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Sun S, Zheng S, Wu J, Tang Z, Shen C, Chen G, Dong K. Clinical application of endoscopic diaphragmotomy and dilation in a congenital duodenal diaphragm. Front Pediatr 2024; 12:1298748. [PMID: 38445081 PMCID: PMC10912644 DOI: 10.3389/fped.2024.1298748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
Background A congenital duodenal diaphragm (CDD) is a rare cause of duodenal obstruction in infants and children. The traditional approach to treatment has been surgical intervention either with excision and duodenoplasty or with bypass through a duodenoduodenostomy, which is invasive and carries the risk of anastomotic leakage. Aims To summarize the key points of differential diagnosis and treatment of a CDD under gastroscopy and to evaluate its efficacy and safety. Methods The clinical data of patients with a duodenal obstruction diagnosed and treated by gastroscopy in our hospital between January 2019 and December 2022 were retrospectively analyzed. The gastroscopic features of the CDD were summarized. The clinical outcomes of patients with CDD treated by gastroscopy were collected and investigated. Results A total of 13 children with a duodenal obstruction underwent a gastroscopic examination and/or treatment, and of these, 10 were diagnosed as having a CDD and 3 were finally diagnosed as having an annular pancreas. A dome-shaped structure during inspiration (9/10) and a guidewire that could be inserted through the opening into the distal lumen (6/10) were the gastroscopic features of the CDD, while the annular pancreas had none of these features. The 10 patients, 4 men and 6 women with the CDD, were treated through endoscopic diaphragmotomy and dilation. The age and weight at operation was 15 days to 7 years (M: 2.25 years) and 2.85-22 kg (M: 13.6 kg), respectively. A total of 11 endoscopic operations were performed in the 10 patients. The time of single operation was 15-55 min (M: 38 min). The patients did not experience complications such as bleeding, pneumoperitoneum, and duodenal papilla injury during the operation. Feeding was started 12-24 h after surgery, and the patients were discharged 2-10 days (M: 7 days) postoperatively. The patients were followed up for 3-36 months (M: 17 months), and none of them had a recurrence of vomiting. However, three showed a recurrence of stenosis in upper gastrointestinal imaging, one of whom underwent a partial diaphragm resection again 2 months after the primary treatment. Conclusions A CDD can be confirmed by endoscopy based on its characteristic features. Endoscopic diaphragmotomy and balloon dilation are safe and effective, which can be a new option for minimally invasive treatment of a CDD.
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Affiliation(s)
- Song Sun
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Shan Zheng
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Jie Wu
- Gastroenterology Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Zifei Tang
- Gastroenterology Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Chun Shen
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Gong Chen
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Kuiran Dong
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
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Soldatskiy YL, Nikitina DN, Polunin MM, Edgem SR, Krugovskaya NL, Subbotina AS. [Balloon dilation as an alternative to tracheotomy for acquired subglottic stenosis in children of the first year of life]. Vestn Otorinolaringol 2024; 89:10-15. [PMID: 38506019 DOI: 10.17116/otorino20248901110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To study the efficacy and safety of balloon dilation as the first choice method in the treatment of children of the first year of life with acquired subglottic stenosis. MATERIAL AND METHODS A retrospective analysis of the treatment of 25 patients aged 27 days to 11 months of life (average age 5.3±3.76 months) with subglottic stenosis caused by prolonged intubation, in whom balloon dilation was the first method of treatment. Grade III Cotton-Myer stenosis was preoperatively detected in 22 children, the remaining 3 had grade II stenosis. RESULTS The success rate of balloon dilation was 100%; tracheotomy was not required in any case, the absence of stenosis during a follow-up examination in the catamnesis was recorded in 14 (56%) children, the remaining 11 (44%) had grade 0-I stenosis and did not cause respiratory disorders. In 1 child (1.5 years old), a subglottic cyst was removed after balloon dilation. One dilation was required in 18 (72%) children, two - in 5 (20%), three and four - respectively for 1 patient. If additional intervention was necessary, the operation was repeated 10 days - 3 months after the previous one. There were no postoperative complications. CONCLUSION Balloon dilation is a highly effective and safe alternative to traditional surgical interventions for acquired subglottic stenosis in children of the first year of life and can be recommended as a method of first choice.
