remarkable patient tolerance to the treatment, we speculate that HFNC can take over the post of noninvasive ventilation as first-line therapy for patients with acute respiratory failure.

The Use of Below-Knee Percutaneous Transluminal Angioplasty in Arterial Occlusive Disease Causing Chronic Critical Limb Ischemia

International Nuclear Information System (INIS)

Loefberg, Ann-Marie; Loerelius, Lars-Erik; Karacagil, Sadettin; Westman, Bo; Almgren, Bo; Berqgvist, David

1996-01-01

Purpose: To determine the efficacy, safety and long-term results of crural artery percutaneous transluminal angioplasty (PTA) in limbs with chronic critical limb ischemia (CLI). Methods: Patients undergoing crural artery PTA due to CLI were followed at regular clinic visits with ankle brachial pressure index (ABPI) measurements. PTA of the crural arteries was attempted either alone (n= 39) or in combination with PTA of the superficial and/or popliteal artery (n= 55) in 86 limbs (82 patients and 94 procedures) presenting with CLI. The ages of patients ranged from 37 to 94 years (mean 72 years). The indications for PTA were rest pain in 10 and ulcer/gangrene in 84 limbs.Results: A technically successful PTA with at least one crural level was achieved in 88% of cases (n= 83). Cumulative primary clinical success rates at 6, 12, 24, and 36 months were 55%, 51%, 36%, and 36%, respectively. Cumulative secondary clinical success and limb salvage rates at 36 months were 44% and 72%, respectively. Conclusion: PTA of the crural arteries might be considered the primary choice of treatment in patients with CLI and distal lesions with localized stenosis or segmental short occlusions

Clinical application of hepatic vein percutaneous transluminal angioplasty and stent after stent placement in inferior vena cava

International Nuclear Information System (INIS)

Xu Hao; Zu Maoheng; Gu Yuming; Li Guojun; Zhang Qingqiao; Wei Ning; Xu Wei; Liu Hongtao

2005-01-01

Objective: To investigate the feasibility and effect of recanalization of hepatic vein with percutaneous transluminal angioplasty (PTA) and stent after stent placement in inferior vena cava (IVC). Methods: Eleven patients with Budd-Chiari syndrome (BCS)were once performed metal stent placement in IVC at other hospital, but ascites was not subsided in 9 patients after the stent placement and occurred again in 2 patients in 3 months after the procedure. PTA and metal stent placement were used to treat the occlusion of the hepatic vein (HV) via stent in IVC. Results: Recanalization of occlusive HV was successful in all 11 patients, and symptoms disappeared or were obviously improved. The mean blood pressure in HV dropped from pre-operation (45.12 ± 1.57) cm H 2 O (1 cm H 2 O=0.098 kPa) to post-operation (17.53 ± 0.68) cm H 2 O (P<0.01). In a period of 4-30 months (mean: 13.6 months) following-up, no patient reoccurred symptoms. Conclusion: Recanalization of HV via stent in IVC is a feasible and effective method for occlusive HV, but it is difficult. (authors)

Obstructive jaundice: a comparative study of forceps and brush biopsy under percutaneous transhepatic cholangiography

International Nuclear Information System (INIS)

Li Yongdong; Han Xinwei; Wu Gang; Ma Bo; Xing Gusheng

2004-01-01

Objective: To compare the sensitivity between forceps biopsy and brushing, and to explore a feasible approach to pathological diagnosis of the obstructive jaundice. Methods: 92 consecutive patients with obstructive jaundice underwent transluminal forceps biopsy and brushing during percutaneous transhepatic cholangiography and percutaneous transhepatic cholangiodrainage. The technique was performed through a preexisting percutaneous transhepatic tract with multiple specimens obtained after passing the forceps biopsy or brush into a 8-French sheath. Finally the specimens were fixed with formalin for pathologic or cytologic diagnosis. Results: The histopathologic diagnosis was acquired in 81 out of 92 patients with forceps biopsy reaching the successful rate of 97.83%. Sensitivity of forceps biopsy in 92 patients was higher than that of brush in 84 patients (88.04% vs 76.19% χ 2 =4.251, P= <0.05). Conclusions: Percutaneous transhepatic cholangiobiopsy is a simple technique with minimal invasion, high sensitivity and worthy to be used spread extensively. Percutaneous transluminal brush cytology is also an useful method for establishing a diagnosis of cholangiocarcinoma. (authors)

A case report of percutaneous endoscopic gastrostomy left-side gastropexy to resolve a recurrent gastric dilatation in a dog previously treated with right-side gastropexy for gastric dilatation volvulus.

Science.gov (United States)

Spinella, Giuseppe; Cinti, Filippo; Pietra, Marco; Capitani, Ombretta; Valentini, Simona

2014-12-01

A 6-year-old, large-breed, female dog was evaluated for gastric dilatation (GD). The dog was affected by GD volvulus, which had been surgically treated with gastric derotation and right incisional gastropexy. Recurrence of GD appeared 36 hours after surgery. The dilatation was immediately treated with an orogastric probe but still recurred 4 times. Therefore, a left-side gastropexy by percutaneous endoscopic gastrostomy (PEG) was performed to prevent intermittent GD. After PEG tube placement, the patient recovered rapidly without side effects. Several techniques of gastropexy have been described as a prophylactic method for gastric dilatation volvulus, but to the authors' knowledge, this is the first report of left-sided PEG gastropexy performed in a case of canine GD recurrence after an incisional right gastropexy. Copyright © 2015 Elsevier Inc. All rights reserved.

Case report: renovascular hypertension following radiotherapy and chemotherapy treated by transluminal angioplasty

International Nuclear Information System (INIS)

Minton, M.J.; McIvor, J.; Cappuccio, F.P.; MacGregor, G.A.; Newlands, E.S.

1986-01-01

A man aged 33 with poorly controlled hypertension who had been treated with radiotherapy and combination chemotherapy for testicular teratoma 8 years earlier was found on arteriography to have 75% stenosis of the left renal artery and occlusion of the right renal artery. The stenosis was dilated by transluminal angioplasty and the hypertension adequately controlled. Patients who develop high blood pressure after abdominal radiotherapy with or without chemotherapy should be investigated for renal artery stenosis. (author)

Diabetes insipidus-like state complicating percutaneous transluminal renal stenting for transplant renal artery stenosis.

Science.gov (United States)

Tian, Lu; He, Yangyan; Zhang, Hongkun; Wu, Ziheng; Li, Donglin; Chen, Shanwen

2014-07-01

To report the incidence, etiology, and treatments of diabetes insipidus-like state that complicate percutaneous transluminal renal stenting (PTRS) for transplant renal artery stenosis (TRAS). Data from 7 patients on whom PTRS for TRAS was performed between October 2008 and March 2012 were reviewed retrospectively. The parameters investigated included blood flow velocity, blood pressure, and creatinine levels before and after the intervention. The procedural success rate was 100%. Three cases developed a diabetes insipidus-like state in the immediate postprocedural period. Urine output returned to normal within 2 weeks after treatment. The median blood flow velocity was significantly reduced from 4.51 m/sec (4.31-4.61 m/sec) at the time of TRAS diagnosis to 1.33 m/sec (1.31-1.51 m/sec) at the most recent follow-up of the group with a diabetes insipidus-like state. The ratio of median blood flow velocity before and after stenting in the group with a diabetes insipidus-like state was significantly higher than that in the group without a diabetes insipidus-like state (3.39 vs. 1.93). Diabetes insipidus-like state that complicates PTRS for TRAS is not an uncommon event, but appears to be underreported in the medical literature. A high ratio of pre- and poststenting median blood flow velocity may be a predictor for a postprocedural diabetes insipidus-like state. The most probable cause may be the marked increase in renal arterial flow. Early recognition of the condition is essential to avoid dehydration and electrolyte imbalance. Copyright © 2014 Elsevier Inc. All rights reserved.

Femoral artery recanalisation with percutaneous angioplasty and segmentally enclosed plasminogen activator

DEFF Research Database (Denmark)

Jørgensen, B; Tønnesen, K H; Bülow, J

1989-01-01

To establish whether re-occlusion of the femoral artery could be prevented, in 6 consecutive patients undergoing percutaneous transluminal angioplasty (PTA) for superficial femoral artery occlusion the recanalised segment was isolated, with a 7-French double-balloon catheter. 5 mg recombined huma...

Percutaneous transluminal angioplasty of stenoses of the proximal subclavian artery

International Nuclear Information System (INIS)

Grote, R.; Freyschmidt, J.; Walterbusch, G.; Medizinische Hochschule Hannover

1983-01-01

Between August 1980 and June 1982, 12 left-sided proximal subclavian stenoses were dilated with balloon catheters. The dilatation was successful in all patients. Differences in blood pressure in the arm could be demonstrated subsequently. Recurrences occurred in two patients after seven and eleven months. Follow-up of nine patients up to 24 months showed them to be symptom-free. (orig.)

Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block for Analgesia During Percutaneous Transluminal Angioplasty for Dialysis Access

International Nuclear Information System (INIS)

Chiba, Emiko; Hamamoto, Kohei; Nagashima, Michio; Matsuura, Katsuhiko; Okochi, Tomohisa; Tanno, Keisuke; Tanaka, Osamu

2016-01-01

PurposeTo evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access.Subjects and MethodsTwenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. The patient’s motor/sensory paralysis after PTA was also examined.ResultsThe mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min.ConclusionUS-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites.Level of EvidenceLevel 4 (case series).

Percutaneous transluminal angioplasty of malfunctioning Brescia-Cimino arteriovenous fistula: analysis of factors adversely affecting long-term patency

International Nuclear Information System (INIS)

Sugimoto, Koji; Hirota, Shozo; Sugimura, Kazuro; Higashino, Takanori; Kuwata, Yoichiro; Imanaka, Kazufumi

2003-01-01

Our objective was to identify the factors adversely affecting long-term patency after percutaneous transluminal angioplasty (PTA) for hemodialysis Brescia-Cimino arteriovenous fistulas. Between November 1995 and March 2000, 91 PTA procedures were performed on 50 patients with 57 Brescia-Cimino fistulas. A retrospective study based on the chart review was performed. The initial technical success rate for all procedures and the primary and secondary patency rates for all fistulas were calculated. Regarding fistulas successfully maintained by the primary PTA, the primary and secondary patency rates were compared using the Kaplan-Meier method between two patient groups. They were classified on the basis of several factors, including age (older, over 70 years, and younger group), age of the fistulas (older, over 6 months, and younger group), with or without diabetes mellitus (DM), solitary or multiple lesions, long or short segment lesion, stenosis or occlusion, and with or without arterial and/or anastomotic lesions. Initial technical success rates for all procedures and fistulas were 91.2 and 89.5%, respectively. Cumulative primary and secondary patency rates at 1 year were 47.3 and 67.3%, respectively. In the comparative study, the secondary patency rate for the older group was lower than that of the younger group with statistical significance (p =0.029). The higher age is the only factor that reduces the long-term patency rate after PTA. (orig.)

Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block for Analgesia During Percutaneous Transluminal Angioplasty for Dialysis Access

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Chiba, Emiko, E-mail: chibaemi23@comet.ocn.ne.jp; Hamamoto, Kohei, E-mail: hkouhei917@gmail.com [Jichi Medical University, Department of Radiology, Saitama Medical Center (Japan); Nagashima, Michio, E-mail: nagamic00@gmail.com [Asahikawa Medical University, Department of Emergency Medicine (Japan); Matsuura, Katsuhiko, E-mail: kmatsur@gmail.com; Okochi, Tomohisa, E-mail: t-shachi@dj8.so-net.ne.jp; Tanno, Keisuke, E-mail: tankichi1974@gmail.com; Tanaka, Osamu, E-mail: otanaka@omiya.jichi.ac.jp [Jichi Medical University, Department of Radiology, Saitama Medical Center (Japan)

2016-10-15

PurposeTo evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access.Subjects and MethodsTwenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. The patient’s motor/sensory paralysis after PTA was also examined.ResultsThe mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min.ConclusionUS-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites.Level of EvidenceLevel 4 (case series).

Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution Thallium scintigraphy

NARCIS (Netherlands)

W. Wijns (William); P.W.J.C. Serruys (Patrick); J.H.C. Reiber (Johan); P.J. de Feyter (Pim); M.J.B.M. van den Brand (Marcel); M.L. Simoons (Maarten); P.G. Hugenholtz (Paul)

1985-01-01

textabstractThe value of exercise testing and thallium scintigraphy in predicting recurrence of angina pectoris and restenosis after a primary successful transluminal coronary angioplasty (PTCA) was prospectively evaluated. In 89 patients, a symptom-limited exercise electrocardiogram (ECG) and

One shot tract dilation for percutaneous nephrolithotomy: is it safe and effective in preschool children?

Science.gov (United States)

Hosseini, Seyed Reza; Mohseni, Mohammad Ghasem; Alizadeh, Farshid

2014-01-01

To evaluate the safety and feasibility of percutaneous tract dilation by the one-stage method in preschool children. Between April 2009 and February 2013, all preschool (stage Amplatz according to Frattini et al. [J Endourol 2001;15:919-923] (group II, 31 patients). The primary endpoint of interest was fluoroscopy time. Secondary endpoints included tract creation and dilation time, success rate and complications. Stone-free status was defined as residuals ≤3 mm. Age, stone size, operation success and operation time were not significantly different between the studied groups. The most common stone composition was calcium oxalate in both groups. The mean ± standard deviation of access and fluoroscopy times in groups I and II were 7.3 ± 1.2 min vs. 5.9 ± 1.5 min (p > 0.05) and 70.0 ± 8.9 s vs. 22.0 ± 5.6 s (p stage method is safe and effective. Also, it is associated with considerably less radiation exposure in preschool children. © 2014 S. Karger AG, Basel.

Balloon dilatation biopsy of the biliary stricture through the percutaneous transhepatic biliary drainage tract: Feasibility and diagnostic accuracy

Energy Technology Data Exchange (ETDEWEB)

Hong, Ji Hoon; Ryeom, Hun Kyu; Jang, Yun Jin; Kim, Gab Chul; Cho, Seung Hyun; Song, Jung Hup [Kyungpook National University Hospital, Daegu (Korea, Republic of)

2016-01-15

To evaluate the feasibility and diagnostic accuracy of the balloon dilatation biopsy for the biliary stricture through the percutaneous transhepatic biliary drainage (PTBD) tract. The study included 35 patients who underwent balloon dilatation biopsy for the biliary stricture through the PTBD tract. Balloon dilatation was done with a balloon catheter of 10-mm or 12-mm diameter. Soft tissue adherent to the retrieved balloon catheter and soft tissue components separated by gauze filtration of evacuated bile were sampled for histopathologic examination. The results were compared with the final diagnosis which was made by clinical and imaging follow-up for mean 989 days (n = 34) and surgery with histopathologic examination (n = 1). Procedure-related complications and diagnostic accuracy were assessed. Tissues suitable for histopathologic examination were obtained in 31 out of 35 patients (88.6%). In 3 patients, self-limiting hemobilia was noted. No major complication was noted. The sensitivity, specificity, diagnostic accuracy, positive and negative predictive values for diagnosis of malignant stricture were 70.0%, 100%, 90.3%, 100%, and 87.5%, respectively. Balloon dilatation biopsy of the biliary stricture through the PTBD tract is a feasible and accurate diagnostic method. It can be a safe alternative to the endoscopic retrograde cholangiography biopsy or forceps biopsy through the PTBD tract.

Percutaneous dilational tracheotomy for airway management in a newborn with Pierre-Robin syndrome and a glossopharyngeal web.

Science.gov (United States)

Pirat, Arash; Candan, Selim; Unlükaplan, Aytekin; Kömürcü, Ozgür; Kuşlu, Selim; Arslan, Gülnaz

2012-04-01

Pierre-Robin syndrome (PRS) is often associated with difficulty in endotracheal intubation. We present the use of percutaneous dilational tracheotomy (PDT) for airway management of a newborn with PRS and a glossopharyngeal web. A 2-day-old term newborn with PRS and severe obstructive dyspnea was evaluated by the anesthesiology team for airway management. A direct laryngoscopy revealed a glossopharyngeal web extending from the base of the tongue to the posterior pharyngeal wall. The infant was spontaneously breathing through a 2 mm diameter fistula in the center of this web. It was decided that endotracheal intubation was impossible, and a PDT was planned. The trachea of the newborn was cannulated, using a 20 gauge peripheral venous catheter and a 0.71 mm guide wire was introduced through this catheter. Using 5 French, 7 French, 9 French, and 11 French central venous catheter kit dilators, staged tracheotomy stoma dilation was performed. By inserting a size 3.0 tracheotomy cannula, PDT was successfully completed in this newborn. This case describes the successful use of PDT for emergency airway management of a newborn with PRS and glossopharyngeal web.

Guidelines for Percutaneous Dilatational Tracheostomy (PDT) from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM)

DEFF Research Database (Denmark)

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

2011-01-01

Percutaneous dilatational tracheostomy is a common procedure in intensive care. This guideline from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM) describes indications and contraindications, timing, complications...

The Use of Color-Coded Duplex Scanning in the Selection of Patients with Lower Extremity Arterial Disease for Percutaneous Transluminal Angioplasty: A Prospective Study

International Nuclear Information System (INIS)

Elsman, Bernard H.P.; Legemate, Dink A.; Heyden, Frank W.H.M. van der; Vos, Henk de; Mali, Willem P.T.M.; Eikelboom, Bert C.

1996-01-01

Purpose: To exploit the potential benefits of percutaneous transluminal angioplasty (PTA) in patients with short obstructive lesions in the lower extremity, it is preferable to select patients suitable for PTA before proceeding to hospital admission and angiography. The aim of this prospective study was to evaluate the role of color-coded duplex scanning in the correct selection of patients for PTA and its influence on planning the approach to the lesion. Methods: On the basis of clinical history, physical examination, pressure indices, and ultrasound duplex scanning, 109 patients were scheduled for PTA. Results: The indication for PTA was correct in 103 patients (94%), while the procedure was performed successfully in 98 patients (90%). The approach to the lesion was planned successfully in the majority of patients. Conclusion: This study shows that it is justifiable to plan PTA on the basis of information obtained by duplex scanning. Results of the duplex scan may guide the catheterization route

The predictive value of angiographic results for the outcome of percutaneous transluminal angioplasty in stenosed femoral bypass grafts

International Nuclear Information System (INIS)

Spijkerboer, Anje M.; Beek, Frederik J. A.; Graaf, Yolanda van der; Eikelboom, Bert C.; Mali, Willem P. T. M.

1997-01-01

Purpose. To assess the predictive value of immediate angiographic results after percutaneous transluminal angioplasty (PTA) for stenoses in femoral bypass grafts using duplex ultrasound (DUS) criteria. Methods. A 1-year follow-up with DUS was performed in 38 patients with 50 stenoses in 41 grafts, treated with PTA for a graft stenosis. The indication for PTA according to DUS criteria was a severe stenosis in 43 lesions, and a moderate stenosis in 7 lesions. In the moderate stenosis group 3 patients showed claudication and 1 patient had a nonhealing ulcer. For the purposes of statistical evaluation, primary patency was considered present if the graft was not occluded. The graft was considered to have failed when it was found to be occluded on DUS, or when secondary interventions (surgery, repeat PTA) were performed. Results. After 1 year the cumulative primary patency rate was 44$ [95% confidence interval (CI) 27.8-59.8]. Stenoses with initially good angiographic results after PTA (<30% residual stenosis) were 2.9 times more likely to be patent at 1 year than stenoses with initially poor or moderate angiographic results (hazard ratio 2.9, 95% CI 1.3-6.4,p=0.007). Conclusion. A poor or moderate angiographic result immediately following PTA was prognostic for poor long-term results and may indicate a requirement for earlier surgical intervention

Single-centre review of radiologically guided percutaneous nephrostomy using 'mixed' technique: Success and complication rates

Energy Technology Data Exchange (ETDEWEB)

Montvilas, Paulius, E-mail: paulmont@rm.dk [Department of Radiology, Aarhus University Hospital, Skejby, Brendstrupgardsvej 100, 8200 Aarhus N (Denmark); Solvig, Jan, E-mail: jansolvi@rm.dk [Department of Radiology, Aarhus University Hospital, Skejby, Brendstrupgardsvej 100, 8200 Aarhus N (Denmark); Bjerklund Johansen, Truls Erik, E-mail: tebj@skejby.rm.dk [Department of Urology, Aarhus University Hospital, Skejby, Brendstrupgardsvej 100, 8200 Aarhus N (Denmark)

2011-11-15

Aim: A review of complication and success rates of the 'mixed' technique in percutaneous nephrostomy using both the Seldinger and one-step techniques in dilated and non-dilated systems. Materials and methods: We retrospectively analysed 500 percutaneous nephrostomies in dilated an non-dilated systems in 353 patients from 2006 to 2007 (208 males (range 19-95 years), 127 females (range 27-91 years) and 21 children (range 3 months-16 years: 6 females, 15 males)). Percutaneous nephrostomy was considered successful if catheter was placed in renal pelvis and drained urine spontaneously. Successful percutaneous nephrostomies were classified as primary (renal system drained instantly) or postponed (drainage achieved within 24 h after initial failure). Number of complications was registered. Results: All of the 500 nephrostomies were successful within 24 h (96.2% primary; 3.8% postponed). The success rate of primary nephrostomy in dilated and non-dilated systems was 98.2% and 82%, respectively. Major complications occurred in 0.45% and minor complications in 14.2%. Conclusion: Percutaneous nephrostomy using the 'mixed' technique is very successful in dilated systems, is not superior to other PCN techniques in non-dilated systems and has a very low rate of major complications.

Pressure-wire-guided percutaneous transluminal pulmonary angioplasty: a breakthrough in catheter-interventional therapy for chronic thromboembolic pulmonary hypertension.

Science.gov (United States)

Inami, Takumi; Kataoka, Masaharu; Shimura, Nobuhiko; Ishiguro, Haruhisa; Yanagisawa, Ryoji; Fukuda, Keiichi; Yoshino, Hideaki; Satoh, Toru

2014-11-01

This study sought to prove the safety and effectiveness of pressure-wire-guided percutaneous transluminal pulmonary angioplasty (PTPA). PTPA has been demonstrated to be effective for treatment of chronic thromboembolic pulmonary hypertension. However, a major and occasionally fatal complication after PTPA is reperfusion pulmonary edema. To avoid this, we developed the PEPSI (Pulmonary Edema Predictive Scoring Index). The pressure wire has been used to detect insufficiency of flow in a vessel. We included 350 consecutive PTPA sessions in 103 patients with chronic thromboembolic pulmonary hypertension from January 1, 2009 to December 31, 2013. During these 5 years, 140 PTPA sessions were performed without guidance, 65 with guidance of PEPSI alone, and 145 with both PEPSI and pressure-wire guidance. Each PTPA session was finished after achieving PEPSI scores of PEPSI guidance and each target lesion achieving distal mean pulmonary arterial pressure PEPSI (0% and 6.9%, respectively). Furthermore, the group guided by pressure wire and PEPSI accomplished the same hemodynamic improvements with fewer numbers of target lesions treated and sessions performed. The combined approach using pressure wire and PEPSI produced more efficient clinical results and greatly reduced reperfusion pulmonary edema and vessel complications. This is further evidence that PTPA is an alternative strategy for treating chronic thromboembolic pulmonary hypertension. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Transluminal angioplasty of a stenotic surgical splenorenal shunt

International Nuclear Information System (INIS)

Beers, B. van; Roche, A.; Cauquil, P.

1988-01-01

A stenosis of a side-to-side splenorenal shunt was treated by percutaneous angioplasty two years after the performance of the shunt. After dilatation, there was a fall of the splenorenal pressure gradient from 28 to 17 cm H 2 O and good transanastomotic flow was re-estabilshed. As in other arterial and venous territories, angioplasty may be an interesting alternative to surgery. (orig.)

Comparison of Complications in Percutaneous Dilatational Tracheostomy versus Surgical Tracheostomy

Science.gov (United States)

Yaghoobi, Siamak; Kayalha, Hamid; Ghafouri, Raziyeh; Yazdi, Zohreh; Khezri, Marzieh Beigom

2014-01-01

Background: Tracheostomy facilitates respiratory care and the process of weaning from mechanical ventilatory support. Aims: To compare the complications found in percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) techniques. Methods: This was a prospective randomized study to evaluate the complications of PDT and ST procedures in patients admitted to ICU unit of a teaching hospital during 2008 to 2011. We studied 40 patients in each group. PDTs were performed with blue rhino technique at the bedside by a skilled clinician and all cases of STs performed by Charles G Durbin technique in operating room under general anesthesia. Bronchoscopic examination through tracheostomy tube was performed to ensure the correct position of tracheostomy tube in the trachea lumen. The duration of procedures and pre- and post-interventional complications were recorded. Results: The most common complications observed in the PDT group were minor bleeding (n=4), hypoxemia, and cardiac dysrhythmias (n=3) whereas in the ST group, the most frequent complications were minor bleeding (n=5) and endotracheal tube puncture (n=3). The difference in overall complications between the two groups was insignificant (P=0.12). Conclusion: PDT with blue rhino technique is a safe, quick, and effective method while the overall complications in both groups were comparable. PMID:24999127

Percutaneous Management of Ureteral Injuries that are Diagnosed Late After Cesarean Section

Energy Technology Data Exchange (ETDEWEB)

Ustunsoz, Bahri; Ugurel, Sahin; Duru, Namik Kemal; Ozgok, Yasar; Ustunsoz, Ayfer [GATA Medical Faculty, Ankara (Turkmenistan)

2008-08-15

We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 +- 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable

Successful intestinal ischemia treatment by percutaneus transluminal angioplasty of visceral arteries in a patient with abdominal angina

Directory of Open Access Journals (Sweden)

Nenezić Dragoslav

2011-01-01

Full Text Available Introduction. Abdominal angina, also known as chronic mesenteric ischemia or intestinal angina, is a rare disease caused by intestinal flow reduction due to stenosis or occlusion of mesenteric arteries. A case of successful treatment of a patient with abdominal angina by percutaneous transuliminal angioplasty of high-grade superior mesenteric artery and coeliac trunk stenosis was presented. Case Outline. A 77-year-old male patient was admitted at our Clinic for severe postprandial abdominal pains followed by frequent diarrhoeas. Extensive gastrointestinal investigations were performed and all results were normal. Multislice computerized (MSCT arteriography was indicated which revealed ostial celiac trunk and superior mesenteric artery subocclusion. Percutaneous transluminal angioplasty of the superior mesenteric artery and coeliac trunk was done with two stents implantation. Just a few hours following the intervention, after food ingestion, there were no abdominal pains. Six months later, the patient described a significant feeling of relief after food ingestion and no arduousness at all. Conclusion. High-grade visceral arteries stenoses in patients with intestinal ischemia symptoms can be treated by either surgical procedures or percutaneus transluminal angioplasty. In cases when a low operative risk is anticipated, surgical treatment is recommended due to a better anatomical outcome, while percutaneus angioplasty is advised to elderly patients in whom increased operative risks can be expected.

Femoro-popliteal artery occlusions treated by percutaneous transluminal angioplasty and enclosed thrombolysis

DEFF Research Database (Denmark)

Tønnesen, K H; Holstein, P; Andersen, E

1991-01-01

dilatation of femoro-popliteal occlusions, the balloons were inflated on both sides of the lesion. The dilated segment was then isolated from the circulation. Through a sideport between the balloons 5 mg of tissue type plasminogen activator and 1000 IU of heparin were installed within the segment for 30 min...

One-day transhepatic billary stricture dilatation

International Nuclear Information System (INIS)

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

1989-01-01

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

Transluminal coronary angioplasty (TCA) techniques, indications and results

International Nuclear Information System (INIS)

Kober, G.; Lang, H.; Vallbracht, C.; Bussmann, W.D.; Hopf, R.; Kunkel, B.; Kaltenbach, M.

1985-01-01

Transluminal coronary angioplasty (TCA) was introduced in 1977 for dilatation of coronary stenoses. From October 1977 to December 1984 1087 procedures have been performed in Frankfurt. The mean success rate was 77% with an increase from 58% to 84% since 1977. Recurrences were seen within the first year in 15% of the patients, which could be treated successfully in a high percentage with a second TCA. Emergency bypass operations were necessary in 5.2%. Four patients (fatality rate 0.37%) died as the consequence of the intervention. Within few years TCA has become an established procedure for myocardial revascularisation, with a high success rate. Major progress has been possible in the last few years due to technical developments, which are still going on. They may lead to further improvement of the results and enlargement of the indication for TCA. (orig.) [de

Intrarenal punctate bleedings after PTA of a poorly perfused kidney: a rare complication

International Nuclear Information System (INIS)

Mali, W.P.T.M.; Straalen, A. van; Puijlaert, C.B.A.J.; Klinge, J.; Geyskes, C.G.; Feldberg, M.A.M.; Kooiker, C.J.

1987-01-01

A 52-year-old male was treated with percutaneous transluminal renal angioplasty (PTA) for hypertension due to renal artery stenosis. After successful dilatation, a CT scan showed extravasation of material with a high CT number thought to be blood. An emergency nephrectomy, however, revealed contrast containing urine. Pathologic examination of the kidney showed numerous punctate bleedings possibly caused by high blood pressure. 7 refs.; 3 figs

Recurrence of hepatocellular carcinoma after liver transplantation presenting as anastomotic biliary stricture Presentación del carcinoma hepatocelular recurrente tras el trasplante de hígado en forma de estenosis biliar anastomótica

OpenAIRE

S. Y. Chen; C. H. Lin; J. C. Yu; C. Y. Yu; C. B. Hsieh

2008-01-01

A 52-year-old man visited our hospital complaining of anorexia and fatigue two months after receiving orthotopic liver transplantation for hepatocellular carcinoma. A laboratory investigation demonstrated a clinical picture of obstructive jaundice. T-tube cholangiography showed biliary stricture over the anastomotic site. Percutaneous transluminal balloon dilatation and stenting was attempted but failed. Magnetic resonance cholangiography showed possible tumor recurrence over the site of the ...

The Role of Duplex Scanning in the Selection of Patients with Critical Lower-Limb Ischemia for Infrainguinal Percutaneous Transluminal Angioplasty

International Nuclear Information System (INIS)

Loefberg, Anne-Marie; Karacagil, Sadettin; Hellberg, Anders; Bostroem, Annika; Ljungman, Christer; Ostholm, Goerel

2001-01-01

Purpose: To investigate the role of duplex scanning in the selection of patients with critical lower-limb ischemia (CLI) for infrainguinal percutaneous transluminal angioplasty (PTA).Methods: One hundred and sixty-two limbs with CLI (150 patients) that underwent duplex scanning within 3 months prior to conventional diagnostic angiography (n = 88) or infrainguinal PTA (n = 74) were retrospectively studied. The findings obtained from duplex scanning and angiography were analyzed in a masked fashion by two different investigators.Results: The accuracy, sensitivity, specificity, and negative and positive predictive values of duplex scanning in the selection of patients for infrainguinal PTA were 86%, 84%, 89%, 86%, and 87% respectively. Forty-two procedures (57%) were performed at multiple arterial segments. The accuracy of duplex scanning in the selection of femoropopliteal and crural lesions for PTA was over 85%. However, the sensitivity of duplex scanning in the selection of popliteal and crural lesions for PTA was 49% and 38% respectively, compared with 80% for superior femoral artery lesions. In 39% of patients who were correctly selected for PTA, duplex scanning misdiagnosed one of the multiple lesions treated by PTA.Conclusion: Duplex scanning can safely be used for the selection of patients for infrainguinal PTA. The sensitivity of duplex scanning in the selection of lesions for PTA was less satisfactory in the popliteal and crural arteries compared with the femoropopliteal arteries

Percutaneous Management of Ureteral Injuries that are Diagnosed Late After Cesarean Section

International Nuclear Information System (INIS)

Ustunsoz, Bahri; Ugurel, Sahin; Duru, Namik Kemal; Ozgok, Yasar; Ustunsoz, Ayfer

2008-01-01

We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 ± 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable

Advances in percutaneous stone surgery

OpenAIRE

Hartman, Christopher; Gupta, Nikhil; Leavitt, David; Hoenig, David; Okeke, Zeph; Smith, Arthur

2015-01-01

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, ...

Neointimal Hyperplasia after Silverhawk Atherectomy versus Percutaneous Transluminal Angioplasty (PTA) in Femoropopliteal Stent Reobstructions: A Controlled, Randomized Pilot Trial

International Nuclear Information System (INIS)

Brodmann, Marianne; Rief, Peter; Froehlich, Harald; Dorr, Andreas; Gary, Thomas; Eller, Philipp; Hafner, Franz; Deutschmann, Hannes; Seinost, Gerald; Pilger, Ernst

2013-01-01

Due to intimal hyperplasia instent reobstruction in the femoropopliteal arterial segment is still an unsolved problem. Different techniques have been discussed in case of reintervention to guarantee longlasting patency rate. We conducted a randomized, controlled, pilot trial comparing Silverhawk atherectomy with percutaneous transluminal angioplasty (PTA) in patients with a first instent reobstruction in the femoropopliteal arterial segment, to evaluate intima media thickness (IMT) within the treated segment, as a parameter of recurrence of intimal hyperplasia. In a total 19 patients were included: 9 patients in the atherectomy device and 10 patients in the PTA arm. IMT within the treated segment was statistically significantly elevated in all patients treated with the Silverhawk device versus the patients treated with PTA. The obvious differentiation in elevation of IMT in nonfavor for patients treated with the Silverhawk device started at month 2 (max IMT SH 0.178 mm vs. IMT PTA 0.1 mm, p = 0.001) with a spike at month 5 (max IMT SH 0.206 mm vs. IMT PTA 0.145 mm, p = 0.003) and a decline once again at month 6 (max IMT SH 0.177 mm vs. IMT PTA 0.121 mm, p = 0.02). The values for mean IMT performed the same way. Although Silverhawk atherectomy provides good results at first sight, in the midterm follow-up of treatment of first instent restenosis it did not perform better than PTA as it showed elevated reoccurrence of intimal media hyperplasia.

Neointimal Hyperplasia after Silverhawk Atherectomy versus Percutaneous Transluminal Angioplasty (PTA) in Femoropopliteal Stent Reobstructions: A Controlled, Randomized Pilot Trial

Energy Technology Data Exchange (ETDEWEB)

Brodmann, Marianne, E-mail: marianne.brodmann@medunigraz.at; Rief, Peter; Froehlich, Harald; Dorr, Andreas; Gary, Thomas; Eller, Philipp; Hafner, Franz [Medical University of Graz, Division of Angiology (Austria); Deutschmann, Hannes [Medical University Graz, Division of Interventional Radiology (Austria); Seinost, Gerald; Pilger, Ernst [Medical University of Graz, Division of Angiology (Austria)

2013-02-15

Due to intimal hyperplasia instent reobstruction in the femoropopliteal arterial segment is still an unsolved problem. Different techniques have been discussed in case of reintervention to guarantee longlasting patency rate. We conducted a randomized, controlled, pilot trial comparing Silverhawk atherectomy with percutaneous transluminal angioplasty (PTA) in patients with a first instent reobstruction in the femoropopliteal arterial segment, to evaluate intima media thickness (IMT) within the treated segment, as a parameter of recurrence of intimal hyperplasia. In a total 19 patients were included: 9 patients in the atherectomy device and 10 patients in the PTA arm. IMT within the treated segment was statistically significantly elevated in all patients treated with the Silverhawk device versus the patients treated with PTA. The obvious differentiation in elevation of IMT in nonfavor for patients treated with the Silverhawk device started at month 2 (max IMT SH 0.178 mm vs. IMT PTA 0.1 mm, p = 0.001) with a spike at month 5 (max IMT SH 0.206 mm vs. IMT PTA 0.145 mm, p = 0.003) and a decline once again at month 6 (max IMT SH 0.177 mm vs. IMT PTA 0.121 mm, p = 0.02). The values for mean IMT performed the same way. Although Silverhawk atherectomy provides good results at first sight, in the midterm follow-up of treatment of first instent restenosis it did not perform better than PTA as it showed elevated reoccurrence of intimal media hyperplasia.

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

International Nuclear Information System (INIS)

Oguzkurt, Levent; Ozkan, Ugur; Gumus, Burcak

2009-01-01

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

Indirect evidence for a role of a subpopulation of activated neutrophils in the remodelling process after percutaneous coronary intervention

NARCIS (Netherlands)

Costa, MA; de Wit, LEA; de Valk, V.; Serrano, P; Wardeh, AJ; Serruys, PW; Sluiter, W

Aim Leukocytes have been implicated in restenosis following percutaneous transluminal coronary angioplasty. We investigated the link between the activated status of circulating neutrophils and restenosis after angioplasty. Methods and Results The population of 108 patients with single, de novo

Evaluation and percutaneous management of atherosclerotic peripheral vascular disease

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Widlus, D.M.; Osterman, F.A. Jr.

1989-01-01

Atherosclerotic peripheral vascular disease (PVD) of the lower extremities deprives a person of the ability to exercise to their satisfaction, later of the ability to perform the activities of their daily life, and finally of their legs themselves. Peripheral vascular disease has long been managed by the vascular surgeon utilizing endarterectomy and peripheral arterial bypass. Patient acceptance of nonsurgical, percutaneous procedures such as percutaneous transluminal balloon angioplasty (PTA) is high. Increased utilization of these procedures has led to improved techniques and adjuncts to therapy, as well as more critical review of long-term results. This article will review the evaluation and nonoperative management of PVD, with an emphasis on the newer modalities of management presently being investigated

Safety of Performing Percutaneous Dilational Tracheostomy in Patients with Preexisting Barotrauma

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Chau-Chyun Sheu

2006-11-01

Full Text Available Since its introduction in 1985 by Ciaglia et al, percutaneous dilational tracheostomy (PDT has gradually become the procedure of choice in establishing a long-term airway in many intensive care units (ICU. However, the safety of performing PDT in patients with barotrauma is still unknown and has never been reported. We present the case of a 35-year-old man with AIDS, who was admitted to our medical ICU for pneumonia and acute respiratory distress syndrome. He developed subcutaneous emphysema and pneumomediastinum as complications of mechanical ventilation. After stabilization of the barotrauma, he underwent PDT with the standard Ciaglia Blue Rhino technique. However, rapid and extensive progression of preexisting barotrauma occurred shortly after PDT. This severe complication was nearly fatal. The prolonged procedure during which the susceptible lung was exposed to longer duration of high airway pressure was thought to be the mechanism of rapid deterioration of the preexisting barotrauma. With aggressive supportive care, the patient survived. To prevent further deterioration of preexisting barotrauma during and after PDT in future cases, we propose some principles that should be strictly followed. Under administration of these principles, we safely performed PDT in another case with preexisting barotrauma 1 month later.

Percutaneous dilatational tracheostomy using the ETView Tracheoscopic Ventilation Tube®: a teaching course in a pig model.

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Fiorelli, Alfonso; Ferraro, Fausto; Frongillo, Elisabetta; Fusco, Pierluigi; Pierdiluca, Matteo; Nagar, Francesca; Iuorio, Angela; Santini, Mario

2017-10-01

We planned a training course for trainees of different specialties with the aim of teaching the skills of a new procedure for performing percutaneous dilatational tracheostomy (PDT) with an ETView tracheoscopic ventilation tube instead of standard bronchoscopy in an ex vivo pig model. The endotracheal tube, with a camera-embedded tip, was used as an alternative to standard bronchoscopy for visualization of patient airways. The procedure was performed on a home-made animal model. The participants were asked to perform PDT in three different sessions to improve their dexterity. The primary endpoint was the reduction of complications seen during the different sessions of the training course. The secondary endpoint was the satisfaction of the participants as assessed by an anonymous survey. Thirty-seven residents in anesthesiology and 7 in thoracic surgery in the first 2 years of their training and without any confidence with percutaneous tracheostomy participated in the study. Tracheal cuff lesions and impalement of the tracheal tube were the most observed complications, and were concentrated in the early sessions. A significant reduction in complications and operative time was seen during the ongoing sessions of the course. No lesions of the posterior tracheal wall and only a ring fracture occurred during the last session of the course. All participants were satisfied with the course. Our course seems to confer the technical skills to perform percutaneous tracheostomy to trainees and instill confidence with the procedure. However, the experience acquired on a training course should be evaluated in clinical practice.

Transcutaneous oximetry compared to ankle-brachial-index measurement in the evaluation of percutaneous transluminal angioplasty

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Wildgruber, Moritz; Wolf, Oliver; Weiss, Wolfgang; Berger, Hermann; Lutzenberger, Werner; Eckstein, Hans-Henning; Heider, Peter

2007-01-01

Objective: To investigate transcutaneous oximetry as parameter of the microcirculation is correlated to ankle-brachial-index as parameter of the macrocirculation after peripheral angioplasty procedures. Design: Prospective study. Materials and methods: 60 patients suffering from intermittent claudication were scheduled for angioplasty treatment. 45 patients were considered as eligible for angioplasty after angiographic evaluation, 15 patients underwent angiography only. Transcutaneous oximetry measurements were performed before the procedure, at the end of intervention, 24 h as well as 2 and 4 weeks after percutaneous transluminal angioplasty. Ankle-brachial-indices were obtained before intervention, 24 h as well as 2 and 4 weeks later. Results: Ankle-brachial-indices increased significantly at 24 h after angioplasty in patients being treated with angioplasty. Transcutaneous oximetry values dropped significantly at the end of the procedure and returned close to the baseline levels at 2 and 4 weeks after angioplasty. Ankle-brachial-indices and transcutaneous oximetry were positively correlated before (r = 0.3833, p = 0.009) as well as 4 weeks after angioplasty (r = 0.4596, p = 0.001). Immediately after radiological interventions, ankle-brachial-indices and transcutaneous oximetry are not positively correlated. In patients undergoing angiography only, transcutaneous oximetry levels drop significantly immediately after angiography and remain at decreased levels even at 4 weeks after intervention. Conclusion: Transcutaneous oximetry as parameter of the microcirculation is positively correlated with ankle-brachial-index as parameter of the macrocirculation before and at 4 weeks after angioplasty. Intraarterial angiography leads to a sudden decrease in skin microcirculation without affecting macrocirculation. As indicated by a lack of recovery in transcutaneous oximetry levels after 4 weeks, angiography alone results in a prolonged impaired microcirculation which may

Use of cone-beam CT and live 3-D needle guidance to facilitate percutaneous nephrostomy and nephrolithotripsy access in children and adolescents

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Hawkins, C.M. [Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA (United States); Kukreja, Kamlesh [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Singewald, Timothy; Johnson, Neil D.; Racadio, John M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Minevich, Eugene; Reddy, Pramod [Cincinnati Children' s Hospital Medical Center, Department of Urology, Cincinnati, OH (United States)

2016-04-15

Gaining access into non-dilated renal collecting systems for percutaneous nephrolithotripsy, particularly in patients with prohibitive body habitus and/or scoliosis, is often challenging using conventional techniques. To evaluate the feasibility of cone-beam CT for percutaneous nephrostomy placement for subsequent percutaneous nephrolithotripsy in children and adolescents. A retrospective review of percutaneous nephrostomy revealed use of cone-beam CT and 3-D guidance in 12 percutaneous nephrostomy procedures for 9 patients between 2006 and 2015. All cone-beam CT-guided percutaneous nephrostomies were for pre-lithotripsy access and all 12 were placed in non-dilated collecting systems. Technical success was 100%. There were no complications. Cone-beam CT with 3-D guidance is a technically feasible technique for percutaneous nephrostomy in children and adolescents, specifically for nephrolithotripsy access in non-dilated collecting systems. (orig.)