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Affiliation(s)
- Yu L Soldatskiy
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - D N Nikitina
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - M M Polunin
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - S R Edgem
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - N L Krugovskaya
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - A S Subbotina
- Pirogov Russian National Research Medical University, Moscow, Russia
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Meier D, Tzimas G, Akodad M, Husain A, Dundas J, Jelisejevas J, Cheung A, Sellers SL, Leipsic JA, Blanke P, Wood DA, Sathananthan J, Webb JG. Case Report: Stretching the limits-late valvuloplasty for THV dysfunction following redo mitral valve-in-valve implantation. Front Cardiovasc Med 2023; 10:1288278. [PMID: 38028444 PMCID: PMC10644176 DOI: 10.3389/fcvm.2023.1288278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Late balloon valvuloplasty can be used to treat under-expansion-related transcatheter heart valve (THV) dysfunction. Whether this can be performed following redo-THV implantation is unknown. Herein, we report a case of a 72-year-old male presenting with symptomatic gradient elevation following redo mitral valve-in-valve implantation. The patient was successfully treated with late balloon valvuloplasty with gradient improvement. In conclusion, late valvuloplasty is effective even with several layers of valves. However, larger studies are required to clarify the role of this approach further.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques-Cartier, Ramsay Santé, Massy, France
| | - Ali Husain
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - James Dundas
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Julius Jelisejevas
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Anson Cheung
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Stephanie L. Sellers
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Jonathon A. Leipsic
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Philipp Blanke
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - David A. Wood
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
| | - John G. Webb
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC, Canada
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Sung D, Zahid U, Singh M. A Different Approach to the Treatment of Tracheal Stenosis. Cureus 2023; 15:e47496. [PMID: 38021857 PMCID: PMC10663530 DOI: 10.7759/cureus.47496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Tracheal stenosis can occur from several malignant and non-malignant conditions, including vascular ring/aneurysms, tracheomalacia, bronchomalacia, endotracheal tubes (ETT), tracheostomy tubes, mucus plug, burn, trauma, tuberculosis, etc. Significant tracheal stenosis typically requires management by bronchoscopy, dilatation, or surgical resection. Bronchoscopic balloon dilatation is a simple, inexpensive, safe, and minimally invasive method that can be used to dilate airway stenosis and restore adequate airflow. A Montgomery tracheostomy tube is often used as a combined tracheal stent and airway device. We describe a 68-year-old female with tracheal stenosis, which was managed with an unconventional approach, a non-compliant endovascular balloon, due to resource scarcity.
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Affiliation(s)
- Deny Sung
- Internal Medicine, St. Joseph's Medical Center, Stockton, USA
| | - Urooj Zahid
- Internal Medicine, St. Joseph's Medical Center, Stockton, USA
| | - Mandeep Singh
- Pulmonary and Critical Care Medicine, St. Joseph's Medical Center, Stockton, USA
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Victoria MG, Tomás FA, Francisco Miguel SM, Federico S. Benefits of accurate and guided endoureterotomy versus ureteral balloon dilatation in the management of ureteral strictures-comparative animal study. Transl Androl Urol 2023; 12:1375-1382. [PMID: 37814702 PMCID: PMC10560343 DOI: 10.21037/tau-23-222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/13/2023] [Indexed: 10/11/2023] Open
Abstract
Background Endoscopic treatment of ureteral strictures provides a minimally invasive approach with a shorter hospital stay and less postoperative pain. There are different therapeutic options, the dilatation balloon and endoureterotomy with holmium yttrium-aluminum-garnet (Ho:YAG) laser are the most used. To assess histological changes after endoureterotomy in the ureteral stricture treatment comparing Ho:YAG laser endoureterotomy versus balloon dilatation endoureterotomy. Methods The subjects used were a total of 48 female pigs. The initial assessment consisted of an endoscopic, nephrosonographic, and contrast fluoroscopic evaluation of the urinary tract. Subsequently, a model of ureteral stricture was performed. Three weeks later, the ureteral stricture was diagnosed and treated. Then animals were randomly assigned to two groups (group A, Balloon dilatation endoureterotomy and group B, Holmium laser retrograde endoureterotomy) in which a double-pigtail ureteral stent was placed for 3 weeks. Follow-up assessments were performed at 3-6 weeks. The final follow-up was completed at 5 months and included the pathological study. Results In terms of therapeutic effectiveness, the overall success was 81.2%. The success rate was 91.7% in group B and 70.8%in group A without statistical significance. No evidence of vesicoureteral reflux nor urinary tract anomalies were observed. Histological assessment showed statistical significance in overall score, lamina propria fibrosis and serosal alterations in group A with higher histological changes. Conclusions The overall histopathological score after ureteral stricture treatment in an animal model showed better remodeling of incised ureteral wall healing after Ho:YAG laser endoureterotomy. Laser endoureterotomy tends to have higher success rate compared to balloon dilatation.