Advances in percutaneous stone surgery.

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Hartman, Christopher; Gupta, Nikhil; Leavitt, David; Hoenig, David; Okeke, Zeph; Smith, Arthur

2015-01-01

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.

Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis

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Ahmed, Ahmed T.; Mohammed, Khaled; Chehab, Monzer; Brinjikji, Waleed; Hassan Murad, M.; Cloft, Harry; Bjarnason, Haraldur

2016-01-01

Background and PurposeSubclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD.Materials and MethodsWe searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model.ResultsA total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8 %, p = 0.007). Long-term primary patency rates (76.9 vs 79.6 %, p = 0.729) and symptom resolution rates (82.2 vs 73.0 %, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death.ConclusionStent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.

Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis

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Ahmed, Ahmed T., E-mail: Ahmed.Ahmed1@mayo.edu; Mohammed, Khaled, E-mail: Mohammed.Khaled@mayo.edu [Mayo Clinic, Evidence-Based Practice Research Program (United States); Chehab, Monzer, E-mail: moe.chehab@beumont.edu [Oakland University William Beaumont School of Medicine, Department of Diagnostic Radiology and Molecular Imaging (United States); Brinjikji, Waleed, E-mail: Brinjikji.Waleed@mayo.edu [Mayo Clinic, Department of Radiology (United States); Hassan Murad, M., E-mail: Murad.Mohammad@mayo.edu [Mayo Clinic, Evidence-Based Practice Research Program (United States); Cloft, Harry, E-mail: Cloft.Harry@mayo.edu; Bjarnason, Haraldur, E-mail: Bjarnason.Haraldur@mayo.edu [Mayo Clinic, Department of Radiology (United States)

2016-05-15

Background and PurposeSubclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD.Materials and MethodsWe searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model.ResultsA total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8 %, p = 0.007). Long-term primary patency rates (76.9 vs 79.6 %, p = 0.729) and symptom resolution rates (82.2 vs 73.0 %, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death.ConclusionStent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.

Efficacy of percutaneous transluminal renal angioplasty with stent in elderly male patients with atherosclerotic renal artery stenosis

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Zhao J

2012-10-01

Full Text Available Jiahui Zhao, Qingli Cheng, Xiaoying Zhang, Meihua Li, Sheng Liu, Xiaodan WangDepartment of Geriatric Nephrology, Chinese PLA General Hospital, Beijing, ChinaObjectives: Percutaneous transluminal renal angioplasty with stent implantation (PTRAS has become the treatment of choice for atherosclerotic renal artery stenosis (ARAS. This study evaluates the long-term effects of PTRAS on hypertension and renal function in elderly patients with ARAS.Methods: We conducted a retrospective cohort study of all patients who underwent PTRAS in the geriatric division of a tertiary medical center during the period 2003–2010. The clinical data were extracted from the medical records of each patient. Changes in blood pressure, antihypertensive treatment, and estimated glomerular filtration rate were analyzed before and after PTRAS.Results: Eighty-six stents in 81 elderly patients were placed successfully. The average age of the patients was 76.2 years (65–89 years. Mean follow-up was 31.3 months (range 12 –49 months. There was a significant decrease in both systolic and diastolic blood pressure at the third day after the PTRAS procedure and the reduction in blood pressure was constant throughout the follow-up period until 36 months after PTRAS. However, there was no marked benefit to renal function outcome during the follow-up period. The incidence of contrast-induced nephropathy was 9.9% in this study group. The rate of renal artery restenosis was 14.8%. The survival rate was 96.3% for 4 years after the procedure.Conclusion: It is beneficial to control blood pressure in elderly patients with ARAS up to 36 months after a PTRAS procedure. However, their renal function improvement is limited.Keywords: angioplasty, hypertension, renal function, elderly, renal artery stenosis

Flow motion waves with high and low frequency in severe ischaemia before and after percutaneous transluminal angioplasty.

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Hoffmann, U; Schneider, E; Bollinger, A

1990-09-01

STUDY OF OBJECTIVE: The aim was to evaluate skin flux and prevalence of low and high frequency flow motion waves in patients with severe ischaemia due to peripheral arterial occlusive disease before and after percutaneous transluminal angioplasty (PTA) with and without local thrombolysis. Flow motion was recorded by the laser Doppler technique at the dorsum of the foot before, one day, and one month after PTA. The results were separately analysed in patients with successful and unsuccessful treatment. 18 patients with rest pain or incipient gangrene were included. Mean pretreatment systolic ankle pressure was 55.8(SD 25.5) mm Hg, and mean transcutaneous PO2 at 43 degrees C was 5.2(9.4) mm Hg. Arteriography revealed relevant stenoses or occlusions of the femoropopliteal and calf arteries. Before treatment two patterns of flow motion with characteristic frequency ranges were observed at the foot dorsum and at a probe temperature of 32 degrees C: low frequency (LF) waves with a mean frequency of 2.2(0.5) cycles.min-1 and a mean amplitude of 0.73(0.42) arbitrary units (AU) and high frequency (HF) waves with a mean frequency of 22.6(4.2) cycles.min-1 and a mean amplitude of 0.39(0.33) AU. PTA was successful in 11 of the 18 patients. After successful treatment, prevalence of HF waves decreased from 10/11 to 4/11 cases (p less than 0.001), but remained nearly unchanged after failed procedure. Prevalence of LF waves before and after PTA did not differ significantly. Our data support the hypothesis that HF waves represent a reaction of skin microcirculation to severe ischaemia. With reference to animal studies it is proposed that HF waves originate from terminal arterioles. They may function as a compensatory mechanism of flow regulation involved in pathophysiology of ischaemia.

Stability of multilead ST-segment "fingerprints" over time after percutaneous transluminal coronary angioplasty and its usefulness in detecting reocclusion.

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Krucoff, M W; Parente, A R; Bottner, R K; Renzi, R H; Stark, K S; Shugoll, R A; Ahmed, S W; DeMichele, J; Stroming, S L; Green, C E

1988-06-01

Multilead ST-segment recordings taken during percutaneous transluminal coronary angioplasty (PTCA) could function as an individualized noninvasive template or "fingerprint," useful in evaluating transient ischemic episodes after leaving the catheterization laboratory. To evaluate the reproducibility of such ST-segment patterns over time, these changes were analyzed in patients grouped according to the time between occlusion and reocclusion. For the patients in group 1, the study required comparing their "fingerprints" in repeat balloon inflation during PTCA (reocclusion in less than 1 hour), for those in group 2, comparing ST "fingerprints" during PTCA with ST changes during spontaneous early myocardial infarction (reocclusion in 24 hours) and in group 3, comparing ST "fingerprints" with ST changes during repeat PTCA for restenosis greater than 1 month after the initial PTCA. The ST "fingerprints" among the 20 patients in group 1 were identical in 14 cases (70%) and clearly related in another 4 (20%). Of the 23 patients in group 2, 12 (52%) had the same and 8 (35%) had related patterns. Of 19 patients in group 3, 8 (42% had the same pattern and 8 (42%) had related patterns. Thus, ST fingerprints were the same or clearly related with reocclusion in the same patient from less than 1 hour to greater than 1 month after initial occlusion in 87% of patients overall, in 90% in less than 1 hour, in 87% in less than 24 hours and in 84% greater than 1 month later. Multilead pattern ST-segment "fingerprints" may serve as a noninvasive marker for detecting site-specific reocclusion.

Neointimal hyperplasia after silverhawk atherectomy versus percutaneous transluminal angioplasty (PTA) in femoropopliteal stent reobstructions: a controlled, randomized pilot trial.

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Brodmann, Marianne; Rief, Peter; Froehlich, Harald; Dorr, Andreas; Gary, Thomas; Eller, Philipp; Hafner, Franz; Deutschmann, Hannes; Seinost, Gerald; Pilger, Ernst

2013-02-01

Due to intimal hyperplasia instent reobstruction in the femoropopliteal arterial segment is still an unsolved problem. Different techniques have been discussed in case of reintervention to guarantee longlasting patency rate. We conducted a randomized, controlled, pilot trial comparing Silverhawk atherectomy with percutaneous transluminal angioplasty (PTA) in patients with a first instent reobstruction in the femoropopliteal arterial segment, to evaluate intima media thickness (IMT) within the treated segment, as a parameter of recurrence of intimal hyperplasia. In a total 19 patients were included: 9 patients in the atherectomy device and 10 patients in the PTA arm. IMT within the treated segment was statistically significantly elevated in all patients treated with the Silverhawk device versus the patients treated with PTA. The obvious differentiation in elevation of IMT in nonfavor for patients treated with the Silverhawk device started at month 2 (max IMT SH 0.178 mm vs. IMT PTA 0.1 mm, p = 0.001) with a spike at month 5 (max IMT SH 0.206 mm vs. IMT PTA 0.145 mm, p = 0.003) and a decline once again at month 6 (max IMT SH 0.177 mm vs. IMT PTA 0.121 mm, p = 0.02). The values for mean IMT performed the same way. Although Silverhawk atherectomy provides good results at first sight, in the midterm follow-up of treatment of first instent restenosis it did not perform better than PTA as it showed elevated reoccurrence of intimal media hyperplasia.

Review of the Latest Percutaneous Devices in Critical Limb Ischemia

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Leila Haghighat

2018-04-01

Full Text Available Critical limb ischemia (CLI is a terminal stage of peripheral arterial disease that, in the absence of intervention, may lead to lower extremity amputation or death. Endovascular interventions have become a first-line approach to the management of CLI and have advanced considerably within the past decade. This review summarizes the types of percutaneous devices and the techniques that are available for the management of CLI and the data supporting their use. These include devices that establish and maintain vessel patency, including percutaneous transluminal angioplasty, drug-coated balloons, bare metal stents, drug-eluting stents, bioresorbable vascular scaffolds, and atherectomy; devices that provide protection from embolization; and, cell-based therapies. Additionally, ongoing trials with important implications for the field are discussed.

Review of the Latest Percutaneous Devices in Critical Limb Ischemia.

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Haghighat, Leila; Altin, Sophia Elissa; Attaran, Robert R; Mena-Hurtado, Carlos; Regan, Christopher J

2018-04-14

Critical limb ischemia (CLI) is a terminal stage of peripheral arterial disease that, in the absence of intervention, may lead to lower extremity amputation or death. Endovascular interventions have become a first-line approach to the management of CLI and have advanced considerably within the past decade. This review summarizes the types of percutaneous devices and the techniques that are available for the management of CLI and the data supporting their use. These include devices that establish and maintain vessel patency, including percutaneous transluminal angioplasty, drug-coated balloons, bare metal stents, drug-eluting stents, bioresorbable vascular scaffolds, and atherectomy; devices that provide protection from embolization; and, cell-based therapies. Additionally, ongoing trials with important implications for the field are discussed.

Treatment of Ureterointestinal Anastomotic Strictures by Diathermal or Cryoplastic Dilatation

International Nuclear Information System (INIS)

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

2007-01-01

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

Increased Plasma Cathepsin S at the Time of Percutaneous Transluminal Angioplasty is Associated with 6-Months’ Restenosis of the Femoropopliteal Artery

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Mijovski Mojca Bozic

2018-01-01

Full Text Available Background: We tested the hypothesis that increased levels of cathepsin S and decreased levels of cystatin C in plasma at the time of percutaneous transluminal angioplasty (PTA are associated with the occurrence of 6-months’ restenosis of the femoropopliteal artery (FPA. Methods: 20 patients with restenosis and 24 matched patients with patent FPA after a 6-months follow-up were in - cluded in this study. They all exhibited disabling claudication or critical limb ischemia and had undergone technically successful PTA. They were all receiving statins and ACE in hi - bitors (or angiotensin II receptor antagonist before the PTA and the therapy did not change throughout the observational period. Plasma concentrations of C-reactive protein were < 10 mg/L and of creatinine within the reference range at the time of the PTA. Plasma concentration and activity of cathepsin S, together with its potent inhibitor cystatin C, were measured the day before and the day after the PTA. Results: The increased plasma concentration and activity of cathepsin S at the time of PTA was associated with the occurrence of 6-months’ restenosis of FPA, independently of established risk factors (lesion complexity, infrapopliteal run-off vessels, type of PTA, age, gender, smoking, diabetes, lipids and of cystatin C. Plasma cystatin C concentration was not associated with restenosis and did not correlate with cathepsin S activity and concentration in the plasma. Conclusion: Increased level of plasma cathepsin S at the time of PTA is associated with 6-months’ restenosis of PTA, independently of established risk factors.

Post-marketing surveillance in the published medical and grey literature for percutaneous transluminal coronary angioplasty catheters: a systematic review.

Science.gov (United States)

Polisena, Julie; Forster, Alan J; Cimon, Karen; Rabb, Danielle

2013-10-10

Post-marketing surveillance (PMS) may identify rare serious incidents or adverse events due to the long-term use of a medical device, which was not captured in the pre-market process. Percutaneous transluminal coronary angioplasty (PTCA) is a non-surgical procedure that uses a balloon-tipped catheter to enlarge a narrowed artery. In 2011, 1,942 adverse event reports related to the use of PTCA catheters were submitted to the FDA by the manufacturers, an increase from the 883 reported in 2008. The primary research objective is to conduct a systematic review of the published and grey literature published between 2007 and 2012 for the frequency of incidents, adverse events and malfunctions associated with the use of PTCA catheters in patients with coronary artery disease (CAD). Grey literature has not been commercially published. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and PubMed for medical literature on PMS for PTCA catheters in patients with CAD published between January 2007 and July 2012. We also searched the grey literature. This review included 11 studies. The in-hospital adverse events reported were individual cases of myocardial infarction and hematoma. In studies of patients with coronary perforation, more patients with balloon angioplasty were identified compared with patients who required stenting. Our systematic review illustrates that the volume and quality of PMS studies associated with the use of PTCA catheters in patients with CAD are low in the published and grey literature, and may not be useful sources of information for decisions on safety. In most studies, the objectives were not to monitor the long-term safety of the use of PTCA catheters in clinical practice. Future studies can explore the strengths and limitations of PMS databases administered by regulatory authorities.

Percutaneous Management of Biliary Strictures After Pediatric Liver Transplantation

International Nuclear Information System (INIS)

Miraglia, Roberto; Maruzzelli, Luigi; Caruso, Settimo; Riva, Silvia; Spada, Marco; Luca, Angelo; Gridelli, Bruno

2008-01-01

We analyze our experience with the management of biliary strictures (BSs) in 27 pediatric patients who underwent liver transplantation with the diagnosis of BS. Mean recipient age was 38 months (range, 2.5-182 months). In all patients percutaneous transhepatic cholangiography, biliary catheter placement, and bilioplasty were performed. In 20 patients the stenoses were judged resolved by percutaneous balloon dilatation and the catheters removed. Mean number of balloon dilatations performed was 4.1 (range, 3-6). No major complications occurred. All 20 patients are symptom-free with respect to BS at a mean follow-up of 13 months (range, 2-46 months). In 15 of 20 patients (75%) one course of percutaneous stenting and bilioplasty was performed, with no evidence of recurrence of BS at a mean follow-up of 15 months (range, 2-46 months). In 4 of 20 patients (20%) two courses of percutaneous stenting and bilioplasty were performed; the mean time to recurrence was 9.8 months (range, 2.4-24 months). There was no evidence of recurrence of BS at a mean follow-up of 12 months (range, 2-16 months). In 1 of 20 patients (5%) three courses of percutaneous stenting and bilioplasty were performed; there was no evidence of recurrence of BS at a mean follow-up of 10 months. In conclusion, BS is a major problem following pediatric liver transplantation. Radiological percutaneous treatment is safe and effective, avoiding, in most cases, surgical revision of the anastomosis.

Pancreatic cancer seeding of percutaneous needle tract

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Qiao Zhou, MD

2017-03-01

Full Text Available A 65-year old African-American female presents with biliary ductal dilatation due to an obstructive pancreatic head mass. Percutaneous transhepatic cholangiogram performed and biliary drainage catheter placement for decompression of the biliary system. The patient had a Whipple procedure performed several months later. On follow up CT imaging, there was interval development and enlargement of a subcutaneous lesion by the right oblique muscles. Biopsy of this lesion revealed pancreatic adenocarcinoma from percutaneous seeding of the transhepatic needle tract.

Temporary percutaneous T-fastener gastropexy and continuous decompressive gastrostomy in dogs with experimentally induced gastric dilatation.

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Fox-Alvarez, W Alexander; Case, J Brad; Cooke, Kirsten L; Garcia-Pereira, Fernando L; Buckley, Gareth J; Monnet, Eric; Toskich, Beau B

2016-07-01

OBJECTIVE To evaluate a percutaneous, continuous gastric decompression technique for dogs involving a temporary T-fastener gastropexy and self-retaining decompression catheter. ANIMALS 6 healthy male large-breed dogs. PROCEDURES Dogs were anesthetized and positioned in dorsal recumbency with slight left-lateral obliquity. The gastric lumen was insufflated endoscopically until tympany was evident. Three T-fasteners were placed percutaneously into the gastric lumen via the right lateral aspect of the abdomen, caudal to the 13th rib and lateral to the rectus abdominis muscle. Through the center of the T-fasteners, a 5F locking pigtail catheter was inserted into the gastric lumen and attached to a device measuring gas outflow and intragastric pressure. The stomach was insufflated to 23 mm Hg, air was allowed to passively drain from the catheter until intraluminal pressure reached 5 mm Hg for 3 cycles, and the catheter was removed. Dogs were hospitalized and monitored for 72 hours. RESULTS Mean ± SD catheter placement time was 3.3 ± 0.5 minutes. Mean intervals from catheter placement to a ≥ 50% decrease in intragastric pressure and to ≤ 6 mm Hg were 2.1 ± 1.3 minutes and 8.4 ± 5.1 minutes, respectively. After catheter removal, no gas or fluid leakage at the catheter site was visible laparoscopically or endoscopically. All dogs were clinically normal 72 hours after surgery. CONCLUSIONS AND CLINICAL RELEVANCE The described technique was performed rapidly and provided continuous gastric decompression with no evidence of postoperative leakage in healthy dogs. Investigation is warranted to evaluate its effectiveness in dogs with gastric dilatation-volvulus.

Percutaneous nephrostomy

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Ryu, In Hoon; Ryu, Kook Hyun; Kim, Jae Kyu; Park, Jin Gyoon; Kang, Heoung Keun; Chung, Hyeon De [Chonnam National University College of Medicine, Chonju (Korea, Republic of)

1990-12-15

Percutaneous nephrostomy was performed in 82 patients under the fluoroscopic guidance for recent 3 years. The cause of hydronephrosis were as follows: unknown origin of stricture (N=37), stone (N=20), tumor (N=14), tuberculosis (N=8), postoperative ureteral injury (N=1), postoperative anastomotic stricture(N=1)and renal transplantation complication (N=1). Successful nephrostomy was achieved in 79 patients (96%). Causes if failure were minimal dilatation of pelvocaliceal system (N=2) and staghorn calculi (N=1). Follow up laboratory test shows high BUN and creatinine level returned to normal limit within 1 or 3 weeks in 73 patient. Major complication was not found, but temporary hematuria (N=4) or fever (N=1) was noted. In conclusion, percutaneous nephrostomy is the safe and effective method for the temporary and permanent relief of urinary obstruction and maintenance of ureteral patency.

Percutaneous nephrostomy

International Nuclear Information System (INIS)

Ryu, In Hoon; Ryu, Kook Hyun; Kim, Jae Kyu; Park, Jin Gyoon; Kang, Heoung Keun; Chung, Hyeon De

1990-01-01

Percutaneous nephrostomy was performed in 82 patients under the fluoroscopic guidance for recent 3 years. The cause of hydronephrosis were as follows: unknown origin of stricture (N=37), stone (N=20), tumor (N=14), tuberculosis (N=8), postoperative ureteral injury (N=1), postoperative anastomotic stricture(N=1)and renal transplantation complication (N=1). Successful nephrostomy was achieved in 79 patients (96%). Causes if failure were minimal dilatation of pelvocaliceal system (N=2) and staghorn calculi (N=1). Follow up laboratory test shows high BUN and creatinine level returned to normal limit within 1 or 3 weeks in 73 patient. Major complication was not found, but temporary hematuria (N=4) or fever (N=1) was noted. In conclusion, percutaneous nephrostomy is the safe and effective method for the temporary and permanent relief of urinary obstruction and maintenance of ureteral patency

Feasibility study of natural orifice transluminal endoscopic surgery inguinal hernia repair.

Science.gov (United States)

Sherwinter, Danny A; Eckstein, Jeremy G

2009-07-01

A potentially less-invasive technique, transluminal surgery, may reduce or eliminate pain and decrease time to full return of activities after abdominal operations. Inguinal hernia repair is perfectly suited to the transgastric endoscopic approach and has not been previously reported. Our purpose was to evaluate the feasibility of transgastric bilateral inguinal herniorrhaphy (BIH). Feasibility study with a nonsurvival canine model. Under general anesthesia, male mongrel dogs weighing 20 to 30 kg had a dual-channel endoscope introduced into the peritoneal cavity over a percutaneously placed guidewire. An overtube with an insufflation channel was used. Peritoneoscopy was performed, and bilateral deep and superficial inguinal rings were identified. The endoscope was removed, premounted with a 4 x 6 cm acellular human dermal implant and then readvanced intraperitoneally through the overtube. The implant was then deployed across the entire myopectineal orifice and draped over the cord structures. Bioglue was then applied endoscopically, and the implant was attached to the peritoneum. After completion of bilateral repairs, the animals were killed and necropsy performed. Five dogs underwent pure natural orifice transluminal endoscopic surgery (NOTES) intraperitoneal onlay mesh (IPOM) BIH. Accurate placement and adequate myopectineal coverage was accomplished in all subjects. At necropsy no injuries to the major structures were noted but Bioglue misapplication with contamination of unintended sites did occur. Our study involved only a small number of subjects in nonsurvival experiments, and no gastric closure was used. Many of the characteristics of inguinal hernia repair are especially well suited to the transgastric approach. The repair is in line with the transgastric endoscope vector, bilateral defects are adjacent, and the IPOM technique does not require significant manipulation or novel instrumentation.

Two-Year Follow-Up After Percutaneous Dilatational Tracheostomy in a Surgical ICU.

Science.gov (United States)

Voelker, Maria Theresa; Wiechmann, Marcus; Dietz, Andreas; Laudi, Sven; Bercker, Sven

2017-07-01

The modalities of tracheostomy for critically ill patients are still controversially discussed. Although the use of percutaneous dilatational tracheostomy (PDT) is generally accepted to be a safe procedure, it is still not considered to be suitable for patients requiring a permanent tracheostomy. This was an observational cohort study investigating long-term outcome parameters of PDT. All patients having received a PDT at the interdisciplinary ICU at the University of Leipzig between October 2008 and August 2009 that survived to discharge were asked for consent to participate ( n = 103). Baseline data, admitting diagnosis, reasons for tracheostomy, and timing for tracheostomy were recorded. Subjects and medical providers were asked for neurological outcome, adverse events, and personal discomfort related to the tracheostomy. The study period was 2 y from the time of tracheostomy. Seventy-one subjects were finally included in the survey. Data of 8 subjects (11%) were incomplete. Reasons for tracheostomy were the need for long-term ventilation (42%), weaning (31%), and neurological deficits (27%). No severe adverse events were registered. Sixty-five percent of all subjects could finally be decannulated. Two subjects remained with their initial tracheostomy, and in 5 subjects (7%) tracheostomy was modified to a surgical tracheostomy. Thirty-seven percent of subjects died during the 2 y. Twenty-five of the surviving subjects (35%) had only minor or moderate neurological and psychological deficits. Complaints were mostly connected to swallowing and breathing. Decannulations after PDT are easily done. Complications after PDT requiring a transformation to a surgical tracheostomy are rare. Elective surgical conversions are not necessary. Copyright © 2017 by Daedalus Enterprises.

Interventional uroradiology

International Nuclear Information System (INIS)

Lang, E.K.

1987-01-01

All extensions of percutaneous nephropyelostomy are addressed, including nephropyelostomy as an adjunct modality in the management of infections. The concepts, techniques, and caveats for placing ureteral stents in the management of traumatic, neoplastic, and inflammatory conditions of the ureter are examined. Particular emphasis is placed on the long-term management with indwelling stents, of patients with ureters compromised by neoplastic disease. Different stent materials and the time factors necessitating replacement of stents are analyzed. Percutaneous ureteroneocystostomies (re-entry procedures) or percutaneous ureteropyelostomies in allograft kidneys are reviewed, along with their indications, techniques, and possible complications. The discussion continues with the management of ureteral strictures by transluminal dilation via antegrade and retrograde approaches as well as under dual control. The advantages of combining antegrade and retrograde techniques to gain access to and maintain control of devices in marginally accessible regions are illustrated with pertinent examples. Percutaneous stone extraction via antegrade and retrograde techniques and adjunctive procedures for dealing with complications of extracorporeal shock wave lithotripsy are discussed

Evaluation of the restenosis of coronary artery after percutaneous transluminal coronary angioplasty by three-dimensional coronary magnetic resonance angiography

International Nuclear Information System (INIS)

Arisaka, Hiraku

2000-01-01

Coronary magnetic resonance angiography (MRA) has been recently brought into clinical use, however, there has not been reports on the comparison with MRA and conventional contrast coronary angiography (CAG) in the detection of the localization and characteristics of coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA). To assess the restenosis of coronary artery after PTCA, this study compared three-dimensional (3D) coronary MRA and CAG. One hundred three patients (76 males and 27 females, average age of 64.6±9.3 years old) were performed coronary MRA at 3-6 months after PTCA. The right coronary artery (RCA) group consist of 21 patients, the left anterior descending branch (LAD) 63 patients and the left circumflex branch (LCX) 19 patients. Coronary MRA was performed with the patients in supine position on a 1.5 T whole body scanner (MAGNETOM VISION, Siemens AG, Germany) using body array coil. The imaging technique used a 3-D gradient echo sequence with respiratory gating and fat suppression. The slice thickness was 2 mm, slab thickness 32 mm, a field of view of 300 mm and a matrix of 128 x 256. Other parameters were an echo time of 2.7 ms and a repetition time of 600 to 1100 msec. The measurement time of 1 imaging slab took 15 to 20 minutes depending on the patient's heart rate. The coronary arteries were reconstructed from the 3-D data set using a multiplanar reconstruction (MPR) technique. According to previous coronary MRA studies, a significant stenosis with a luminal reduction of ≥50% was assumed if a marked signal reduction or signal loss of a vessel segment was visible. In CAG, 57 of 103 patients showed restenosis. In coronary MRA, 37 of 103 patients demonstrated restenosis. The sensitivity, specificity, positive and negative predictive values were 64.9%, 100%, 100% and 69.6%, respectively. Predictive accuracy was 79.6%. Three-dimensional coronary MRA is useful in a noninvasive diagnostic method to evaluate the coronary

Late hemodynamic failure following percutaneous transluminal angioplasty for long and multifocal femoropopliteal stenoses

DEFF Research Database (Denmark)

Jørgensen, B; Tønnesen, K H; Holstein, P

1991-01-01

separate segments were dilated. Following 98% initial technical success, 3-year patency was 68% for single short stenoses, as opposed to 20% for long and multifocal stenoses (p = 0.05, logrank test). Antiplatelet therapy with acetylsalicyclic acid was not found to influence occurrence of restenosis...

Percutaneous intervention in obstructive

International Nuclear Information System (INIS)

Souftas, V.

2012-01-01

, performed by the urologist. Before performing a lithotripsy, percutaneous access of the renal collecting system is necessary. Percutaneous ureteral lithotripsy is indicated for management of large renal stones. The kidneys are accessed either using ultrasound, if there is a dilated collecting system, or fluoroscopy, if there is a radiopaque stone. The most ideal access is a calyx that bears the stone. Once access is obtained an angled glide wire is used to cross the obstructing stone and gain access to the ureter. Two wires can then be advanced to the bladder to provide a 'working wire' and a 'safety wire'. Success of lithotripsy is 98-99% for targeted renal stones and 88-89% for ureteral stones. If using only fluoroscopy, a sheathed needle may be used to access the bladder under fluoroscopy. Once urine is aspirated through the sheathed needle, a 3Jwire is inserted into the bladder under fluoroscopy. Using an angled guiding catheter, the 3J-wire is exchanged for an Amplatz and serial dilatation of the tract is performed over the Amplatz. Finally, an 8-F to 12-F suprapubic Foley catheter is inserted over the Amplatz wire into the bladder. Success rate for suprapubic tube insertion has been reported to approach 100% and is comparable to surgical insertion. Complications include bleeding, infection, and bladder or bowel perforation. Perinephric/retroperitoneal urinomas/abscesses drainages are usually due to ureteral obstruction/ trauma from calculi and rupture of the collecting system or to iatrogenic trauma. Most often they are performed under CT guidance, with success rates 100% and very low complication rates. Pigtail drainage catheters 8-F (up to 14-F for abscesses) are used. Sometimes these procedures have to be combined with percutaneous nephrostomy and percutaneous or antegrade ureteral stent placement.

Pulmonary edema predictive scoring index (PEPSI), a new index to predict risk of reperfusion pulmonary edema and improvement of hemodynamics in percutaneous transluminal pulmonary angioplasty.

Science.gov (United States)

Inami, Takumi; Kataoka, Masaharu; Shimura, Nobuhiko; Ishiguro, Haruhisa; Yanagisawa, Ryoji; Taguchi, Hiroki; Fukuda, Keiichi; Yoshino, Hideaki; Satoh, Toru

2013-07-01

This study sought to identify useful predictors for hemodynamic improvement and risk of reperfusion pulmonary edema (RPE), a major complication of this procedure. Percutaneous transluminal pulmonary angioplasty (PTPA) has been reported to be effective for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). PTPA has not been widespread because RPE has not been well predicted. We included 140 consecutive procedures in 54 patients with CTEPH. The flow appearance of the target vessels was graded into 4 groups (Pulmonary Flow Grade), and we proposed PEPSI (Pulmonary Edema Predictive Scoring Index) = (sum total change of Pulmonary Flow Grade scores) × (baseline pulmonary vascular resistance). Correlations between occurrence of RPE and 11 variables, including hemodynamic parameters, number of target vessels, and PEPSI, were analyzed. Hemodynamic parameters significantly improved after median observation period of 6.4 months, and the sum total changes in Pulmonary Flow Grade scores were significantly correlated with the improvement in hemodynamics. Multivariate analysis revealed that PEPSI was the strongest factor correlated with the occurrence of RPE (p PEPSI to be a useful marker of the risk of RPE (cutoff value 35.4, negative predictive value 92.3%). Pulmonary Flow Grade score is useful in determining therapeutic efficacy, and PEPSI is highly supportive to reduce the risk of RPE after PTPA. Using these 2 indexes, PTPA could become a safe and common therapeutic strategy for CTEPH. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

The balloon dilatation and large profile catheter maintenance method for the management of the bile duct stricture following liver transplantation

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Choo, Sung Wook; Shin, Sung Wook; Do, Young Soo; Park, Kwang Bo; Sung, Yon Mi; Choo, In Wook [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Liu, Wei Chiang [Sungae General Hospital, Seoul (Korea, Republic of)

2006-03-15

We wanted to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and large profile catheter maintenance method for the management of patients with anastomotic biliary strictures following liver transplant. From May 1999 to June 2003, 12 patients with symptomatic benign biliary stricture complicated by liver transplantation were treated with the percutaneous balloon dilatation and large profile catheter maintenance method (1-6 months). The patients were eight males and four females, and their ages ranged from 20 to 62 years (mean age: 44 years). Ten patients underwent living donor liver transplantation and two underwent cadaveric liver transplantation. Postoperative biliary strictures occurred from two to 21 months (mean age: 18 months) after liver transplantation. The initial technical success rate was 92%. Patency of the bile duct was preserved for eight to 40 months (mean period: 19 months) in 10 of 12 (84%) patients. When reviewing two patients (17%), secondary balloon dilatations were needed for treating the delayed recurrence of biliary stricture. In one patients, no recurrent stenosis was seen during the further 10 months follow-up after secondary balloon dilatation. Another patient did not response to secondary balloon dilatation, and he was treated by surgery. Eleven of 12 patients (92%) showed good biliary patency for 8-40 months (mean period: 19 months) of follow-up. The percutaneous balloon dilatation and large profile catheter maintenance method is an effective therapeutic alterative for the treatment of most biliary strictures that complicate liver transplantation. It has a high success rate and it should be considered before surgery.

Percutaneous treatment of transplant renal artery stenosis in children.

Science.gov (United States)

Repetto, Horacio A; Rodríguez-Rilo, Laila; Mendaro, Esteban; Basso, Laura; Galvez, Hugo; Morrone, Gabriela; Vazquez, Luis A

2004-12-01

Percutaneous treatment of renal artery stenosis (RAS) is an accepted procedure and numerous reports have been published. However, experience with its use in RAS in the transplanted kidney in children is scarce. Since 1994 we have diagnosed RAS in seven children with the use of Doppler ultrasonography (US), confirming it with percutaneous angiography (PAG). In six of the seven patients percutaneous transluminal angioplasty (PTA) was performed. In one patient a metallic stent was placed due to the extension of the arterial lesion, and a second stent was placed in another child when a re-stenosis was diagnosed 1 month after the PTA. All patients presented with hypertension (de novo or 30% increase over previous values). After ruling out acute rejection, calcineurin inhibitor toxicity, and urinary obstruction, US was performed and, when an increase in arterial flux velocity was registered, PAG was also performed. Six children showed an increase in serum creatinine (Cr) and proteinuria. Blood pressure decreased after the procedure and Cr returned to previous levels in all children. One of the grafts was lost due to chronic transplant rejection 7 years later. The other children have a functioning kidney. Although this is a small group of patients, the consistently good results and the lack of reported experience prompted us to communicate our preliminary observation.

Balloon dilation of congenital supravalvular pulmonic stenosis in a dog.

Science.gov (United States)

Treseder, Julia R; Jung, SeungWoo

2017-03-30

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

Percutaneous 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.

Clinical effectiveness of percutaneous angioplasty for acute and chronic mesenteric ischemia: a six case series.

Science.gov (United States)

Jung, Yu Min; Jo, Yun Ju; Ahn, Sang Bong; Son, Byoung Kwan; Kim, Seong Hwan; Park, Young Sook; Bae, June Ho; Cho, Young Kwon

2011-04-01

Intestinal ischemia is divided into three categories, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), and colonic ischemia. AMI can result from arterial or venous thrombi, emboli, and vasoconstriction secondary to low-flow states. It is an urgent condition which can result in high mortality rate. The predominant causative factor of CMI is stenosis or occlusion of the mesenteric arterial circulation, and it is characterized by postprandial abdominal pain and weight loss. Surgery is the treatment of choice for intestinal ischemia. However, it has been recently reported that percutaneous transluminal angioplasty with stent placement and/or thrombolysis is an effective therapy in various types of mesenteric ischemia. We report six cases of mesenteric ischemia which were successfully treated by percutaneous angioplasty, and review the literature from South Korea.

Angioplasty in stenosis of the innominate artery

International Nuclear Information System (INIS)

Kobinia, G.S.; Bergmann, H. Jr.

1983-01-01

We describe a successful percutaneous transluminal dilatation (PTD) of an innominate artery stenosis in a 40-year-old patient with aortic arch syndrome. Five years earlier both a left central carotid artery occlusion and an innominate and left subclavian artery stenosis were treated by grafting from the aorta to the distal vessels. At recurrence of the neurological symptoms, reocclusion of the graft to the innominate artery and subtotal stenosis of the left carotid anastomosis were noted. The prevent the hazards of a reoperation, the innominate artery stenosis was dilated by means of PTD via the right brachial artery. Success of the procedure was demonstrated by Doppler sonography and angiography. It appears that PTD serves as an excellent method of treating stenoses of the aortic arch branches in aortic arch syndrome. (orig.)

Effect of PTA on blood pressure, renal plasma flow and renal venous renin activity in renovascular hypertension

International Nuclear Information System (INIS)

Arlart, I.P.; Dewitz, H. von; Rosenthal, J.

1983-01-01

Percutaneous transluminal angioplasty (PTA) is more and more accepted for interventional management of renal artery stenosis in hypertensive patients. This study was carried out to assess the behaviour of arterial blood-pressure, renal plasma flow and renal venous rening activity in renovascular hypertension following catheter dilatation. Using the data the possibility is calculated to predict the effect of PTA on blood pressure preinterventionally. The results demonstrate that a successful employment of PTA depends on a normal contralateral renal plasma flow and a normalization of plasma flow of the poststenotic kidney. Determination of plasma renin activity is only of restricted value. (orig.)

Morphological differences in coronary arteries following rotational atherectomy versus balloon angioplasty: ultrasound and angioscopic observations

Science.gov (United States)

Bass, Theodore A.; Gilmore, Paul S.; White, Christopher J.; Chami, Youssef G.; Kircher, Barbara J.; Conetta, Donald A.

1993-09-01

Percutaneous transluminal coronary rotational atherectomy (PTCRA) is an exciting new device to recannulate obstructed coronary arteries. This device works as a high speed `drill,' selectively cutting hard atherosclerotic plaque while preferentially sparing the softer, less diseased vascular luminal surface. At speeds as high as 200,000 rpm the plaque is pulverized into small particles easily handled by the circulatory system with no untoward clinical sequela. Balloon angioplasty does not remove atherosclerotic plaque. It dilates the vessel by mechanically stretching, compressing and splitting the plaque and vessel lining. We compare morphological and surface luminal characteristics of vessels post PTCRA to vessels post PTCA.

Percutaneous gastrostomy and jejunostomy: Technique, results, and complications in 55 cases

International Nuclear Information System (INIS)

Mueller, P.R.; Brown, A.; Saini, S.; Hahn, P.F.; Steiner, E.; Ferrucci, J.T.; Forman, B.H.; Silverman, S.G.

1987-01-01

Percutaneous radiologic gastrostomy is a well-described method that has not been widely adopted by radiologists. The authors reviewed their experience to highlight technical points and clinical results. Direct percutaneous gastrostomy was performed in 51 patients and percutaneous jejunostomy in four. Indications for gastrostomy procedures were the need for general nutrition (n = 31), complications of use of a nasogastric feeding tube (n = 7), gastric or small bowel decompression (n = 4) and endoscopic failure (n = 5). The major indication for percutaneous jejunostomy was decompression of small bowel obstruction. Key technical aspects include the use of a novel needle device that tacks the abdominal wall to the stomach, thus assuring a seal between the two structures. In the percutaneous gastrostomies, 18-F Foley catheters were introduced through the tacked portion of the stomach with a Seldinger technique and dilators. For percutaneous jejunostomy, 18-F feeding tubes were placed. All procedures were performed under local anesthesia. The authors conclude that a radiologic percutaneous gastrostomy is a safe and effective procedure and should be pursued aggressively by interventional radiologists

Experimental examinations with a new percutaneously insertable, expandable vascular endoprosthesis

International Nuclear Information System (INIS)

Strecker, E.P.; Berg, G.; Weber, H.; Bohl, M.; Dietrich, B.; Freiburg Univ.; Karlsruhe Univ.

1987-01-01

Restenosis and occlusion are the most common reasons why transluminal balloon angioplasty may fail to provide long-term benefit. To prevent restonosis and occlusion of diseased arteries after angioplasty an arterial endoprosthesis has been developed which is positioned to the balloon of an angioplasty catheter and which consists of a stainless steel pliable and elastic tube. With the inflation of the balloon the endoprosthesis will dilate and give the arterial wall a new mechanical support. This new device has been implanted in 12 experimental dogs in arteries of different size and lumen. The longest patency rate of nine months was observed with the completely developed method. (orig.) [de

Balloon Angioplasty - The Legacy of Andreas Grüntzig, M.D. (1939-1985).

Science.gov (United States)

Barton, Matthias; Grüntzig, Johannes; Husmann, Marc; Rösch, Josef

2014-01-01

In 1974, at the Medical Policlinic of the University of Zürich, German-born physician-scientist Andreas Grüntzig (1939-1985) for the first time applied a balloon-tipped catheter to re-open a severely stenosed femoral artery, a procedure, which he initially called "percutaneous transluminal dilatation". Balloon angioplasty as a therapy of atherosclerotic vascular disease, for which Grüntzig and Charles T. Dotter (1920-1985) received a nomination for the Nobel Prize in Physiology or Medicine in 1978, became one of the most successful examples of translational medicine in the twentieth century. Known today as percutaneous transluminal angioplasty (PTA) in peripheral arteries or percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) in coronary arteries, balloon angioplasty has become the method of choice to treat patients with acute myocardial infarction or occluded leg arteries. On the occasion of the 40(th) anniversary of balloon angioplasty, we summarize Grüntzig's life and career in Germany, Switzerland, and the United States and also review the developments in vascular medicine from the 1890s to the 1980s, including Dotter's first accidental angioplasty in 1963. The work of pioneers of catheterization, including Pedro L. Fariñas in Cuba, André F. Cournand in France, Werner Forssmann, Werner Porstmann and Eberhard Zeitler in Germany, António Egas Moniz and Reynaldo dos Santos in Portugal, Sven-Ivar Seldinger in Sweden, and Barney Brooks, Thomas J. Fogarty, Melvin P. Judkins, Richard K. Myler, Dickinson W. Richards, and F. Mason Sones in the United States, is discussed. We also present quotes by Grüntzig and excerpts from his unfinished autobiography, statements of Grüntzig's former colleagues and contemporary witnesses, and have included hitherto unpublished historic photographs and links to archive recordings and historic materials. This year, on June 25, 2014, Andreas Grüntzig would have celebrated his 75(th

77 FR 11120 - Scientific Information Request on Treatment Strategies for Patients With Peripheral Artery...

Science.gov (United States)

2012-02-24

... transluminal angioplasty, atherectomy, or stents), and/or surgical revascularization (endarterectomy, bypass... endovascular intervention (percutaneous transluminal angioplasty, atherectomy, or stents) and surgical...

Incidence of vascular complications in patients submitted to percutaneous transluminal coronary angioplasty by transradial and transfemoral arterial approach Incidencia de complicaciones vasculares en pacientes sometidos a angioplastía coronaria transluminal percutánea por vía arterial transradial y transfemoral Incidência de complicações vasculares em pacientes submetidos a angioplastia coronariana transluminal percutânea por via arterial transradial e transfemoral

Directory of Open Access Journals (Sweden)

Marinez Kellermann Armendaris

2008-03-01

Full Text Available OBJECTIVE: To describe the vascular complications of transradial and transfemoral artery punctures in patients submitted to percutaneous transluminal coronary angioplasty (PTCA. METHODS: Prospective cohort study including patients submitted to PTCA. An interview was performed and an instrument applied to collect risk factors/predictors of complications. After the procedure, a physical examination was performed, vital signs were measured and the puncture site was assessed. RESULTS: 199 patients were included, age 64±10 years. Complications found for the radial and femoral approach were respectively: ecchymosis (18.29%, (17.14%; bruising (17.66%, (14.27%; urinary retention (2.43%, (25.71%; loss of vessel permeability (8.53%, (0%. CONCLUSION: The complications found were considered minor or secondary, depending on the classification found in literature. A higher rate of vascular complications related to transradial artery punctures compared to the interventions performed by transfemoral approach.OBJETIVO: Describir complicaciones vasculares relacionadas a punciones arteriales transradial y transfemoral en pacientes sometidos a angioplastía coronaria transluminal percutánea (ACTP. MÉTODOS: Se trata de un estudio de cohorte prospectivo realizado con pacientes sometidos a ACTP. Se llevó a cabo una entrevista y aplicó un instrumento para obtener factores de riesgo/predictores. Fue realizado un examen físico, medición de signos vitales y se evaluó el lugar de punción. RESULTADOS: Fueron incluidos 199 pacientes, edad 64±10 años. Las complicaciones encontradas para vía radial y femoral respectivamente, fueron: esquimosis (18,29%, (17,14%; hematoma (17,66%, (14,27%; retención urinaria (2,43%, (25,71%; pérdida de permeabilidad de vaso (8,53%, (0%. CONCLUSIÓN: Las complicaciones fueron consideradas menores o secundarias conforme clasificación literaria. Existe una mayor incidencia de complicaciones vasculares relacionadas a punciones

Interventional treatment of renal artery stenosis: a mid-term evaluation of clinical efficacy

International Nuclear Information System (INIS)

Liu Jing; Zhang Xitong

2009-01-01

Objective: To assess the clinical efficacy of interventional management for the treatment of renal artery stenosis. Methods: Percutaneous transluminal balloon renal angioplasty and / or percutaneous transluminal renal artery stenting were performed in 47 patients with renal artery stenosis (55 stenosed arteries in total). A follow-up study on the blood pressure and renal function was conducted and the results were statistically analyzed. Results: Fifty-four stenosed renal arteries were successfully reopened, of which only percutaneous transluminal balloon angioplasty was adopted in 17 and percutaneous transluminal renal artery stenting in 37. One patient died during the procedure. A follow-up for a mean period of (2.5 ± 0.6) years was carried out. The blood pressure determined at one (n = 46), 6 (n = 46), 12 (n = 33) and 24 (n = 29) months after the treatment was significantly decreased when compared to that determined before the treatment (P < 0.01). The clinical effective rate was 89.13% (41 / 46), 72.73% (24 / 33) and 62.07% (18 / 29), respectively. After the therapy,the renal function was improved in 5, remained unchanged in 33 and became worse in 3 patients. The comparison of the post-operative renograms (obtained within 2 months) with the pre-operative ones showed that in eight patients there was an increase in renal blood flow with an improvement in renal function impairment, which took a turn from severe degree to mild or moderate degree. Nevertheless, severe impairment in renal blood flow remained in 3 patients. Conclusion: Percutaneous transluminal balloon renal angioplasty and percutaneous transluminal renal artery stenting are safe and effective treatments for the renal artery stenosis, which also has a beneficial effect on the related renal hypertension and renal insufficiency. (authors)

Percutaneous transluminal angioplasty in renal artery stenosis by takayasu's arteritis

International Nuclear Information System (INIS)

Zeon, Seok Kil; Kim, Ok Bae; Kim, Hyun Chul

1984-01-01

Authors want to report that PTA was an out-standing therapeutic method in treatment of renovascular hypertension by renal artery stenosis due to Takayasu's arteritis in an 18-years-old Korean female. Abdominal aortogram and bilateral renal arteriogram showed mild smooth narrowing of the mid abdominal aorta of 4cm length from origin of renal arteries, complete occlusion of left renal artery from it's origin with a few small collateral arteries and severe stenosis of proximal right renal artery. PTA of right renal artery was performed with Gruntzig Balloon dilatation catheter, and the patient's blood pressure was down to 120/80 from 220/130, stable for 8 months follow-up examination. Takayasu's arteritis is one of the most important cause of renovascular hypertension in Orientals. Multiple treatment modalities, such as steroid administration or variable surgical intervention, were attempted and limited response was presented. But PTA is a simple, cost-effective, repeated, and relatively complication-free method in treatment of renovascular hypertension due to Takayasu's arteritis, with an outstanding result, as authors case

Percutaneous tracheostomy: a comprehensive review

Science.gov (United States)

Rashid, Ashraf O.

2017-01-01

Tracheostomy is a common procedure. It can be done surgically or percutaneously by dilating the stoma using Seldinger technique. Percutaneous tracheostomy (PT) is now routinely performed by surgeons and non-surgeons such as intensivists and anesthesiologists in the intensive care units (ICU) all over the world. Although obesity, emergent tracheostomy, coagulopathy, inability to extend the neck and high ventilator demand (HVD) were initially thought to be a relative contraindication, recent data suggest safety of PT in these patient population. Ultrasound can be helpful in limited cases to identify the neck structure especially in patients with a difficult anatomy. Bronchoscopy during PT can shorten the duration and avoid complications. PT has favorable complication rate, lower infection rate, shorter procedural duration and is cost-effective. Experience with the technique and careful planning is needed to minimize any avoidable potential complication. PMID:29214070

Survival and sudden cardiac death after septal ablation for hypertrophic obstructive cardiomyopathy

DEFF Research Database (Denmark)

Jensen, Morten Kvistholm; Havndrup, Ole; Hassager, Christian

2011-01-01

Reports of long-term survival and the risk of sudden cardiac death (SCD) after percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) are sparse.......Reports of long-term survival and the risk of sudden cardiac death (SCD) after percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) are sparse....

Percutaneous balloon dilatation for transplant ureteral strictures

Energy Technology Data Exchange (ETDEWEB)

Kim, Jong Chul [Chungnam National University School of Medicine, Taechun (Korea, Republic of); Banner, Marc P [University of Pennsylvania School of Medicine, Philadelphia (United States)

1993-09-15

We report 10 kidney allografted patients treated for 11 ureteral strictures with standard endourlogic balloon catheter dilatation and internal stenting between August 1979 and December 1991. They have been followed until 2 to 140 months (mean 42). We compared and analyzed the 6 successful strictures (54%) and 5 unsuccessful strictures. There was no statistically significant difference of demographic, clinical and radiologic interventional techniques between two groups. But there was slightly higher success rate in abruptly narrowed shorter fibrotic strictures in ureteroneocystomy sites than smoothly taped longer ones in other sites of the ureter. Longterm stenting by the transplantation team with cystoscopic removal of internal ureteral stents by urologists resulted in 3 cases of stent occlusion, encrustation or fracture. Exact early diagnosis of ureteral stricture with continued close follow up and proper radiologic interventional procedure with optimal stenting period may increase the success rate and still provide an alternative to surgery.

Diagnosing pancreatic cancer: the role of percutaneous biopsy and CT

International Nuclear Information System (INIS)

Amin, Z.; Theis, B.; Russell, R.C.G.; House, C.; Novelli, M.; Lees, W.R.

2006-01-01

Aims: To determine the sensitivity and complications of percutaneous biopsy of pancreatic masses, and whether typical computed tomography (CT) features of adenocarcinoma can reliably predict this diagnosis. Materials and methods: A 5 year retrospective analysis of percutaneous core biopsies of pancreatic masses and their CT features was undertaken. Data were retrieved from surgical/pathology databases; medical records and CT reports and images. Results: Three hundred and three patients underwent 372 biopsies; 56 of 87 patients had repeat biopsies. Malignancy was diagnosed in 276 patients, with ductal adenocarcinoma in 259 (85%). Final sensitivity of percutaneous biopsy for diagnosing pancreatic neoplasms was 90%; for repeat biopsy it was 87%. Complications occurred in 17 (4.6%) patients, in three of whom the complications were major (1%): one abscess, one duodenal perforation, one large retroperitoneal bleed. CT features typical of ductal adenocarcinoma were: hypovascular pancreatic mass with bile and/or pancreatic duct dilatation. Atypical CT features were: isodense or hypervascular mass, calcification, non-dilated ducts, cystic change, and extensive lymphadenopathy. Defining typical CT features of adenocarcinoma as true-positives, CT had a sensitivity of 68%, specificity of 95%, positive predictive value (PPV) of 98%, and negative predictive value of 41% for diagnosing pancreatic adenocarcinoma. Conclusion: Final sensitivity of percutaneous biopsy for establishing the diagnosis was 90%. CT features typical of pancreatic adenocarcinoma had high specificity and PPV. On some occasions, especially in frail patients with co-morbidity, it might be reasonable to assume a diagnosis of pancreatic cancer if CT features are typical, and biopsy only if CT shows atypical features

Diagnosing pancreatic cancer: the role of percutaneous biopsy and CT

Energy Technology Data Exchange (ETDEWEB)

Amin, Z.; Theis, B.; Russell, R.C.G.; House, C.; Novelli, M.; Lees, W.R

2006-12-15

Aims: To determine the sensitivity and complications of percutaneous biopsy of pancreatic masses, and whether typical computed tomography (CT) features of adenocarcinoma can reliably predict this diagnosis. Materials and methods: A 5 year retrospective analysis of percutaneous core biopsies of pancreatic masses and their CT features was undertaken. Data were retrieved from surgical/pathology databases; medical records and CT reports and images. Results: Three hundred and three patients underwent 372 biopsies; 56 of 87 patients had repeat biopsies. Malignancy was diagnosed in 276 patients, with ductal adenocarcinoma in 259 (85%). Final sensitivity of percutaneous biopsy for diagnosing pancreatic neoplasms was 90%; for repeat biopsy it was 87%. Complications occurred in 17 (4.6%) patients, in three of whom the complications were major (1%): one abscess, one duodenal perforation, one large retroperitoneal bleed. CT features typical of ductal adenocarcinoma were: hypovascular pancreatic mass with bile and/or pancreatic duct dilatation. Atypical CT features were: isodense or hypervascular mass, calcification, non-dilated ducts, cystic change, and extensive lymphadenopathy. Defining typical CT features of adenocarcinoma as true-positives, CT had a sensitivity of 68%, specificity of 95%, positive predictive value (PPV) of 98%, and negative predictive value of 41% for diagnosing pancreatic adenocarcinoma. Conclusion: Final sensitivity of percutaneous biopsy for establishing the diagnosis was 90%. CT features typical of pancreatic adenocarcinoma had high specificity and PPV. On some occasions, especially in frail patients with co-morbidity, it might be reasonable to assume a diagnosis of pancreatic cancer if CT features are typical, and biopsy only if CT shows atypical features.

Emphysema and pneumothorax after percutaneous tracheostomy: case reports and an anatomic study.

NARCIS (Netherlands)

Fikkers, B.G.; Veen, J.A. van; Kooloos, J.G.M.; Pickkers, P.; Hoogen, F.J.A. van den; Hillen, B.; Hoeven, J.G. van der

2004-01-01

STUDY OBJECTIVE: Part 1: To describe cases of emphysema (subcutaneous and/or mediastinal) and pneumothorax after percutaneous dilational tracheostomy (PDT) in a series of 326 patients, and to review the existing literature describing the incidence and possible mechanisms. Part 2: To analyze the

Natural orifice transluminal endoscopic surgery for patients with perforated peptic ulcer.

Science.gov (United States)

Bonin, Eduardo A; Moran, Erica; Gostout, Christopher J; McConico, Andrea L; Zielinski, Martin; Bingener, Juliane

2012-06-01

Perforation accounts for 70% of deaths attributed to peptic ulcers. Laparoscopic repair is effective but infrequently used. Our aim was to assess how many patients with perforated peptic ulcer could be candidates for a transluminal endoscopic omental patch closure. This retrospective study reviewed patients with perforated peptic ulcer from 2005 to 2010. Demographics, ulcer characteristics, operative procedure, and outcomes were recorded. Candidates for endoscopic transluminal repair were defined as those having undergone omental patch closure of an ulcer of appropriate size and no contraindications to laparoscopy or endoscopy. In the retrospective review, a total of 104 patients were identified; 62% female, mean age = 68 years, mean ASA of 3, and 63% medication-related ulcers. Fifty-nine (63%) had an omental patch (80% open), and 35 (37%) had other procedures. Ten patients had nonoperative management. Thirty-day mortality was 14% and 1 year mortality was 35%. Forty-nine patients (52%) were considered potential candidates for transluminal repair. Sixty-three percent of our patients sustained a medication-related perforation with 1 year mortality of 35%. The majority of patients were treated using open omental patch repair. Transluminal endoscopic repair may provide an additional situation for a minimally invasive approach for a number of these patients.

Nuclear medical quality control of transluminal coronary angioplastic (TCA)

International Nuclear Information System (INIS)

Klepzig, H. Jr.; Scherer, D.; Kober, G.; Kaltenbach, M.; Maul, F.D.; Standke, R.; Hoer, G.; Kanemoto, N.

1984-01-01

To assess the results of transluminal coronary angioplasty 48 patients with coronary heart disease were investigated at rest and during exercise with the ECG (46 patients), thallium-201 myocardial scintigraphy (26 patients), and equilibrium radionuclide ventriculography (38 patients). Exercise stress test was quantified by means of an ischemia score, myocardial scintigraphy by an vitality index and by corresponding redistribution factors, and radionuclide ventriculography by ejection fraction and maximum systolic volume change as a fraction of enddiastolic volume. The patients were divided into three groups: 36 patients had successful TCA (group 1); 6 patients underwent aortocoronary bypass operation (ACB, group 2); in 6 patients TCA was unsuccessful, they served as control (group 3). On average TCA yielded a reduction of coronary artery stenosis from 83% to 44%. Functional improvement was comparable in group 1 and 2: Ischemia score was reduced significantly. Perfusion index increased, the corresponding redistribution factors decreased. Left ventricular ejection fraction increased at rest and during exercise. Maximum systolic volume change increased correspondingly. Only slight changes were noted in group 3. Three months later 2 of 16 reinvestigated patients showed a restenosis and one a new narrowing distal to the successfully dilated stenosis. Functional deterioration could be demonstrated in these, whilst maintainance of the good functional results was documented in the others. (orig./MG) [de

Our experience with percutaneous nephrolithotomy in pediatric renal stone disease.

Science.gov (United States)

Oral, İlknur; Nalbant, İsmail; Öztürk, Ufuk; Can Şener, Nevzat; Yeşil, Süleyman; Göksel Göktuğ, H N; Abdurrahim İmamoğlu, M

2013-03-01

In this paper, we present our experience with percutaneous nephrolithotomy (PNL) in a pediatric patient group. From June 2007 to September 2010, we performed PNL on 57 pediatric patients. children with a mean age of 7.56 (1-15) years. Study population consisted of 30 male, and 27 female children with a mean age of 7.56 (1-5) years. Mean stone burden was calculated to be 312.2 (95-1550) mm(2). Percutaneous access was performed under fluoroscopy. Tract dilatation was accomplished with 20 F Amplatz dilators. Pneumatic lithotripsy was used to fragment the renal calculi. Mean operating time was 34 (3-80) minutes. With a single session of PNL, complete stone-free rates were achieved in 55 (96.4%) patients. Residual fragments were remained in 2 (3.5%) patients. Two patients had a febrile episode without signs and symptoms of bacteremia. Subcostal access was used in all of the patients, and none of the patients had any complications. Based on our experience, we conclude that PNL is a safe and effective method in the management of pediatric stone disease.

[Natural Orifice Transluminal Endoscopic Surgery (NOTES)].

Science.gov (United States)

Kim, Yong Sik; Kim, Chul Young; Chun, Hoon Jai

2008-03-01

Recently, the field of gastrointestinal endoscopy is developing rapidly. Once limited to the gastroinstestinal lumen, the endoscopic technology is now breaking the barriers and extending its boundary to peritoneal and pleural space. In 2004, Dr. Kalloo, a gastroenterologist, observed intraperitoneal organs of a pig using a conventional endoscope through the stomach wall. Since then, new endoscopic technique of intraperitoneal intervention with transluminal approach named the Natural Orifice Transluminal Endoscopic Surgery or NOTES has been introduced. NOTES reaches the target organ by inserting the endoscope through a natural orifice (e.g. mouth, anus, vagina, urethra) and entering the peritoneal lumen by means of making an incision on the luminal wall. After a series of successful experiences in animal studies, NOTES are now being tried on human subjects. There are still many obstacles to overcome, but bright future for this new technology is expected because of its proposed advantages of less pain, lower complication rate, short recovery time, and scarless access. In this review, we plan to learn about NOTES.

Balloon dilation of congenital supravalvular pulmonic stenosis in a dog

OpenAIRE

Treseder, Julia R.; Jung, SeungWoo

2017-01-01

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

Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

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Ozcan, Nevzat, E-mail: nevzatcan@yahoo.com; Kahriman, Guven, E-mail: guvenkahriman@hotmail.com; Mavili, Ertugrul, E-mail: ertmavili@yahoo.com [Erciyes University, Department of Radiology, Medical Faculty (Turkey)

2012-08-15

Purpose: To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient. Methods: Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14-92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. Percutaneous transhepatic cholangiography was performed, and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones were pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation. Results: Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 major complications (6.8%), including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were observed after the procedure. There was no mortality. Conclusion: Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.

Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

International Nuclear Information System (INIS)

Ozcan, Nevzat; Kahriman, Guven; Mavili, Ertugrul

2012-01-01

Purpose: To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient. Methods: Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14–92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. Percutaneous transhepatic cholangiography was performed, and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones were pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation. Results: Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 major complications (6.8%), including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were observed after the procedure. There was no mortality. Conclusion: Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.

The Relationship Between Neutrophil–Lymphocyte Ratio and Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Arteriovenous Fistula Stenosis When Using Conventional and Drug-Eluting Balloons

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Çildağ, Mehmet Burak, E-mail: mbcildag@yahoo.com [Adnan Menderes University, Department of Diagnostic and Interventional Radiology (Turkey); Çildağ, Songül, E-mail: songulcildag@yahoo.com [Adnan Menderes University, Department of Immunology and Allergy (Turkey); Köseoğlu, Ömer Faruk Kutsi, E-mail: kutsikoseoglu@yahoo.com [Adnan Menderes University, Department of Diagnostic and Interventional Radiology (Turkey)

2016-12-15

ObjectiveThe aim of this study is to investigate the potential association of neutrophil–lymphocyte ratio (NLR) between primary patency of percutaneous transluminal angioplasty (PTA) in hemodialysis arteriovenous fistula stenosis and type (Conventional and Drug-Eluting) of balloons used in PTA.Material-MethodThis retrospective study consists of 78 patients with significant arteriovenous fistulas stenosis who were treated with PTA by using Drug-Eluting Balloon (DEB) (n = 29) or Conventional Balloon (CB) (n = 49). NLR was calculated from preinterventional blood samples. All patients were classified into two groups. Group A; primary patency <12 months (43/78), Group B; primary patency ≥12 months (35/78). Cox regression analysis and Kaplan–Meier method were used to determine respectively independent factors affecting the primary patency and to compare the primary patency for the two balloon types.ResultsNLR ratio and balloon type of the two groups were significantly different (p = 0.002, p = 0.010). The cut-off value of NLR was 3.18 for determination of primary patency, with sensitivity of 81.4 % and specificity of 51.4 %. Primary patency rates between PTA with DEB and CB displayed statistically significant differences (p < 0.05). The cut-off value was 3.28 for determination of 12-month primary patency with the conventional balloon group; sensitivity was 81.8 % and specificity was 81.3 %. There was no statistical relation between NLR levels and the drug-eluting balloon group in 12-month primary patency (p = 0.927).ConclusionIncreased level of NLR may be a risk factor in the development of early AVF restenosis after successful PTA. Preferring Drug-Eluting Balloon at an increased level of NLR can be beneficial to prolong patency.

Effect of Post-Dilatation Following Primary PCI With Everolimus-Eluting Bioresorbable Scaffold Versus Everolimus-Eluting Metallic Stent Implantation

DEFF Research Database (Denmark)

Yamaji, Kyohei; Brugaletta, Salvatore; Sabaté, Manel

2017-01-01

OBJECTIVES: This study sought to investigate the effect of post-dilatation on angiographic and intracoronary imaging parameters in the setting of primary percutaneous coronary intervention comparing the everolimus-eluting bioresorbable scaffold (BRS) with the everolimus-eluting metallic stent (EE...

Percutaneous transhepatic cholangiographic forceps biopsy in pathologic diagnosis for obstructive jaundice

International Nuclear Information System (INIS)

Han Xinwei; Li Yongdong; Ma Bo; Xing Gusheng; Wu Gang; Gao Xuemei; Ma Nan

2004-01-01

Objective: To evaluate the technical feasibility and sensitivity of percutaneous transhepatic cholangiographic forceps biopsy in bile duct diseases. Methods: Between April 2001 and March 2003, 65 consecutive patients (36 men and 29 women; age range 33-88 years, mean 54 years) with obstructive jaundice underwent transluminal forceps biopsy or/and brush during percutaneous transhepatic cholangiography, percutaneous transhepatic cholangiography and drainage, or placement of stents. The technique was performed through an existing percutaneous transhepatic tract. Multiple specimens were obtained after passing the biopsy forceps or brush into a long 8-French sheath, and the specimens were fixed with formalin for pathologic or cytologic diagnosis. Statistical analysis was performed with the χ 2 test or Fisher exact probability, and P 2 =5.919, P=0.015). The cyctologic diagnosis was acquired in 43 of 58 patients with brush biopsy. Pathologic reports included cholangioadenocarcinoma (n=36), cholangiosquam-ocarcinoma (n=1), pancreatic adenocarcinoma (n=1), hepatocellular carcinoma (n=2), metastatic carcinoma (n=2), zoogloea aggregation (n=1), and negative results (n=15). The sensitivity rate of brush biopsy was 74.14%. Sensitivity of brush in the 45 patients with cholangiocarcinoma was higher than in the 11 patients with malignant tumors other than cholangiocarcinoma (82.22% vs 45.45%, χ 2 =4.563, P=0.033). Sensitivity of forceps biopsy in the 65 patients was higher than that of brush in the 58 patients (χ 2 =4.754, P=0.029). Conclusion: Percutaneous transhepatic cholangiobiopsy is a safe and minimal invasive procedure with no pain and low complication that is easy to perform with no addition trauma through a transhepatic biliary drainage tract. It is an effective, economic, accurate, and reliable new approach, which is safe and easy to perform in acquiring the pathologic diagnosis worthy to spread extensively. (authors)

Percutaneous yttrium aluminum garnet-laser lithotripsy of intrahepatic stones and casts after liver transplantation

DEFF Research Database (Denmark)

Schlesinger, Nis Hallundbaek; Svenningsen, Peter; Frevert, Susanne

2015-01-01

% needed additional interventions in the form of percutaneous transhepatic cholangiography and dilation (17%), re-PTCSL (11%), self-expandable metallic stents (22%), or hepaticojejunostomy (6%); and 22% eventually underwent retransplantation. The overall liver graft survival rate was 78%. Two patients died...

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

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Abhinav Goyal

2017-07-01

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

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

Science.gov (United States)

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

2017-01-01

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

Percutaneous treatment of critical lower limb ischemia in patients with obstruction of the crural arteries

International Nuclear Information System (INIS)

Falkowski, A.; Rutkowski, D.; Poncyliusz, W.; Sienko, J.

2006-01-01

This article describes the application of percutaneous transluminal angioplasty (PTA) in the treatment of crural artery obstruction in patients with critical lower limb ischemia. In 17 patients, 24 PTAs of crural artery obstructions were performed. The clinical material consisted of 9 men and 8 women, whose mean age was 72 years (range 54-85 years). 11 patients were classified in clinical stage Fontaine IV, and 6 in stage III. The obstructions were from 3 to 21 cm (mean 6 cm). In 8 cases, PTA of the femoropopliteal segment was also carried out. The risk factors and comorbidities included diabetes 10 cases (58.8%), hypertension 9 cases (56%), ischemic heart disease 8 cases (50%), hyperlipidaemia 7 cases (43.8%), cerebrovascular diseases 3 cases (18.8%), and cigarette smoking 6 cases (37.5%). Technical success was defined as restoration of the artery along its whole length to the foot. Pain relief at rest and healing of trophic lesions at 30-day follow-up were recognized as a good outcome. Technical success was achieved in 12 patients (70.6%). In 2 cases the patency was only restored in the proximal part of the artery (12.5%). In 3 cases (17.6%) the procedure failed. In one case acute occlusion of the artery occurred. In 2 cases the obstruction was not successfully passed with a guidewire. In 4 cases hematoma was found at the puncture site, without clinical consequences. In 13 patients (76.4%) clinical success was achieved. Percutaneous transluminal angioplasty is an effective and relatively safe method of treatment of patients with critical limb ischemia caused by obstruction of the crural arteries. (author)

Pediatric interventional radiology: Indications, techniques, and management

International Nuclear Information System (INIS)

Towbin, R.B.; Ball, W.S. Jr.

1987-01-01

This course develops a practical approach to pediatric interventional radiology. Radiologic intervention in the pediatricage group is possible by attending to the care and special needs of the child. The authors also emphasize their approach to patient preparation, sedation and anesthesia, nursing care, monitoring of the patient during the procedure, and follow-up care. The course is divided into nonvascular and vascular sections. The discussion of nonvascular procedures focus on the chest and the GU and GI systems. Biopsy techniques and drainage of effusions and abscesses within the chest are discussed. A variety of GU procedures are presented including insertion of a nephrostomy tube and percutaneous tract dilation for placement of internal stents, percutaneous stone removal, and percutaneous surgery for pyeloplasty. The authors approach to percutaneous pyeloplasty is briefly discussed. Intervention within the GI system includes percutaenous aspiration, drainage, and biopsies. Emphasis is placed on the selection of embolic agents and catheter delivery systems, techniques, and current treatment concepts. The authors describe experience with embolization of vascular malformations, renovascular disease, uncontrollable hemorrhage, and selected neoplastic processes. Comments on the indications for and techniques of transluminal angioplasty and fibrinolytic therapy in children conclude the lecture

Percutaneous dilational tracheostomy (PDT) and prevention of blood aspiration with superimposed high-frequency jet ventilation (SHFJV) using the tracheotomy-endoscope (TED): results of numerical and experimental simulations.

Science.gov (United States)

Nowak, Andreas; Langebach, Robin; Klemm, Eckart; Heller, Winfried

2012-04-01

We describe an innovative computer-based method for the analysis of gas flow using a modified airway management technique to perform percutaneous dilatational tracheotomy (PDT) with a rigid tracheotomy endoscope (TED). A test lung was connected via an artificial trachea with the tracheotomy endoscope and ventilated using superimposed high-frequency jet ventilation. Red packed cells were instilled during the puncture phase of a simulated percutaneous tracheotomy in a trachea model and migration of the red packed cells during breathing was continuously measured. Simultaneously, the calculation of the gas-flow within the endoscope was numerically simulated. In the experimental study, no backflow of blood occurred during the use of superimposed high-frequency jet ventilation (SHFJV) from the trachea into the endoscope nor did any transportation of blood into the lower respiratory tract occur. In parallel, the numerical simulations of the openings of TED show almost positive volume flows. Under the conditions investigated there is no risk of blood aspiration during PDT using the TED and simultaneous ventilation with SHFJV. In addition, no risk of impairment of endoscopic visibility exists through a backflow of blood into the TED. The method of numerical simulation offers excellent insight into the fluid flow even under highly transient conditions like jet ventilation.

Angioplasty: MedlinePlus Health Topic

Science.gov (United States)

... segment (Medical Encyclopedia) Also in Spanish Directional coronary atherectomy (DCA) (Medical Encyclopedia) Also in Spanish Percutaneous transluminal ... segment Coronary artery balloon angioplasty - slideshow Directional coronary atherectomy ... transluminal coronary angioplasty (PTCA) Stent Related ...

Percutaneous Balloon Dilatation for the Treatment of Early and Late Ureteral Strictures After Renal Transplantation: Long-Term Follow-Up

International Nuclear Information System (INIS)

Bachar, Gil N.; Mor, E.; Bartal, G.; Atar, Eli; Goldberg, N.; Belenky, A.

2004-01-01

We report our experience with percutaneous balloon dilatation (PBD) for the treatment of ureteral strictures in patients with renal allografts. Of the 422 consecutive patients after renal transplantation in our center 10 patients had ureteral strictures. An additional 11 patients were referred from other centers. The 21 patients included 15 men and 6 women aged 16 to 67 years. Strictures were confirmed by sonography and scintigraphy in all cases. Patients underwent 2 to 4 PBDs at 7-10-day intervals. Clinical success was defined as resolution of the stenosis and hydronephrosis on sequential ultrasound and normalization of creatinine levels. Patients were divided into two groups: those who underwent transplantation more than 3 months previously and those who underwent transplantation less than 3 months previously. PBD was successful in 13 of the 21 patients (62%). There was no statistically significant difference in success rate between the patients with early (n 12) and those with late (n = 9) obstruction: 58.4% and 66%, respectively. No major complications were documented. PBD is a safe and simple tool for treating ureteral strictures and procedure-related morbidity is low. It can serve as an initial treatment in patients with early or late ureteral strictures after renal transplantation

Trabectome-Initiated Gonioscopy-Assisted Transluminal Trabeculotomy.

Science.gov (United States)

Smith, Brett L; Ellyson, Austin C; Kim, Won I

2018-03-01

To introduce a trabectome-initiated gonioscopy-assisted transluminal trabeculotomy (TIGATT) procedure and to report preliminary results. A preliminary case series of eight patients who have undergone the newly proposed TIGATT procedure is presented. TIGATT is a new concept that modifies established techniques by replacing the initial goniotomy incision of gonioscopy-assisted transluminal trabeculotomy (GATT) with an ab interno trabeculectomy ablation utilizing the trabectome. All surgeries were performed by a single surgeon (W.I.K.) between November 2014 and October 2015 in adults with primary open-angle glaucoma. Recorded outcome measures were intraocular pressure (IOP), number of medications, and complications. Eight patients with an age range of 63-93 yr underwent TIGATT with at least 3 mo of follow-up. Five of the eight initial patients had follow-up to 2 yr. The mean pre-operative IOP was 25 mmHg (standard deviation [SD] 7.0) on four medications (SD 1.1). The mean post-operative IOP at 3 mo was 14 mmHg (SD 1.8) on two medications (SD 1.3). The average decrease in IOP was 9.9 mmHg (SD 7.5) with an average decrease in medications of two (SD 1.4) at 3 mo. At 2 yr, the mean post-operative IOP was 14 mmHg (SD 3.2) on one medication (SD 1.1). The average decrease in IOP was 7.8 mmHg (SD 3.1) with an average decrease in medications of two (SD 1.8). There were two treatment failures that required further glaucoma surgery and one patient was lost to follow-up. The preliminary results and safety profile for TIGATT are promising and appear at least comparable with previously published results for both GATT and trabectome. Initiating the transluminal trabeculotomy with trabectome clearly exposes Schlemm's canal and facilitates threading the microcatheter into the canal. Additionally, if the 360-degree trabeculotomy cannot be completed because of an incompletely patent Schlemm's canal, the patient will at least have a trabectome ablation that can serve as their glaucoma

Percutaneous coil embolization in the management of spermatic varicocele

Energy Technology Data Exchange (ETDEWEB)

Yang, Seoung Oh [Capital Armed Forces General Hospital, Seoul (Korea, Republic of); Park, Jae Hyung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

1987-10-15

Percutaneous occlusion of the internal spermatic vein is a new, safe, and effective alternative therapy to surgical ligation in the treatment of spermatic varicocele. Embolization with stainless steel coils was done on 10 patients with symptomatic spermatic varicocele immediately after diagnostic venography. The results of these procedures were assessed by clinical improvement of symptoms and objective diminution of the dilated pampiniform plexus demonstrable using scrotal ultrasonography. In one patient with single coil occlusion had a recurrence, and the other 9 patients showed both clinical and ultrasonographic improvements of the varicocele. Percutaneous embolization with steel coils appeared to be effective without major complications and the savings of hospitalization and general anesthesia are important additional merits of this method being performed in the radiologic department on an outpatient basis.

Transluminal laser angioplasty

Science.gov (United States)

Otto, Wlodzimierz

1996-03-01

Twenty seven patients with femoral artery occlusion were treated by transluminal Nd:YAG laser angioplasty, in 16 patients the procedure was combined with intraarterial infusion of rTPA (actilyse-Boehringer Ing). In 5 out of 11 patients from the initial group recanalization was not successful. In 16 patients from the rTPA group satisfactory immediate results were achieved in all cases. In long time observations ranging from 9 to 24 months all patients remained free from symptoms, although in 4 of them angiography and Doppler ultrasound examination reveal no flow in the femoral artery. In the remaining 12 patients (75%), the previously occluded artery is patent. No complications of laser angioplasty nor intraarterial infusion of rTPA were noted in this series.

Transluminal Angioplasty of Peroneal Artery Branches in Diabetics: Initial Technical Experience

International Nuclear Information System (INIS)

Graziani, Lanfroi; Silvestro, Antonio; Monge, Luca; Boffano, Gian Mario; Kokaly, Francesco; Casadidio, Ilaria; Giannini, Francesco

2008-01-01

The present study aimed to report the technical feasibility of percutaneous transluminal angioplasty (PTA) of obstructed or insufficient collateral branches (anterior and posterior perforating branches) from distal peroneal to foot arteries in diabetic patients with chronic critical limb ischemia (CLI) and chronic noncrossable occlusion of the anterior and posterior tibial arteries. Twenty-four diabetic CLI patients (age, 67 ± 8 years; 87% males) undergoing collateral PTA were included. Baseline clinical angiographic and follow-up data were retrospectively reviewed. Collateral PTA was associated with a concomitant PTA of other sites in 21 (83%) cases. In 15 cases the treated collateral linked the peroneal with the plantaris communis; in 9 cases, the peroneal with the dorsalis pedis. Angiographic results of collateral PTA were good in 13 cases (<30% residual stenosis), whereas the result was considered moderate (30%-49% residual stenosis) in the remaining cases. Neither perforation nor acute occlusion of the treated collaterals or other relevant complications were observed. Mean follow-up was 32 ± 17 months. Major amputation was necessary for two (8.3%) patients. Cumulative limb salvage rates at 2 and 4 years were 96% and 87%, respectively. In conclusion, this initial experience shows that PTA of the collateral branches from distal peroneal to foot arteries is a feasible technique. Future studies are required to define the clinical role of this novel approach

Central venous obstruction in hemodialysis patients: the usefulness of percutaneous treatment

International Nuclear Information System (INIS)

Kim, Cheol Young; Goo, Dong Erk; Kim, Dae Ho; Hong, Hyun Suk; Lee, Hae Kyoung; Choi, Duk Lin; Yang, Sung Boo; Moon, Chul

2002-01-01

To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. In 100 patients, 107 central venous strictures (56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23,stenosis:28)) were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion was also determined. We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2-and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required

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

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Diana Martins

2018-02-01

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

Pioneers of invasive cardiovascular medicine - Charles Theodore dotter and colleagues: Short historical review

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Kostić Jelena

2014-01-01

Full Text Available Within modern medicine at the beginning of 21st century, we are witnessing a revolutionary development of the invasive diagnostics and therapy of cardiovascular system diseases. With the discovery of X-rays at the end of 19th century by Wilhelm Roentgen, it is appropriate to reflect on the gifted individuals whose efforts drastically altered radiology and cardiology. The early techniques used in peripheral percutaneous transluminal angioplasty form the basis for subsequent percutaneous intervention both in the peripheral and coronary arteries and are largely the contribution of Charles Dotter. The main goal of his work was the use of catheters for diagnosis and treatment in an attempt to replace the scalpel. He was 20 years ahead of his time, especially with percutaneous transluminal angioplasty. The first percutaneous transluminal angioplasty marked a new era in the treatment of peripheral atherosclerotic lesions. This practical genius dedicated his considerable energy to the belief that there is always a better way to treat disease. His personal contributions to clinical medicine, research, and teaching have saved millions of limbs and lives all over the world. European physicians, who were more open to unproven techniques, almost immediately embraced percutaneous transluminal angioplasty. Without the contribution and help of his colleagues, Forssmann, Sones and Gruntzig, all of them pioneers, nothing would be done. They were all ahead of there time and opened completely new chapter in medicine.

Antegrade balloon dilatation and ureteral stenting for the benign ureteral strictures

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Kim, Seung Hyup; Park, Jae Hyung; Han, Man Chung

1994-01-01

To evaluate the role of antegrade balloon dilatation and ureteral stenting in benign ureteral strictures. Percutaneous antegrade balloon dilatation was attempted in 46 patients with benign ureteral strictures. The underlying causes of the strictures were urinary tract tuberculosis in 20 patients, congenital ureteropelvic junction obstruction in eight, ureteroneocystostomy or ureteroileostomy state in five, postoperative or post-extracorporeal shock wave lithotripsy state for ureteral calculi in eight, ureteral injury during surgery in four, and retroperitoneal fibrosis in one. Antegrade balloon dilatation was performed with initial technical success in 43 patients but the procedure was aborted in the remaining three with urinary tract tuberculosis due to the failure in passing a guidewire through the stenotic lesions. Intravenous urograms obtained 4-76 months after the procedure showed improvements in 76% (13/17) with urinary tract tuberculosis, in 63%(5/8) with congenital ureteropelvic junction obstruction, in 88%(7/8) with strictures associated with ureteral calculi, and in 100%(4/4) with iatrogenic ureteral injury. The results were relatively poor in strictures of the ureteral anastomosis(1/5) and in ureteral strictures associated with retroperitoneal fibrosis (0/1). Antegrade balloon dilatation of the urinary tract combined with ureteral stenting was an effective technique for the management of the benign ureteral strictures

Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures

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Patel, Prashant, E-mail: p.patel@bham.ac.uk [University of Birmingham, School of Cancer Sciences, Vincent Drive (United Kingdom); Rangarajan, Balaji; Mangat, Kamarjit, E-mail: kamarjit.mangat@uhb.nhs.uk, E-mail: kamarjit.mangat@nhs.net [University Hospital Birmingham NHS Trust, Department of Radiology (United Kingdom)

2015-08-15

PurposeVarious methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.Materials and MethodsFifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified “cross and push” technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing the stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.ResultsWe report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2 %, respectively. There was one procedure-related late complication.ConclusionWe propose that the modified “cross and push” technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree.

Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures

International Nuclear Information System (INIS)

Patel, Prashant; Rangarajan, Balaji; Mangat, Kamarjit

2015-01-01

PurposeVarious methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.Materials and MethodsFifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified “cross and push” technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing the stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.ResultsWe report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2 %, respectively. There was one procedure-related late complication.ConclusionWe propose that the modified “cross and push” technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree

Percutaneous reconstruction of the innominate bifurcation using the retrograde 'kissing stents' technique

International Nuclear Information System (INIS)

Nagata, Shun-ichi; Kazekawa, Kiyoshi; Matsubara, Shuko; Sugata, Sei

2006-01-01

Obstructions of the supraaortic vessels are an important cause of morbidity associated with a variety of symptoms. Percutaneous transluminal angioplasty has evolved as an effective and safe treatment modality for occlusive lesions of the supraaortic vessels. However, the endovascular management of an innominate bifurcation has not previously been reported. A 53-year-old female with a history of systematic hypertension, diabetes mellitus and hypercholesterolemia presented with left hemiparesis and dysarthria. Angiography of the innominate artery showed a stenosis of the innominate bifurcation. The lesion was successfully treated using the retrograde kissing stent technique via a brachial approach and an exposed direct carotid approach. The retrograde kissing stent technique for the treatment of a stenosis of the innominate bifurcation was found to be a safe and effective alternative to conventional surgery. (orig.)

Postoperative intraabdominal fluid collections : a modified percutaneous drainage method using a surgical drain track

International Nuclear Information System (INIS)

Lee, Deok Hee; Kim, Gab Choul; Hwang, Jae Cheol; Yoon, Hyun Ki; Song, Ho Young; Sung, Kyu Bo

2000-01-01

In the management of postoperative fluid collection, the conventional percutaneous drainage method can be employed. Because of abdominal incisions and various types of surgical drains and/or T-tubes, the application of this method is not always easy, however. We inserted a drainage catheter through a pre-existing percutaneous track formed by a surgical drain located adjacent to the site of abnormal fluid collection. There was no need to remove the drain nor make an additional puncture in the abdominal wall. A dilator was inserted along the drain, and a guide wire was used to negotiate its intraperitoneal track and reach the accumulated fluid. The procedure was simple and safe. We briefly describe our experience of this modified percutaneous drainage technique, as used in three cases involving postoperative fluid collection. (author)

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

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

1988-01-01

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

Submucosal tunneling using endoscopic submucosal dissection for peritoneal access and closure in natural orifice transluminal endoscopic surgery: a porcine survival study.

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Yoshizumi, F; Yasuda, K; Kawaguchi, K; Suzuki, K; Shiraishi, N; Kitano, S

2009-08-01

Safe peritoneal access and gastric closure are the most important concerns in the clinical application of natural orifice transluminal endoscopic surgery (NOTES). We aimed to clarify the feasibility of a submucosal tunnel technique using endoscopic submucosal dissection (ESD) for transgastric peritoneal access and subsequent closure for NOTES. Seven female pigs, each weighing about 40 kg were included in the study. The following procedures were performed: (i) after injection of normal saline into the submucosa, the mucosa was cut with a flex knife; (ii) the submucosal layer was dissected using an insulation-tipped electrosurgical knife to make a narrow longitudinal 50-mm submucosal tunnel; (iii) a small incision was made at the end of the tunnel and enlarged with a dilation balloon. After transgastric peritoneoscopy, the mucosal incision site was closed with clips. The following outcome measures were used: (a) evaluation of the technical feasibility of making a submucosal tunnel; (b) clinical monitoring for 7 days; (c) follow-up endoscopy and necropsy; and (d) peritoneal fluid culture. Natural orifice transluminal endoscopic peritoneoscopy with a submucosal tunnel was successfully carried out in all pigs. The pigs recovered well, without signs of peritonitis. Follow-up endoscopy showed healing of mucosal incision sites without open defects. Necropsy revealed no findings of peritonitis, confirming completeness of gastric closure; there was a thin scar in one pig and adhesion of the omentum in six pigs. Peritoneal fluid culture demonstrated no bacterial growth. The submucosal tunnel technique is feasible and effective for transgastric peritoneal access and closure.

Percutaneous Tracheostomy

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Mehta, Chitra; Mehta, Yatin

2017-01-01

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. PMID:28074819

Cirugía endoscópica transluminal por orificios naturales: NOTES Natural orifice transluminal endoscopic surgery: NOTES

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M. J. Varas Lorenzo

2009-04-01

Full Text Available Se presenta una revisión actual, puesta al día, y punto de vista de los autores sobre un tema sumamente novedoso y atractivo, como es la Cirugía Endoscópica Transluminal por Orificios Naturales (NOTES: Natural Orifice Translumenal Endoscopic Surgery. La mayoría de los trabajos revisados se han realizado en animales de experimentación, pero la publicación de la colecistectomía por vía transvaginal, y la aparición de editoriales y artículos de revisión sobre el tema, nos llevan a realizar una serie de preguntas no resueltas actualmente sobre este tipo de cirugía, que representa un avance potencial para conseguir "una cirugía endoscópica sin cicatrices, sin infecciones, con mínimos requerimientos de anestesia y una inmediata recuperación".A current review and update of an exceedingly novel and appealing topic, namely natural orifice transluminal endoscopic surgery (NOTES, is discussed, as well as the authors' viewpoint thereon. Most reviewed studies were performed in laboratory animals, but reports on transvaginal cholecystectomy and the emergence of editorials and review articles on this topic pose a number of as yet unanswered questions on this type of surgery, which represents a potential advance towards "endoscopic surgery with no scars, no infection, minimal anesthesia requirements, and immediate recovery".