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Affiliation(s)
| | | | | | - Soria Federico
- Department of Endosurgery, Jesus Usón Minimally Invasive Surgery Centre, Caceres, Spain
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6
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Ichikawa Y, Kurokawa K, Furusho S, Nakatsumi Y, Yasui M, Katayama N. An effective case of bronchoscopic balloon dilatation for tuberculous bronchial stenosis. Respirol Case Rep 2023; 11:e01191. [PMID: 37469570 PMCID: PMC10352644 DOI: 10.1002/rcr2.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023] Open
Abstract
Endobronchial tuberculosis often causes bronchial stenosis. Balloon dilation is a minimally invasive and effective bronchoscopic intervention for bronchial stenosis; however, reports on balloon dilation in older individuals are limited. We present a case of a 77-year-old woman with endobronchial tuberculosis and clarify the efficacy and safety of balloon dilation. She presented with dyspnea, right lung atelectasis, and respiratory failure 55 days after initiation of antituberculosis therapy. We performed bronchoscopic balloon dilatation for the right main bronchial stenosis. Consequently, respiratory failure rapidly improved. Chest computed tomography (CT) showed improved lung atelectasis; however, severe bronchial stenosis and rhonchi persisted. Therefore, we performed a second balloon dilatation. CT 3 months after the first balloon dilation showed right upper bronchial stenosis and right lung middle lobe atelectasis. Restenosis was absent 21 months after third balloon dilatation. Bronchoscopic balloon dilation is effective for restenosis with repeated treatment and can be safely performed in older individuals.
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Affiliation(s)
- Yukari Ichikawa
- Department of Respiratory MedicineKanazawa Municipal HospitalKanazawaJapan
| | - Koji Kurokawa
- Department of Respiratory MedicineKanazawa Municipal HospitalKanazawaJapan
| | - Shiho Furusho
- Department of Respiratory MedicineKanazawa Municipal HospitalKanazawaJapan
| | - Yasuto Nakatsumi
- Department of Respiratory MedicineKanazawa Municipal HospitalKanazawaJapan
| | - Masahide Yasui
- Department of Respiratory MedicineNational Hospital Organization Nanao HospitalNanaoJapan
| | - Nobuyuki Katayama
- Department of Respiratory MedicineKanazawa Municipal HospitalKanazawaJapan
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Zhu CM, Li Q, Zeng W, Liu AF, Zhou J, Zhang M, Jiang YF, Li X, Jiang WJ. Safety and efficacy of endovascular recanalization in patients with mild anterior stroke due to large-vessel occlusion exceeding 24 hours. Int J Neurosci 2023:1-10. [PMID: 37458211 DOI: 10.1080/00207454.2023.2236781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Endovascular recanalization (ER) has demonstrated efficacy as a treatment modality for patients presenting with acute ischemic stroke (AIS) caused by large-vessel occlusion (LVO) within a 24-hour timeframe. Nevertheless, the safety and effectiveness of ER in patients with a time of onset exceeding 24 h remain uncertain. OBJECTIVE To evaluate the safety and efficacy of ER treatment for mild ischemic stroke beyond 24-h from symptom onset. METHODS A retrospectively maintained database of mild AIS due to LVO from March2018 to September 2022 at a comprehensive stroke center was screened.Patients received ER or standard medical therapies (SMT) for anterior circulation AIS due to LVO > 24-h were selected. RESULTS We included 47 LVO patients with mild AIS beyond 24-h who suffered neurological deterioration (ND). 34 of these patients underwent ER, the other 13 received SMT. The technical success rate of recanalization was 82.4% (28/34). Patients received ER had significantly lower NIHSS score at discharge and 90-day mRS score (p = 0.028, p = 0.037, respectively) compared to SMT. In addition, they had significantly lower 90-day recurrence of ischemic stroke and lower incidence of moderate-severe stroke (with a NIHSS score at least 5) (p = 0.037, p = 0.033). There were 4 patients (11.7%) had perioperative complications, and no symptomatic intracranial hemorrhage occurred. CONCLUSION ER treatment for mild AIS due to LVO encountered ND was generally safe and effective, even beyond 24-h, and resulted in a good prognosis and lower 90-day recurrence compared to SMT.