Relationship between the total length of the stents and patients' quality of life after percutaneous coronary intervention.

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Liu, Wei; Yang, Xuming; Dong, Pingshuan; Li, Zhijuan

2015-01-01

The aim of this study was to examine the relationship between the total length of the stents and the postoperative life quality of patients with multi-vessel coronary artery disease who undergo percutaneous coronary intervention (PCI). Using the short-form health survey (SF-36) items, we analyzed the data on the postoperative life quality of 166 patients with multi-vessel coronary artery disease who underwent percutaneous transluminal coronary intervention in the Department of Cardiology of the First Affiliated Hospital of Henan University of Science and Technology from September 2011 to September 2013. Follow-up was performed 6 months later. All of the dimensionalities, except general health and mental health, showed significantly higher scores after PCI. No significant relationships were observed between the total length of the stents and the postoperative life quality of patients with multi-vessel coronary artery disease who underwent PCI. PCI can effectively improve the postoperative life quality of patients; however, there was no significant relationship between the total length of the stents and postoperative life quality of patients.

Percutaneous coil embolization of massive pelvic pseudoaneurysm in an infant.

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

2015-06-01

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

Percutaneous treatment of benign bile duct strictures

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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.

[Percutaneous tracheotomy].

Science.gov (United States)

Paleczny, J; Maciejewski, D; Łoniewska-Paleczny, E; Sawczuk, M; Kaczur, A

2000-01-01

The purpose of this study was to compare on the basis of up to date papers currently applied methods of the percutaneous tracheostomy (PT). There are four main PT methods by: Ciaglia, Schachner, Griggs and Fantoni. In these methods a wire is introduced into the trachea serving as a guide for special forceps or series of dilatators of increasing diameter to dilate the wall and allow cannulation of the trachea. In the literature authors found a low incidence of complications after PT. Acute complications were documented in 6-18% and late complications in 1-3% of the patients. Follow-up showed no late obstructive complications at the level of stomia and very low (0.3-0.36%) mortality risk. Translaryngeal tracheostomy (TLT) by Fantoni ensures minimal risk of complications and tissue trauma. In the TLT method through a needle inserted in to the trachea a guide wire is retrogradely pushed out of the mouth and attached to special flexible tracheostomy tube by flexible plastic cone with pointed metal tip. This device is then pulled back through larynx and outwards across the trachea and neck wall by traction on the wire. TLT can also be used in infants and children and in difficult patients in whom other techniques are riskier Review of the literature suggests that the PT can be safe and also cost-effective for properly selected patients in intensive care and other hospital units.

Percutaneous transhepatic fragmentation of gall stones and extraction of fragments

International Nuclear Information System (INIS)

Guenther, R.; Klose, K.; Schmidt, H.D.; Staritz, M.; Mainz Univ.; Mainz Univ.

1983-01-01

Attempts at percutaneous removal have been made in 13 patients with solitary and multiple intra- and extra-hepatic biliary duct stones measuring 5 to 30 mm. The stones were fragmented with a Dormia basket and the fragments removed transhepatically. In ten patients the procedure was successful, including one patient with multiple intra-hepatic stones. The procedure can be recommended for cases of calculous obstruction of biliary anastomoses or of stones which could not be removed by endoscopy, or where there is already biliary drainage being carried out, or in patients with a high opertive risk. In two patients, dilatation of the papilla was also carried out, in four patients a stenosis was dilated and in a further two patients, electro-incision of a stenosis was performed. (orig.) [de

EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos).

Science.gov (United States)

Khashab, Mouen A; Valeshabad, Ali Kord; Modayil, Rani; Widmer, Jessica; Saxena, Payal; Idrees, Mehak; Iqbal, Shahzad; Kalloo, Anthony N; Stavropoulos, Stavros N

2013-11-01

EUS-guided biliary drainage (EGBD) can be performed via direct transluminal or rendezvous techniques. It is unknown how both techniques compare in terms of efficacy and adverse events. To describe outcomes of EGBD performed by using a standardized approach and compare outcomes of rendezvous and transluminal techniques. Retrospective analysis of prospectively collected data. Two tertiary-care centers. Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EGBD after failed ERCP between July 2006 and December 2012 were included. EGBD by using a standardized algorithm. Technical success, clinical success, and adverse events. During the study period, 35 patients underwent EGBD (rendezvous n = 13, transluminal n = 20). Technical success was achieved in 33 patients (94%), and clinical success was attained in 32 of 33 patients (97.0%). The mean postprocedure bilirubin level was 1.38 mg/dL in the rendezvous group and 1.33 mg/dL in the transluminal group (P = .88). Similarly, length of hospital stay was not different between groups (P = .23). There was no significant difference in adverse event rate between rendezvous and transluminal groups (15.4% vs 10%; P = .64). Long-term outcomes were comparable between groups, with 1 stent migration in the rendezvous group at 62 days and 1 stent occlusion in the transluminal group at 42 days after EGBD. Retrospective analysis, small number of patients, and selection bias. EGBD is safe and effective when the described standardized approach is used. Stent occlusion is not common during long-term follow-up. Both rendezvous and direct transluminal techniques seem to be equally effective and safe. The latter approach is a reasonable alternative to rendezvous EGBD. Copyright © 2013. Published by Mosby, Inc.

Percutaneous reconstruction of the innominate bifurcation using the retrograde 'kissing stents' technique

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Nagata, Shun-ichi; Kazekawa, Kiyoshi; Matsubara, Shuko [Fukuoka University Chikushi Hospital, Department of Neurosurgery, Chikushino, Fukuoka (Japan); Sugata, Sei [Bironoki Neurosurgical Hospital, Shibushi, Kagoshima (Japan)

2006-08-15

Obstructions of the supraaortic vessels are an important cause of morbidity associated with a variety of symptoms. Percutaneous transluminal angioplasty has evolved as an effective and safe treatment modality for occlusive lesions of the supraaortic vessels. However, the endovascular management of an innominate bifurcation has not previously been reported. A 53-year-old female with a history of systematic hypertension, diabetes mellitus and hypercholesterolemia presented with left hemiparesis and dysarthria. Angiography of the innominate artery showed a stenosis of the innominate bifurcation. The lesion was successfully treated using the retrograde kissing stent technique via a brachial approach and an exposed direct carotid approach. The retrograde kissing stent technique for the treatment of a stenosis of the innominate bifurcation was found to be a safe and effective alternative to conventional surgery. (orig.)

Ultrasound-Guided Percutaneous Dilational Tracheostomy: A Systematic Review of Randomized Controlled Trials and Meta-Analysis.

Science.gov (United States)

Gobatto, André L N; Besen, Bruno A M P; Cestari, Mino; Pelosi, Paolo; Malbouisson, Luiz M S

2018-01-01

Percutaneous dilational tracheostomy (PDT) is a common and increasingly used procedure in the intensive care unit (ICU). It is usually performed with bronchoscopy guidance. Ultrasound has emerged as a useful tool in order to assist PDT, potentially improving its success rate and reducing procedural-related complications. To investigate whether the ultrasound-guided PDT is equivalent or superior to the bronchoscopy-guided or anatomical landmarks-guided PDT with regard to procedural-related and clinical complications. A systematic review of randomized clinical trials was conducted comparing an ultrasound-guided PDT to the control groups (either a bronchoscopy-guided PDT or an anatomical landmark-guided PDT) in patients undergoing a PDT in the ICU. The primary outcome was the incidence of major procedural-related and clinical complication rates. The secondary outcome was the incidence of minor complication rates. Random-effect meta-analyzes were used to pool the results. Four studies fulfilled the inclusion criteria and they were analyzed. The studies included 588 participants. There were no differences in the major complication rates between the patients who were assigned to the ultrasound-guided PDT when compared to the control groups (pooled risk ratio [RR]: 0.48; 95% confidence interval [CI]: 0.13-1.71, I 2 = 0%). The minor complication rates were not different between the groups, but they had a high heterogeneity (pooled RR: 0.49; 95% CI 0.16-1.50; I 2 = 85%). The sensitivity analyzes that only included the randomized controlled trials that used a landmark-guided PDT as the control group showed lower rates of minor complications in the ultrasound-guided PDT group (pooled RR: 0.55; 95% CI: 0.31-0.98, I 2 = 0%). The ultrasound-guided PDT seems to be safe and it is comparable to the bronchoscopy-guided PDT regarding the major and minor procedural-related or clinical complications. It also seems to reduce the minor complications when compared to the anatomical

Kronisk tarmiskæmi hos en yngre patient

DEFF Research Database (Denmark)

Hansen, Lars Koch; Kammerlander, Heidi; Cecere, Stefano

2012-01-01

A 46 year-old woman presented with classic symptoms. Computed tomography-angiography and duplex ultrasonography showed stenosis of the aa. mesenteria superior et inferior. The patient was moved to a university hospital and a percutaneous transluminal angioplasty with insertion of stents was perfo......A 46 year-old woman presented with classic symptoms. Computed tomography-angiography and duplex ultrasonography showed stenosis of the aa. mesenteria superior et inferior. The patient was moved to a university hospital and a percutaneous transluminal angioplasty with insertion of stents...... was performed. She was discharged shortly after feeling well....

Long-Term Results of Percutaneous Bilioenteric Anastomotic Stricture Treatment in Liver-Transplanted Children

International Nuclear Information System (INIS)

Moreira, Airton Mota; Carnevale, Francisco Cesar; Tannuri, Uenis; Suzuki, Lisa; Gibelli, Nelson; Maksoud, Joao Gilberto; Cerri, Giovanni Guido

2010-01-01

The purpose of this study was to evaluate the mid- and long-term results of percutaneous transhepatic cholangiography (PTC) and biliary drainage in children with isolated bilioenteric anastomotic stenosis (BAS) after pediatric liver transplantation. Sixty-four children underwent PTC from March 1993 to May 2008. Nineteen cholangiograms were normal; 10 showed intrahepatic biliary stenosis and BAS, and 35 showed isolated BAS. Cadaveric grafts were used in 19 and living donor grafts in 16 patients. Four patients received a whole liver, and 31 patients received a left lobe or left lateral segment. Roux-en-Y hepaticojejunostomy was performed in all patients. Indication for PTC was based on clinical, laboratory, and histopathologic findings. In patients with isolated BAS, dilation and biliary catheter placement, with changes every 2 months, were performed. Patients were separated into 4 groups according to number of treatment sessions required. The drainage catheter was removed if cholangiogram showed no significant residual stenosis and normal biliary emptying time after a minimum of 6 months. The relationship between risk factors (recipient's weight 20 months, 4 patients (4 of 35; 11.4%) required 1 additional treatment session (group III), and 1 patient (1 of 35; 2.9%) had a catheter placed at the end of the study period (group IV). Drainage time in group I was significantly shorter than those in groups II, III, and IV (p 0.05). The majority of complications, such as catheter displacement and leakage, were classified as minor; however, 2 patients (5.7%) with hemobilia were noted. Complications increased according to the need for reintervention. In conclusion, balloon dilation and percutaneous drainage placement is safe and effective, and it has long-term patency for children with BAS after liver transplantation. Because of prolonged treatment time, reintervention may be necessary, thereby increasing the complication rate. Balloon dilation and percutaneous drainage

Ultrasound-Guided Percutaneous Drainage of Neonatal Pyometrocolpos Under Local Anesthesia

International Nuclear Information System (INIS)

Algin, Oktay; Erdogan, Cuneyt; Kilic, Nizamettin

2011-01-01

Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improved clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.

Patient and physician perception of natural orifice transluminal endoscopic appendectomy

Czech Academy of Sciences Publication Activity Database

Hucl, T.; Saglová, A.; Beneš, M.; Kocík, M.; Oliverius, M.; Valenta, Zdeněk; Špičák, J.

2012-01-01

Roč. 18, č. 15 (2012), s. 1800-1805 ISSN 1007-9327 Institutional research plan: CEZ:AV0Z10300504 Keywords : natural orifice transluminal endoscopic surgery * patient perception * physician perception * appendectomy * laparoscopy Subject RIV: FJ - Surgery incl. Transplants Impact factor: 2.547, year: 2012

PTA and Stenting of Benign Venous Stenoses in the Pelvis: Long-Term Results

International Nuclear Information System (INIS)

Wohlgemuth, Walter A.; Weber, Hermann; Loeprecht, Henning; Tietze, Wolfram; Bohndorf, Klaus

2000-01-01

Purpose: To provide follow-up data on endovascular intervention for venous stenoses in the pelvis.Methods: Between 1985 and 1995, 35 patients presented with 42 stenoses of the pelvic veins after operative thrombectomy and creation of an arteriovenous fistula, combined with intraoperative venous angioscopy. All patients underwent angioplasty and, if unsuccessful, percutaneous insertion of an endovascular stent (n = 7).Results: Angioplasty with and without endovascular stenting was technically successful in 34 of 35 patients (97%). Average length of the stenoses was 20.6 mm (range 10-90 mm), average diameter before dilation 4.1 mm (range 2-6 mm), and average diameter after dilation 10.1 mm (range 5-18 mm). Intraoperative angioscopy showed pathologic findings (intimal laceration or residual thrombotic material) in 14 patients. After an average follow-up period of 4.13 years, 24 (69%) patients had patent veins. The difference in the primary patency rate between patients with angioscopically abnormal veins (6 of 14 patients, corresponding to a patency rate of 43%) and patients with angioscopically normal veins after thrombectomy (18 of 21 patients, corresponding to a patency rate of 86%) was statistically significant (p < 0.01, log rank test).Conclusions: Percutaneous transluminal angioplasty and/or stenting are good treatment modalities for pelvic vein stenosis following surgical thrombectomy. Angioscopically abnormal veins have a poorer long-term patency, regardless of the type of intervention

Esophageal dilatation using the Eder Puestow dilators.

Science.gov (United States)

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

1976-06-01

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

Percutaneous trans-papillary elimination of common bile duct stones using an existing gallbladder drain for access.

Science.gov (United States)

Atar, Eli; Neiman, Chaim; Ram, Eduard; Almog, Mazal; Gadiel, Itai; Belenky, Alexander

2012-06-01

The presence of stones in the common bile duct (CBD) may cause complications such as obstructing jaundice or ascending cholangitis, and the stones should be removed. To assess the efficacy of percutaneous elimination of CBD stones from the gallbladder through the papilla. During a 4 year period, six patients (five men and one woman, mean age 71.5 years) who had CBD stones and an existing gallbladder drain underwent percutaneous stone push into the duodenum after balloon dilatation of the papilla, with a diameter equal to that of the largest stone. Access into the CBD was from the gallbladder, using an already existing percutaneous gallbladder drain (cholecystostomy tube). Each patient had one to three CBD stones measuring 7-14 mm. Successful CBD stone elimination into the duodenum was achieved in five of the six patients. The single failure occurred in a patient with choledochal diverticulum, who was operated successfully. There were no major or minor complications during or after the procedures. Trans-cholecystic CBD stone elimination is a safe and feasible percutaneous technique that utilizes existing tracts, thus obviating the need to create new percutaneous access. This procedure can replace endoscopic or surgical CBD exploration.

Transhepatic Balloon Dilatation of Early Biliary Strictures in Pediatric Liver Transplantation: Successful Initial and Mid-Term Outcome

International Nuclear Information System (INIS)

Belenky, Alexander; Mor, Eytan; Bartal, Gabriel; Atar, Eli; Shapiro, Riki; Bar-Nathan, Nathan; Bachar, Gil N.

2004-01-01

Purpose: To evaluate the initial and mid-term outcomes of transhepatic balloon dilatation for the treatment of early biliary strictures in lateral left-segment liver transplants in young children.Methods: Between April 1997 and May 2001, seven children aged 9 months to 6 years with nine benign strictures in left-segment liver grafts were treated percutaneously. Sessions of two or three dilations were performed three or four times at average intervals of 10-20 days. In each session, the biliary stenoses were gradually dilated using balloons of 3-7 mm. Follow-up ranged from 12 to 54 months (mean 27 months, median 12 months). Clinical success was defined as resolution of the stenosis, normalization of liver enzymes and lack of clinical symptoms. Results: Technical success was achieved in all nine strictures. Hemobilia occurred in one patient and was successfully treated. On follow-up, all patients had complete clinical recovery with normalization of liver function and imaging of patent bile ducts. Conclusion: Balloon dilatation is an effective and relatively safe method for the treatment of early biliary strictures in left-segment liver transplantation in young children. We recommend this approach as the initial treatment for early strictures. Metal stents or surgery should be reserved for patients with late appearance of strictures or failure of balloon dilatation

The Accordion Sign in the Transplant Ureter: Ramifications During Balloon Dilation of Strictures

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Kriegshauser, J. Scott, E-mail: skriegshauser@mayo.edu; Naidu, Sailen G. [Mayo Clinic Hospital, Department of Radiology (United States); Chang, Yu-Hui H. [Mayo Clinic, Department of Biostatistics (United States); Huettl, Eric A. [Mayo Clinic Hospital, Department of Radiology (United States)

2015-04-15

PurposeThis study was designed to demonstrate the accordion sign within the transplant ureter and evaluate its ramifications during balloon dilation of strictures.MethodsA retrospective electronic chart and imaging review included demographic characteristics, procedure reports, and complications of 28 renal transplant patients having ureteral strictures treated with percutaneous balloon dilation reported in our transplant nephrology database during an 8-year period. The accordion sign was deemed present or absent on the basis of an imaging review and was defined as present when a tortuous ureter became kinked and irregular when foreshortened after placement of a wire or a catheter. Procedure-related urine leaks were categorized as occurring at the stricture if within 2 cm; otherwise, they were considered away from the stricture.ResultsThe accordion sign was associated with a significantly greater occurrence of leaks away from the stricture (P = 0.001) but not at the stricture (P = 0.34).ConclusionsThe accordion sign is an important consideration when performing balloon dilation procedures on transplant ureteral strictures, given the increased risk of leak away from the stricture. Its presence should prompt additional care during wire and catheter manipulations.

Percutaneous Transluminal Angioplasty of Dysplastic Stenoses of the Renal Artery: Results on 70 Adults

International Nuclear Information System (INIS)

Fraissinette, Bruno de; Garcier, Jean Marc; Dieu, Valerie; Mofid, Reza; Ravel, Anne; Boire, Jean Yves; Boyer, Louis

2003-01-01

Purpose: Retrospective analysis of the dilatation (PTRA) of renal arterial dysplastic stenosis (RADS). Methods: Seventy patients suffering from hypertension (87RADS) were treated at our institution for medial (83%) or non-classified fibrodysplasias (17%). Four patients suffered from renal insufficiency. Two endoprostheses were implanted. We evaluated blood pressure with the USCSRH criteria and renal insufficiency with the Martin criteria. Results: Ninety-five percent technical success and 87.9% clinical success for blood pressure were obtained, with worse results for patients older than 57 years or with a history of hypertension greater than 9 years. Results were better when the RADS was responsible for an ipsilateral renal atrophy or for poorly controlled hypertension. No renal insufficiency worsened during the follow-up. Conclusion: PTRA is a first-line treatment for renovascular hypertension caused by RADS. The results were encouraging despite a high average age of the subjects and frequent associated extrarenal vascular lesions

Challenging the wisdom of puncture at the calyceal fornix in percutaneous nephrolithotripsy: feasibility and safety study with 137 patients operated via a non-calyceal percutaneous track.

Science.gov (United States)

Kyriazis, Iason; Kallidonis, Panagiotis; Vasilas, Marinos; Panagopoulos, Vasilios; Kamal, Wissam; Liatsikos, Evangelos

2017-05-01

To present our experience with a central, non-calyceal puncture protocol for percutaneous nephrolithotripsy (PCNL) in an attempt to challenge the opinion of worldwide adopted calyceal puncture as the less traumatic site of percutaneous entrance into the collecting system. During 2012, a total of 137 consecutive, unselected patients were subjected to PCNL in our department. Non-calyceal punctures were performed to all cases and followed by subsequent track dilations up to 30 Fr. Perioperative and postoperative data were prospectively collected and analyzed. Mean operative time (from skin puncture to nephrostomy tube placement) was 48 min. Patients with single, multiple and staghorn stones had primary stone-free rates of 89.2, 80.4 and 66.7 % after PCNL, respectively. The overall complication rate was 10.2 %, while bleeding complications were minimal. Only 4 patients (2.9 %) required blood transfusion. Five patients (3.6 %) had Clavien Grade IIIa complications requiring an intervention for their management and none Grade IV or V. Despite the absence of evidence that non-calyceal percutaneous tracts could be a risk factor for complications, the concept of calyceal puncture has been worldwide adopted by PCNL surgeons as the sole safe percutaneous entrance into the collective system. Based on our experience, other pathways than the worldwide recognized rule, calyceal puncture, are possible and probably not as dangerous as has been previously stated.

Milrinone infusion: A therapeutic option in coronary vasospasm after primary percutaneous transluminal coronary angioplasty

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Singh Amarpal

2009-01-01

Full Text Available A 42-year-old male presented to the emergency department with acute chest pain. The electrocardiogram revealed inferior wall myocardial infarction. Emergency coronary angiography revealed total occlusion of the distal right coronary artery with thrombus. Patient was taken up for primary percutaneous coronary angioplasty with stenting of distal right coronary artery. Six hours following the procedure, the patient developed re-elevation of ST-segment in inferior leads of electrocardiogram and subsequent haemodynamic instability. Repeat coronary angiography revealed patent stent and coronary artery spasm in proximal part, which was relieved by intracoronary injection of nitroglycerine. After an hour, the patient re-developed symptoms of chest pain along with bradycardia, hypotension and ST segment elevation. Intravenous infusion of nitroglycerine did not improve the condition but produced persistent hypotension. Infusion of milrinone was then started. Over time, normalisation of electrocardiogram occurred. The patient was discharged in stable condition. This case suggests that milrinone may be effective in alleviating coronary artery spasm when the use of other agents fails

Interventional radiological management of complications in renal transplantation

International Nuclear Information System (INIS)

Popovic, P.; Surlan, M.

2004-01-01

Background. The most frequent radiologically evaluated and treated complications in renal transplantation are perirenal and renal fluid collection and abnormalities of the vasculature and collecting system. Renal and perirenal fluid collection is usually treated successfully with percutaneous drainage. Doppler US, MRA and digital subtraction angiography (DSA) are most important in the evaluation of vascular complications of renal transplantation and management of the endovascular therapy. Conclusions. Stenosis, the most common vascular complication, occurs in 1% to 12% of transplanted renal arteries and represents a potentially curable cause of hypertension following transplantation and/or renal dysfunction. Treatment with percutaneous transluminal renal angioplasty (PTRA) or PTRA with stent has been technically successful in 82 to 92% of the cases, and graft salvage rate has ranged from 80-100%. Complications such as arterial and vein thrombosis are uncommon. Intrarenal A/V fistulas and pseudoaneurysms are occasionally seen after biopsy, the treatment requires superselective embolisation. Urologic complications are relatively uncommon; they consist predominantly of the urinary leaks and urethral obstruction. Interventional treatment consists of percutaneous nephrostomy, balloon dilation, insertion of the double J stents, metallic stent placement and external drainage of the extrarenal collections. The aim of the paper is to review the role of interventional radiology in the management of complications in renal transplantation. (author)

Percutaneous diagnosis and treatment in disease conditions of the bile ducts and the gallbladder

International Nuclear Information System (INIS)

Hauenstein, K.H.; Wimmer, B.; Salm, R.; Farthmann, E.H.

1991-01-01

Percutaneous transhepatic access to the bile duct has opened up new possibilities not only for diagnosis by means of cholangiography and cholangioscopy with endoscopically guided biopsy by small-bore equipment, but also for the treatment of benign and malignant obstructive jaundice. In malignant disease recanalization of the obstruction is possible by means of laser, intracavitary irritation, internal bile drainage in Klatskin tumors, large-diameter endoprostheses (e.g., a Y-shaped prosthesis) or metal stents. In benign disease, balloon dilatation of inflammatory stenoses, stone extractions from the bile duct or gallbladder by means of Dormia baskets, ultrasound or pezo electric shockwave-contact lithotripsy and chemical litholysis are possible very often percutaneous access is a real alternative to surgical intervention. (orig.) [de

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Full Text Available ... breast Macular degeneration Nerve conduction Osteoarthritis Osteoporosis Ovulation Parkinson disease Percutaneous transluminal coronary angioplasty (PTCA) Peristalsis Phagocytosis ...

Percutaneous Implantation of A Parachute Device For Treatment of Ischemic Heart Failure

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Cilingiroglu, Mehmet, E-mail: mcilingiroglu@yahoo.com; Rollefson, William A.; Mego, David

2013-07-15

Congestive heart failure (CHF) secondary to ischemic cardiomyopathy is associated with significant morbidity and mortality despite currently available medical therapy. The Parachute{sup TM} device is a novel left ventricular partitioning device that is delivered percutaneously in the left ventricle (LV) in patients with anteroapical regional wall motion abnormalities, dilated LV and systolic dysfunction after anterior myocardial infarction with favorable clinical and LV hemodynamic improvements post-implantation. Here, we do review the current literature and present a case of the Parachute device implantation.

Percutaneous Implantation of A Parachute Device For Treatment of Ischemic Heart Failure

International Nuclear Information System (INIS)

Cilingiroglu, Mehmet; Rollefson, William A.; Mego, David

2013-01-01

Congestive heart failure (CHF) secondary to ischemic cardiomyopathy is associated with significant morbidity and mortality despite currently available medical therapy. The Parachute TM device is a novel left ventricular partitioning device that is delivered percutaneously in the left ventricle (LV) in patients with anteroapical regional wall motion abnormalities, dilated LV and systolic dysfunction after anterior myocardial infarction with favorable clinical and LV hemodynamic improvements post-implantation. Here, we do review the current literature and present a case of the Parachute device implantation

Medline Plus

Full Text Available ... breast Macular degeneration Nerve conduction Osteoarthritis Osteoporosis Ovulation Parkinson disease Percutaneous transluminal coronary angioplasty (PTCA) Peristalsis Phagocytosis Pituitary ...

Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

NARCIS (Netherlands)

Drenth, Derk Jan

2005-01-01

This thesis describes and discusses the results of a prospective randomized controlled clinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and off-pump coronary artery bypass grafting with a left internal mammary artery (surgery) in patients with a high-grade stenosis

Natural orifice transluminal endoscopic surgery vs laparoscopic ovariectomy: Complications and inflammatory response

Czech Academy of Sciences Publication Activity Database

Martínek, J.; Ryska, O.; Filípková, T.; Doležel, R.; Juhás, Štefan; Motlík, Jan; Holubová, Monika; Nosek, V.; Rotnáglová, B.; Zavoral, M.; Ryska, M.

2012-01-01

Roč. 18, č. 27 (2012), s. 3558-3564 ISSN 1007-9327 Institutional research plan: CEZ:AV0Z50450515 Keywords : Natural orifice transluminal endoscopic surgery * Laparoscopy * Ovariectomy Subject RIV: FP - Other Medical Disciplines Impact factor: 2.547, year: 2012

Clinical significance of exercise induced ST segment depression after successful percutaneous transluminal coronary angioplasty

International Nuclear Information System (INIS)

Aoki, Toshikazu; Konishi, Tokuji; Futagami, Yasuo

1989-01-01

To evaluate the clinical significance of ST segment depression during repeated Treadmill exercise after successful PTCA, Thallium-201 SPECT was performed. The Thallium-201 SPECT was performed before, one week after and 3-6 months after PTCA. All thirty-five patients had one vessel disease and positive Thallium-201 exercise test. During follow-up period for 3-6 months, 11 of 35 patients had persistent ST segment depression. Restenosis of dilated coronary lesion was demonstrated in 6 of 11 patients. In another 3 of 35 patients, exercise induced ST segment depression was disappered during follow-up Treadmill exercise. In 14 patients with persistent or transient ST segment depression after PTCA, Thallium-201 SPECT demonstrated transient ischemia in 5 of 6 patients with restenosis. In other 8 patients without restenosis, SPECT images did not demonstrate myocardial ischemia and coronary arteriographic findings could not verify side branch stenosis or intimal dissection which might cause myocardial ischemia. The etiology of ST segment depression after successful PTCA in one vessel disease is not produced by exercise induced myocardial ischemia but still unknown mechanisms may be present. (author)

Effectiveness of selective intracoronary thrombolysis in acute myocardial infarction

Energy Technology Data Exchange (ETDEWEB)

Yamaguchi, Hiroshi; Nosaka, Hideyuki; Saitoh, Taroh

1984-10-01

Protective effects of percutaneous transluminal coronary recanalization (PTCR) on the myocardium were investigated by creatine phosphokinase levels, regional left ventricular wall motion in chronic stage and /sup 201/Tl myocardial single photon emission computed tomography. Recanalization of the occlusive coronary artery at the early stage of myocardial infarction was effective for the protection of the myocardium and heart functions. This effect depended largely on the degree of occlusion at the time of the first imaging, the final degree of occlusion after recanalization, and the time required for the recanalization. Cases in which percutaneous transluminal coronary angiography was performed following PTCR are also presented and examined. (Namekawa, K.).

Effectiveness of selective intracoronary thrombolysis in acute myocardial infarction

International Nuclear Information System (INIS)

Yamaguchi, Hiroshi; Nosaka, Hideyuki; Saitoh, Taroh

1984-01-01

Protective effects of percutaneous transluminal coronary recanalization (PTCR) on the myocardium were investigated by creatine phospho kinase levels, regional left ventricular wall motion in chronic stage and 201 Tl myocardial single photon emission computed tomography. Recanalization of the occlusive coronary artery at the early stage of myocardial infarction was effective for the protection of the myocardium and heart functions. This effect depended largely on the degree of occlusion at the time of the first imaging, the final degree of occlusion after recanalization, and the time required for the recanalization. Cases in which percutaneous transluminal coronary angiography was performed following PTCR are also presented and examined. (Namekawa, K.)

Interval biliary stent placement via percutaneous ultrasound guided cholecystostomy: another approach to palliative treatment in malignant biliary tract obstruction.

Science.gov (United States)

Harding, James; Mortimer, Alex; Kelly, Michael; Loveday, Eric

2010-12-01

Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.

Interval Biliary Stent Placement Via Percutaneous Ultrasound Guided Cholecystostomy: Another Approach to Palliative Treatment in Malignant Biliary Tract Obstruction

International Nuclear Information System (INIS)

Harding, James; Mortimer, Alex; Kelly, Michael; Loveday, Eric

2010-01-01

Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.

Ultrasound-guided percutaneous transhepatic biliary drainage: Experiences in 146 patients

Energy Technology Data Exchange (ETDEWEB)

Kim, Jai Keun [Sohwa Children' s Hospital, Seoul(Korea, Republic of); Yu, Jeong Sik; Kim, Ki Whang; Chung, Soo Yoon; Jeong, Mi Gyoung [Yonsei University College of Medicine, Seoul (Korea, Republic of); Choi, Deuk Lin; Kwon, Gui Hyang; Lee, Hae Kyung [Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

1999-03-15

Percutaneous biliary drainage is an important technique for palliative therapy of obstructive biliary disease and diagnostic information. The purpose of this study is to review and evaluate the experiences of ultrasound-guided percutaneous transhepatic biliary drainage. Ultrasound-guided percutaneous transhepatic biliary drainage was performed on 146 occasions in 134 patients. The causes of biliary obstruction were: benign diseases (19 cases, 14.2%) such as bile duct stones or stricture, cholangiocarcinoma (37 cases, 27.6%), pancreatic carcinoma (35 cases, 26.1%), metastasis (22 cases, 16.5%), gall bladder cancer (14 cases, 10.4%), ampulla of Vater cancer (4 cases, 3.0%), hepatocellular carcinoma (3 cases, 2.2%). Retrospectively reviewing medical records, we found out frequency of external or external/internal biliary drainages, puncture of left or right hepatic duct, and presence of bileinfection. Ultrasound-guided percutaneous transhepatic biliary drainage was compared with conventional biliary drainage of previous reports on the basis of frequency of complications. External (124 procedures, 84.9%) and external/internal biliary drainage (22 procedures, 15.1%) were carried out by puncture of dilated right (59.6%) or left (40.4%) intrahepatic duct. Sixty-nine complications occurred in 47 patients. Catheter related complications (33/69, 47.8%) were most common: catheter dislodgement (17/69, 24.6%), malfunction (9/69, 13.1%), leakage (7/69, 10.1%). Other minor complications such as simple fever (16/69, 23.2%), cholangitis (7/69, 10.1%), hemobilia (4/69, 5.8%), biloma (2/69, 2.9%) and wound infection (1/69, 1.5%) occurred. Major complications including sepsis (4/69, 5.8%) and bile peritonitis (2/69, 2.9%) were also noted. Puncture-related complications such as hemobilia, biloma and bile peritonitis occurred in 8 cases (5.5%). Comparing with conventional X-ray guided drainage, ultrasound-guided percutaneous transhepatic biliary drainage is a safe procedure for

Left Atrial Decompression by Percutaneous Left Atrial Venting Cannula Insertion during Venoarterial Extracorporeal Membrane Oxygenation Support

Directory of Open Access Journals (Sweden)

Ha Eun Kim

2016-06-01

Full Text Available Patients with venoarterial extracorporeal membrane oxygenation (ECMO frequently suffer from pulmonary edema due to left ventricular dysfunction that accompanies left heart dilatation, which is caused by left atrial hypertension. The problem can be resolved by left atrium (LA decompression. We performed a successful percutaneous LA decompression with an atrial septostomy and placement of an LA venting cannula in a 38-month-old child treated with venoarterial ECMO for acute myocarditis.

Dilated Cardiomyopathy

Science.gov (United States)

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

Percutaneous common femoral artery interventions using angioplasty, atherectomy, and stenting.

Science.gov (United States)

Mehta, Manish; Zhou, Yi; Paty, Philip S K; Teymouri, Medhi; Jafree, Kamran; Bakhtawar, Humayun; Hnath, Jeffrey; Feustel, Paul

2016-08-01

This study evaluated the feasibility, safety, and effectiveness of endovascular interventions for common femoral artery (CFA) occlusive disease. Using a prospectively maintained multicenter database, we analyzed outcomes in 167 consecutive patients who underwent percutaneous CFA interventions for Rutherford class 3 to class 6 (R3-R6) disease. The standardized treatment approach included primary percutaneous transluminal angioplasty (PTA) only, atherectomy + PTA, and provisional stenting. Outcomes included technical failure rate, recurrence, complications, and major or minor amputation rate. Data were analyzed using multivariate regression analysis. During a 7-year period, 167 patients with R3 (n = 91 [54.5%]) and R4 to R6 (n = 76 [45.5%]) disease underwent CFA interventions that included PTA only (n = 114 [68.2%]), atherectomy ± PTA (n = 38 [22.8%]), and provisional stenting (n = 15 [9.0%]) for failed atherectomy ± PTA. Procedure-related complications included pseudoaneurysm (n = 1 [0.6%]), thrombosis (n = 1 [0.6%]), distal embolization (n = 1 [0.6%]), and death (R6, n = 1 [0.06%]). CFA restenosis was observed in 34 (20.4%) patents; these underwent further percutaneous (n = 18 [10.8%]) or surgical (n = 17 [10.2%]) revascularization that included CFA endarterectomy ± femoral distal bypass. Major or minor amputations were observed in none of the R3 patients and in only three (3.9%) and five (6.5%) of the R4 to R6 patients, respectively. Compared with the atherectomy + PTA group, patients in the PTA-only group had a significantly lower patency. Furthermore, during long-term mean follow-up of 42.5 months, the CFA provisional stent group had a 100% primary patency, which was significantly better than the primary patency in the CFA nonstent groups combined (77.0%; P = .0424). Data from this study to date would suggest that percutaneous CFA interventions in select patients are relatively safe and effective. In the long term, CFA stenting has

Dilations and interaction

International Nuclear Information System (INIS)

Buchholz, D.; Fredenhagen, K.

1976-07-01

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

Dipyridamole induced directory disfunction of infarcted vessel, and estimation of patients with acute myocardial infarction and successful PTCA

International Nuclear Information System (INIS)

Hashimoto, Yasunori; Yamabe, Hiroshi; Kim, Sushik; Yano, Takashi; Fujita, Hideki; Kakimoto, Tetsuya; Namura, Hiroyuki; Maeda, Kazumi; Yokoyama, Mitsuhiro

1993-01-01

The purpose of this study was to determine whether transient disturbance of vascular dilation in the peripheral coronary vessels in patients with myocardial infarction in whom coronary recanalization was successfully attained in the acute stage. The subjects were 6 patients with acute myocardial infarction in whom recanalization was successfully attained without a significant coronary stenosis by emergency percutaneous transluminal coronary angioplasty (PTCA). Dipyridamole-loaded thallium-201 myocardial scintigraphy was undertaken during the acute stage (an average of 5 days after PTCA) and during convalescent stage (an average 24 days after PTCA). Defect was seen in the infarcted areas on early images during the acute stage in all 6 patients, and Tl uptake in the infarcted areas was improved during the convalescent stage in 2 of the 6 patients. In these two patients, fill-in phenomenon was seen in the infarcted area during acute stage when images were acquired after re-injection of Tl-201. These findings suggested that transient disturbance of vascular dilation may occur in the peripheral coronary artery vessels in the infarcted area where recanalization was successfully attained in patients with acute myocardial infarction. (N.K.)

A radiologic evaluation of obstructive jaundice using percutaneous transhepatic cholangiography

International Nuclear Information System (INIS)

Schim, G. T.; Kim, T. H.; Zeon, S. K.; Ra, W. Y.

1980-01-01

Percutaneous transhepatic cholangiography (P.T.C.) is a most valuable procedure in differentiation of obstructive jaundice, whether benign (chiefly stone) or malignant condition. Authors present the clinical and P.T.C. findings of 30 cases of obstructive jaundice which were experienced from December 1975 to May 1977, at Department of Radiology, Kyung Pook National University Hospital. The summarized results were as follows. 1. The incidence of malignancy beyond the age of 40 was high compared with stone, which revealed relatively equal age distribution. 2. The stone showed as concave cupping in all cases (11 cases), but the malignancy showed as nipple formation (10 cases) and irregular narrowings (9 cases). 3. The dilation of the intrahepatic bile duct appeared 10 cases on malignancy among 19 cases of malignancy (52.6%) and 4 caes on stone which were multiple intrahepatic or common hepatic duct stones. 4. The dilation of the justproximal bile duct was severe on malignancy compared with stone. 5. The mean bilirubin level was high on malignancy (12.8 mg-%) compared with stone (10.3 mg-%).

Diagnostic value of percutaneous transhepatic cholangiography judged by personal experience of 58 patients

International Nuclear Information System (INIS)

Nagasue, N.; Inokuchi, K.

1979-01-01

During the last seven years percutaneous transhepatic cholangiography (PTC) using a fine needle was performed in 58 patients. The biliary tract was visualised and opacified in the 52 patients with dilated biliary ducts. The correct diagnoses were made in 51 of them. In six patients with a non-dilated biliary system, successful PTC was carried out with the correct diagnoses in four of them. There were four non-fatal complications; two septic reactions, one haemobilia, and one subcapsular haematoma, but all were controlled by conservative treatment alone. The PTC with a fine needle is an accurate, useful and safe procedure of choice for the diagnosis of obstructive jaundice and jaundice of obscure origin. It is useful in distinguishing hepatocellular jaundice from obstructive jaundice thus preventing an unnecessary operation. Failure to visualise the biliary tract by an experienced hand strongly indicates that the jaundice is not-obstructive. (author)

[Thomas' shunt for hemodialysis: dysfunction and its percutaneous treatment].

Science.gov (United States)

Gallego, J J; Santos, E; Méndez, J V; Coronel, F; Torrente, J; Holguín, A; Moreno, R

2003-01-01

To assess the usefulness of percutaneous treatment of abnormalities of the venous tree in extending the survival of external Thomas shunts (TS). Twelve cases of TS were included in a hemodialysis access fistula dysfunction monitoring program and were followed for up to 48 months. The abnormalities found were treated by percutaneous transluminal angioplasty (PTA) or thrombolysis and PTA. Survival curves and the Kaplan-Meier method were used to calculate the likelihood of primary patency (P1), secondary patency (P2), and overall patency (OP). A total of 61 interventions were performed during the period of follow-up. On 12 occasions the fistula was thrombosed; in the rest, increased venous pressure to 150 mmHg or higher was detected during dialysis. Fistulography was performed after washing the thrombosed fistulas with urokinase, and revealed one or more of the following angiographic signs: 1) a short reduction of more than 50% in lumen caliber in the femoral vein adjacent to the anastomosis, present in 52% of the cases (fig. 1); 2) imaging a "jet" of contrast material at the site of entry of the shunt into the femoral vein (fig. 2), present in 22% of the cases; and 3) a filling defect or "flap" at the same site, owing to hyperplastic tissue or piece of thrombus adhering to the intima, present in 34% of the cases (figs. 3-5). This last-mentioned finding ordinarily gave rise to a "valve" effect, whereby injection into the venous branch was feasible but aspiration from the venous branch was difficult or impossible. PTA was carried out and attained anatomical and functional success in 100% of cases. PI was 58%, 33%, 8%, and 0% at 6, 12, 24, and 36 months, respectively; P2 was 100%, 75%, 58%, and 25%; respectively, at those same times. The comparison of the PI and P2 curves was statistically significant; p < 0.001 (table 1). OP was 83%, 66%, 50% and 41% at 12, 24, 36 and 48 months. The comparison of the PI surgical and OP curves was statistically significant; p < 0

Endoscopic treatment of multilocular walled-off pancreatic necrosis with the multiple transluminal gateway technique.

Science.gov (United States)

Jagielski, Mateusz; Smoczyński, Marian; Adrych, Krystian

2017-06-01

The development of minimally invasive techniques allowed access to the necrotic cavity through transperitoneal, retroperitoneal, transmural and transpapillary routes. The choice of access to walled-off pancreatic necrosis (WOPN) should depend not only on the spread of necrosis, but also on the experience of the clinical center. Herein we describe treatment of a patient with multilocular symptomatic walled-off pancreatic necrosis using minimally invasive techniques. The single transmural access (single transluminal gateway technique - SGT) to the necrotic collection of the patient was ineffective. The second gastrocystostomy was performed using the same minimally invasive technique as an extra way of access to the necrosis (multiple transluminal gateway technique - MTGT). In the described case the performance of the new technique consisting in endoscopic multiplexing transmural access (MTGT) was effective enough and led to complete recovery of the patient.

Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes.

LENUS (Irish Health Repository)

Keeling, Aoife N

2011-03-01

To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI).

Acute occlusion of the coronary artery after transluminal balloon coronary angioplasty

International Nuclear Information System (INIS)

Savchenko, A.P.; Matchin, Yu.G.; Lyakishev, A.A.

1995-01-01

The research was aimed at elucidation of the relationship of the clinical and angiographic factors, on the one hand, and development of acute occlusion following transluminal balloon coronary angioplasty TBCA, on the other. TBCA was carried out in 162 patients. Eight (4.9 %) patients developed acute occlusion of the coronary artery, which was complicated by acute myocardial infarction in 50 % cases. 35 refs.; 4 tabs

Percutaneous balloon dilatation of stenotic calyceal diverticular infundibula in patients with recurrent urinary tract infections.

LENUS (Irish Health Repository)

Keeling, Aoife N

2011-02-01

Renal calyceal diverticula are usually detected as incidental findings on intravenous pyelograms (IVPs) and rarely manifest any clinical signs or symptoms. However, they can interfere with patient\\'s quality of life in a number of instances causing pain, recurrent urinary tract infections (UTIs), abscess, systemic sepsis and calculus formation. The purpose of this study was to review the clinical indications, procedure technique and clinical outcome in all patients referred to Interventional Radiology for the percutaneous management of renal calyceal diverticula.

Hybrid natural orifice transluminal endoscopic cholecystectomy: prospective human series.

Science.gov (United States)

Cuadrado-Garcia, Angel; Noguera, Jose F; Olea-Martinez, Jose M; Morales, Rafael; Dolz, Carlos; Lozano, Luis; Vicens, Jose-Carlos; Pujol, Juan José

2011-01-01

Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with a minimal number of access points in the abdominal wall. Currently, it is not possible to perform these interventions without the help of abdominal wall entryways, so these procedures are hybrids fusing minilaparoscopy and transluminal endoscopic surgery. This report presents a prospective clinical series of 25 patients who underwent transvaginal hybrid cholecystectomy for cholelithiasis. The study comprised a clinical series of 25 consecutive nonrandomized women who underwent a fusion transvaginal NOTES and minilaparoscopy procedure with two trocars for cholelithiasis: one 5-mm umbilical trocar and one 3-mm trocar in the upper left quadrant. The study had no control group. The scheduled surgical intervention was performed for all 25 women. No intraoperative complications occurred. One patient had mild hematuria that resolved in less than 12 h, but no other complications occurred during an average follow-up period of 140 days. Of the 25 women, 20 were discharged in 24 h, and 5 were discharged less than 12 h after the procedure. Hybrid transvaginal cholecystectomy, combining NOTES and minilaparoscopy, is a good surgical model for minimally invasive surgery. It can be performed in surgical settings where laparoscopy is practiced regularly using the instruments normally used for endoscopy and laparoscopic surgery. Due to the reproducibility of the intervention and the ease of vaginal closure, hybrid transvaginal cholecystectomy will permit further development of NOTES in the future.

Endoscopic dilation of complete oesophageal obstructions with a combined antegrade-retrograde rendezvous technique.

Science.gov (United States)

Bertolini, Reto; Meyenberger, Christa; Putora, Paul Martin; Albrecht, Franziska; Broglie, Martina Anja; Stoeckli, Sandro J; Sulz, Michael Christian

2016-02-21

To investigate the combined antegrade-retrograde endoscopic rendezvous technique for complete oesophageal obstruction and the swallowing outcome. This single-centre case series includes consecutive patients who were unable to swallow due to complete oesophageal obstruction and underwent combined antegrade-retrograde endoscopic dilation (CARD) within the last 10 years. The patients' demographic characteristics, clinical parameters, endoscopic therapy, adverse events, and outcomes were obtained retrospectively. Technical success was defined as effective restoration of oesophageal patency. Swallowing success was defined as either percutaneous endoscopic gastrostomy (PEG)-tube independency and/or relevant improvement of oral food intake, as assessed by the functional oral intake scale (FOIS) (≥ level 3). The cohort consisted of six patients [five males; mean age 71 years (range, 54-74)]. All but one patient had undergone radiotherapy for head and neck or oesophageal cancer. Technical success was achieved in five out of six patients. After discharge, repeated dilations were performed in all five patients. During follow-up (median 27 mo, range, 2-115), three patients remained PEG-tube dependent. Three of four patients achieved relevant improvement of swallowing (two patients: FOIS 6, one patient: FOIS 7). One patient developed mediastinal emphysema following CARD, without a need for surgery. The CARD technique is safe and a viable alternative to high-risk blind antegrade dilation in patients with complete proximal oesophageal obstruction. Although only half of the patients remained PEG-tube independent, the majority improved their ability to swallow.

Intrabiliary growth of recurrent tumor after percutaneous RF ablation for treating liver metastasis from colon cancer: a case report

Energy Technology Data Exchange (ETDEWEB)

Lee, Youn Kyung; Kim, Seung Kwon; Hong, Hyun Pyo [Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2007-12-15

A 64-year-old man who underwent right hemicolectomy 3.5 years ago for ascending colon cancer and then RF ablation for two metastatic nodules in the liver was admitted to our hospital with a new metastatic nodule in the S6/7 segment of the liver. The CT scan showed a low attenuating metastatic nodule 2.2 cm in diameter in the S6/7 segment of the liver, and the liver showed peripheral bile duct dilatation. This nodule was treated with percutaneous RF ablation. A follow-up CT seven months after RF ablation showed the presence of a viable tumor in the RF ablation zone, with tumor extension along the dilated bile duct. These findings were confirmed on the resected specimen.

Dilation and Curettage (D&C)

Science.gov (United States)

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

Placement of percutaneous transhepatic biliary stent using a silicone drain with channels

Science.gov (United States)

Yoshida, Hiroshi; Mamada, Yasuhiro; Taniai, Nobuhiko; Mineta, Sho; Mizuguchi, Yoshiaki; Kawano, Yoichi; Sasaki, Junpei; Nakamura, Yoshiharu; Aimoto, Takayuki; Tajiri, Takashi

2009-01-01

This report describes a method for percutaneous transhepatic biliary stenting with a BLAKE Silicone Drain, and discusses the usefulness of placement of the drain connected to a J-VAC Suction Reservoir for the treatment of stenotic hepaticojejunostomy. Percutaneous transhepatic biliary drainage was performed under ultrasonographic guidance in a patient with stenotic hepaticojejunostomy after hepatectomy for hepatic hilum malignancy. The technique used was as follows. After dilatation of the drainage root, an 11-Fr tube with several side holes was passed through the stenosis of the hepaticojejunostomy. A 10-Fr BLAKE Silicone Drain is flexible, which precludes one-step insertion. One week after insertion of the 11-Fr tube, a 0.035-inch guidewire was inserted into the tube. After removal of the 11-Fr tube, the guidewire was put into the channel of a 10-Fr BLAKE Silicone Drain. The drain was inserted into the jejunal limb through the intrahepatic bile duct and was connected to a J-VAC Suction Reservoir. Low-pressure continued suction was applied. Patients can be discharged after insertion of the 10-Fr BLAKE Silicone Drain connected to the J-VAC Suction Reservoir. Placement of a percutaneous transhepatic biliary stent using a 10-Fr BLAKE Silicone Drain connected to a J-VAC Suction Reservoir is useful for the treatment of stenotic hepaticojejunostomy. PMID:19725159

Percutaneous Transhepatic Bile Duct Ablation with n-Butyl Cyanoacrylate in the Treatment of a Biliary Complication after Split Liver Transplantation

Directory of Open Access Journals (Sweden)

Andrea Lauterio

2009-01-01

Full Text Available Biliary complications continue to be a major cause of morbidity after split-liver transplantation (SLT. In this report we describe an uncommon late biliary complication. One year after SLT the patient showed an intrahepatic bile dicy dilatation with severe cholangitis episodes. The segmentary bile duct of hepatic segment VI-VII draining in the left duct was unidentified and tied at the time of the in situ split-liver procedure. We perform a permanent obliteration of the dilated intrahepatic ducts by a percutaneous embolization using an n-butyl cyanoacrylate (NABC. The management of biliary complications after SLT requires a multidisciplinary approach. The use of NBCA in obliteration of a dilated bile duct seems to be a safe procedure with good results providing a less invasive option than hepatic resection and decreasing the morbidity associated with chronic external biliary drainage. Further studies are needed to determine whether this approach is effective and safe and whether it could reduce hospital stay and cost.

Efficacy and safety in performing of large bore percutaneous nephrostomy under ultrasound guidance

International Nuclear Information System (INIS)

Smilov, N.; Mlachkova, D.; Rizov, A.; Lozev, I.

2009-01-01

The aim of the study was to compare the success rate, complications and the outcomes from large-bore percutaneous nephrostomy under ultrasound guidance performed to 178 cases with another 54 when nephrostomy under x-ray control was performed. We have performed 178 large-bore percutaneous nephrostomy under ultrasound guidance and another 54 percutaneous nephrostomy under x-ray guidance to patients diagnosed with obstructive uropathy resulting from benign or malignant supravesical obstruction. We have performed successful nephrostomy in 93,8% of the cases under ultrasound guidance and 100% successful nephrostomy in the cases under x-ray control. In 2,8% of patients under ultrasound guidance the nephrostomy was performed using 4 additional punctures of the pyelocaliceal system and artificially caused hydronephrosis via infiltration of normal saline; and in the remaining 1,7% it was successful at the second attempt after 24 hours. It was not necessary to perform open surgery nephrostomy in any of the cases. The performance of percutaneous nephrostomy under ultrasound guidance has a success rate similar to the one done under x-ray guidance and with commensurable frequency and severity of complications, however without the patient and the operator being exposed to x-ray radiation. In general, the percutaneous nephrostomy under ultrasound guidance is performed without difficulties in the cases of third or fourth degree hydronephrosis. The lateral decubital patient position, the appropriate place for the puncture, the usage of Color Doppler imaging when the puncture is performed and the continuos ultrasound guidance during dilatation and placement of the nephrostomy tube should ensure the successful performance of the procedure in the case of first or second degree hydronephrosis. When hydronephrosis is absent, the nephrostomy should be performed under x-ray guidance. In emergency cases the application of ultrasound guidance allows the nephrostomy to be performed along the

Exact measurement of vascular lumina in digital subtraction arteriography (DSA) during stent implantations and percutaneous transluminal angioplasty (PTA)

Energy Technology Data Exchange (ETDEWEB)

Pfluger, T [Dept. of Radiology, Univ. of Munich (Germany); Kueffer, G [Dept. of Radiology, Univ. of Munich (Germany); Hahn, D [Dept. of Radiology, Univ. of Munich (Germany)

1992-06-01

There are inherent difficulties in using high-resolution DSA in interventional radiology for measuring vascular luminal diameter since enlargement ratios are not constant. We present a system that permits accurate determination of vascular lumen diameters by means of a special angiographic catheter with predefined marking points. The accuracy of this measuring method was explored in tests using phantoms. In vivo practicability of the method was proved in PTA and stent implantations in 39 patients. This method with a maximum error of measurement of 5% appears to provide adequate safety in the choice of suitable dilating balloons and stents in interventional vascular procedures. In follow-up, it permits the accurate measurement of neo-intimal thickness. (orig.)

Percutaneous transluminal angioplasty of brachiocephalic arteries: Indications and long-term success in a series of 25 patients

International Nuclear Information System (INIS)

Burke, D.R.; Gordon, R.; Mishkin, J.D.; Meranze, S.G.; McLean, G.K.

1986-01-01

The clinical records and procedural details of 28 angioplasty procedures performed on 25 patients were reviewed. Long-term follow-up was conducted by examining the referring physicians' records and by direct telephone contact with the patient. Nine patients had neurologic symptoms only, eight patients had arm claudication symptoms only, seven patients had both neurologic and arm symptoms, and two patients underwent dilation procedures to provide graft inflow. Procedural complications were a stroke in the contralateral carotid distribution during follow-up thoracic aortography, and an embolus to the fifth digit (of no clinical significance). Long-term success of the angioplasty procedure did not correlate with initial symptoms, degree of stenosis, lesion length, or postangioplasty appearance. All patients with arm and neurologic symptoms and who were followed up for 3 years, with the exception of the patient who suffered a periprocedural stroke

Percutaneous Transhepatic Endoscopic Holmium Laser Lithotripsy for Intrahepatic and Choledochal Biliary Stones

International Nuclear Information System (INIS)

Rimon, Uri; Kleinmann, Nir; Bensaid, Paul; Golan, Gil; Garniek, Alexander; Khaitovich, Boris; Winkler, Harry

2011-01-01

Purpose: To report our approach for treating complicated biliary calculi by percutaneous transhepatic endoscopic biliary holmium laser lithotripsy (PTBL). Patients and Methods: Twenty-two symptomatic patients (11 men and 11 women, age range 51 to 88 years) with intrahepatic or common bile duct calculi underwent PTBL. Nine patients had undergone previous gastrectomy and small-bowel anastomosis, thus precluding endoscopic retrograde cholangiopancreatography. In the other 13 patients, stone removal attempts by ERCP failed due to failed access or very large calculi. We used a 7.5F flexible ureteroscope and a 200-μm holmium laser fiber by way of a percutaneous transhepatic tract, with graded fluoroscopy, to fragment the calculi with direct vision. Balloon dilatation was added when a stricture was seen. The procedure was performed with the patient under general anaesthesia. A biliary drainage tube was left at the end of the procedure. Results: All stones were completely fragmented and flushed into the small bowel under direct vision except for one patient in whom the procedure was aborted. In 18 patients, 1 session sufficed, and in 3 patients, 2 sessions were needed. In 7 patients, balloon dilatation was performed for benign stricture after Whipple operation (n = 3), for choledochalenteric anastomosis (n = 3), and for recurrent cholangitis (n = 1). Adjunctive “balloon push” (n = 4) and “rendezvous” (n = 1) procedures were needed to completely clean the biliary tree. None of these patients needed surgery. Conclusion: Complicated or large biliary calculi can be treated successfully using PTBL. We suggest that this approach should become the first choice of treatment before laparoscopic or open surgery is considered.

CIRUGÍA ENDOSCÓPICA TRANSLUMINAL: ¡ES POSIBLE!

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Arecio Peñaloza-Ramírez

2015-03-01

Full Text Available Introducción: La cirugía endoscópica transluminal es una técnica de ingreso a través de orificios naturales a la cavidad peritoneal y a los órganos allí contenidos, que busca disminuir los efectos adversos y las complicaciones de los procedimientos abiertos, acorde con la tendencia mundial de obtener resultados iguales a través de abordajes menos invasivos. Objetivo: Determinar las complicaciones de la cirugía endoscópica transluminal para la revisión de la cavidad peritoneal y la toma de biopsia hepática en cerdos. Metodología: Estudio experimental en 12 cerdos. Se tomó biopsia hepática transgástrica y se hizo un seguimiento durante 30 días, evaluando complicaciones y mortalidad. Al final se realizó autopsia al animal. Resultados: No se encontró mortalidad intraoperatoria. La mediana de tiempo quirúrgico fue de 84,5 minutos (RIQ 76-99. Se utilizaron para el cierre de la gastrotomía en promedio 7,8 clips (DE 3.5. En la peritoneoscopia se observó el intestino delgado, bazo, hígado y colon en la mayoría de los casos. La calidad de la biopsia hepática fue buena en 10 especímenes. La cicatrización gástrica fue adecuada en el 81.8%. Se encontraron cultivos de líquido peritoneal positivos en 9 casos. Conclusiones: La técnica requiere destreza y la peritoneoscopia es difícil por la falta de apoyo del equipo al maniobrar en retroflexión. El potencial de la técnica y el enorme beneficio para los pacientes son razones suficientes para continuar avanzando en este tipo de abordajes

Flow-mediated dilatation has no independent prognostic effect in patients with chest pain with or without ischaemic heart disease

DEFF Research Database (Denmark)

Ulriksen, Line Skjold; Malmqvist, Beata B; Hansen, Are

2009-01-01

OBJECTIVE: The purpose of this study was to assess the prognostic effect of flow-mediated dilatation (FMD) in patients with chest pain admitted to a coronary care unit. METHODS: Endothelium-dependent FMD in the brachial artery was examined in 223 patients with acute chest pain. All patients...... underwent a stress test at the time of admittance. On the basis of a positive stress test, a prior myocardial infarction (MI), prior percutaneous coronary intervention (PCI) or coronary bypass surgery (CABG), 137 patients were categorized as having ischaemic heart disease (IHD). RESULTS: Patients with IHD...

Pnematic Dilation in Achalasia

Directory of Open Access Journals (Sweden)

Maximilian Bittinger

2001-01-01

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

Transluminal endovascular stent-graft for the treatment of aortic aneurysms

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Lee, Do Yun; Chang, Byung Chul; Shim, Won Heum; Cho, Seung Yun; Chung, Nam Sik; Kwon, Hyuk Moon; Lee, Young Joon; Lee, Jong Tae [Yonsei University College of Medicine, Seoul (Korea, Republic of)

1995-09-15

The standard treatment for aortic aneurysms is surgical replacement with a prosthetic graft. Currently there is great interest in endoluminal intervention for treatment of aortic aneurysm. The purpose of this study was to evaluate the safety and effectiveness of endoluminally placed Stent-graft for the treatment of aortic aneurysms. Transluminal endovascular Stent-graft placements were attempted in 9 patients with infra-renal aortic aneurysms(n 6), thoracic aortic aneurysm(n = 1), and aortic dissection(n = 2). The endovascular Stent-grafts were custom-designed for each patient and were constructed of self-expandable modified Gianturco Stents covered with polytetrafluroethylene. The Stent-grafts were introduced through a 16-18 French sheath and expanded to 17-30 mm in diameter. The endovascular therapy was performed using a common femoral artery cutdown with local anesthesia. The endovascular Stent-graft deployment was achieved in 7 of 9 patients. Two cases failed deployment of the Stent-graft due to iliac artery stenosis and tortousity. There were complete thrombosis of the thoracic and infra-renal aortic aneurysm surround the Stent-graft in 3 patients, and persistent leak with partial thrombosis in 2. Two patients with aortic dissection were successfully treated by obliteration of entry tears. There were no major complication associated with Stent-graft placement. These preliminary results show that transluminal endovascular Stent-grafts offer great promise and good results. Further investigation is needed to establish its long-term safety and efficacy.

Transluminal endovascular stent-graft for the treatment of aortic aneurysms

International Nuclear Information System (INIS)

Lee, Do Yun; Chang, Byung Chul; Shim, Won Heum; Cho, Seung Yun; Chung, Nam Sik; Kwon, Hyuk Moon; Lee, Young Joon; Lee, Jong Tae

1995-01-01

The standard treatment for aortic aneurysms is surgical replacement with a prosthetic graft. Currently there is great interest in endoluminal intervention for treatment of aortic aneurysm. The purpose of this study was to evaluate the safety and effectiveness of endoluminally placed Stent-graft for the treatment of aortic aneurysms. Transluminal endovascular Stent-graft placements were attempted in 9 patients with infra-renal aortic aneurysms(n 6), thoracic aortic aneurysm(n = 1), and aortic dissection(n = 2). The endovascular Stent-grafts were custom-designed for each patient and were constructed of self-expandable modified Gianturco Stents covered with polytetrafluroethylene. The Stent-grafts were introduced through a 16-18 French sheath and expanded to 17-30 mm in diameter. The endovascular therapy was performed using a common femoral artery cutdown with local anesthesia. The endovascular Stent-graft deployment was achieved in 7 of 9 patients. Two cases failed deployment of the Stent-graft due to iliac artery stenosis and tortousity. There were complete thrombosis of the thoracic and infra-renal aortic aneurysm surround the Stent-graft in 3 patients, and persistent leak with partial thrombosis in 2. Two patients with aortic dissection were successfully treated by obliteration of entry tears. There were no major complication associated with Stent-graft placement. These preliminary results show that transluminal endovascular Stent-grafts offer great promise and good results. Further investigation is needed to establish its long-term safety and efficacy

Percutaneous treatment of extrahepatic bile duct stones assisted by balloon sphincteroplasty and occlusion balloon

Energy Technology Data Exchange (ETDEWEB)

Park, Yong Sung; Kim, Ji Hyung; Choi, Young Woo; Lee, Tae Hee; Hwang, Cheol Mog; Cho, Young Jun; Kim, Keum Won [Konyang University Hospital, Daejeon (Korea, Republic of)

2005-12-15

To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing. Fifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated. Eight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patients, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis. Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful.

Percutaneous treatment of extrahepatic bile duct stones assisted by balloon sphincteroplasty and occlusion balloon

International Nuclear Information System (INIS)

Park, Yong Sung; Kim, Ji Hyung; Choi, Young Woo; Lee, Tae Hee; Hwang, Cheol Mog; Cho, Young Jun; Kim, Keum Won

2005-01-01

To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing. Fifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated. Eight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patients, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis. Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful

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

Science.gov (United States)

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

2014-07-01

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

Percutaneous intervention in the menagement of insufficient native arteriovenous hemodialysis fistulae

International Nuclear Information System (INIS)

Kim, Hye Jung; Seong, Chang Kyu; Kwon, Jae Hyun; Kim, Young Hwan; Park, Noh Hyuck; Kim, Tae Hun; Kim, Yong Joo; Kang, Duck Sik; Shin, Tae Beom

2002-01-01

To determine the effectiveness and patency of percutaneous intervention in insufficient native arteriovenous hemodialysis fistulae (AVFs). Between March 1997 and September 2001, 67 cases of insufficient native AVFs resulted from central vein lesion, PTA was performed in 48 cases, and thrombolytic therapy with or without PTA in 11. In eight of the cases, in which central vein stenosis had led to the insufficency, percutaneous transluminal angioplasty (PTA) was performed, and in three of the eight, a stent was inserted. Angiography findings and complications, as well as success and patency rates in the non-thrombosis and thrombosis group, were evaluated; the central vein lesion group was analysed separately. Among 84 lesions observed at angiography, three were 54 cases of stenosis, 17 of occlusion, and 13 of combined thrombosis. The lesions were located in a proximal vein (n=51), distal vein (n=14), artery (n=6), and at the site of anastomosis (n=13). In the central vein lesion group (n=8), seven cases of stenosis and one of occlusion were noted. The overall procedural success rate was 79.1% (53/67). That is, in patients with no central vein lesion, the procedural success rate of PTA of native AVFs was 85.4% (41/48) and the patency rates of this were 83.1% at 6 months and 67.4% at 12 months. In cases of thrombolysis with/without PTA, the procedural success rate was 54.5% (6/11) and the patency rates were 83.3% at 6 months and 62.5% at 12 months. Finally, in patients with a central vein lesion, the procedural success rate was 75% (6/8) and the patency rates were 80% at 6 months and 30% at 12 months. There was one case of pseudoaneurysm formation at the puncture site of the brachial artery, which was used as the access route for intervention; one embolism in the brachial artery; and three cases of vascular spasm and two of hematoma which did not require active treatment. Percutaneous intervention offers effective and safe management of insufficient AVFs. The procedural

A Segmental Hypoplastic Anterior Tibial Artery Coexisting with a Hypertrophied Perforating Fibular Artery a Case Report and Clinical Implications

OpenAIRE

Ariyo, Olutayo

2015-01-01

Vascular injuries of the lower limb, especially from penetrating gunshot wounds, and peripheral arterial diseases are on the increase and management of these and many other lower limb injuries involve increasing usage of vascular interventions like by-pass surgery, per-cutaneous transluminal angioplasty, arterial cannulation, arterial bypass graft or minimally invasive measures like percutaneous trans-arterial catheterization, among others. A thorough knowledge of infrapopliteal branching mos...

Evaluating the Learning Curve for Percutaneous Nephrolithotomy under Total Ultrasound Guidance.

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Yan Song

Full Text Available To investigate the learning curve of percutaneous nephrolithotomy under total ultrasound guidance.One hundred and twenty consecutive PCNL operations under total ultrasound guidance performed by a novice surgeon in a tertiary referral center were studied. Operations were analyzed in cohorts of 15 to determine when a plateau was reached for the variables such as operation duration, ultrasound screening time, tract dilation time, stone-free rate and complication rate. Comparison was made with the results of a surgeon who had performed more than 1000 PCNLs. Fluoroscopy was not used at all during procedure.The mean operation time dropped from 82.5 min for the first 15 patients to a mean of 64.7 min for cases 46 through 60(P = 0.047. The ultrasound screening time was a peak of 6.4 min in the first 15 cases, whereas it dropped to a mean of 3.9 min for cases 46 through 60(P = 0.01. The tract dilation time dropped from 4.9 min for the first 15 patients to a mean of 3.8 min for cases 46 through 60(P = 0.036. The senior surgeon had a mean operating time, screening time and tract dilation time equivalent to those of the novice surgeon after 60 cases. There was no significant difference in stone free rate and complication rate.The competence of ultrasound guided PCNL is reached after 60 cases with good stone free rate and without major complications.

Transluminal color-coded three-dimensional magnetic resonance angiography for visualization of signal Intensity distribution pattern within an unruptured cerebral aneurysm: preliminarily assessment with anterior communicating artery aneurysms

International Nuclear Information System (INIS)

Satoh, T.; Ekino, C.; Ohsako, C.

2004-01-01

The natural history of unruptured cerebral aneurysm is not known; also unknown is the potential growth and rupture in any individual aneurysm. The authors have developed transluminal color-coded three-dimensional magnetic resonance angiography (MRA) obtained by a time-of-flight sequence to investigate the interaction between the intra-aneurysmal signal intensity distribution patterns and configuration of unruptured cerebral aneurysms. Transluminal color-coded images were reconstructed from volume data of source magnetic resonance angiography by using a parallel volume-rendering algorithm with transluminal imaging technique. By selecting a numerical threshold range from a signal intensity opacity chart of the three-dimensional volume-rendering dataset several areas of signal intensity were depicted, assigned different colors, and visualized transparently through the walls of parent arteries and an aneurysm. Patterns of signal intensity distribution were analyzed with three operated cases of an unruptured anterior communicating artery aneurysm and compared with the actual configurations observed at microneurosurgery. A little difference in marginal features of an aneurysm was observed; however, transluminal color-coded images visualized the complex signal intensity distribution within an aneurysm in conjunction with aneurysmal geometry. Transluminal color-coded three-dimensional magnetic resonance angiography can thus provide numerical analysis of the interaction between spatial signal intensity distribution patterns and aneurysmal configurations and may offer an alternative and practical method to investigate the patient-specific natural history of individual unruptured cerebral aneurysms. (orig.)

Percutaneous dilatational tracheostomy

DEFF Research Database (Denmark)

Johnsen, R.

2015-01-01

implies the risk of several complications, some of which may be lethal. Severe complications include hemorrhage, displacement and pneumothorax. Different methods of PDT are described in the literature, each with disadvantages and benefits. The aim of this study was to analyze complications due to PDTs...... of transfusion of blood products, one case of PDT displacement, one case of ventilation-related problems during procedure and, finally, one case of tracheal cartilage fracture. There were no incidents of pneumothorax. No PDTs had a lethal outcome due to the procedure itself. The total complication rate was 9...

Assessing transgastric Natural Orifice Transluminal Endoscopic Surgery prior to clinical implementation

DEFF Research Database (Denmark)

Donatsky, Anders Meller

2014-01-01

The objective was to investigate whether transgastric Natural Orifice Transluminal Endoscopic Surgery (NOTES) could be implemented safely in clinical practice. The experimental studies proved ultrasonography guided access through the stomach to be feasible and safe without iatrogenic complications......-abdominal abscess formation as a result of contamination from the access route was still present. To reduce this contamination, mouthwash with chlorhexidine was effective in a human randomised study. The same study also found significant higher bacterial load in the stomach of patients using proton pump inhibitor...

Intraarterial 192Ir high-dose-rate brachytherapy for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty: the prospective randomized Vienna-2-trial radiotherapy parameters and risk factors analysis

International Nuclear Information System (INIS)

Pokrajac, Boris; Poetter, Richard; Maca, Thomas; Fellner, Claudia; Mittlboeck, Martina; Ahmadi, Ramazanali; Seitz, Wolfgang; Minar, Erich

2000-01-01

Purpose: The aim of the Vienna-2-trial was to compare the restenosis rate of femoropopliteal arteries after percutaneous transluminal angioplasty (PTA) with or without intraarterial high-dose-rate (HDR) brachytherapy (BT) using an 192 Ir source. Materials and Methods: A prospective, randomized trial was conducted from 11/96 to 8/98. A total of 113 patients (63 men, 50 women), with a mean age of 71 years (range, 43-89 years) were included. Inclusion criteria were (1) claudication or critical limb ischemia, (2) de-novo stenosis of 5 cm or more, (3) restenosis after former PTA of any length, and (4) no stent implantation. Patients were randomized after successful PTA for BT vs. no further treatment. A well-balanced patient distribution was achieved for the criteria used for stratification, as there were 'de-novo stenosis vs. restenosis after former PTA', 'stenosis vs. occlusion', 'claudication vs. critical limb ischemia' and above these for 'diabetes vs. nondiabetes'. PTA length was not well balanced between the treatment arms: a PTA length of 4-10 cm was seen in 19 patients in the PTA alone group and in 11 patients in the PTA+BT group, whereas a PTA length of greater than10 cm was seen in 35 patients and 42 patients, respectively. A dose of 12 Gy was prescribed in 3-mm distance from the source axis. According to AAPM recommendations, the dose was 6.8 Gy in 5-mm distance (vessel radius + 2 mm). Primary endpoint of the study was femoropopliteal patency after 6 months. Results: PTA and additional BT were feasible and well tolerated by all 57 pts in this treatment arm. No acute, subacute, and late adverse side effects related to BT were seen after a mean follow up of 12 months (6-24 months) in 107 patients (PTA n = 54; PTA+ BT n = 53). Crude restenosis rate at 6 months was in the PTA arm 54% vs. 28% in the PTA + BT arm (χ 2 test; p 10 cm) showed significant decrease of the restenosis rate, if BT was added. Significant reduction was not achieved in diabetes patients

Fluoroscopically guided percutaneous jejunostomy: outcomes in 25 consecutive patients

International Nuclear Information System (INIS)

Yang, Z.Q.; Shin, J.H.; Song, H.-Y.; Kwon, J.H.; Kim, J.-W.; Kim, K.R.; Kim, J.-H.

2007-01-01

Aim: To assess the feasibility and safety of fluoroscopically guided percutaneous jejunostomy. Material and methods: Between May 1999 and August 2006 percutaneous jejunostomy was attempted in 25 patients. A 5 F vascular catheter (n = 20) or a 7.5 F multifunctional coil catheter (n = 5) was used to insufflate the jejunum. The distended jejunum was punctured using a 17 G needle (n = 19) or a 21 G Chiba needle (n = 6) with the inserted catheter as a target. A 12 or 14 F loop feeding tube was inserted after serial dilations. The technical success, complications, 30-day mortality, and in-dwelling period of the feeding tube placement were evaluated. Results: The technical success rate was 92% (23/25). Technical failures (n = 2) resulted from the inability to insufflate the jejunum secondary to failure to pass the catheter through a malignant stricture at the oesophagojejunostomy site and thus subsequent puncture of the undistended jejunum failed, or failure to introduce the Neff catheter into the jejunum. Pericatheter leakage with pneumoperitoneum was a complication in three patients (12%) and was treated conservatively. The 30-day mortality was 13% (3/23); however, there was no evidence that these deaths were attributed to the procedure. Except for four patients who were lost to follow-up and two failed cases, 15 of the 19 jejunostomy catheters were removed because of patient death (n = 12) or completion of treatment (n = 3), with a mean and median in-dwelling period of 231 and 87 days, respectively. Conclusions: Fluoroscopically guided percutaneous jejunostomy is a feasible procedure with a high technical success and a low complication rate. In addition to a 17 G needle, a 21 G needle can safely be used to puncture the jejunum

Recurrent Complete Pharyngo-Oesophageal Stricture Treated by Multidisciplinary Anterograde-Retrograde Endoscopic Dilation

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Paulo Castro Soares

2016-10-01

Full Text Available Complete pharyngo-oesophageal stricture (PES after radiotherapy for head and neck cancer is a relatively rare and difficult complication to manage. Historically this condition has been treated surgically, but endoscopic approaches are now available. We present a 61-year-old man with an epidermoid carcinoma of the supraglottic stage and a micro-invasive epidermoid carcinoma of the oropharynx treated surgically and subsequently by adjuvant radiotherapy. Eight months after the end of the radiotherapy, a complete PES was diagnosed and treated with a combined anterograde-retrograde endoscopic dilation (CARD. The procedure was performed using a transoral anterograde progression with a rigid pharyngoscope and a retrograde progression with an extra-slim nasal endoscope using the percutaneous gastrostomy already in place. Using both transillumination and direct visualisation from both sides of the complete stenosis patency was restored between the neopharynx and the oesophagus. Despite the use of an endoprosthesis, the complete PES recurred and the technique had to be performed a second time. Illustrating the complexity of the case different types of endoprosthesis and several dilations had to be performed for our patient to achieve and maintain a normal oral intake. This case report illustrates that even in complicated recurrent radiation-induced complete PES a CARD can be performed safely and successfully using different types of endoprosthesis.

The role of interventional radiology in management of patients with end-stage renal disease

International Nuclear Information System (INIS)

Surlan, M.; Popovic, P.

2003-01-01

percutaneous drainage. Doppler US, magnetic resonance angiography and digital subtraction angiography have a principle role in the evaluation of vascular complications of renal transplantation and management of the endovascular therapy. Stenosis, the most common vascular complication, occurs in 1-12% of transplanted renal arteries and represents a potentially curable cause of hypertension following transplantation and/or renal dysfunction. Treatment with percutaneous transluminal renal angioplasty (PTRA) or PTRA with stent has been technically successful in 82-92% of the cases, and graft salvage rate has ranged from 80 to 100%. Restenosis occurs in up to 20% of cases, but are usually amenable to repeated PTRA. Complications such as arterial and vein thrombosis are uncommon. Intrarenal A/V fistulas and pseudoaneurysms are occasionally seen after biopsy, the treatment requires superselective embolisation. Urologic complications are relatively uncommon, predominantly they consist of the urinary leaks and urethral obstruction. Interventional treatment consists of percutaneous nephrostomy, balloon dilation, insertion of the double J stents, metallic stent placement and external drainage of the extrarenal collections

Less invasive causal treatment of ejaculatory duct obstruction by balloon dilation: a case report, literature review and suggestion of a CT- or MRI-guided intervention

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Ole Kayser

2012-03-01

Full Text Available Uni- or bilateral ejaculatory duct obstruction (EDO is a rare but correctable cause of infertility, chronic pelvic pain and postejaculatory pain. EDO is a congenital or acquired condition, it is the underlying cause of infertility in approximately 5% of infertile men. If acquired, the etiology often remains unresolved, but prostatitis or urethritis with post-inflammatory adhesion of the duct walls seems to be a common underlying pathomechanism. Although a certain constellation of physicochemical semen parameters may lead to correct diagnosis, EDO often resembles a diagnosis by exclusion. Imaging of acquired EDO remains a challenge and the established surgical therapy, transurethral resection of the ejaculatory ducts (TURED, leads to a low rate of natural conception and a high rate of complications such as reflux of urine and epididymitis. We present a case of a male with suspected EDO who underwent a combined approach to both, semi-invasive diagnosis and therapy by transrectal puncture of the seminal vesicles and antegrade balloon-dilation of the ejaculatory ducts. Possibilities and pitfalls of this procedure are described and the literature is reviewed. Furthermore, we suggest a CT- or MRI-guided, percutaneous intervention for treatment of ejaculatory duct obstruction by balloon dilation and demonstrate initial steps of this procedure with a body donor. We call this new procedure PTED (percutaneous transgluteal ejaculatory ductoplasty.

Safety and efficacy of recombinant hirudin (CGP 39 393) versus heparin in patients with stable angina undergoing coronary angioplasty

NARCIS (Netherlands)

van den Bos, A. A.; Deckers, J. W.; Heyndrickx, G. R.; Laarman, G. J.; Suryapranata, H.; Zijlstra, F.; Close, P.; Rijnierse, J. J.; Buller, H. R.; Serruys, P. W.

1993-01-01

Enhanced thrombin activity has been associated with acute and long-term complications following balloon angioplasty (percutaneous transluminal coronary angioplasty (PTCA). We evaluated, in a 2-to-1 randomized, double-blind trial, the effects of recombinant hirudin, CGP 39 393, relative to

Safety and efficacy of recombinant Hirudin (CGP 39 393) versus Heparin in patients with stable angina undergoing coronary angioplasty

NARCIS (Netherlands)

A.A. van den Bos (Arjan); G.R. Heyndrickx (Guy); G-J. Laarman (GertJan); H. Suryapranata (Harry); F. Zijlstra (Felix); P. Close (Philip); J.J.M.M. Rijnierse (Joep); H.R. Büller (Harry); P.W.J.C. Serruys (Patrick); J.W. Deckers (Jaap)

1993-01-01

textabstractBACKGROUND. Enhanced thrombin activity has been associated with acute and long-term complications following balloon angioplasty (percutaneous transluminal coronary angioplasty (PTCA). We evaluated, in a 2-to-1 randomized, double-blind trial, the effects of recombinant hirudin, CGP 39

Hemodynamic Measurements for the Selection of Patients With Renal Artery Stenosis: A Systematic Review

NARCIS (Netherlands)

van Brussel, Peter M.; van de Hoef, Tim P.; de Winter, Robbert J.; Vogt, Liffert; van den Born, Bert-Jan

2017-01-01

Interventions targeting renal artery stenoses have been shown to lower blood pressure and preserve renal function. In recent studies, the efficacy of catheter-based percutaneous transluminal renal angioplasty with stent placement has been called into question. In the identification of functional

Revascularização miocárdica de urgência após complicação de angioplastia transluminal coronária: abordagem cirúrgica atual Emergency myocardial revascularization after complicated percutaneous transluminal coronary angioplasty: actual surgical approach

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Luís Alberto Dallan

1990-04-01

Full Text Available Entre julho de 1981 e fevereiro de 1990, foram realizados no INCOR 3016 angioplastias transluminais coronárias (ATC, em 2431 pacientes portadores de insuficiência coronária em suas diferentes manifestações. A cirurgia de revascularizaçâo do miocárdio de urgência foi necessária em 79 (3,2% desses pacientes, dos quais 32 (40,5% infartaram e 12 (15,2% faleceram. Dos 1530 pacientes submetidos estivamente a ATC por angina estável, 11,9% (7/59 faleceram no intra ou no pós-operatório. Dentre os 112 pacientes em que a ATC foi realizada de urgência devido a angina instável, 18,2% (2/11 evoluíram para óbito operatório. Nos 789 já infartados previamente à ATC, a mortalidade cirúrgica foi de 33,3% (3/9. A análise estatística demonstrou mortalidade mais elevada em pacientes idosos, em pacientes com dissecção do tronco da artéria coronária esquerda ou trombose coronária tardia e, especialmente, naqueles com instabilidade hemodinâmica após a ATC. O tempo decorrido entre a complicação da ATC e a revascularizaçâo do miocárdio também constitui fator agravante no prognóstico. O número de cirurgias de urgência após ATC diminuiu significativamente nos últimos dois anos (10/1351, a despeito do grau progressivo de complexidade das lesões dilatadas. O emprego de balões com extremidade atraumática e, especialmente, de cateter de reperíusão (Stack, que mantém o fluxo coronário mesmo diante do desprendimento da placa ateromatosa, contribuiu, decisivamente, para esses resultados. As modificações introduzidas na sistematização operatória, principalmente o uso de cardioplegia sangüínea com indução normotérmica e administrada por vias anterógrada e retrógrada, também propiciaram melhores resultados cirúrgicos. A associação desses procedimentos vem se mostrando benéfica, não tendo sido observados óbitos nos últimos 14 meses.Between July 1981 and February 1990, 2431 patients underwent attempted percutaneous

First report on a human percutaneous transluminal implantation of a self-expanding valve prosthesis for interventional treatment of aortic valve stenosis.

Science.gov (United States)

Grube, Eberhard; Laborde, Jean C; Zickmann, Bernfried; Gerckens, Ulrich; Felderhoff, Thomas; Sauren, Barthel; Bootsveld, Andreas; Buellesfeld, Lutz; Iversen, Stein

2005-12-01

Percutaneous aortic valve replacement is a new technology for the treatment of patients with significant aortic valve stenosis. We present the first report on a human implantation of a self-expanding aortic valve prosthesis, which is composed of three bovine pericardial leaflets inserted within a self-expanding nitinol stent. The 73-year-old woman presented with severe symptomatic aortic valve stenosis (mean transvalvular gradient of 45 mmHg; valve area of 0.7 cm2). Surgical valve replacement had been declined for the patient because of comorbidities, including previous bypass surgery. A retrograde approach via the common iliac artery was used for valve deployment. The contralateral femoral vessels were used for a temporary extracorporal circulation, unloading the left ventricle during the actual stent expansion. Clinical, hemodynamic, and echocardiographic outcomes were assessed serially during the procedure. Clinical and echocardiographic follow-up at day 1, 2, and 14 post procedure was performed to evaluate the short-term outcome. The prosthesis was successfully deployed within the native aortic valve, with accurate and stable positioning and with no impairment of the coronary artery or vein graft blood flow. 2D and doppler echo immediately after device deployment showed a significant reduction in transaortic mean pressure gradient (from 45 to 8 mmHg) without evidence of aortic or mitral valve insufficiency. The clinical status has then significantly improved. These results remained unchanged up to the day 14 follow-up. This case report demonstrates a successful percutaneous implantation of a self-expanding aortic valve prosthesis with remarkable functional and clinical improvements in the acute and short-term outcome. Copyright (c) 2005 Wiley-Liss, Inc.

Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study

NARCIS (Netherlands)

Yamaguchi, Akito; Skolarikos, Andreas; Buchholz, Niels-Peter Noor; Chomón, Gonzalo Bueno; Grasso, Michael; Saba, Pietro; Nakada, Stephen; de la Rosette, Jean

2011-01-01

The study investigated factors that affect operating times and bleeding complications associated with percutaneous nephrolithotomy (PCNL) in the PCNL Global Study. All patients who underwent PCNL for primary or secondary treatment of kidney stone indications during the study period (November

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

Science.gov (United States)

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

2016-11-01

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

Renal sympathetic denervation: MDCT evaluation of the renal arteries.

LENUS (Irish Health Repository)

Hutchinson, Barry D

2013-08-01

Percutaneous transluminal renal sympathetic denervation is a new treatment of refractory systemic hypertension. The purpose of this study was to assess the clinical utility of MDCT to evaluate the anatomic configuration of the renal arteries in the context of renal sympathetic denervation.

Effect of percutaneous renal sympathetic nerve radiofrequency ablation in patients with severe heart failure.