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Affiliation(s)
- Can-Min Zhu
- Department of Medicine, Soochow University School of Medicine, Suzhou, Jiang-su, China
- Department of Neurology, The First people's Hospital of Jiangxia District, Wuhan, Hu-bei, China
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
| | - Qiang Li
- Department of Neurology, Wuhan Fifth Hospital, Jianghan University School of Medicine, Wuhan, Hu-bei, China
| | - Wei Zeng
- Department of Neurology, Wuhan Fifth Hospital, Jianghan University School of Medicine, Wuhan, Hu-bei, China
| | - Ao-Fei Liu
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
| | - Ji Zhou
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
| | - Mei Zhang
- Department of Neurology, Wuhan Fifth Hospital, Jianghan University School of Medicine, Wuhan, Hu-bei, China
| | - Yuan-Feng Jiang
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
| | - Xia Li
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
| | - Wei-Jian Jiang
- Department of Medicine, Soochow University School of Medicine, Suzhou, Jiang-su, China
- Department of Vascular Neurosurgery, The PLA Rocket Force Characteristic Medical Center, Soochow University School of Medicine, Beijing, China
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Mechelinck M, Hein M, Kupp C, Braunschweig T, Helmedag MJ, Klinkenberg A, Habigt MA, Klinge U, Tolba RH, Uhlig M. Experimental Liver Cirrhosis Inhibits Restenosis after Balloon Angioplasty. Int J Mol Sci 2023; 24:11351. [PMID: 37511114 PMCID: PMC10379020 DOI: 10.3390/ijms241411351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
The effect of liver cirrhosis on vascular remodeling in vivo remains unknown. Therefore, this study investigates the influence of cholestatic liver cirrhosis on carotid arterial remodeling. A total of 79 male Sprague Dawley rats underwent bile duct ligation (cirrhotic group) or sham surgery (control group) and 28 days later left carotid artery balloon dilatation; 3, 7, 14 and 28 days after balloon dilatation, the rats were euthanized and carotid arteries were harvested. Histological sections were planimetrized, cell counts determined, and systemic inflammatory parameters measured. Up to day 14 after balloon dilatation, both groups showed a comparable increase in neointima area and degree of stenosis. By day 28, however, both values were significantly lower in the cirrhotic group (% stenosis: 20 ± 8 vs. 42 ± 10, p = 0.010; neointimal area [mm2]: 0.064 ± 0.025 vs. 0.138 ± 0.025, p = 0.024). Simultaneously, cell density in the neointima (p = 0.034) and inflammatory parameters were significantly higher in cirrhotic rats. This study demonstrates that cholestatic liver cirrhosis in rats substantially increases neointimal cell consolidation between days 14 and 28. Thereby, consolidation proved important for the degree of stenosis. This may suggest that patients with cholestatic cirrhosis are at lower risk for restenosis after coronary intervention.