Science.gov (United States)

Dai, Qiming; Lu, Jing; Wang, Benwen; Ma, Genshan

2015-01-01

This study aimed to investigate the clinical feasibility and effects of percutaneous renal sympathetic nerve radiofrequency ablation in patients with heart failure. A total of 20 patients with heart failure were enrolled, aged from 47 to 75 years (63±10 years). They were divided into the standard therapy (n = 10), and renal nerve radiofrequency ablation groups (n = 10). There were 15 males and 5 female patients, including 8 ischemic cardiomyopathy, 8 dilated cardiomyopathy, and 8 hypertensive cardiopathy. All of the patients met the criteria of New York Heart Association classes III-IV cardiac function. Patients with diabetes and renal failure were excluded. Percutaneous renal sympathetic nerve radiofrequency ablation was performed on the renal artery wall under X-ray guidance. Serum electrolytes, neurohormones, and 24 h urine volume were recorded 24 h before and after the operation. Echocardiograms were performed to obtain left ventricular ejection fraction at baseline and 6 months. Heart rate, blood pressure, symptoms of dyspnea and edema were also monitored. After renal nerve ablation, 24 h urine volume was increased, while neurohormone levels were decreased compared with those of pre-operation and standard therapy. No obvious change in heart rate or blood pressure was recorded. Symptoms of heart failure were improved in patients after the operation. No complications were recorded in the study. Percutaneous renal sympathetic nerve radiofrequency ablation may be a feasible, safe, and effective treatment for the patients with severe congestive heart failure.

Results of arthrospine assisted percutaneous technique for lumbar discectomy

Directory of Open Access Journals (Sweden)

Mohinder Kaushal

2016-01-01

Full Text Available Background: Avaialable minimal invasive arthro/endoscopic techniques are not compatible with 30 degree arthroscope which orthopedic surgeons uses in knee and shoulder arthroscopy. Minimally invasive “Arthrospine assisted percutaneous technique for lumbar discectomy” is an attempt to allow standard familiar microsurgical discectomy and decompression to be performed using 30° arthroscope used in knee and shoulder arthroscopy with conventional micro discectomy instruments. Materials and Methods: 150 patients suffering from lumbar disc herniations were operated between January 2004 and December 2012 by indiginously designed Arthrospine system and were evaluated retrospectively. In lumbar discectomy group, there were 85 males and 65 females aged between 18 and 72 years (mean, 38.4 years. The delay between onset of symptoms to surgery was between 3 months to 7 years. Levels operated upon included L1-L2 (n = 3, L2-L3 (n = 2, L3-L4 (n = 8, L4-L5 (n = 90, and L5-S1 (n = 47. Ninety patients had radiculopathy on right side and 60 on left side. There were 22 central, 88 paracentral, 12 contained, 3 extraforaminal, and 25 sequestrated herniations. Standard protocol of preoperative blood tests, x-ray LS Spine and pre operative MRI and pre anaesthetic evaluation for anaesthesia was done in all cases. Technique comprised localization of symptomatic level followed by percutaneous dilatation and insertion of a newly devised arthrospine system devise over a dilator through a 15 mm skin and fascial incision. Arthro/endoscopic discectomy was then carried out by 30° arthroscope and conventional disc surgery instruments. Results: Based on modified Macnab's criteria, of 150 patients operated for lumbar discectomy, 136 (90% patients had excellent to good, 12 (8% had fair, and 2 patients (1.3% had poor results. The complications observed were discitis in 3 patients (2%, dural tear in 4 patients (2.6%, and nerve root injury in 2 patients (1.3%. About 90% patients

Histologic assessment of biliary obstruction with different percutaneous endoluminal techniques

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Guido Giampiero

2004-08-01

Full Text Available Abstract Background Despite the sophisticated cross sectional image techniques currently available, a number of biliary stenosis or obstructions remain of an uncertain nature. In these pathological conditions, an "intrinsic" parietal alteration is the cause of biliary obstruction and it is very difficult to differentiate benign from malignant lesions using cross-sectional imaging procedures alone. We evaluated the efficacy of different endoluminal techniques to achieve a definitive pathological diagnosis in these situations. Methods Eighty patients underwent brushing, and or biopsy of the biliary tree through an existing transhepatic biliary drainage route. A subcoort of 12 patients needed balloon-dilatation of the bile duct and the material covering the balloon surface was also sent for pathological examination (balloon surface sampling. Pathological results were compared with surgical findings or with long-term clinical and instrumental follow-ups. Success rates, sensitivity, specificity, accuracy, confidential intervals, positive predictive value and negative predictive value of the three percutaneous techniques in differentiating benign from malignant disease were assessed. The agreement coefficient of biopsy and brushing with final diagnosis was calculated using the Cohen's "K" value. Results Fifty-six patients had malignant strictures confirmed by surgery, histology, and by clinical follow-ups. Success rates of brushing, balloon surface sampling, and biopsy were 90.7, 100, and 100%, respectively. The comparative efficacy of brushing, balloon-surface sampling, and biopsy resulted as follows: sensitivity of 47.8, 87.5, and 92.1%, respectively; specificity of 100% for all the techniques; accuracy of 69.2, 91.7 and 93.6%, Positive Predictive Value of 100% for all the procedures and Negative Predictive Value of 55, 80, and 75%, respectively. Conclusions Percutaneous endoluminal biopsy is more accurate and sensitive than percutaneous bile duct

Brain Abscess after Esophageal Dilatation

DEFF Research Database (Denmark)

Gaïni, S; Grand, M; Michelsen, J

2007-01-01

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

Esophageal achalasia : results of balloon dilation

Energy Technology Data Exchange (ETDEWEB)

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

1996-08-01

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

Esophageal achalasia : results of balloon dilation

International Nuclear Information System (INIS)

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

1996-01-01

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

Long-Term Outcomes After Percutaneous Lower Extremity Arterial Interventions With Atherectomy vs. Balloon Angioplasty　- Propensity Score-Matched Registry.

Science.gov (United States)

Janas, Adam; Buszman, Piotr P; Milewski, Krzysztof P; Wiernek, Szymon; Janas, Ksenia; Pruski, Maciej; Wojakowski, Wojciech; Błachut, Aleksandra; Picheta, Wojciech; Buszman, Pawel; Kiesz, Stefan

2017-02-24

The impact of endovascular revascularization of the lower extremity arteries with atherectomy (AT) compared with percutaneous transluminal angioplasty (PTA) is still unclear. Therefore, the aim of the study was to compare long-term outcomes after percutaneous PTA and AT in patients requiring endovascular revascularization.Methods and Results:This was a single-center, retrospective registry of obstructive and symptomatic PAD patients who underwent endovascular revascularization. PTA was performed in 215 patients, and AT in 204 (Silver Hawk, EV3, n=125; CSI 360°, n=66; Pathway Medical Technologies, n=13). There were no significant between-group differences in baseline characteristics except for increased CAD, dialysis and CLI prevalence in the PTA group. Following propensity score analysis 131 well-matched pairs were included in analysis. Bail-out stenting was more frequent in the reference group (PTA, 6.1% vs. AT, 0%; P=0.004). At 6- and 12-month follow-up there were no differences in TLR between the groups (PTA, 8.3% vs. AT, 5.3%; P=0.47; and PTA, 16.7% vs. AT, 13.7%; P=0.73, respectively). The difference was in favor of AT at 24-month follow-up (PTA, 29.0% vs. AT, 16.7%; P=0.05). No difference was observed in amputation rate (PTA, 0.7% vs AT, 1.5%; P=0.62). On Kaplan-Meier analysis there were no significant differences between groups in time to TLR, amputation or death. AT was associated with lower risk of TLR, and this should be confirmed in randomized controlled trials.

Pure natural orifice transluminal endoscopic surgery (NOTES) with ultrasonography-guided transgastric access and over-the-scope-clip closure

DEFF Research Database (Denmark)

Donatsky, Anders Meller; Andersen, Luise; Nielsen, Ole Lerberg

2012-01-01

Most natural orifice transluminal endoscopic surgery (NOTES) procedures to date rely on the hybrid technique with simultaneous laparoscopic access to protect against access-related complications and to achieve adequate triangulation for dissection. This is done at the cost of the potential benefi...

Percutaneous mechanical atherectomy for treatment of peripheral arterial occlusive disease

International Nuclear Information System (INIS)

Buecker, A.; Minko, P.; Massmann, A.; Katoh, M.

2010-01-01

Peripheral arterial occlusive disease (PAOD) is still an extremely important politico-economic disease. Diverse treatment procedures exist but the pillars of therapy are changes in lifestyle, such as nicotine abstinence and walking exercise as well as drug therapy. Further therapy options are considered after conventional procedures have been exhausted. These further options consist of improvement of the blood supply by surgical or minimally invasive procedures. The latter therapy options include balloon dilatation and stenting as the most widely used techniques. More recent techniques also used are cryoplasty, laser angioplasty, drug-coated stents or balloons as well as brachytherapy or atherectomy, whereby this list makes no claims to completeness. The multitude of different treatment methods emphatically underlines the fact that no resounding success can be achieved with one single method. The long-term results of both balloon dilatation and stenting techniques show a need for improvement, which elicited the search for additional methods for the treatment of PAOD. Atherectomy represents such an alternative method for treatment of PAOD. Basically, the term atherectomy means the removal of atheroma tissue. For percutaneous atherectomy, in contrast to surgical procedures, it is not necessary to create surgically access to the vessel but accomplishes the atherectomy by means of dedicated systems via a minimally invasive access. There are two basic forms of mechanical atherectomy: directional and rotational systems. (orig.) [de

Pneumatosis in canine gastric dilatation-volvulus syndrome.

Science.gov (United States)

Fischetti, Anthony J; Saunders, H Mark; Drobatz, Kenneth J

2004-01-01

Retrospectively, 243 dogs with radiographic evidence of gastric dilatation-volvulus (GDV) were studied for radiographic signs of pneumatosis (intramural gas), pneumoperitoneum, splenomegaly, and severity of gastric distention. The sensitivity, specificity, and predictive value of these imaging signs as predictors of gastric wall necrosis, as determined by visual inspection at surgery or necropsy, were determined. The sensitivity and specificity of gastric pneumatosis were 14.1% and 92.7%, respectively. The prevalence of gastric wall necrosis was 26.6%. The positive and negative predictive values of gastric pneumatosis for predicting gastric necrosis were 40.9% and 74.9%, respectively. Gastric pneumatosis and pneumoperitoneum were identified together in four dogs. Pneumoperitoneum, either alone or in conjunction with pneumatosis, yielded similar results as a test for gastric necrosis. Splenomegaly and severity of gastric distention were insensitive and nonspecific for gastric wall necrosis. Splenomegaly did not predict the need for splenectomy at surgery. Although pneumatosis and pneumoperitoneum are relatively specific signs of gastric wall necrosis, the utility of these signs as a test for gastric necrosis is limited in clinical practice. The significance of pneumatosis should be taken into consideration with previous treatments for gastric decompression, as percutaneous gastric trocharization or orogastric intubation may increase the number of false-positive results.

Drug therapy or coronary angioplasty for the treatment of coronary artery disease : New insights

NARCIS (Netherlands)

Amoroso, G; Van Boven, AJ; Crijns, HJGM

Background In the last decade percutaneous transluminal coronary angioplasty has become a very popular strategy For the treatment of coronary artery disease, although its efficacy in reducing ischemic events and the subsequent need for revascularization has yet to be proved. Methods We reviewed the

Quantitative angiographic follow-up of the coronary wallstent in native vessels and bypass grafts (European experience - March 1986 to March 1990)

NARCIS (Netherlands)

B.H. Strauss (Bradley); P.W.J.C. Serruys (Patrick); M.E. Bertrand (Michel); J. Puel (Jacques); B. Meier (Bernard); J-J. Goy (Jean-Jacques); L. Kappenberger (Lukas); A.F. Rickards (Anthony); U. Sigwart (Ulrich); M-A.M. Morel (Marie-Angèle); E.W.J. Montauban van Swijndregt (Eline)

1992-01-01

textabstractThe coronary stent has been investigated as an adjunct to percutaneous transluminal coronary angioplasty to obviate the problems of early occlusion and late restenosis. From March 1986 to March 1990, 265 patients (308 lesions) were implanted with the coronary Wallstent in 6 European

Coronary stenting as an adjunct to balloon angioplasty

NARCIS (Netherlands)

B.H. Strauss (Bradley)

1991-01-01

textabstractAndreas Gruentzig initiated the era of interventional cardiology in 19n with the introduction of percutaneous transluminal coronary angioplasty (PTCA) (1). The acceptance of coronary angioplasty is obvious by the widespread use of the procedure (>300,000 cases in the United States in

Laserassisteret ballonangioplastik af okklusioner i det femoropopliteale segment

DEFF Research Database (Denmark)

Eiberg, J P; Rasmussen, John Bøje Grønvall; Schroeder, T V

1995-01-01

of collateral vessels. In this series, laser angioplasty carried a high risk of perforation. The initial and long-term results were no better than could be expected of percutaneous transluminal angioplasty, suggesting that laser-assisted balloon angioplasty has no place in the vascular surgical armamentarium....

Percutaneous Management of Occlusive Arterial Disease Associated with Vasculitis: A Single Center Experience

International Nuclear Information System (INIS)

Both, M.; Jahnke, T.; Reinhold-Keller, E.; Reuter, M.; Grimm, J.; Biederer, J.; Brossmann, J.; Gross, W.L.; Heller, M.; Mueller-Huelsbeck, S.

2003-01-01

The purpose of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty for occlusive arterial disease associated with vasculitis. Eleven patients(10 women, 1 man; ages 35-82 years) with the diagnosis of vasculitis of the large vessels underwent interventional treatment during intraarterial angiography. The causes included giant cell arteritis(n = 8) and Takayasu arteritis (n = 3).Thirty-three occlusive lesions (including brachiocephalic and renalarteries, and arteries of upper and lower extremities) were treated with balloon angioplasty and/or stent placement. Follow-up included clinical examination, angiography, and color duplex ultrasound.Technical success was 100% (25/25) for stenoses and 50% (4/8) for occlusive lesions, representing all lesions combined from different anatomic locations. Dissection (n = 3) and arterial rupture with retroperitoneal hematoma (n = 1) was found in three patients. During follow-up (mean 12 months), restenoses(n = 8) and re-restenoses (n = 1)occurred in 8 vascular areas. Three of these lesions were treated with repeated PTA (n = 4). The cumulative primary clinical success rate was 67.6%, cumulative secondary success rate 74.4%, and cumulative tertiary success rate 75.9%. Interventional therapy in systemic vasculitis provides promising results in technical success rates and followup. Angioplasty may result in arterial injury, but the rate of complications is low

Characterization of dilation-analytic operators

Energy Technology Data Exchange (ETDEWEB)

Balslev, E; Grossmann, A; Paul, T

1986-01-01

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

Diuretic Agent and Normal Saline Infusion Technique for Ultrasound-Guided Percutaneous Nephrostomies in Nondilated Pelvicaliceal Systems

International Nuclear Information System (INIS)

Yagci, Cemil; Ustuner, Evren; Atman, Ebru Dusunceli; Baltaci, Sumer; Uzun, Caglar; Akyar, Serdar

2013-01-01

Percutaneous nephrostomy (PCN) in a nondilated pelvicaliceal system is technically challenging. We describe an effective method to achieve transient dilatation of the pelvicaliceal system via induction of diuresis using infusion of a diuretic agent in normal saline, therefore allowing easier access to the pelvicaliceal system. Under real-time ultrasound guidance, the technique had been tested in 22 nephrostomies with nondilated system (a total of 20 patients with 2 patients having bilateral nephrostomies) during a 5-year period. Patients were given 40 mg of furosemide in 250 ml of normal saline solution intravenously by rapid infusion. As soon as maximum calyceal dilatation of more than 5 mm was observed, which is usually 15 min later after the end of rapid infusion, patients were positioned obliquely, and PCN procedure under ultrasound guidance was performed. The procedure was successful in 19 of the nephrostomies in 17 patients with a success rate of 86.36 % per procedure and 85 % per patient in nondilated pelvicaliceal systems. No major nephrostomy-, drug-, or technique-related complications were encountered. The technique failed to work in three patients due to the presence of double J catheters and preexisting calyceal perforation which avoided transient dilation of the pelvicaliceal system with diuresis. Diuretic infusion in saline is a feasible and effective method for PCN in nondilated pelvicaliceal systems.

Diuretic Agent and Normal Saline Infusion Technique for Ultrasound-Guided Percutaneous Nephrostomies in Nondilated Pelvicaliceal Systems

Energy Technology Data Exchange (ETDEWEB)

Yagci, Cemil, E-mail: cemil.yagci@medicine.ankara.edu.tr; Ustuner, Evren, E-mail: evrenustuner@hotmail.com; Atman, Ebru Dusunceli, E-mail: ebrumd2001@yahoo.com [Ankara University, Department of Radiology, School of Medicine (Turkey); Baltaci, Sumer, E-mail: sbaltaci@hotmail.com [Ankara University, Department of Urology, School of Medicine (Turkey); Uzun, Caglar, E-mail: cuzun77@yahoo.com; Akyar, Serdar, E-mail: yusuf.s.akyar@medicine.ankara.edu.tr [Ankara University, Department of Radiology, School of Medicine (Turkey)

2013-04-15

Percutaneous nephrostomy (PCN) in a nondilated pelvicaliceal system is technically challenging. We describe an effective method to achieve transient dilatation of the pelvicaliceal system via induction of diuresis using infusion of a diuretic agent in normal saline, therefore allowing easier access to the pelvicaliceal system. Under real-time ultrasound guidance, the technique had been tested in 22 nephrostomies with nondilated system (a total of 20 patients with 2 patients having bilateral nephrostomies) during a 5-year period. Patients were given 40 mg of furosemide in 250 ml of normal saline solution intravenously by rapid infusion. As soon as maximum calyceal dilatation of more than 5 mm was observed, which is usually 15 min later after the end of rapid infusion, patients were positioned obliquely, and PCN procedure under ultrasound guidance was performed. The procedure was successful in 19 of the nephrostomies in 17 patients with a success rate of 86.36 % per procedure and 85 % per patient in nondilated pelvicaliceal systems. No major nephrostomy-, drug-, or technique-related complications were encountered. The technique failed to work in three patients due to the presence of double J catheters and preexisting calyceal perforation which avoided transient dilation of the pelvicaliceal system with diuresis. Diuretic infusion in saline is a feasible and effective method for PCN in nondilated pelvicaliceal systems.

Technical skill set training in natural orifice transluminal endoscopic surgery: how should we approach it?

LENUS (Irish Health Repository)

Nugent, Emmeline

2011-03-01

The boundaries in minimally invasive techniques are continually being pushed further. Recent years have brought new and exciting changes with the advent of natural orifice transluminal endoscopic surgery. With the evolution of this field of surgery come challenges in the development of new instruments and the actual steps of the procedure. Included in these challenges is the idea of developing a proficiency-based curriculum for training.

Ultrasound guided percutaneous removal of wooden foreign bodies in the extremities with hydro-dissection technique

Energy Technology Data Exchange (ETDEWEB)

Park, HeeJin; Lee, So Yeon; Chung, Eun Chul; Rho, Myung Ho [Dept. of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul (Korea, Republic of); Lee, Sung Moon; Son, Eun Seok [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of); Lee, Sun Joo [Dept. of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan (Korea, Republic of)

2015-12-15

We described the technique of ultrasound (US)-guided percutaneous removal of the foreign bodies (FB) with hydro-dissection in the radiologic department and presented video files of several cases.Four patients referred to the radiology department for US evaluation and US-guided percutaneous removal of the FBs in the upper and lower extremities between November, 2006 and November, 2013 were included in this study. The procedures started with US evaluation for the exact location and shape of the FB. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. We adopted a hydro dissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution. Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. After the tip of the mosquito forceps reached the FB, the wooden FBs were removed. The mean time required for the entire procedure was approximately 20 minutes. There were no significant complications during the US-guided removal or long-term complications after the procedure. All 4 FBs were successfully removed from the soft tissue under US guidance. Ultrasound-guided percutaneous removal of the FBs with hydro-dissection in the radiology department is a less invasive and safe method over surgical removal in the operating room. Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.

Long-term results of percutaneous balloon valvuloplasty in pulmonary valve stenosis in the pediatric population.

Science.gov (United States)

Merino-Ingelmo, Raquel; Santos-de Soto, José; Coserria-Sánchez, Félix; Descalzo-Señoran, Alfonso; Valverde-Pérez, Israel

2014-05-01

Percutaneous pulmonary valvuloplasty is the preferred interventional procedure for pulmonary valve stenosis. The aim of this study was to evaluate the effectiveness of this technique, assess the factors leading to its success, and determine the long-term results in the pediatric population. The study included 53 patients with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty between December 1985 and December 2000. Right ventricular size and functional echocardiographic parameters, such as pulmonary regurgitation and residual transvalvular gradient, were assessed during long-term follow-up. Peak-to-peak transvalvular gradient decreased from 74 mmHg [interquartile range, 65-100 mmHg] to 20 mmHg [interquartile range, 14-34 mmHg]. The procedure was unsuccessful in 2 patients (3.77%). The immediate success rate was 73.58%. Follow-up ranged from 10 years to 24 years (median, 15 years). During follow-up, all patients developed late pulmonary regurgitation which was assessed as grade II in 58.4% and grade III in 31.2%. There was only 1 case of long-term restenosis (2.1%). Severe right ventricular dilatation was observed in 27.1% of the patients. None of the patients developed significant right ventricular dysfunction. Pulmonary valve replacement was not required in any of the patients. Percutaneous balloon valvuloplasty is an effective technique in the treatment of pulmonary valve stenosis with good long-term results. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Percutaneous Trans-hepatic Obliteration for Bleeding Esophagojejunal Varices After Total Gastrectomy and Esophagojejunostomy

International Nuclear Information System (INIS)

Boku, Michiko; Sugimoto, Koji; Nakamura, Tetsu; Kita, Yasufumi; Zamora, Carlos A.; Sugimura, Kazuro

2006-01-01

A 72-year-old man who had undergone a total gastrectomy with a Roux-en-Y esophagojejunostomy for gastric cancer 6 years earlier presented to our hospital with massive hematemesis and melena. Endoscopic examination indicated esophageal varices with cherry-red spots and hemorrhage arising from beyond the anastomosis. Abdominal contrast-enhanced computed tomography and angiography revealed a dilated vein in the elevated jejunal limb supplying the varices. Percutaneous trans-hepatic obliteration (PTO) of the varices through the jejunal vein was performed using microcoils, ethanolamine oleate, and gelatin sponge cubes. Ten days after the procedure, endoscopic examination revealed reduction and thrombosis of the varices. We consider PTO to be an effective alternative method for treating ruptured esophagojejunal varices after total gastrectomy

Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention

DEFF Research Database (Denmark)

Jensen, Lisette Okkels; Thayssen, Per; Lassen, Jens Flensted

2007-01-01

AIMS: Collateral flow may influence long-term results after percutaneous coronary intervention (PCI) because of haemodynamic forces compete with the antegrade flow through the dilated lesion. The aim of the study was to assess the influence of recruitable collateral blood flow on restenosis...... in patients undergoing PCI with bare metal stents and using optimal antithrombotic treatment. METHODS AND RESULTS: In 95 patients, 95 de novo lesions were treated with PCI and a bare metal stent. Fractional flow reserve (FFR) at maximum hyperaemia induced by intravenous adenosine was determined. The pressure.......02-1.12, P = 0.016). CONCLUSION: Recruitable collateral blood flow measured during balloon inflation predicts angiographic instent restenosis in PCI patients treated with bare metal stents. Udgivelsesdato: 2007-Aug...

Percutaneous Ureteral stent insertion

Energy Technology Data Exchange (ETDEWEB)

Yoon, Yup; Sung, Dong Wook; Choi, Woo Suk; Lee, Dong Ho; Ko, Young Tae; Lee, Sun Wha; Lim, Jae Hoon [Kyung Hee University Hospital, Seoul (Korea, Republic of)

1990-10-15

Percutaneous ureteral stent insertion is a treatment of permanent or temporary urinary diversion to maintain continuity and function of the obstructed and injured ureter. We performed 31 cases of percutaneous double pig tall ureteral stent insertion in 21 patients, included 13 patients with malignant ureteral obstruction and eight patients with injured ureter as well as benign inflammatory stricture. Satisfactory resulted was obtained in all patients but one, who need percutaneous nephrostomy on week later for urinary diversion. No significant complication was encountered. The authors concluded that percutaneous ureteral stent insertion, an interventional procedure alternative to urologic retrograde method, is an effective method for urinary diversion.

Nuclear medical control of the efficiency of transluminal coronary angioplasty (TCA)

International Nuclear Information System (INIS)

Klepzig, H. Jr.; Scherer, D.; Kober, G.; Maul, F.D.; Kanemoto, N.; Standke, R.; Hoer, G.; Kaltenbach, M.; Frankfurt Univ.

1982-01-01

To assess the results of transluminal coronary angioplasty 48 patients with coronary heart disease were investigated at rest and during exercise with the ECG (46 patients), thallium-201 myocardial scintigraphy (26 patients), and equilibrium radionuclide ventriculography (38 patients). Exercise stress test was quantified by means of an ischemia score, myocardial scintigraphy by an vitality index and by corresponding redistribution factors, and radionuclide ventriculography by ejection fraction and maximum systolic volume change as a fraction of enddiastolic volume. This, the results show, that in selected cases, TCA can achieve improved left ventricular function and perfusion comparable to that of aortocoronary bypass surgery. (orig./MG) [de

Evaluation of the Pullback Atherectomy Catheter in the Treatment of Lower Limb Vascular Disease

International Nuclear Information System (INIS)

Grubnic, Sisa; Heenan, Susan D.; Buckenham, Timothy M.; Belli, Anna-Maria

1996-01-01

Purpose: To evaluate prospectively the Pullback Atherectomy Catheter (PAC) in terms of its technical success and 1-year patency in the treatment of lower limb vascular disease. Methods: Thirty-nine PAC procedures were performed in 34 patients to treat atherosclerotic disease (occlusive in 51%) of the femoropopliteal arteries, including four cases of graft neointimal hyperplasia and three dissection flaps. Follow-up was by ankle - brachial indices at 24 hr and 1 month, and arteriography at 6 and 12 months. Results: Technical success was achieved in 38 of 39 procedures (97.4%). There was a reduction in mean stenosis from 89.4% to 12.1%, but 69.2% of procedures required additional balloon dilatation to achieve an adequate arterial lumen. Complications followed 15.4% of procedures, a third of which required surgery. Conclusion: The PAC is an easy and relatively safe catheter to use, but does not provide a satisfactory arterial lumen without additional percutaneous transluminal angioplasty (PTA). It proved to be effective, however, in the treatment of graft neointimal hyperplasia and in the resection of obstructive intimal flaps following PTA

Interventional treatment of iliac vein compression syndrome

International Nuclear Information System (INIS)

Li Xiaoqiang; Zhou Weiming; Nie Zhonglin; Yu Chaowen

2002-01-01

Objective: To explore the clinical significance of interventional treatment of iliac vein compression syndrome (IVCS). Methods: Percutaneous transluminal angioplasty (PTA) was performed in 40 cases. Thirty-three cases underwent endovascular stent implantation and 27 cases underwent second-stage left saphenous vein ligation and stripping and the valves of left femoral veins narrowing. Thirty-one cases were followed-up postoperatively and the duration was 6-66 months (mean 28 months). Results: The dilation of iliac veins was successful in 36 cases and there were god efficacy in all patients when they discharged from hospital. Followed-up during post-operation, all the limbs ulcers were cured and varicose veins disappeared. The skin pigmentation disappeared in 17 of 19 cases and markedly relieved in 2 cases. Left lower limb swelling disappeared in 15 of 17 cases and relieved in 2 cases. Conclusion: There is good efficacy in the interventional treatment of left iliac vein lesions, but second-stage procedures should be performed in secondary lesions of saphenous veins and valves of femoral veins

Complications of Percutaneous Nephrostomy, Percutaneous Insertion of Ureteral Endoprosthesis, and Replacement Procedures

International Nuclear Information System (INIS)

Kaskarelis, Ioannis S.; Papadaki, Marina G.; Malliaraki, Niki E.; Robotis, Epaminondas D.; Malagari, Katerina S.; Piperopoulos, Ploutarchos N.

2001-01-01

Purpose: The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses.Methods: During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting).Results: There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter.Conclusion: The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures

Balloon dilatation of ureteric strictures.

Directory of Open Access Journals (Sweden)

Punekar S

2000-01-01

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

The prevention and treatment of biliary complications occurred after CT-guided percutaneous radiofrequency ablation for hepatic neoplasms

International Nuclear Information System (INIS)

Li Jianjun; Zheng Jiasheng; Cui Xiongwei; Cui Shichang; Sun Bin

2011-01-01

Objective: To discuss the prevention and treatment of biliary complications occurred after CT-guided percutaneous radiofrequency ablation (RFA) for hepatic neoplasms. Methods: A total of 1136 patients, including 920 males and 216 females, with hepatic neoplasms were enrolled in this study. The hepatic tumors consisted of primary hepatocellular carcinoma (n=1037), hepatic metastasis (n=83) and hepatic cavernous hemangioma (n=16). The diameters of the tumors ranged from 0.5 to 16 cm. A total of 1944 RFA procedures were carried out in all patients. Results: Thirty-five patients developed biliary complication (35/1944, 1.80%). Twelve patients developed asymptomatic bile duct dilatation and no special treatment was given. Obstructive jaundice occurred in two patients and percutaneous transhepatic cholangiocholecystic drainage (PTCD) together with subsequent inner stent implantation had to be carried out. Eighteen patients developed biloma, and liver abscess formation secondary to biloma infection occurred in seven of them. Percutaneous transhepatic biloma drainage (PTBD) was adopted in all these patients. One patient suffered from obstructive jaundice complicated by biloma, and both PTCD and PTBD combined with inner stent implantation were simultaneously performed. One patient had the biloma secondary to obstructive jaundice, and PTCD followed by PTBD was conducted in turn. One patient developed obstructive jaundice secondary to biloma, and PTBD followed by PTCD was employed in turn. Conclusion: Obstructive jaundice and biloma are severe biliary complications occurred after CT-guided percutaneous radiofrequency ablation for hepatic tumors, and PTCD and/or PTBD should be carried out without delay to treat these complications. The clinical symptoms can be relieved, or even completely disappear, after treatment. (authors)

Reversible Congestive Heart Failure after Percutaneous Closure of a Large PDA in a 34-year-old Woman

Directory of Open Access Journals (Sweden)

Ramazan Kargın

2010-08-01

Full Text Available Patent ductus arteriosus is a congenital heart disease which can cause chronic volume overload leading to congestive heart failure. A 34-year-old woman with rest dyspnea was found to have patent ductus arteriosus and echocardiogram revealed a markedly dilated left ventricle (8.9 cm and severely-compromised left ventricle systolic functions (ejection fraction~24%. The patent ductus arteriosus was successfully closed percutaneously with Amplatzer occluder device. The patient was discharged on optimal dosages of ramipril, metoprolol, furosemide, spiranolactone and aspirin. On the follow-up after 18 months, the symptoms were found to have regressed and echocardiographic parameters improved (ejection fraction~55%.

Balloon dilatation of iatrogenic urethral strictures

International Nuclear Information System (INIS)

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

1988-01-01

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

Vessel dilatation in coronary angiograms

International Nuclear Information System (INIS)

Hinterauer, L.; Goebel, N.

1983-01-01

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

Vessel dilatation in coronary angiograms

Energy Technology Data Exchange (ETDEWEB)

Hinterauer, L.; Goebel, N.

1983-11-01

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

Percutaneous, radiology-assisted stent implantation by means of a novel prosthesis of the bile duct in cases of inoperable cholangioma. Perkutane radiologische Stentimplantation beim inoperablen Gallengangskarzinom mittels einer neuen Gallengangsprothese

Energy Technology Data Exchange (ETDEWEB)

Beck, A; Nanko, N [Freiburg Univ. (Germany, F.R.). Abt. Roentgendiagnostik; Milic, S [Consiglio Nazionale delle Ricerche, Rome (Italy); Volk, B [Freiburg Univ. (Germany, F.R.). Abt. Innere Medizin 1 (Haematologie und Onkologie)

1989-07-01

In case of malignant growth causing biliary obstruction, biliary decompression can be achieved by surgery, or by means of external/internal drainage. A novel stent with an F7 outer diameter can be percutaneously introduced and positioned through an F8 sluice, assisted by radiologic and cholangioscopic control, and can be dilated to the required diameter by means of a balloon catheter. The implentation can entirely be done through the sluice.

Radiologic percutaneous gastrostomy and gastroenterostomy: Indications, results, and difficulties

International Nuclear Information System (INIS)

Casola, G.; Van Sonnenberg, E.; Sukthankar, R.; Varney, R.A.; Stavas, J.; Cohen, M.; Christensen, R.A.; Wittich, G.R.

1987-01-01

This paper summarizes the authors' experience with 130 radiologic percutaneous gastrostomies (PG) and percutaneous gastroenterostomies (PGE). Procedures were accomplished successfully in 127 of 130 candidates. One case was unsuccessful and two were unfeasible. Indications were for feeding, decompression, or both. Underlying diseases included neurologic disorders, head and neck and esophageal tumors, pelvic and abdominal malignancies, trauma, and a variety of other diseases. Various guidance systems, techniques, and catheters were used. Complications occurred in 8%, most being minor. Three patients were operated on after PG/PGE-two had peritonitis, one due to tube dislodgment. Difficulties were encountered at different portions of the procedure. During catheter insertion the following problems were most common: (1) the access route was difficult because of overlying colon, (2) inability to insert a nasogastric tube in patients with esophageal carcinoma or large head and neck tumors, (3) inability to keep the stomach distended in patients with increased motility and those with surgical gastroenterostomies (Billroth I or II), (4) high position of the residual stomach in patients with hemigastrectomy, (5) the presence of ascites or peritoneal tumor anterior to the stomach in patients with ovarian carcinoma, and (6) tenting or herniation of the anterior wall of the stomach during dilatation. Difficulties that were encountered following catheter insertion included (1) chemical peritonitis from leakage of gastric juices, (2) peritonities from leakage of gastric feedings, (3) leakage around the skin entry site in patients with ascites, (4) catheters backing out and forming an intraperitorial loop, (5) catheters kinking and becoming occluded, and (6) catheters being pulled out

Dilation of non-quasifree dissipative evolution

Energy Technology Data Exchange (ETDEWEB)

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

1981-03-01

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

A characterization of dilation-analytic operators

International Nuclear Information System (INIS)

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

1986-01-01

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

Segmental dilatation of the ileum

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Tune-Yie Shih

2017-01-01

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

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

Science.gov (United States)

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

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

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

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Alireza Bakhshipour

2010-03-01

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

Balloon Angioplasty – The Legacy of Andreas Grüntzig, M.D. (1939–1985)

Science.gov (United States)

Barton, Matthias; Grüntzig, Johannes; Husmann, Marc; Rösch, Josef

2014-01-01

In 1974, at the Medical Policlinic of the University of Zürich, German-born physician-scientist Andreas Grüntzig (1939–1985) for the first time applied a balloon-tipped catheter to re-open a severely stenosed femoral artery, a procedure, which he initially called “percutaneous transluminal dilatation”. Balloon angioplasty as a therapy of atherosclerotic vascular disease, for which Grüntzig and Charles T. Dotter (1920–1985) received a nomination for the Nobel Prize in Physiology or Medicine in 1978, became one of the most successful examples of translational medicine in the twentieth century. Known today as percutaneous transluminal angioplasty (PTA) in peripheral arteries or percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) in coronary arteries, balloon angioplasty has become the method of choice to treat patients with acute myocardial infarction or occluded leg arteries. On the occasion of the 40th anniversary of balloon angioplasty, we summarize Grüntzig’s life and career in Germany, Switzerland, and the United States and also review the developments in vascular medicine from the 1890s to the 1980s, including Dotter’s first accidental angioplasty in 1963. The work of pioneers of catheterization, including Pedro L. Fariñas in Cuba, André F. Cournand in France, Werner Forssmann, Werner Porstmann and Eberhard Zeitler in Germany, António Egas Moniz and Reynaldo dos Santos in Portugal, Sven-Ivar Seldinger in Sweden, and Barney Brooks, Thomas J. Fogarty, Melvin P. Judkins, Richard K. Myler, Dickinson W. Richards, and F. Mason Sones in the United States, is discussed. We also present quotes by Grüntzig and excerpts from his unfinished autobiography, statements of Grüntzig’s former colleagues and contemporary witnesses, and have included hitherto unpublished historic photographs and links to archive recordings and historic materials. This year, on June 25, 2014, Andreas Grüntzig would have celebrated

Vaginal dilator therapy for women receiving pelvic radiotherapy.

Science.gov (United States)

Miles, Tracie; Johnson, Nick

2014-09-08

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

Transluminal recanalization of chronic total occlusion of radial artery using rendezvous technique: a case report and literature review.

Science.gov (United States)

Arabi, Mohammad; Ahmed, Ishtiaq; Qattan, Nabeel

2014-01-01

Although endovascular management of lower extremity peripheral arterial disease (PAD) is well studied, little information exists regarding endovascular treatment of critical upper limb ischemia. We report a case of transluminal recanalization of right radial artery chronic total occlusion (CTO) using rendezvous technique in a patient with critical hand ischemia and dry gangrene of the right index finger.

Major complications after percutaneous nephrostomy--lessons from a department audit

International Nuclear Information System (INIS)

Lewis, S.; Patel, U.

2004-01-01

four cases [medial renal puncture (n=1), damage due to fascial dilator (n=1) or peelaway sheath (n=2)] and delay in diagnosis/therapy (of 1-8 days, in six of 10 cases of whom four out of six became septic). One pelvic injury required surgical correction (contributory factor-faulty use of peelaway sheath). Patients with haemorrhage settled with prolonged tube drainage alone. CONCLUSION: An adequately staffed percutaneous nephrostomy service can perform within published clinical standards. Best practice factors identified were: attention to agreed protocols and algorithms, pre-procedure antibiotics, careful renal puncture and care with use of dilators/peelaway sheaths, but the paramount finding was that sepsis was the most serious complication, contributing to death (two of 10 in this study) or a significant increase in the level of care required. The risk is greatest after failed instrumentation (retrograde ureteral stent or percutaneous nephrostomy insertion) and particularly if there is a further delay before establishment of renal drainage. A close working relationship between interventional radiologists and urologists is crucial

Percutaneous transhepatic biliary drainage

International Nuclear Information System (INIS)

Park, Jae Hyung; Hong, Seong Mo; Han, Man Chung

1982-01-01

Percutaneous transhepatic biliary drainage was successfully made 20 times on 17 patients of obstructive jaundice for recent 1 year since June 1981 at Department of Radiology in Seoul National University Hospital. The causes of obstructive jaundice was CBD Ca in 13 cases, metastasis in 2 cases, pancreatic cancer in 1 case and CBD stone in 1 case. Percutaneous transhepatic biliary drainage is a relatively ease, safe and effective method which can be done after PTC by radiologist. It is expected that percutaneous transhepatic biliary drainage should be done as an essential procedure for transient permanent palliation of obstructive jaundice

Roentgenoendovascular dilatation of brachycephalic arteries

International Nuclear Information System (INIS)

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

1988-01-01

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

Upper gastrointestinal strictures: The results of balloon dilatation

Energy Technology Data Exchange (ETDEWEB)

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

1990-12-15

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

Time-dependent dilatancy for brittle rocks

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Jie Li

2017-12-01

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

Transluminal Recanalization of Chronic Total Occlusion of Radial Artery Using Rendezvous Technique: A Case Report and Literature Review

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Mohammad Arabi

2014-01-01

Full Text Available Although endovascular management of lower extremity peripheral arterial disease (PAD is well studied, little information exists regarding endovascular treatment of critical upper limb ischemia. We report a case of transluminal recanalization of right radial artery chronic total occlusion (CTO using rendezvous technique in a patient with critical hand ischemia and dry gangrene of the right index finger.

Percutaneous nephrolithotomy in very elderly patients (Age 75 and Over

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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.

False-positive liver scans due to portal hypertension: correlation with percutaneous transhepatic portograms in 33 patients

International Nuclear Information System (INIS)

Takayasu, K.; Moriyama, N.; Suzuki, M.; Yamada, T.; Fukutake, T.; Shima, Y.; Kobayashi, C.; Musha, H.; Okuda, K.

1983-01-01

Tc-99m-phytate scanning of the liver and percutaneous transhepatic catheterization of the portal vein were performed in 33 patients--26 with cirrhosis, 3 with chronic active hepatitis, 2 with idiopathic portal hypertension, and 2 with unresolved acute hepatitis. A discrete defect in the porta hepatis area was seen in 6 of 28 patients who had portal vein pressure above 200 mm H2O. In 5 of the 6 patients with a false-positive scan, the umbilical portion of the left portal vein branch was dilated (larger than 25 x 20 mm) on the portogram, with or without a patent paraumbilical vein. The anatomical basis of this phenomenon is discussed, and it is suggested that this area be given special attention

Percutaneous anterior C1/2 transarticular screw fixation: salvage of failed percutaneous odontoid screw fixation for odontoid fracture

OpenAIRE

Wu, Ai-Min; Jin, Hai-Ming; Lin, Zhong-Ke; Chi, Yong-Long; Wang, Xiang-Yang

2017-01-01

Background The objective of this study is to investigate the outcomes and safety of using percutaneous anterior C1/2 transarticular screw fixation as a salvage technique for odontoid fracture if percutaneous odontoid screw fixation fails. Methods Fifteen in 108 odontoid fracture patients (planned to be treated by percutaneous anterior odontoid screw fixation) were failed to introduce satisfactory odontoid screw trajectory. To salvage this problem, we chose the percutaneous anterior C1/2 trans...

Use of a balloon-expandable metallic stent for treatment of nasopharyngeal stenosis in dogs and cats: six cases (2005-2007).

Science.gov (United States)

Berent, Allyson C; Weisse, Chick; Todd, Kimberly; Rondeau, Mark P; Reiter, Alexander M

2008-11-01

To determine outcome associated with use of a balloon-expandable metallic stent for treatment of nasopharyngeal stenosis in dogs and cats. Retrospective case series. 3 dogs and 3 cats. All 6 animals had severe inspiratory stertor at initial examination. Two animals had no orifice present at the stenosis. Nasopharyngeal stenosis was diagnosed and stent size determined by use of computed tomography. A percutaneous transluminal angioplasty balloon premounted with a balloon-expandable metallic stent was placed over a guidewire, advanced through the stenotic lesion under fluoroscopic and rhinoscopic guidance, and dilated to restore patency. All animals had immediate resolution of clinical signs after stent placement. The procedure took a median of 38 minutes (range, 22 to 70 minutes). One animal with a stenosis located far caudally needed the tip of the stent resected because of hairball entrapment and exaggerated swallowing. Both animals without an orifice in the stenosis had tissue in-growth requiring a covered stent. All animals were reexamined 6 to 12 weeks after treatment via rhinoscopy, radiography, computed tomography, or a combination of techniques. All animals lacked signs of discomfort; 5 of 6 were breathing normally 12 to 28 months after the procedure. Transnasal balloon-expandable metallic stent placement may represent a rapid, safe, noninvasive, and effective treatment in animals with nasopharyngeal stenosis. If the stenosis is extremely caudal in the nasopharynx, serial balloon dilatation might be considered prior to stent placement. A covered stent should be considered initially if the stenosis is completely closed.

Dilatation effect of ''quantum clocks''

International Nuclear Information System (INIS)

Chylinski, Z.

1981-01-01

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

An Intestinal Occlusion Device for Prevention of Small Bowel Distention During Transgastric Natural Orifice Transluminal Endoscopic Surgery

OpenAIRE

Tomasko, Jonathan M.; Mathew, Abraham; Moyer, Matthew T.; Haluck, Randy S.; Pauli, Eric M.

2013-01-01

Background and Objectives: Bowel distention from luminal gas insufflation reduces the peritoneal operative domain during natural orifice transluminal endoscopic surgery (NOTES) procedures, increases the risk for iatrogenic injury, and leads to postoperative patient discomfort. Methods: A prototype duodenal occlusion device was placed in the duodenum before NOTES in 28 female pigs. The occlusion balloon was inflated and left in place during the procedure, and small bowel distension was subject...

A review on the status of natural orifice transluminal endoscopic surgery (NOTES cholecystectomy: techniques and challenges

Directory of Open Access Journals (Sweden)

Michael C Meadows

2010-09-01

Full Text Available Michael C Meadows1,3, Ronald S Chamberlain1,2,31Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; 2Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA; 3Saint George’s University, School of Medicine, West Indies, GrenadaIntroduction: The evolution of techniques for the performance of a cholecystectomy over the last 25 years has been swift. The laparoscopic approach is now the gold standard for removal of the gall bladder and is the most frequently performed minimally invasive procedure globally. Currently in its infancy stage, natural orifice transluminal endoscopy surgery, or NOTES, is purported to be the next leap forward in minimally invasive approaches. The safety, feasibility, and effectiveness of this procedure, as well as the significance of potential benefits to patients beyond current surgical approaches are yet undetermined.Methods: A comprehensive literature search was conducted using PubMed, a search engine ­created by the National Library of Medicine. Keywords used in the search included “natural orifice transluminal endoscopic surgery”, “NOTES”, “cholecystectomy”, “transcolonic”, “transvaginal”, and “transgastric”. The accumulated literature was critically analyzed and reviewed.Results: One-hundred and eighty-six cases of NOTES cholecystectomies have been published to date. Of these, 174 have been performed through a transvaginal approach. The remainder of the procedures were performed transgastrically. There are no published reports of ­transcolonic cholecystectomies performed in humans. Four of 186 cases (2.15% were converted to traditional laparoscopy due to intraoperative complications. No significant complications or mortalities have been reported.Conclusion: NOTES cholecystectomy appears to be a feasible procedure. However, technical, safety, and ethical issues remain relatively unresolved. Besides improved cosmesis, whether additional

Usefulness of magnetic resonance cholangiography and additional T2-weighted axial image in evaluating focaI intrahepatic ductal dilatation

International Nuclear Information System (INIS)

Park, Yeong Mi; Cha, Sung Sook; Lee, Jong Yuk

2004-01-01

To evaluate the value of MR cholangiography (MRC) and MRC with additional T2-weighted axial imaging for evaluating the cause and determining the therapeutic plan in patients with a focal dilatation of the intrahepatic bile ducts(IHBD). Forty nine patients (male, 27; female, 22; age range, 12-72 (mean, 51) years) with a focal intrahepatic ductal dilatation confirmed surgically and pathologically (lobectomy, 34; biopsy, 7; surgical finding and T-tube cholangiography, 7; percutaneous transhepatic biliary drainage with bile cytology, 1) underwent MRC and T2-weighted axial imaging. The MRC were obtained in one of two ways (a single slab or multislice acquisition under chemical fat saturation) using RARE (31 patients, source images and single slice images), or TSE (18 patients, source images and MIP reconstruction images). Two radiologists reviewed the MRC images alone, and the MRC images with the T2-weighted axial images. A diagnosis was determined by consensus. In 37 out of 49 patients, the causes of a bile duct dilation were benign diseases (IHBD stones in 33 cases, liver abscesses with IHBD stones in three cases, one inflammatory pseudotumor). Twelve patients had cholangiocarcinomas (mass-forming type in seven cases, intraductal type in three cases, and periductaI infiltrating type in two cases). A correct diagnosis was confirmed in 47 out of 49 cases(96.0%), i.e. all the 37 benign lesions and 10 out of 12 malignant lesions. The addition of the T2-weighted axial image to the MRC did not alter the diagnosis of the causes of the focal intrahepatic ductal dilatation, but was helpful in 10 cases (20.4%). Nine cases (7 cholangiocarcinomas and 2 abscesses), in which MRC showed masses, were visualized more definitely on the additional T2-weighted axial images to the MRC than on the MRC alone. The remaining cases were hepatolithiasis, where stones could be easily differentiated from air by the air-fluid level on the axial images. MRC is a good diagnostic modality for

Remodeling after acute myocardial infarction: mapping ventricular dilatation using three dimensional CMR image registration

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O’Regan Declan P

2012-06-01

Full Text Available Abstract Background Progressive heart failure due to remodeling is a major cause of morbidity and mortality following myocardial infarction. Conventional clinical imaging measures global volume changes, and currently there is no means of assessing regional myocardial dilatation in relation to ischemic burden. Here we use 3D co-registration of Cardiovascular Magnetic Resonance (CMR images to assess the long-term effects of ischemia-reperfusion injury on left ventricular structure after acute ST-elevation myocardial infarction (STEMI. Methods Forty six patients (age range 33–77 years underwent CMR imaging within 7 days following primary percutaneous coronary intervention (PPCI for acute STEMI with follow-up at one year. Functional cine imaging and Late Gadolinium Enhancement (LGE were segmented and co-registered. Local left ventricular wall dilatation was assessed by using intensity-based similarities to track the structural changes in the heart between baseline and follow-up. Results are expressed as means, standard errors and 95% confidence interval (CI of the difference. Results Local left ventricular remodeling within infarcted myocardium was greater than in non-infarcted myocardium (1.6% ± 1.0 vs 0.3% ± 0.9, 95% CI: -2.4% – -0.2%, P = 0.02. One-way ANOVA revealed that transmural infarct thickness had a significant effect on the degree of local remodeling at one year (P 20% (4.8% ± 1.4 vs −0.15% ± 1.2, 95% CI: -8.9% – -0.9%, P = 0.017. Conclusions The severity of ischemic injury has a significant effect on local ventricular wall remodeling with only modest dilatation observed within non-ischemic myocardium. Limitation of chronic remodeling may therefore depend on therapies directed at modulating ischemia-reperfusion injury. CMR co-registration has potential for assessing dynamic changes in ventricular structure in relation to therapeutic interventions.

Dynamical and hamiltonian dilations of stochastic processes

International Nuclear Information System (INIS)

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

1982-01-01

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

High dose rate brachytherapy for prevention of restenosis after percutaneous transluminal coronary angioplasty: preliminary dosimetric tests of a new source presentation

International Nuclear Information System (INIS)

Popowski, Youri; Verin, Vitali; Papirov, Igor; Nouet, Philippe; Rouzaud, Michel; Grob, Eugene; Schwager, Michael; Urban, Philippe; Rutishauser, Wilhelm; Kurtz, John M.

1995-01-01

Purpose: Balloon dilatation of coronary artery stenosis has become a standard treatment of atherosclerotic heart disease. Restenosis due to excessive intimal cell proliferation, which subsequently occurs in 20-50% of patients, represents one of the major clinical problems in contemporary cardiology, and no satisfactory method for its prevention has thus far been found. Because modest doses of radiation have proved effective in preventing certain types of abnormal cellular proliferation resulting from surgical trauma, and brachytherapy has already been used successfully after dilatation of peripheral arteries, development of a radioactive source suitable for coronary artery applications would be of great interest. Methods and Materials: Nonradioactive flexible yttrum-89 wires (diameter of 0.15 and 0.26 mm) were activated within the thermal neutron flux of an experimental reactor. Standard angioplasty balloons (2 cm long, 2.5 mm in diameter when inflated) were inserted for dosimetry into a specially manufactured tissue equivalent phantom. Four wells, drilled perpendicular to the axis of the balloon, allowed for the insertion of thermal luminescent dosimeters (TLDs; 2 mm of diameter) and spacers. The angioplasty balloon was inflated with air or with contrast media. Radioactive yttrium-90 wires were left in the central lumen of the balloon for 2 min. Doses at the surface of the balloon, and at 1, 2, and 3 mm were determined from TLD readings. Results: Doses obtained at the surface of the balloon, for a 2-min exposure for the 0.26 mm wire (balloon inflated with air) and the 0.15 mm wire (air or contrast), were 56.5 Gy, 17.8 Gy, 5.4 Gy, respectively. As expected for a beta emitter, the fall-off in dose as a function of depth was rapid. External irradiation from the beta source was negligible. Conclusions: Our experiments indicate that the dose rates attainable at the surface of the angioplasty balloon using this technique allow the doses necessary for the inhibition of

Balloon catheter dilatation of esophageal strictures

Energy Technology Data Exchange (ETDEWEB)

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

1990-07-15

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

Balloon catheter dilatation of esophageal strictures

International Nuclear Information System (INIS)

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

1990-01-01

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

Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

NARCIS (Netherlands)

Muinck, Ebo Derk de

1994-01-01

In this thesis several aspects of passive and active coronary perfusion during coronary angioplasty are investigated. The autoperfusion balloon catheters that were evaluated are the Stack® and the RX-60® catheters (Advanced Cardiovascular Systems, inc., Santa Clara, California, U.S.A). The coronary

Paschke Dilations

Directory of Open Access Journals (Sweden)

Abraham Westerbaan

2017-01-01

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

Percutaneous transhepatic sphincterotomy

International Nuclear Information System (INIS)

Gandin, G.; Zanon, E.; Righi, D.; Fonio, P.; Ferrari, A.; Recchia, S.

1990-01-01

The authors describe the techique employed for percutaneous trans-hepatic sphincterotomy as performed on 3 patients with common bile duct (CBD) stones. In all patients, previous endoscopic attempt had failed for anatomical reasons (Billroth II gastric resection or partial gastric resection with brown anastomosis), and the ampulla could not be correctly incannulated with the sphincterotome. In all aptients endoscopy was useful to check the position of the diethermic loop inserted percutaneously. Conplete and immediate success was obtained in all 3 cases. No major complications occurred during transhepatic treatment. To date, 1 recurrence has been observed, and the patient has been retreated with bilioplasty. All patients were followed after 5-6 months with US, plain X-rays of the abdomen and blood tests (γGt, alkaline phosphatase, and bilirubinemia). The authors suggest that percutaneous transhepatic sphincterotomy be employed electively in patients with biliary tree diseases in case the endoscopic approach failes

Balloon dilatation of nasopharyngeal stenosis in a dog.

Science.gov (United States)

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

2006-08-01

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

Achalasia: pneumatic Dilation. Experience in a reference hospital

International Nuclear Information System (INIS)

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

2005-01-01

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

Congenital segmental dilatation of the colon

African Journals Online (AJOL)

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

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.)

Percutaneous management of tumoral biliary obstruction in children

International Nuclear Information System (INIS)

Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan; Ekinci, Saniye; Akcoren, Zuhal; Kutluk, Tezer

2007-01-01

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.)

Boston's balloon dilatation for treatment of cardiac achalasia

International Nuclear Information System (INIS)

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

2001-01-01

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

Esophageal dilations in eosinophilic esophagitis: A single center experience

OpenAIRE

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

2014-01-01

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

Clinical analysis and management of infections relative to percutaneous biliary drainage or stenting dilation

International Nuclear Information System (INIS)

Yu Ping; Dai Dingke; Qian Xiaojun; Zhai Renyou

2007-01-01

Objective: To analyze the occurrence of infectious relative to percutaneous biliary drainage (PTBD)or stenting for malignant obstructive jaundice and explore the therapy and prevention. Methods: 181 patients (130 male and 51 female; median age 64.5 years old) with malignant biliary obstructive jaundice were investigated including 81 hepatobiliary cancers, 42 pancreatico-ampullae tumors, 58 gestro-intestinal portal lymphatic metastasis. All cases accepted PTBD or placement of metallic stents and the perioperative complications were recorded and analysed including the occurance and treatment. Results: All cases accepted PTBD or stenting successfully. The perioperative biliary infection was the major complication including 50 out of 62 preoperative infected cases (34.25%). 18 cases (15.13%)suffered from biliary infection after operation with 13 under control, 5 without control, 4 complicated with pulmonary infection and 17 (9.39%)died of serious biliary infections. Gram-negative bacilli and endotoxin were the main cause of the severe biliary infection. Postoperative mild pancreatitis occurred in 65 cases (35.91%)without severe necrotic changes and were cured alter anti-inflammatory treatment. Hepatic abscess due to biliary leak occurred in 1 case (0.55%), and was cured by CT-guided drainage. Conclusion: Biliary infection is the most common complication after interventional therapy and should be promptly under control for preventing mortality and prolonging survival. Simultaneously, acute pancreatitis should also be on alert but good prognosis would be obtained with apt therapy. (authors)

Percutaneous suprapubic stone extraction for posterior urethral stones in children: efficacy and safety.

Science.gov (United States)

Safwat, Ahmed S; Hameed, Diaa A; Elgammal, Mohamed A; Abdelsalam, Yasser M; Abolyosr, Ahmad

2013-08-01

To evaluate the safety and efficacy of percutaneous suprapubic stone extraction (PSPSE) for pediatric posterior urethral stones. Between July 2007 and June 2010, 54 boys presenting with acute urinary retention due to posterior urethral stones underwent PSPSE. Patients were a mean age of 66.4 months (range, 8-180 months). The stone size was 0.7-1.9 cm. Patients were placed under general anesthesia, and a 7F urethroscope was used to pushback the stone to the bladder. A 3-mm suprapubic puncture with a scalpel was performed, followed by insertion of a straight narrow hemostat through the puncture aided with cystoscopic guidance. The stone was grasped with the hemostat in its narrowest diameter and was extracted percutaneously or crushed if friable. The suprapubic puncture was closed with a single 4-0 Vicryl (Ethicon) suture. Intact stone retrieval was achieved in 45 patients, and the stone was crushed into minute fragments in 9 patients. Intraperitoneal extravasation developed in 1 patient that required open surgical intervention. Mean operative time was 22 minutes. Patients were monitored for up to 17 months, with complete resolution of symptoms and stone clearance. PSPSE provides a minimally invasive approach for the extraction of urethral and bladder stones in the pediatric population. The use of a straight hemostat for suprapubic stone extraction or crushing is a good alternative to suprapubic tract dilation, with minimal morbidity. Copyright © 2013 Elsevier Inc. All rights reserved.

Transluminal radio-frequency thermal ablation using a stent-type electrode: an experimental study

Energy Technology Data Exchange (ETDEWEB)

Kim, Young Sun; Rhim, Hyun Chul [Hanyang University College of Medicine, Seoul (Korea, Republic of); Song, Ho Young [Asan Medical Center, Seoul (Korea, Republic of)] [and others

2003-06-01

To assess the feasibility of transluminal radiofrequency thermal ablation using a stent-type electrode and to determine, by means of in-vivo and in-vivo animal studies, the appropriate parameters. In-vivo: the radiofrequency electrode used was a self-expandable nitinol stent with 1cm insulated ends. A stent was placed in the portal vein of bovine liver, and ablations at target temperatures of 70, 80, 90, and 100 .deg. C were performed. Ablated sizes were measured longitudinally. In vivo: four mongrel dogs were anesthetized, and a stent was inserted in the common bile duct under fluoroscopic guidance through an ultrasound-guided gall bladder puncture site. The ablation temperature was set at 80 .deg. C, and each dog underwent proximal and distal esophageal ablations lasting 12 minutes. They were sacrificed immediately. In-vivo: ablated sizes showed significant correlation with target temperatures (r>0.04; p<0.05). Although most lesions were fusiform, dumbbell-shaped lesions with central thinning were found in two cases in the 70 .deg. C group. In all cases in the 70 .deg. C and 80 .deg. C group, the length of the insulated segment was less than 1cm. In-vivo: at microscopy, tissues at the center of the biliary stent showed more prominent pathological change than those at the periphery while those remote from the stent showed minimal or no change. In esophageal ablations, the mean highest temperature was 48.6 .deg. C. Microscopy demonstrated the destruction and shedding of mucosa, edema, and coagulation necrosis of submucosa, but in muscle layers no abnormalities were apparent. Transluminal radio-frequency thermal ablation using a stent-type electrode may be useful for elongating patency. The appropriate target temperature for biliary ablation is 80 .deg. C.

Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

Directory of Open Access Journals (Sweden)

Ana Grilo

2012-09-01

Full Text Available CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory

Salivary gland enlargement during oesophageal stricture dilatation.

OpenAIRE

Martin, D.

1980-01-01

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

Pheripheral Simpson atherectomy

International Nuclear Information System (INIS)

Kueffer, G.

1990-01-01

A report is given on the experience acquired to date with a new catheter method (Simpson atherectomy, S-AE) for reducing arteriosclerotic stenoses in the pelvic and leg arteries of 47 patients. If the correct instrument size is selected, one can regularly perform complete atherectomies in femoropopliteal vessels. The result of recanalization is not affected by the form of the stenosis, but eccentric, calcified or ulcerated lesions are ideal indications. Percutaneous transluminal angioplasty and atherectomy can be used as complementary methods to optimize, percutaneous peripheral vascular recanalization. The histological findings, methodological limitations, and clinical results are discussed. (orig.) [de

Computed tomography of localized dilatation of the intrahepatic bile ducts

International Nuclear Information System (INIS)

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

1981-01-01

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

An Erupted Dilated Odontoma: A Rare Presentation

Directory of Open Access Journals (Sweden)

Gaurav Sharma

2016-01-01

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

The rendezvous technique involving insertion of a guidewire in a percutaneous transhepatic gallbladder drainage tube for biliary access in a case of difficult biliary cannulation.

Science.gov (United States)

Sunada, Fumiko; Morimoto, Naoki; Tsukui, Mamiko; Kurata, Hidekazu

2017-05-01

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic method and treatment approach for biliary diseases. However, biliary cannulation can be difficult in some cases. We performed ERCP in a 97-year-old woman with abdominal pain resulting from acute cholangitis caused by choledocholithiasis and observed difficult biliary cannulation. Eventually, the patient was successfully treated with the rendezvous technique. We could not cannulate the biliary duct during ERCP twice. Therefore, we placed a percutaneous transhepatic gallbladder drainage (PTGBD) tube without intrahepatic dilation. The rendezvous technique was performed using the PTGBD tube. The patient did not experience pancreatitis or perforation.

Salivary gland enlargement during oesophageal stricture dilatation.

Science.gov (United States)

Martin, D.

1980-01-01

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

Traumatic tracheobronchial stricture treated with the Eder-Puestow dilator.

Science.gov (United States)

Erichsen, H G

1980-09-01

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

Complication rates of open surgical versus percutaneous tracheostomy in critically ill patients.

Science.gov (United States)

Johnson-Obaseki, Stephanie; Veljkovic, Andrea; Javidnia, Hedyeh

2016-11-01

In the setting of critical care, the most common indications for tracheostomy include: prolonged intubation, to facilitate weaning from mechanical ventilation, and for pulmonary toileting. In this setting, tracheostomy can be performed either via open surgical or percutaneous technique. Advantages for percutaneous dilatational tracheostomy (PDT) include: simplicity, smaller incision, less tissue trauma, lower incidence of wound infection, lower incidence of peristomal bleeding, decreased morbidity from patient transfer, and cost-effectiveness. Despite many studies comparing surgical tracheostomy (ST) versus PDT, there remains no consensus on which of these techniques minimizes complications in critically ill patients. To provide an updated meta-analysis to answer the following question: Is there a difference in complication rates between ST and PDT in the setting of critically ill patients? Our secondary outcome of interest was to examine the difference in procedure time in the ST versus PDT groups. We conducted a literature search using the following databases: Ovid MEDLINE, Embase, Google Scholar, and Cochrane Database of Systematic Reviews. Studies from 1985 until October 2014 published in French or English languages in peer-reviewed journals were included. With regard to rates of mortality, intraoperative hemorrhage, and postoperative hemorrhage, there was no statistically significant difference between the two techniques. Evaluation of infections rates and operative time, however, revealed a statistically significant difference, favoring PDT over ST. In critically ill patients, PDT appears to be a safe and efficient alternative to open ST. NA Laryngoscope, 126:2459-2467, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Gastric Necrosis due to Acute Massive Gastric Dilatation

Directory of Open Access Journals (Sweden)

Ibrahim Aydin

2013-01-01

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

Gastric Necrosis due to Acute Massive Gastric Dilatation.

Science.gov (United States)

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

2013-01-01

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

On $rho$-dilations of commuting operators

Czech Academy of Sciences Publication Activity Database

Müller, Vladimír

2017-01-01

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

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

Science.gov (United States)

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

2004-01-01

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

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...... internationally accepted penetration rates and/or absorption percentages very useful for regulatory toxicology. The work of the Percutaneous Penetration Subgroup of EC Dermal Exposure Network has been focussed on the standardization and validation of in vitro experiments, necessary to obtain internationally...... accepted penetration rates for regulatory purposes. The members of the Subgroup analyzed the guidelines on percutaneous penetration in vitro studies presented by various organizations and suggested a standardization of in vitro models for percutaneous penetration taking into account their individual...

Behandling af renovaskulær hypertension med transluminal angioplastik--13 års erfaring--sekundærpublikation

DEFF Research Database (Denmark)

Øvrehus, Kristian Altern; Andersen, Poul Erik; Jacobsen, Ib Abildgaard

2008-01-01

angioplasty. A total of 124 patients were treated; 31% were normotensive immediately after angioplasty, 59% had improved blood pressure control and 10% had unchanged hypertension. The corresponding figures after six months and at the latest follow-up were 13, 72 and 15%. Udgivelsesdato: 2008-Jan-21......The result of treatment of renovascular hypertension by renal angioplasty over a period of 13 years was analysed. Patients with a positive diagnostic work-up with renography or renal vein renin measurement had renal angiography performed and in cases of renal artery stenosis, transluminal...

Percutaneous endoscopic cecostomy (introducer method) in chronic intestinal pseudo-obstruction: Report of two cases and literature review.

Science.gov (United States)

Küllmer, Armin; Schmidt, Arthur; Caca, Karel

2016-03-01

We report on two patients with recurrent episodes of chronic intestinal pseudo-obstruction (CIPO). A 50-year-old woman with severe multiple sclerosis and an 84-year-old man with Parkinson's disease and dementia had multiple hospital admissions because of pain and distended abdomen. Radiographic and endoscopic findings showed massive dilation of the colon without any evidence of obstruction. Conservative management resolved symptoms only for a short period of time. As these patients were poor candidates for any surgical treatment we carried out percutaneous endoscopic colostomy by placing a 20-Fr tube in the cecum with the introducer method. The procedure led to durable symptom relief without complications. We present these two cases and give a review through the existing literature of the procedure in CIPO. © 2015 Japan Gastroenterological Endoscopy Society.

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

Science.gov (United States)

Rago, E; Boesby, S; Spencer, J

1983-01-01

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

Minimally invasive percutaneous management of large bladder stones with a laparoscopic entrapment bag.

Science.gov (United States)

Tan, Yung K; Gupta, Dilan M; Weinberg, Aaron; Matteis, August J; Kotwal, Sunny; Gupta, Mantu

2014-01-01

The treatment of large volume bladder stones is a management conundrum. Transurethral methods are plagued by long operative times, trauma to the bladder mucosa, and the need for a postoperative urethral catheter. Open cystolithotomy has higher morbidity. We present the percutaneous management of bladder stones with the novel use of a laparoscopic entrapment bag. Twenty-five patients (mean age 65.7), including 22 men and 3 women, 4 with a neurogenic bladder and 21 with a prior diagnosis of benign prostatic hyperplasia, underwent our novel technique. The mean number of stones was 6.8±8.0 (range, 1 to 30) and total stone burden 10.4±10.5 cm (range, 3.0 to 50.0 cm). Using regional or general anesthesia and flexible cystoscopic guidance, percutaneous bladder access was achieved. The tract was balloon dilated to 30F and stones captured in a laparoscopic entrapment bag. The bag's opening was exteriorized and stone fragmentation and comminution were achieved using a nephroscope and pneumatic or ultrasonic lithotripters. The bag was extracted and a 22F suprapubic catheter was inserted into the bladder; the patient was discharged the next day after a voiding trial. The procedure was done without fluoroscopy. No foley catheter was necessary. All patients were rendered stone free. The mean estimated blood loss was 11.1±3.93 mL (range, 10 to 25 mL). The mean operative time was 102.3 minutes. There was minimal trauma to the bladder mucosa and no complications of fluid extravasation, hematuria, or urethral trauma were noted. All patients were discharged within 24 hours of the operation. Percutaneous cystolithotomy with the use of an entrapment bag is an efficient, safe technique for treating large volume bladder calculi. We recommend this technique as an alternative to open surgery for patients with too large a stone burden to remove transurethrally.

Short term results of percutaneous transluminal coronary angioplasty with the monorail technique: experience in the first 1000 patients.

Science.gov (United States)

de Feyter, P J; Serruys, P W; van den Brand, M; Suryapranata, H; Beatt, K

1990-04-01

The monorail technique allows monitoring of all steps of the coronary angioplasty procedure by high quality coronary angiography; easy, rapid, and safe recrossing and redilatation of the lesion if necessary; and stepwise dilatation of a stenosis with sequential increase of size of balloons. Transstenotic pressure differences cannot, however, be measured through the narrow shaft of the standard monorail balloon catheter. The monorail technique was used in 1014 patients (820 men, 194 women; mean age 57.8 years (range 24 to 84]. The indication for coronary angioplasty was stable angina in 52%, unstable angina in 40%, and acute myocardial infarction in 8%. Single vessel coronary angioplasty was attempted in 78%, multilesion coronary angioplasty in 11%, and multivessel coronary angioplasty in 11%. Angiographic success (reduction of stenosis to less than 50% of the luminal diameter) of all attempted lesions was achieved in 93%. The technique was clinically successful--that is, angiographic success of all attempted lesions, no occurrence of a major complication (death, myocardial infarction, acute bypass surgery), and improvement of symptoms--in 92% and partially successful in 1.3%. The clinical success rates were similar for stable angina (91%) and unstable angina (94%), but were somewhat lower for acute myocardial infarction (88%). Failure without major complication occurred in 3.4% of the patients. Failure with a major complication occurred in 3.3% (death 0.3%, myocardial infarction 2.4%, and acute bypass surgery 2.3%). The total major complication rate was higher in unstable angina (4.2%) than in stable angina (3.0%). These results indicate that the monorail technique can be applied safely and effectively for coronary angioplasty of patients with stable angina, unstable angina, and acute myocardial infarction.

Computed tomography of hepatocellular carcinoma. Dilatation of intrahepatic bile duct

Energy Technology Data Exchange (ETDEWEB)

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

1983-10-01

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

Percutaneous vertebroplasty (pv): indications, contraindications, and technique

International Nuclear Information System (INIS)

Hoffmann, R.T.; Jakobs, T.F.; Wallnoefer, A.; Reiser, M.F.; Helmberger, T.K.

2003-01-01

Percutaneous vertebroplasty (pv) is a worldwide increasingly performed interventional therapeutic procedure. This article addresses indications, patient preparation, technical requirements and approach as well as possible complications of percutaneous vertebroplasty. Percutaneous vertebroplasty is a technique consisting in an injection of bone cement into a vertebral body under imaging guidance. This procedure is performed to relief pain and support the mechanical stability in partially collapsed vertebral bodies. In the management of spinal compression fractures secondary to osteoporosis, myeloma, osteolytic metastases and aggressive hemangiomas, percutaneous vertebroplasty yields analgesic effect, and provides additional fortification in weakened segments of the vertebral column. Contraindications include major bleeding disorders, radicular pain and pain caused by compression of the myelon. Percutaneous vertebroplasty results in prompt pain relief and rapid rehabilitation. In experienced hands, using correct technique, pv is a safe and effective procedure for treating pain, caused either by osteoporotic or malignant vertebral compression fractures. (orig.) [de

Impact of previous open renal surgery on the outcomes of subsequent percutaneous nephrolithotomy: a meta-analysis.

Science.gov (United States)

Hu, Henglong; Lu, Yuchao; Cui, Lei; Zhang, Jiaqiao; Zhao, Zhenyu; Qin, Baolong; Wang, Yufeng; Wang, Qing; Wang, Shaogang

2016-04-28

The aim of this study was to systematically compare the perioperative outcomes of percutaneous nephrolithotomy in patients with or without previous ipsilateral open renal surgery (POS). Systematic searches of the PubMed, Web of Science and Cochrane Library databases were used to identify relevant studies, and, following literature screening and data extraction, a meta-analysis was performed. 17 retrospective cohort studies involving 4833 procedures (4784 patients) were included. No statistically significant differences were observed between patients with or without POS in terms of supracostal access; single/multiple tracts; metal dilator need; time required to access the collecting system; fluoroscopic duration; demand for analgesics; hospital stay; final stone-free rate; and risk of developing certain complications (eg, fever, haemorrhage, haemo/hydro/pneumothorax, blood transfusion, urinary tract infection and sepsis) as well as regarding the risk of total complications. Patients with POS, however, had a greater drop in haemoglobin (weighted mean difference (WMD), 1.78 g/L; 95% CI 1.09 to 2.47; pPOS also had a lower initial stone-free rate (RR, 0.96; 95% CI 0.92 to 0.99; p=0.007) and more secondary treatment (RR, 1.61; 95% CI 1.09 to 2.37; p=0.02). Sensitivity analysis produced comparable results except for differences in operative time and initial stone-free rate, which did, however, prove to be statistically insignificant (p=0.16 and 0.69, respectively). Current evidence suggests that percutaneous nephrolithotomy in patients with POS is associated with a significantly greater drop in haemoglobin, higher risk of requiring angiographic embolisation and auxiliary procedures, potentially longer operative time, and lower initial stone-free rate than percutaneous nephrolithotomy in patients without POS. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Cushing’s Disease Presented by Reversible Dilated Cardiomyopathy

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Berna İmge Aydoğan

2015-01-01

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

Cardiovascular effects of oesophageal dilation under general anaesthesia

DEFF Research Database (Denmark)

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

1999-01-01

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

Treatments for pediatric achalasia: Heller myotomy or pneumatic dilatation?

Science.gov (United States)

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

2010-03-01

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

Hemodynamic Measurements for the Selection of Patients With Renal Artery Stenosis: A Systematic Review.

Science.gov (United States)

van Brussel, Peter M; van de Hoef, Tim P; de Winter, Robbert J; Vogt, Liffert; van den Born, Bert-Jan

2017-05-22

Interventions targeting renal artery stenoses have been shown to lower blood pressure and preserve renal function. In recent studies, the efficacy of catheter-based percutaneous transluminal renal angioplasty with stent placement has been called into question. In the identification of functional coronary lesions, hyperemic measurements have earned a place in daily practice for clinical decision making, allowing discrimination between solitary coronary lesions and diffuse microvascular disease. Next to differences in clinical characteristics, the selection of renal arteries suitable for intervention is currently on the basis of anatomic grading of the stenosis by angiography rather than functional assessment under hyperemia. It is conceivable that, like the coronary circulation, functional measurements may better predict therapeutic efficacy of percutaneous transluminal renal angioplasty with stent placement. In this systematic review, the authors evaluate the available clinical evidence on the optimal hyperemic agents to induce intrarenal hyperemia, their association with anatomic grading, and their predictive value for treatment effects. In addition, the potential value of combined pressure and flow measurements to discriminate macrovascular from microvascular disease is discussed. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

The Erasme Study: A Multicenter Study on the Safety and Technical Results of the Palmaz Stent Used for the Treatment of Atherosclerotic Ostial Renal Artery Stenosis

International Nuclear Information System (INIS)

Bakker, Jeannette; Goffette, Pierre P.; Henry, Michel; Mali, Willem P.T.M.; Melki, Jean-Pierre; Moss, Jon G.; Rabbia, Claudio; Therasse, Eric; Thomson, Kenneth R.; Thurnher, Siegfried; Vignali, Claudio

1999-01-01

Purpose: To assess, in a multicenter setting, safety, technical results, and restenosis rate of the Palmaz stent for treatment of atherosclerotic ostial renal artery stenosis. Methods: Ten centers enrolled 106 patients (120 treated renal artery stenoses) in the study. Patient selection was based on unsuccessful percutaneous transluminal renal angioplasty (residual stenosis ≥ 20%) performed for treatment of ostial stenosis ≥ 50%, in patients with hypertension and/or impaired renal function. Safety was assessed by means of the complication rate, and technical results by the number of successful stent placements and occurrence of restenosis (>50%) at intraarterial angiographic follow-up. Results: Stent placement was successful (n = 112) or partially successful (n = 5) in 117 (98%) arteries. Complications occurred in 19 procedures; seven were of serious clinical significance. Angiographic follow-up was performed in 89 of 117 (76%) cases, at a mean of 8 months (range 2.5-18 months). Fifteen stents (16.9%) showed restenosis (at a mean of 8.5 months), of which 10 were successfully redilated. Conclusion: Renal artery stenting has a high technical success rate, a complication rate comparable to percutaneous transluminal renal angioplasty, and a low rate of restenosis at 8 months angiographic follow-up

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.

Percutaneous treatment of liver hydatid cysts

International Nuclear Information System (INIS)

Akhan, Okan; Oezmen, Mustafa N.

1999-01-01

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

Duodenal perforation during percutaneous nephrolithotomy (PCNL ...

African Journals Online (AJOL)

A. Bansal

2016-06-03

Jun 3, 2016 ... Calculus;. Duodenum;. Injury;. Paediatric;. Percutaneous nephrolithotomy. Abstract. Introduction: Colonic perforations are known complications of percutaneous nephrolithotomy (PCNL). However, to the best of our knowledge, small bowel perforation has rarely been reported.. Observation: We report the ...

Angioplasty for Non-arteriosclerotic Renal Artery Stenosis: The Efficacy of Cutting Balloon Angioplasty Versus Conventional Angioplasty

International Nuclear Information System (INIS)

Tanaka, Ryoichi; Higashi, Masahiro; Naito, Hiroaki

2007-01-01

Purpose. We examined the efficacy of conventional balloon angioplasty and cutting balloon angioplasty (CBA) for the treatment of non-arteriosclerotic renal artery stenosis (RAS). Materials and Methods. From 1993 to 2005, 20 patients underwent 27 percutaneous transluminal renalangioplasty (PTRA) for non-arteriosclerotic RAS (men: 8, women: 12, 25.5 +/- 2 years old; 16 fibromuscular dysplasia (FMD), 4 Takayasu disease). We evaluated the efficacy of CBA by comparing the rate of initial technical success and surgical conversion. Results. Before the clinical authorization of CBA, three of twelve patients (25 %) underwent surgical bypass due to the failure of PTRA due to the hardness of the lesion. After the approval of cutting balloon, we performed CBA in four cases (2 FMD,2 Takayasu disease) to dilate hard lesions, within which a properly sized balloon could not dilate due to their hardness, or to reduce the risk of local dissection. Initial successes were obtained in all patients (8/8, 100%) and none of the patients underwent surgical conversion. Despite of the good initial result, restenosis was observed in three cases within 6 month (3/4, 75 %). Additional interventions were performed in all patients, then, the severity of the restenotic lesion was found not to be exceeded comparing with the initial lesion. Conclusion. The cutting balloon angioplasty may be safe and useful procedure for hard lesions of RAS caused by non-arteriosclerotic disease? especially fibromuscular dysplasia. The cutting balloon may provide the initial success, but the effect on long-term patency is still controversial

The role of atherectomy in the treatment of lower extremity peripheral artery disease

Science.gov (United States)

2012-01-01

Background The incidence of lower extremity peripheral artery disease (LE-PAD) continues to increase and associated morbidity remains high. Despite the significant development of percutaneous revascularization strategies, over the past decade, LE-PAD still represents a unique challenge for interventional cardiologists and vascular surgeons. Method Typical features of atherosclerosis that affects peripheral vascular bed (diffuse nature, poor distal runoff, critical limb ischemia, chronic total occlusion) contribute to the disappointing results of traditional percutaneous transluminal angioplasty (PTA). New technologies have been developed in attempt to improve the safety and effectiveness of percutaneous revascularization. Among these, atherectomy, debulking and removing atherosclerotic plaque, offers the potential advantage of eliminating stretch on arterial walls and reducing rates of restenosis. Conclusions This review summarizes the features and the current applications of new debulking devices. PMID:23173800

Balloon dilatation of the prostatic urethra

International Nuclear Information System (INIS)

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

1991-01-01

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

PTMC in post-MV repair status

Directory of Open Access Journals (Sweden)

Lachikarathman Devegowda

2016-09-01

Full Text Available MV repair in the rheumatic population is feasible with acceptable long-term results.1 Incidence of mitral stenosis (MS following mitral valve (MV repair for severe rheumatic mitral regurgitation (MR and usefulness of percutaneous transluminal mitral valvuloplasty (PTMC in these patients is not described in literature. We report a case of successful PTMC in severe MS following MV repair for severe rheumatic MR.

Balloon dilatations of esophageal strictures

International Nuclear Information System (INIS)

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

1990-01-01

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

Balloon dilatations of esophageal strictures

Energy Technology Data Exchange (ETDEWEB)

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

1990-04-15

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

The effect of pneumatic dilation in management of postfundoplication dysphagia.

Science.gov (United States)

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

2017-06-01

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

Robotics in percutaneous cardiovascular interventions.

Science.gov (United States)

Pourdjabbar, Ali; Ang, Lawrence; Behnamfar, Omid; Patel, Mitul P; Reeves, Ryan R; Campbell, Paul T; Madder, Ryan D; Mahmud, Ehtisham

2017-11-01

The fundamental technique of performing percutaneous cardiovascular (CV) interventions has remained unchanged and requires operators to wear heavy lead aprons to minimize exposure to ionizing radiation. Robotic technology is now being utilized in interventional cardiology partially as a direct result of the increasing appreciation of the long-term occupational hazards of the field. This review was undertaken to report the clinical outcomes of percutaneous robotic coronary and peripheral vascular interventions. Areas covered: A systematic literature review of percutaneous robotic CV interventions was undertaken. The safety and feasibility of percutaneous robotically-assisted CV interventions has been validated in simple to complex coronary disease, and iliofemoral disease. Studies have shown that robotically-assisted PCI significantly reduces operator exposure to harmful ionizing radiation without compromising procedural success or clinical efficacy. In addition to the operator benefits, robotically-assisted intervention has the potential for patient advantages by allowing more accurate lesion length measurement, precise stent placement and lower patient radiation exposure. However, further investigation is required to fully elucidate these potential benefits. Expert commentary: Incremental improvement in robotic technology and telecommunications would enable treatment of an even broader patient population, and potentially provide remote robotic PCI.

Total plasma proANP increases with atrial dilatation in horses

DEFF Research Database (Denmark)

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

2015-01-01

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

Percutaneous management of urolithiasis during pregnancy.

Science.gov (United States)

Kavoussi, L R; Albala, D M; Basler, J W; Apte, S; Clayman, R V

1992-09-01

A total of 6 pregnant women with obstructing urinary calculi was managed by percutaneous nephrostomy drainage placed under ultrasound guidance with the patient under local anesthesia. All patients initially had relief of acute obstruction. However, occlusion of the percutaneous nephrostomy tubes with debris necessitated tube changes in 5 of 6 patients. In 2 patients recurrent nephrostomy tube obstruction, fever and pain led to percutaneous stone removal during pregnancy. In the remaining 4 patients the nephrostomy tubes were left indwelling through delivery. During the postpartum period 3 patients successfully underwent ureteroscopic stone extraction and 1 passed the stone spontaneously. Bacteriuria developed in each patient despite the use of preventive antibiotics. All 6 women had uncomplicated vaginal deliveries of healthy newborns and are currently asymptomatic with no evidence of obstruction. Percutaneous drainage of an acutely obstructed kidney in a pregnant woman is an effective temporizing alternative to ureteral stent placement until definitive treatment can be performed.

The neural substrates of subjective time dilation

Directory of Open Access Journals (Sweden)

Marc Wittmann

2010-02-01

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

Utilization of a modified Clavien Classification System in reporting complications after ultrasound-guided percutaneous nephrostomy tube placement: comparison to standard Society of Interventional Radiology practice guidelines.

Science.gov (United States)

Degirmenci, Tansu; Gunlusoy, Bulent; Kozacioglu, Zafer; Arslan, Murat; Ceylan, Yasin; Ors, Bumin; Minareci, Suleyman

2013-06-01

To report our results on percutaneous nephrostomy (PCN) and classify our complications with the Standard of Practice Committee of the Society of Interventional Radiology guidelines and the modified Clavien Classification System (CCS). Three hundred eighty-nine PCN insertions were performed in 322 patients (224 men and 98 women) at our institution. PCN insertion was performed under ultrasound for dilated pelvicalyceal system and ultrasound/fluoroscopy for nondilated system. PCN was considered successful if the catheter was drained urine spontaneously. Number of complications was registered. Primary successful PCN insertion was achieved in 368 of the 389 procedures (94.6%). The success rates for nondilated and dilated systems were 82.7% and 96.4%, respectively. Major complications occurred in 9.6% and minor complications in 9.9% according to the Society of Interventional Radiology. According to the modified CCS grades I, II, III, IV, and V was 9.9%, 1.2%, 6.8%, 1.2%, and 0.3%, respectively. Age, grade of the hydronephrosis, serum creatinine levels, and mean hemoglobin levels were statistically significant parameters for the occurrence of complications on univariate analysis. The nondilated system has statistically significant parameters affecting the complication rates on multivariate analysis (P = .001, odds ratio [OR] = 6.1, 95% confidence interval [CI] = 2-18.4). Percutaneous nephrostomy is a well-known procedure in the treatment of temporary or permanent drainage of an obstructed system. It is very important to define the complications related to interventions for interpretation of clinical comparisons more accurately. Modified CCS is a reproducible system to evaluate the complications. Copyright © 2013 Elsevier Inc. All rights reserved.

Ultrasound guided percutaneous fine needle aspiration biopsy ...

African Journals Online (AJOL)

)-guided percutaneous fine needle aspiration biopsy (PFNAB)/US-guided percutaneous needle core biopsy (PNCB) of abdominal lesions is efficacious in diagnosis, is helpful in treatment choice, to evaluate whether various other investigations ...

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

Science.gov (United States)

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

2016-01-01

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

Italian Percutaneous EVAR (IPER) Registry: outcomes of 2381 percutaneous femoral access sites' closure for aortic stent-graft.