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Affiliation(s)
- Mare Mechelinck
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Marc Hein
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Carolin Kupp
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Till Braunschweig
- Department of Pathology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Marius J Helmedag
- Department of General, Visceral and Transplantation Surgery, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Axel Klinkenberg
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Moriz A Habigt
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Uwe Klinge
- Department of General, Visceral and Transplantation Surgery, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - René H Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Moritz Uhlig
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
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Erlandsson A, Werner M, Holm A, Schindele A, Olofsson K. Balloon dilatation versus CO 2 laser surgery in subglottic stenosis, a retrospective analysis of therapeutic approaches. Acta Otolaryngol 2023:1-8. [PMID: 37343275 DOI: 10.1080/00016489.2023.2222756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Subglottic stenosis (SGS) is a narrowing of the airway just below the vocal folds. The cause of SGS and the optimal care for these patients, have remained elusive. Endoscopic surgery of SGS using either balloon or CO2 laser is associated with recurrence. AIMS AND OBJECTIVES Our aim is to compare surgery free intervals (SFI) between these two methods applied in two different timeframes. The knowledge gained from this project can support decision-making regarding surgical method choice. MATERIAL AND METHODS Participants were retrospectively identified using medical records between 1999 - 2021. We used pre-defined broad inclusion criteria to identify cases using the International Classification of Disease (ICD-10). Primary outcome was surgery free intervals. RESULTS 141 patients were identified, 63 met the criteria for SGS, and were included in the analysis. Results show no significant difference in SFI, comparing balloon dilatation and CO2 laser. CONCLUSION These findings demonstrate no detected difference in treatment intervals (SFI) when comparing these two commonly used surgical alternatives for SGS. SIGNIFICANCE The outcome of this report supports surgical freedom of choice based on the surgeon's experience and skill and ushes for further studies on patient experience regarding these two therapeutic approaches.
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Affiliation(s)
- Anders Erlandsson
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Mimmi Werner
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Anna Holm
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Östersund, Sweden
| | - Alexandra Schindele
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Östersund, Sweden
| | - Katarina Olofsson
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
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10
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Michael FA, Friedrich-Rust M, Erasmus HP, Graf C, Ballo O, Knabe M, Walter D, Steup CD, Mücke MM, Mücke VT, Peiffer KH, Görgülü E, Mondorf A, Bechstein WO, Filmann N, Zeuzem S, Bojunga J, Finkelmeier F. Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy? J Clin Med 2023; 12:jcm12103491. [PMID: 37240598 DOI: 10.3390/jcm12103491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Non-anastomotic biliary strictures (NAS) are a common cause of morbidity and mortality after liver transplantation. METHODS All patients with NAS from 2008 to 2016 were retrospectively analyzed. The success rate and overall mortality of an ERCP-based stent program (EBSP) were the primary outcomes. RESULTS A total of 40 (13.9%) patients with NAS were identified, of which 35 patients were further treated in an EBSP. Furthermore, 16 (46%) patients terminated EBSP successfully, and nine (26%) patients died during the program. All deaths were caused by cholangitis. Of those, one (11%) patient had an extrahepatic stricture, while the other eight patients had either intrahepatic (3, 33%) or combined extra- and intrahepatic strictures (5, 56%). Risk factors of overall mortality were age (p = 0.03), bilirubin (p < 0.0001), alanine transaminase (p = 0.006), and aspartate transaminase (p = 0.0003). The median duration of the stent program was 34 months (ITBL: 36 months; IBL: 10 months), and procedural complications were rare. CONCLUSIONS EBSP is safe, but lengthy and successful in only about half the patients. Intrahepatic strictures were associated with an increased risk of cholangitis.