Science.gov (United States)

Pratesi, G; Barbante, M; Pulli, R; Fargion, A; Dorigo, W; Bisceglie, R; Ippoliti, A; Pratesi, C

2015-12-01

The aim of this paper was to report outcomes of endovascular aneurysm repair with percutaneous femoral access (pEVAR) using Prostar XL and Proglide closure systems (Abbot Vascular, Santa Clara, CA, USA), from the multicenter Italian Percutaneous EVAR (IPER) registry. Consecutive patients affected by aortic pathology treated by EVAR with percutaneous access (pEVAR) between January 2010 and December 2014 at seven Italian centers were enrolled in this multicenter registry. All the operators had an experience of at least 50 percutaneous femoral access procedures. Data were prospectively collected into a dedicated online database including patient's demographics, anatomical features, intra- and postoperative outcomes. A retrospective analysis was carried out to report intraoperative and 30-day technical success and access-related complication rate. Uni- and multivariate analyses were performed to identify factors potentially associated with an increased risk of percutaneous pEVAR failure. A total of 2381 accesses were collected in 1322 patients, 1249 (94.4%) male with a mean age of 73.5±8.3 years (range 45-97). The overall technical success rate was 96.8% (2305/2381). Major intraoperative access-related complications requiring conversion to surgical cut-down were observed in 3.2% of the cases (76/2381). One-month pEVAR failure-rate was 0.25% (6/2381). Presence of femoral artery calcifications resulted to be a significant predictor of technical failure (OR: 1.69; 95% CI: 1.03-2.77; P=0.036) at multivariate analysis. No significant association was observed with sex (P=0.28), obesity (P=0.64), CFA diameter (P=0.32), level of CFA bifurcation (P=0.94) and sheath size >18 F (P=0.24). The use of Proglide was associated with a lower failure rate compared to Prostar XL (2.5% vs. 3.3%) despite not statistically significant (P=0.33). The results of the IPER registry confirm the high technical success rate of percutaneous EVAR when performed by experienced operators, even in

Clinical-pathological-angiographic correlations following transluminal atherectomy

International Nuclear Information System (INIS)

Althaus, S.J.; Maynar, M.; Reyes, R.; Pulido-Duque, J.M.; Casal, G.; Hunter, D.W.; Castaneda-Zuniga, W.R.; Amplatz, K.

1989-01-01

Following percutaneous atherectomy, arterial and catheter diameter relationships were correlated with angiographic and ankle-arm index results. There was a greater amount of tissue removed, improved luminal reconstitution, and ankle-arm index in lesions where the catheter and arterial diameters were equal or within 0.5 mm. Excluding lesions requiring angioplasty, 77% of our lesions had less than 30% residual stenosis; including lesions requiring concomitant angioplasty, the initial overall patency was 93%, with a 1-year patency rate of 92.5%. This study indicates that adequate matching of the atherectomy catheter diameter to the arterial diameter is necessary to optimize tissue removal and clinical results

Percutaneous transcatheter sclerotherapy of oophoritic cysts

International Nuclear Information System (INIS)

Huang Youhua; Xu Qiang; Sun Jun; Shen Tao; Shi Hongjian; Tang Qingfang; Chen Qiying; Zhou Mingxia; Li Hongyao

2005-01-01

Objective: To evaluate the clinical value of percutaneous transcatheter sclerotherapy in oophoritic cysts. Methods: Seventy six oophoritic cysts incluoling 48 simple and 28 chocolate cysts of 64 patients were treated with percutaneous transcatheter sclerotherapy under CT guidance. 4F multisideholes pigtail catheter was introduced into cyst using absolute alcohol as sclerosing agents. Results: The successful rate of percutaneous oophoritc cyst puncture was 100% in all 64 patients. Among them 58 were cured (90.6%), 6 improved significantly (9.4%). The total effective rate reached 100% with no serious complications. Conclusions: Catheterization sclerotherapy for oophoritic cyst is a simple, complete, safe and effective method. (authors)

Long-Term Follow-Up of Percutaneous Balloon Angioplasty in Adult Aortic Coarctation

International Nuclear Information System (INIS)

Paddon, Alex J.; Nicholson, Anthony A.; Ettles, Duncan F.; Travis, Simon J.; Dyet, John F.

2000-01-01

Purpose: To assess long-term outcomes following percutaneous transluminal angioplasty (PTA) of congenital aortic coarctation in adults.Methods: Seventeen patients underwent PTA for symptomatic adult coarctation of the aorta. Sixteen patients, with a mean age of 28 years (range 15-60 years), were reviewed at a mean interval after angioplasty of 7.3 years (range 1.5-11 years). Assessment included magnetic resonance imaging (MRI), Doppler echocardiography, and clinical examination. Current clinical measurements were compared with pre- and immediate post-angioplasty measurements.Results: At follow-up 16 patients were alive and well. The patient not included in follow-up had undergone surgical repair and excision of the coarctation segment following PTA. Mean brachial systolic blood pressure for the group decreased from 174 mmHg before angioplasty to 130 mmHg at follow-up (p 0.0001). The mean gradient had fallen significantly from 50.9 to 17.8 at follow-up (p = 0.001). The average number of antihypertensive drugs required per patient decreased from 0.56 to 0.31 (p = 0.234). No significant residual stenoses or restenoses were seen at MRI. Small but clinically insignificant residual pressure gradients were recorded in all patients using Doppler echocardiography. Complications included one transient ischemic attack at 5 days, one external iliac dissection requiring stent insertion, and a further patient who developed a false aneurysm close to the coarctation site at 12 months which subsequently required surgical excision.Conclusion: PTA of adult coarctation is safe and effective in the long term. Although primary stenting has recently been advocated in the treatment of this condition, our results suggest that PTA remains the treatment of choice

Gonioscopy-assisted Transluminal Trabeculotomy (GATT): Thermal Suture Modification With a Dye-stained Rounded Tip.

Science.gov (United States)

Grover, Davinder S; Fellman, Ronald L

2016-06-01

To describe a novel technique for thermally marking the tip of a suture, in preparation for a gonioscopy-assisted transluminal trabeculotomy. One patient was used as an example for this technique. Technique report. The authors introduce a modification of a novel surgical procedure (GATT) in which a suture is marked and thermally blunted allowing a proper visualization while performing an ab interno, minimally invasive, circumferential 360-degree suture trabeculotomy. The authors have previously reported on the GATT surgery with the use of an illuminated microcatheter, which allowed for visualization of the tip of the catheter as it circumnavigated Schlemm canal. This modification allows for similar visualization of the tip of the suture, however, is much more cost-effective while still maintaining similar safety.

Extended indications for percutaneous tracheostomy.

Science.gov (United States)

Ben Nun, Alon; Altman, Eduard; Best, Lael Anson

2005-10-01

In recent years, percutaneous tracheostomy has become a routine practice in many hospitals. In the early publications, most authors considered adverse conditions such as short, fat neck or obesity as relative contraindications whereas cervical injury, coagulopathy, and emergency were regarded as absolute contraindications. More recently, several reports demonstrated the feasibility of percutaneous tracheostomy in patients with some of these contraindications. The aim of this study is to determine the safety and efficacy of percutaneous tracheostomy in conditions commonly referred to as contraindications. Between June 2000 and July 2001, 157 consecutive percutaneous tracheostomy procedures were performed on 154 critically ill adult patients in the general intensive care unit of a major tertiary care facility. The Griggs technique and Portex set were used at the bedside. All procedures were performed by staff thoracic surgeons and anesthesiologists experienced with the technique. Anatomical conditions, presence of coagulopathy and anti-coagulation therapy, demographics, and complication rates were recorded. Five of 157 procedures (154 patients owing to three repeat tracheostomies) had complications. In patients with normal anatomical conditions and coagulation profiles, there was one case of bleeding (50 cc to 120 cc) and one case of mild cellulitis around the stoma. In patients with adverse conditions, there was one case of bleeding (50 cc to 120 cc) and two cases of minor bleeding (< 50 cc). Patients with adverse conditions had a low complication rate similar to patients with normal conditions. For this reason, we believe that percutaneous tracheostomy is indicated in patients with short, fat neck; inability to perform neck extension; enlarged isthmus of thyroid; previous tracheostomy; or coagulopathy and anti-coagulation therapy.

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

Science.gov (United States)

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

2015-01-01

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

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

Directory of Open Access Journals (Sweden)

Siobhan Simpson

2015-03-01

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

Percutaneous nephroscopic management of an isolated giant renal hydatid cyst guided by single-incision laparoscopy using conventional instruments: the Santosh-PGI technique.

Science.gov (United States)

Kumar, Santosh; Choudhary, Gautam R; Pushkarna, Arawat; Najjapa, Bhuvnesh; Ht, Vatasla

2013-11-01

Isolated renal hydatid rarely presents, but when it does occur, it requires surgical treatment. We report our experience with a novel technique involving percutaneous management of a giant renal hydatid cyst with single-incision laparoscopic assistance. First we performed retrograde ureteropyelogram, which did not show any communication between the cyst and the calyceal. A Veress needle was used for pneumoperitoneum. Three conventional laparoscopic trocars used. Under laparoscopic guidance, we punctured the cyst. The scolicidal solution used was 10% povidone-iodine. The endocyst was removed under vision with grasping forceps through the nephroscope. A Portex drain was placed into the cyst cavity. Percutaneous aspiration and instillation of scolicidal agents followed by re-aspiration have been previously reported. This is an attractive procedure because of its acceptable success rates and reduced morbidity. In our case, simple aspiration of the cyst would not have been successful because the cyst was full of daughter cysts. Also, a blind percutaneous puncture of the cyst and dilatation could have perforated the colon or the mesocolon, which is often wrapped over the surface of such giant cysts thereby making laparoscopic guidance and mobilization of the colon imperative. We devised this unique treatment method for this patient involving three conventional ports at a single umbilical site. We believe this is the first reported case of its kind in the world. Not only this technique is minimally invasive, it is also cost-effective, as only conventional laparoscopic ports and instruments are used during the procedure. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

Percutaneous catheter drainage of intrapulmonary fluid collection

International Nuclear Information System (INIS)

Park, E. D.; Kim, H. J.; Choi, P. Y.; Jung, S. H.

1994-01-01

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

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.

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.)

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

Science.gov (United States)

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

2018-05-01

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

Angioplasty of symptomatic high-grade internal carotid artery stenosis with intraluminal thrombus: therapeutic approach

Energy Technology Data Exchange (ETDEWEB)

Gonzalez, A.; Mayol, A. [Seccion de Neurorradiologia Intervencionista, Servicio de Radiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Gil-Peralta, A.; Gonzalez-Marcos, J.R. [Servicio de Neurologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Boza, F. [Servicio de Neurofisiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Ruano, J. [Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain)

2004-04-01

Intraluminal thrombus in the internal carotid artery (ICA) is usually found in patients with severe atheromatous stenosis. Having reviewed 300 carotid angioplasties for symptomatic >70% ICA stenosis, we found three patients (1%) with intraluminal thrombus. Conservative treatment with anticoagulants and double antiplatelet coverage can result in lysis of the thrombus without severe risks. Percutaneous transluminal angioplasty and stenting, preferably with distal protection, can be an excellent alternative to carotid endarterectomy. (orig.)

Reperfusion hemorrhage following superior mesenteric artery stenting.

LENUS (Irish Health Repository)

Moore, Michael

2012-02-03

Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We describe both spontaneous cessation of bleeding and treatment with coil embolization.

Prospective randomized clinical trial comparing laparoscopic cholecystectomy and hybrid natural orifice transluminal endoscopic surgery (NOTES) (NCT00835250).

Science.gov (United States)

Noguera, José F; Cuadrado, Angel; Dolz, Carlos; Olea, José M; García, Juan C

2012-12-01

Natural orifice transluminal endoscopic surgery (NOTES) is a technique still in experimental development whose safety and effectiveness call for assessment through clinical trials. In this paper we present a three-arm, noninferiority, prospective randomized clinical trial of 1 year duration comparing the vaginal and transumbilical approaches for transluminal endoscopic surgery with the conventional laparoscopic approach for elective cholecystectomy. Sixty female patients between the ages of 18 and 65 years who were eligible for elective cholecystectomy were randomized in a ratio of 1:1:1 to receive hybrid transvaginal NOTES (TV group), hybrid transumbilical NOTES (TU group) or conventional laparoscopy (CL group). The main study variable was parietal complications (wound infection, bleeding, and eventration). The analysis was by intention to treat, and losses were not replaced. Cholecystectomy was successfully performed on 94% of the patients. One patient in the TU group was reconverted to CL owing to difficulty in maneuvering the endoscope. After a minimum follow-up period of 1 year, no differences were noted in the rate of parietal complications. Postoperative pain, length of hospital stay, and time off from work were similar in the three groups. No patient developed dyspareunia. Surgical time was longer among cases in which a flexible endoscope was used (CL, 47.04 min; TV, 64.85 min; TU, 59.80 min). NOTES approaches using the flexible endoscope are not inferior in safety or effectiveness to conventional laparoscopy. The transumbilical approach with flexible endoscope is as effective and safe as the transvaginal approach and is a promising, single-incision approach.

Roentgenoendovascular dilatation and recanalization of vessels of lower extremities

International Nuclear Information System (INIS)

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

1987-01-01

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

Gastric dilatation and volvulus in brown bear (Ursus arctos)

OpenAIRE

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

2016-01-01

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

Balloon catheter dilation of benign esophageal stenosis in children

International Nuclear Information System (INIS)

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

2001-01-01

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

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.)

Accuracy of percutaneous lung biopsy for invasive pulmonary aspergillosis

International Nuclear Information System (INIS)

Hoffer, F.A.; Gow, K.; Davidoff, A.; Flynn, P.M.

2001-01-01

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.)

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

Directory of Open Access Journals (Sweden)

S Jayachandran

2016-01-01

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

Treatment of urethral strictures with balloon dilation: A forgotten tale

Directory of Open Access Journals (Sweden)

Konstantinos Stamatiou

2015-09-01

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

Investigation of renovascular hypertension with 99mTC-DTPA dynamic renal scanning and digital subtraction angiography

International Nuclear Information System (INIS)

Stavraka-Kakavakis, A.; Vlontjou, E.; Apostolopoulos, D.; Mourikis, D.; Venetsanakis, N.; Lazarou, S.; Vlahos, L.

1989-01-01

Sixty-four selected hypertensive patients, aged 17-45 years, were evaluated for renovascular hypertension. They were studied with 99m TC-DTPA dynamic renal scanning (DRS) and intravenous digital subtraction angiography (IV-DSA). Intra-arterial DSA was further performed to demonstrate renal vascular anatomy in all disputable cases. Agreement of diagnosis occurred in 58 patients (32 with renal artery stenosis). There was one false positive with DRS and one false positive with IV-DSA. In another four patients with proven renovascular disease, IV-DSA was positive while DRS negative, but in two of them the stenotic lesion was considered insignificant, as they failed to respond to percutaneous transluminal dilatation (PTA). In contrast, nearly all patients whose hypertension improved after PTA or surgery had positive DRS and greater than 40% reduction of relative function of the affected kidney. IV-DSA yielded better results than DRS in the detection of renal arterial stenosis (especially whenever bilateral stenosis or rich collateral circulation was present), but DRS showed better correlation with the functional significance of a certain vascular abnormality. Thus the combination of the two methods seems to be a reasonable diagnostic approach to hypertensive patients with the aim of selecting those with curable hypertension due to renal vascular disease. (orig.)

Clinical advantages of three dimensional cine cardiac images

International Nuclear Information System (INIS)

Kinosada, Yasutomi; Okuda, Yasuyuki; Nakagawa, Tsuyoshi; Itou, Takafumi; Hattori, Takao.

1996-01-01

We evaluated clinical advantages and the quantitativeness of computerized three-dimensional (3D) cinematic images of a human heart, which were produced with a set of magnetic resonance (MR) images by using the computer graphic technique. Many contiguous, multi-location and multi-phase short axis images were obtained with the ECG gated conventional and fast cardiac imaging sequences in normal volunteers and selected patients with myocardial infarction, hypertrophic cardiomyopathy, dilated cardiomyopathy and left ventricular dysfunction. Judging by visual impressions of the computerized 3D cinematic cardiac images, we could easily understand and evaluate the myocardial motions or the anatomic and volumetric changes of a heart according to the cardiac phases. These images were especially useful to compare the wall motion, the left ventricular ejection-fraction (LVEF), or other cardiac functions and conditions between before and after therapeutic procedures such as percutaneous transluminal coronary angioplasty for patients with myocardial infarction. A good correlation between the LVEF calculated from a set of computerized 3D cinematic images and the ultra sound examinations were found. The results of our study showed that computerized 3D cinematic cardiac images were clinically useful to understand the myocardial motions qualitatively and to evaluate cardiac functions such as the LVEF quantitatively. (author)

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

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

2016-09-01

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

High Residual Collagen-Induced Platelet Reactivity Predicts Development of Restenosis in the Superficial Femoral Artery After Percutaneous Transluminal Angioplasty in Claudicant Patients

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Gary, Thomas, E-mail: thomas.gary@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria); Prüller, Florian, E-mail: florian.prueller@klinikum-graz.at; Raggam, Reinhard, E-mail: reinhard.raggam@klinikum-graz.at [Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics (Austria); Mahla, Elisabeth, E-mail: elisabeth.mahla@medunigraz.at [Medical University of Graz, Department of Anesthesiology and Intensive Care Medicine (Austria); Eller, Philipp, E-mail: philipp.eller@medunigraz.at; Hafner, Franz, E-mail: franz.hafner@klinikum-graz.at; Brodmann, Marianne, E-mail: marianne.brodmann@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria)

2016-02-15

PurposeAlthough platelet reactivity is routinely inhibited with aspirin after percutaneous angioplasty (PTA) in peripheral arteries, the restenosis rate in the superficial femoral artery (SFA) is high. Interaction of activated platelets and the endothelium in the region of intervention could be one reason for this as collagen in the subendothelium activates platelets.Materials and MethodsA prospective study evaluating on-site platelet reactivity during PTA and its influence on the development of restenosis with a total of 30 patients scheduled for PTA of the SFA. Arterial blood was taken from the PTA site after SFA; platelet function was evaluated with light transmission aggregometry. After 3, 6, 12, and 24 months, duplex sonography was performed and the restenosis rate evaluated.ResultsEight out of 30 patients developed a hemodynamically relevant restenosis (>50 % lumen narrowing) in the PTA region during the 24-month follow-up period. High residual collagen-induced platelet reactivity defined as AUC >30 was a significant predictor for the development of restenosis [adjusted odds ratio 11.8 (9.4, 14.2); P = .04].ConclusionsHigh residual collagen-induced platelet reactivity at the interventional site predicts development of restenosis after PTA of the SFA. Platelet function testing may be useful for identifying patients at risk.

Image guided percutaneous splenic interventions

International Nuclear Information System (INIS)

Kang, Mandeep; Kalra, Naveen; Gulati, Madhu; Lal, Anupam; Kochhar, Rohit; Rajwanshi, Arvind

2007-01-01

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

Biomechanical study of percutaneous lumbar diskectomy

International Nuclear Information System (INIS)

Li Yuan; Huang Xianglong; Shen Tianzhen; Hu Zhou; Hong Shuizong; Mei Haiying

2003-01-01

Objective: To investigate the stiffness of lumbar spine after the injury caused by percutaneous diskectomy and evaluate the efficiency of percutaneous lumbar diskectomy by biomechanical study. Methods: Four fresh lumbar specimens were used to analyse load-displacement curves in the intact lumbar spine and vertical disc-injured lumbar spine. The concepts of average flexibility coefficient (f) and standardized average flexibility coefficient (fs) were also introduced. Results: The load-displacement curves showed a good stabilization effect of the intact lumbar spine and disc-injured lumbar spine in flexion, extension, right and left bending. The decrease of anti-rotation also can be detected (P<0.05). Conclusion: In biomechanical study, percutaneous lumbar diskectomy is one of the efficiency methods to treat lumbar diac hernia

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

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E R Siddeshi

2015-01-01

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

Characteristic adaptations of the extracellular matrix in dilated cardiomyopathy

NARCIS (Netherlands)

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

2016-01-01

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

Percutaneous lumbar discectomy

International Nuclear Information System (INIS)

Xiao Chengjiang; Su Huanbin; Xu Sui; He Xiaofeng; Li Yanhao

2004-01-01

Objective: To probe the therapeutic effects, indications and safety of the percutaneous lumbar discectomy (PLDP). Methods: To ameliorate percutaneous punctured route based on classic PLD and modified jaw structure of pulpiform nacleus forceps, with statistic analysis of the therapeutic results of 352 cases of patient undergone PLDP and follow up ranging from 6 to 38 months retrospectively. Results: The effective ratios were excellent in 45.5%, good for 45.4% and bad in 9.1%. 44 of 352 cases with pulps prolapse were cured. No intervertebral inflammation and paradisc hematoma took place. One case complicated with cauda equina injury and 4 cases with appliances broken inside the disc. Conclusions: PLDP is effective and safe, not only adaptive to the contained disc herniation, but also for noncontained herniation. (authors)

Balloon catheter dilatation of esophageal strictures in children and an infant

International Nuclear Information System (INIS)

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

1986-01-01

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

First magnetic resonance imaging-guided aortic stenting and cava filter placement using a polyetheretherketone-based magnetic resonance imaging-compatible guidewire in swine: proof of concept.

Science.gov (United States)

Kos, Sebastian; Huegli, Rolf; Hofmann, Eugen; Quick, Harald H; Kuehl, Hilmar; Aker, Stephanie; Kaiser, Gernot M; Borm, Paul J A; Jacob, Augustinus L; Bilecen, Deniz

2009-05-01

The purpose of this study was to demonstrate feasibility of percutaneous transluminal aortic stenting and cava filter placement under magnetic resonance imaging (MRI) guidance exclusively using a polyetheretherketone (PEEK)-based MRI-compatible guidewire. Percutaneous transluminal aortic stenting and cava filter placement were performed in 3 domestic swine. Procedures were performed under MRI-guidance in an open-bore 1.5-T scanner. The applied 0.035-inch guidewire has a PEEK core reinforced by fibres, floppy tip, hydrophilic coating, and paramagnetic markings for passive visualization. Through an 11F sheath, the guidewire was advanced into the abdominal (swine 1) or thoracic aorta (swine 2), and the stents were deployed. The guidewire was advanced into the inferior vena cava (swine 3), and the cava filter was deployed. Postmortem autopsy was performed. Procedural success, guidewire visibility, pushability, and stent support were qualitatively assessed by consensus. Procedure times were documented. Guidewire guidance into the abdominal and thoracic aortas and the inferior vena cava was successful. Stent deployments were successful in the abdominal (swine 1) and thoracic (swine 2) segments of the descending aorta. Cava filter positioning and deployment was successful. Autopsy documented good stent and filter positioning. Guidewire visibility through applied markers was rated acceptable for aortic stenting and good for venous filter placement. Steerability, pushability, and device support were good. The PEEK-based guidewire allows either percutaneous MRI-guided aortic stenting in the thoracic and abdominal segments of the descending aorta and filter placement in the inferior vena cava with acceptable to good device visibility and offers good steerability, pushability, and device support.

First Magnetic Resonance Imaging-Guided Aortic Stenting and Cava Filter Placement Using a Polyetheretherketone-Based Magnetic Resonance Imaging-Compatible Guidewire in Swine: Proof of Concept

International Nuclear Information System (INIS)

Kos, Sebastian; Huegli, Rolf; Hofmann, Eugen; Quick, Harald H.; Kuehl, Hilmar; Aker, Stephanie; Kaiser, Gernot M.; Borm, Paul J. A.; Jacob, Augustinus L.; Bilecen, Deniz

2009-01-01

The purpose of this study was to demonstrate feasibility of percutaneous transluminal aortic stenting and cava filter placement under magnetic resonance imaging (MRI) guidance exclusively using a polyetheretherketone (PEEK)-based MRI-compatible guidewire. Percutaneous transluminal aortic stenting and cava filter placement were performed in 3 domestic swine. Procedures were performed under MRI-guidance in an open-bore 1.5-T scanner. The applied 0.035-inch guidewire has a PEEK core reinforced by fibres, floppy tip, hydrophilic coating, and paramagnetic markings for passive visualization. Through an 11F sheath, the guidewire was advanced into the abdominal (swine 1) or thoracic aorta (swine 2), and the stents were deployed. The guidewire was advanced into the inferior vena cava (swine 3), and the cava filter was deployed. Postmortem autopsy was performed. Procedural success, guidewire visibility, pushability, and stent support were qualitatively assessed by consensus. Procedure times were documented. Guidewire guidance into the abdominal and thoracic aortas and the inferior vena cava was successful. Stent deployments were successful in the abdominal (swine 1) and thoracic (swine 2) segments of the descending aorta. Cava filter positioning and deployment was successful. Autopsy documented good stent and filter positioning. Guidewire visibility through applied markers was rated acceptable for aortic stenting and good for venous filter placement. Steerability, pushability, and device support were good. The PEEK-based guidewire allows either percutaneous MRI-guided aortic stenting in the thoracic and abdominal segments of the descending aorta and filter placement in the inferior vena cava with acceptable to good device visibility and offers good steerability, pushability, and device support.

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

Science.gov (United States)

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

2016-05-01

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

Pneumatic dilatation in achalasia cardia results and follow-up.

Directory of Open Access Journals (Sweden)

Supe A

1990-10-01

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

Age-related percutaneous penetration part 1: skin factors.

Science.gov (United States)

Konda, S; Meier-Davis, S R; Cayme, B; Shudo, J; Maibach, H I

2012-05-01

Changes in the skin that occur in the elderly may put them at increased risk for altered percutaneous penetration from pharmacotherapy along with potential adverse effects. Skin factors that may have a role in age-related percutaneous penetration include blood flow, pH, skin thickness, hair and pore density, and the content and structure of proteins, glycosaminoglycans (GAGs), water, and lipids. Each factor is examined as a function of increasing age along with its potential impact on percutaneous penetration. Additionally, topical drugs that successfully overcome the barrier function of the skin can still fall victim to cutaneous metabolism, thereby producing metabolites that may have increased or decreased activity. This overview discusses the current data and highlights the importance of further studies to evaluate the impact of skin factors in age-related percutaneous penetration.

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

NARCIS (Netherlands)

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

2018-01-01

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

False coronary dissection with the new Monorail angioplasty balloon catheter.

Science.gov (United States)

Esplugas, E; Cequier, A R; Sabaté, X; Jara, F

1990-01-01

During percutaneous transluminal coronary angioplasty, the appearance of persistent staining in the vessel by contrast media suggests coronary dissection. We report seven patients in whom a false image of severe coronary dissection was observed during angioplasty performed with the new Monorail balloon catheter. This image emerges at the moment of balloon inflation, is distally located to the balloon, and disappears with balloon catheter deflation. No complications were associated with the appearance of this image.

Molecular genetics of dilated cardiomyopathy in the Dobermann dog

NARCIS (Netherlands)

Stabej, Polona

2005-01-01

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

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

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

1994-12-15

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

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

International Nuclear Information System (INIS)

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

1994-01-01

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

Radionuclide esophageal emptying study before and after pneumatic dilatation in achalasia

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

1987-11-01

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

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.

Bovine aortic arch: A novel association with thoracic aortic dilation

International Nuclear Information System (INIS)

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

2012-01-01

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

Peritonitis following percutaneous gastrostomy tube insertions in children

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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

Peritonitis following percutaneous gastrostomy tube insertions in children

International Nuclear Information System (INIS)

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

2016-01-01

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

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

Dilatancy of Shear Transformations in a Colloidal Glass

Science.gov (United States)

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

2018-01-01

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

Balloon dilatation of the esophageal stricture in infants and children

Energy Technology Data Exchange (ETDEWEB)

Choo, Sung Wook; Kim, In One; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Woo Ki; Park, Kwi Won; Han, Man Chung [Seoul Natioal University College of Medicine, Seoul (Korea, Republic of); Lee, Gi Jae [Inje University Paik Hospital, Seoul (Korea, Republic of); Yu, Pil Mun [Dankuk University College of Medicine, Seoul (Korea, Republic of)

1992-09-15

Balloon dilatation has been applied in treating of various pathologic narrowing of the hollow viscus. It is now accepted as a very effective modality especially in treating esophageal stenosis obviating surgical procedure. We performed 128 balloon dilatations in 29 patients with the number of dilatations in each patient ranging from once to 12 times. The age distribution of the patients was from 3 weeks to 6 years, with the median age of 3 months. Twenty nine patients consisted of 25 postoperative esophageal strictures (21 esophageal atresia with tracheoesophageal fistula, 1 congenital esophageal stenosis, 2 tracheobronchial remnant, and 1 congenital esophageal stenosis with esophageal atresia), 2 achalasia, 1 congenital esophageal stenosis, and 1 corrosive esophagitis. We had successful dilatation in 22 patients, who showed subsequent relief of symptoms and improvement in the diameter of stenotic segment. In 14 patients, esophageal perforation occurred during the procedure, one requiring emergency thoracotomy and the other three conservative management. Seven patients had no improvement in stenotic sites after several balloon dilatations. Failed cases were congenital stenosis, achalasia, corrosive esophagitis and four postoperative strictures. We believe that balloon dilatation is the procedure of choice in the treatment of postoperative esophageal stricture in infants and children and is a safe method as the perforation which can complicate the procedure could be managed conservatively.

Balloon dilatation of the esophageal stricture in infants and children

International Nuclear Information System (INIS)

Choo, Sung Wook; Kim, In One; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Woo Ki; Park, Kwi Won; Han, Man Chung; Lee, Gi Jae; Yu, Pil Mun

1992-01-01

Balloon dilatation has been applied in treating of various pathologic narrowing of the hollow viscus. It is now accepted as a very effective modality especially in treating esophageal stenosis obviating surgical procedure. We performed 128 balloon dilatations in 29 patients with the number of dilatations in each patient ranging from once to 12 times. The age distribution of the patients was from 3 weeks to 6 years, with the median age of 3 months. Twenty nine patients consisted of 25 postoperative esophageal strictures (21 esophageal atresia with tracheoesophageal fistula, 1 congenital esophageal stenosis, 2 tracheobronchial remnant, and 1 congenital esophageal stenosis with esophageal atresia), 2 achalasia, 1 congenital esophageal stenosis, and 1 corrosive esophagitis. We had successful dilatation in 22 patients, who showed subsequent relief of symptoms and improvement in the diameter of stenotic segment. In 14 patients, esophageal perforation occurred during the procedure, one requiring emergency thoracotomy and the other three conservative management. Seven patients had no improvement in stenotic sites after several balloon dilatations. Failed cases were congenital stenosis, achalasia, corrosive esophagitis and four postoperative strictures. We believe that balloon dilatation is the procedure of choice in the treatment of postoperative esophageal stricture in infants and children and is a safe method as the perforation which can complicate the procedure could be managed conservatively

Psychological and neural mechanisms of subjective time dilation

Directory of Open Access Journals (Sweden)

Virginie evan Wassenhove

2011-04-01

Full Text Available For a given physical duration, certain events can be experienced as subjectively longer in duration than others. Try this for yourself: take a quick glance at the second hand of a clock. Immediately, the tick will pause momentarily and appear to be longer than the subsequent ticks. Yet, they all last exactly one second. By and large, a deviant or an unexpected stimulus in a series of similar events (same duration, same features can elicit a relative overestimation of subjective time (or "time dilation" but, as is shown here, this is not always the case. We conducted an event-related functional magnetic neuroimaging (fMRI study on the time dilation effect. Participants were presented with a series of five visual discs, all static and of equal duration (standards except for the fourth one, a looming or a receding target. The duration of the target was systematically varied and participants judged whether it was shorter or longer than all other standards in the sequence. Subjective time dilation was observed for the looming stimulus but not for the receding one, which was estimated to be of equal duration to the standards. The neural activation for targets (looming and receding contrasted with the standards revealed an increased activation of the anterior insula and of the anterior cingulate cortex. Contrasting the looming with the receding targets (i.e. capturing the time dilation effect proper revealed a specific activation of cortical midline structures. The implication of midline structures in the time dilation illusion is here interpreted in the context of self-referential processes.

[Non-biological 3D printed simulator for training in percutaneous nephro- lithotripsy].

Science.gov (United States)

Alyaev, Yu G; Sirota, E S; Bezrukov, E A; Ali, S Kh; Bukatov, M D; Letunovskiy, A V; Byadretdinov, I Sh

2018-03-01

To develop a non-biological 3D printed simulator for training and preoperative planning in percutaneous nephrolithotripsy (PCNL), which allows doctors to master and perform all stages of the operation under ultrasound and fluoroscopy guidance. The 3D model was constructed using multislice spiral computed tomography (MSCT) images of a patient with staghorn urolithiasis. The MSCT data were processed and used to print the model. The simulator consisted of two parts: a non-biological 3D printed soft model of a kidney with reproduced intra-renal vascular and collecting systems and a printed 3D model of a human body. Using this 3D printed simulator, PCNL was performed in the interventional radiology operating room under ultrasound and fluoroscopy guidance. The designed 3D printed model of the kidney completely reproduces the individual features of the intra-renal structures of the particular patient. During the training, all the main stages of PCNL were performed successfully: the puncture, dilation of the nephrostomy tract, endoscopic examination, intra-renal lithotripsy. Our proprietary 3D-printed simulator is a promising development in the field of endourologic training and preoperative planning in the treatment of complicated forms of urolithiasis.

Cystic dilatation of ventriculus terminalis in adults: MRI

International Nuclear Information System (INIS)

Matsubayashi, R.; Uchino, A.; Kato, A.; Kudo, S.; Sakai, S.; Murata, S.

1998-01-01

We report the MRI findings in two patients with cystic dilatation of the ventriculus terminalis. The latter is usually a tiny ependyma-lined cavity of the conus medullaris. In both cases the markedly dilated ventriculus terminalis was seen as a rounded cavity with regular margins, the content of which gave the same signal as cerebrospinal fluid with all MR pulse sequences. No contrast enhancement was seen. (orig.)

Long-term outcome of endovascular treatment versus medical care for carotid artery stenosis in patients not suitable for surgery and randomised in the Carotid and Vertebral Artery Transluminal Angioplasty study (CAVATAS).

LENUS (Irish Health Repository)

Ederle, Jörg

2009-01-01

Optimal treatment of carotid stenosis in patients not suitable for surgery is unclear. The Carotid and Vertebral Artery Transluminal Angioplasty study contained a trial comparing medical and endovascular treatment in patients not suitable for surgery.

The impact of duct-to-duct interaction on the hex duct dilation

International Nuclear Information System (INIS)

Lee, M.J.; Chang, L.K.; Lahm, C.E.; Porter, D.L.

1992-01-01

Dilation of the hex duct is an important factor in the operational lifetime of fuel subassemblies in liquid metal fast reactors. It is caused primarily by the irradiation-enhanced creep and void swelling of the hex duct material. Excessive dilation may jeopardize subassembly removal from the core or cause a subassembly storage problem where the grid size of the storage basket is limited. Dilation of the hex duct in Experimental Breeder Reactor II (EBR-II) limits useful lifetime because of these storage basket limitations. It is, therefore, important to understand the hex duct dilation behavior to guide the design and in-core management of fuel subassemblies in a way that excessive duct deformation can be avoided. To investigate the dilation phenomena, finite-element models of the hex duct have been developed. The inelastic analyses were performed using the structural analysis code, ANSYS. Both Type 316 and D9 austenitic stainless steel ducts are considered. The calculated dilations are in good agreement with profilometry measurements made after irradiation. The analysis indicates that subassembly interaction is an important parameter in addition to neutron fluence and temperature in determining hex duct dilation. 5 refs

The Enright phenomenon. Stereoscopic distortion of perceived driving speed induced by monocular pupil dilation.

Science.gov (United States)

Carkeet, Andrew; Wood, Joanne M; McNeill, Kylie M; McNeill, Hamish J; James, Joanna A; Holder, Leigh S

The Enright phenomenon describes the distortion in speed perception experienced by an observer looking sideways from a moving vehicle when viewing with interocular differences in retinal image brightness, usually induced by neutral density filters. We investigated whether the Enright phenomenon could be induced with monocular pupil dilation using tropicamide. We tested 17 visually normal young adults on a closed road driving circuit. Participants were asked to travel at Goal Speeds of 40km/h and 60km/h while looking sideways from the vehicle with: (i) both eyes with undilated pupils; (ii) both eyes with dilated pupils; (iii) with the leading eye only dilated; and (iv) the trailing eye only dilated. For each condition we recorded actual driving speed. With the pupil of the leading eye dilated participants drove significantly faster (by an average of 3.8km/h) than with both eyes dilated (p=0.02); with the trailing eye dilated participants drove significantly slower (by an average of 3.2km/h) than with both eyes dilated (p<0.001). The speed, with the leading eye dilated, was faster by an average of 7km/h than with the trailing eye dilated (p<0.001). There was no significant difference between driving speeds when viewing with both eyes either dilated or undilated (p=0.322). Our results are the first to show a measurable change in driving behaviour following monocular pupil dilation and support predictions based on the Enright phenomenon. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

Percutaneous aspiration of hydatid cysts

International Nuclear Information System (INIS)

Hernandez, G.; Serrano, R.

1996-01-01

A perspective study was carried out to assess the efficacy of a combination of percutaneous aspiration plus oral albendazole to assess its efficacy as an alternative to surgery in the treatment of hydatid cyst. We performed percutaneous aspiration followed by injection of 20% hypertonic saline solution into 16 hydatid cysts in 13 patients. All the patients received oral albendazole (400 mg/12 hours) starting 2 days before and lasting until there weeks after the procedure. There were no anaphylactic reactions during or after the procedure. Follow-up included monthly ultrasound over a period ranging between 10 and 36 months. Three cysts disappeared completely; in 10 cases, the cysts cavity was replaced by a complex ultrasonographic findings, with strong signals similar to those of a pseudotumor. In another case, the aspirate was sterile and its morphology remained unchanged. In two cases, infection of the cyst ensued, requiring surgical treatment. We consider that percutaneous aspiration in combination with albendazole may prove to be a good alternative to surgery for the management of hepatic hydatid disease. (Author) 15 refs

Prevention and treatment of complications following percutaneous nephrolithotomy

NARCIS (Netherlands)

Skolarikos, Andreas; de la Rosette, Jean

2008-01-01

PURPOSE OF REVIEW: The aim of this article is to identify classification and grading systems of percutaneous nephrolithotomy-related complications and evidence for the prevention and treatment of these complications. RECENT FINDINGS: A total complication rate of up to 83% following percutaneous

Percutaneous brachial artery catheterization for coronary angiography and percutaneous coronary interventions (pci): an encouraging experience of 100 cases

International Nuclear Information System (INIS)

Islam, Z.U.; Maken, G.R.; Saif, M.; Khattak, Z.A.

2013-01-01

Objective: To evaluate the practicability and safety of the percutaneous transbrachial approach (TBA) for diagnostic coronary angiography and therapeutic percutaneous coronary interventions. Study Design: Quasi experimental study. Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology- National Institute of Heart Diseases (AFIC-NIHD) from March 2009 to May 2011. Patients and Methods: We collected data of 100 consecutive patients who underwent coronary catheterization by the percutaneous transbrachial approach. Transbrachial catheterization was performed only if the radial access failed or radial pulse was feeble. Study endpoints included successful brachial artery catheterization, vascular and neurological complications at access site and procedure success rate. Results: Mean age of the patients was 54 years (range 33-79 yrs) and 65(65%) were males and 35 (35%) were females. The right brachial artery was used in all of the cases. Procedural success was achieved in 100% of the patients. Coronary angiography was performed in 70 patients and percutaneous coronary interventions were done in 30 cases. Out of these 30 cases, PCI to left coronary arteries (LAD and LCX) were performed in 19 patients while 11 patients had PCI to right coronary artery (RCA). No case of vascular complications such as major access site bleeding, vascular perforation, brachial artery occlusion causing forearm ischemia, compartment syndrome, vascular spasm or failure to catheterize coronary arteries requiring alternate vascular access were observed. Conclusion: Brachial artery is a safe and easily accessible approach for coronary angiography and percutaneous coronary interventions. (author)

Temporal evolution of intraocular pressure elevation after pupillary dilation in pigment dispersion syndrome.

Science.gov (United States)

Jewelewicz, Daniel A; Radcliffe, Nathan M; Liebmann, Jeffrey; Ritch, Robert

2009-03-01

To report 4 patients with pigment dispersion syndrome (PDS) who had delayed intraocular pressure (IOP) spikes after pharmacologic pupillary dilation. Four patients with a diagnosis of PDS with documented IOP spike after pharmacologic pupillary dilation were included. Study patients were examined before and after pupillary dilation. The amount of pigment present in the anterior chamber and the IOP were measured at hourly intervals. Although maximal pigment liberation occurred immediately after maximal dilation, the IOP continued to elevate for at least 1.5 hours. The increase in IOP after pupillary dilation may not occur simultaneously with maximal pigment liberation but may follow it after the pigment has settled out of the anterior chamber. This has implications for monitoring patients with PDS after dilation to detect and treat rises in IOP.

Mixed Mode cohesive law with interface dilatation

DEFF Research Database (Denmark)

Sørensen, Bent F.; Goutianos, Stergios

2014-01-01

displacements. As the crack faces displace relatively to each other, the roughness asperities ride on top of each other and result in an opening (dilatation) in the normal direction. Furthermore, the interaction of the crack surfaces in the contact zone gives rise to compressive normal stresses and frictional...... shear stresses opposing the crack face displacements. A phenomenological Mixed Mode cohesive zone law, derived from a potential function, is developed to describe the above mentioned fracture behaviour under monotonic opening. The interface dilatation introduces two new lengths. The cohesive law...

A novel dosimeter for measuring the amount of radiation exposure of surgeons during percutaneous nephrolithotomy: Instadose™

Science.gov (United States)

Yuruk, Emrah; Gureser, Gokhan; Tuken, Murat; Ertas, Kasim

2016-01-01

Introduction The aim of this study was to demonstrate the efficacy of Instadose™, a novel dosimeter designed for radiation workers to provide a measurement of the radiation dose at any time from any computer; to determine the amount of radiation exposure during percutaneous nephrolithotomy (PNL); and to evaluate the factors that affect the amount of radiation exposed. Material and methods Two experienced surgeons wore Instadose™ on the outer part of their lead aprons during the PNL procedures performed between December 2013 and July 2014. Patient demographics and stone characteristics were noted. Factors affecting radiation dose were determined. Fluoroscopic screening time was compared with the amount of radiation in order to validate the measurements of Instadose™. Results Overall, 51 patients with a mean age of 43.41 ±18.58 (range 1–75) years were enrolled. Male to female ratio was 35/16. The amount of radiation was greater than 0.01mSv in only 19 (37.25%) cases. Stone location complexity (p = 0.380), dilation type (p = 0.584), stone size (p = 0.565), dilation size (p = 0.891) and access number (p = 0.268) were not associated with increased radiation exposure. Instadose™ measurements were correlated with fluoroscopic screening time (r = 0.519, p = 0.001). Conclusions Instadose™ is a useful tool for the measurement of radiation exposure during PNL. The advantage of measuring the amount of radiation exposure after each PNL operation is that it may aid urologists in taking appropriate precautions to minimize the risk of radiation related complications. PMID:27551558

Percutaneous management of staghorn renal calculi

International Nuclear Information System (INIS)

Lee, Won Jay

1989-01-01

During a four year period, ending May 1987, 154 cases of symptomatic staghorn calculi have been treated by percutaneous nephrolithotomy. Of these patients,86% were discharged completely stone free with the remainder having fragments less than 5 mm in greatest diameter. More than one operative procedure during the same hospitalizations was required in 24% of patients and multiple percutaneous tracts were established in excess of 73% of them. Significant complications occurred in 16% of patients and there was one death. Most complications can be generally by minimized by careful approach and manageable by interventional radiological means. The management of patients with staghorn calculi requires a comprehensive understanding of the renal anatomy, selection of appropriate percutaneous nephrostomy tract sites, and radiologic-urologic expertise needed to remove the large stone mass. The advent of extracorporeal shock wave lithotripsy will not abolish the need for nephrolithotomy, particularly complex stones such as staghorn calculi