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Affiliation(s)
- Florian A Michael
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Hans-Peter Erasmus
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Christiana Graf
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Olivier Ballo
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Mate Knabe
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Dirk Walter
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Christoph D Steup
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Marcus M Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Victoria T Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Kai H Peiffer
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Esra Görgülü
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Antonia Mondorf
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Wolf O Bechstein
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Jörg Bojunga
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Fabian Finkelmeier
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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11
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de Boutray M, Pons M, Graillon N, Chossegros C, Reyre A, Chagnaud C, Varoquaux A. Stensen's Duct Stenosis Balloon Dilatation: Long-term Evaluation of Clinical Outcomes and Quality of Life Impacts. Otolaryngol Head Neck Surg 2023; 168:696-703. [PMID: 35503255 DOI: 10.1177/01945998221097636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To conduct a long-term retrospective evaluation of the safety and effectiveness of sialographic balloon dilatation in Stensen's duct stenosis (SDS). STUDY DESIGN Retrospective cohort. SETTING Single-institution academic tertiary referral center. METHODS All SDS balloon dilatations (SSBDs) performed from 2011 to 2017 were monitored. Pain relief was evaluated by a numeric rating scale at 3-year follow-up at least. Long-term glandular swelling frequency patterns, quality of life (QoL), and drug consumption were retrospectively assessed. Procedure-related complications were recorded. RESULTS Twenty-one SSBD procedures were recorded (mean ± SD age, 55 ± 12 years), all performed under local anesthesia. SSBD led to complete dilatation in 7 patients (33%), residual stenosis in 8 (38%), and no dilatation (failure) in 6 (29%). Retrospective analysis of clinical outcomes was possible for 17 patients, 71% of whom presented with long-term pain relief, at a mean relief of 3.2 points on the numeric rating scale (P < .001). Long after SSBD, patients presented with a mean decrease of 15.4 glandular swellings per month (P < .001). Medical consumption was reduced to 18% of patients taking some drugs because of SDS after SSBD vs 71% before. SSBD showed an impact on QoL in >80% of patients, with mean improvements of 26% and 25% in the percentage point reduction of physical and mental QoL, respectively (P < .001). No complications were noted except temporary discomfort due to the procedure. CONCLUSION Despite the advent of sialendoscopy-guided techniques, SSBD should be considered for SDS treatment, as it is a safe procedure and provides sustained pain relief.
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Affiliation(s)
- Marie de Boutray
- Department of Otorhinolaryngology and Maxillofacial Surgery, Gui de Chauliac University Hospital, Montpellier University School of Medicine, Montpellier, France
| | - Mélanie Pons
- Department of Maxillofacial Surgery, La Conception University Hospital, Aix-Marseille University, Marseille, France
- Department of Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, Besançon, France
| | - Nicolas Graillon
- Department of Maxillofacial Surgery, La Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Cyrille Chossegros
- Department of Maxillofacial Surgery, La Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Anthony Reyre
- Department of Radiology, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Christophe Chagnaud
- Department of Radiology, La Conception University Hospital, Aix-Marseille University, Marseille, France
- Aix-Marseille University, CNRS, CRMBM-CEMEREM (UMR73-39), Marseille, France
| | - Arthur Varoquaux
- Department of Radiology, La Conception University Hospital, Aix-Marseille University, Marseille, France
- Aix-Marseille University, CNRS, CRMBM-CEMEREM (UMR73-39), Marseille, France
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12
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Li Z, Yang K, Li X, Chen S, Wang X, Li Z, Li X. Minimally invasive ureteral reimplantation or endoscopic management for primary obstructive megaureter: a narrative review of technical modifications and clinical outcomes. Transl Androl Urol 2022; 11:1786-1797. [PMID: 36632159 PMCID: PMC9827399 DOI: 10.21037/tau-22-448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
Background and Objective Primary obstructive megaureter (POM) has various courses in different age populations. Although open ureteral reimplantation (OUR) remains the standard treatment for symptomatic POM, it is highly invasive with potential complications. In recent years, minimally invasive ureteral reimplantation (MIUR), including laparoscopic ureteral reimplantation (LUR) and robotic-assisted laparoscopic ureteral reimplantation (RALUR), and endoscopic management, such as double-J stent insertion, endoureterotomy and endoscopic balloon dilatation (EBD), have been utilized for POM in selected patients. However, few comparable studies between MIUR and endoscopic management have been published to date, and it remains unclear which surgical management is the optimal choice for POM in different age groups. This review provides a comprehensive perspective on technical development and clinical outcomes of MIUR and endoscopic management for POM in pediatric and adult populations. Methods The PubMed and Web of Science databases were used to comprehensively search English language articles related to MIUR and endoscopic management for POM in pediatric and adult populations up to March 2022. The technical modifications and the relevant clinical outcomes were reviewed. Key Content and Findings MIUR with various technical modifications related to intracorporeal suturing and ureteroneocystostomy with anti-reflux techniques appears to be as safe and effective for POM in different age groups as the open procedure. Double-J stent insertion should be regarded as a temporary option for infants by achieving internal urinary drainage, as it may present limited success rates and various complications. Endoureterotomy using pure cutting current or laser appears to be a safer, easier, and less invasive alternative to open surgical management. While EBD has emerged as a definite treatment for POM in the pediatric population, it is debatable whether EBD can substitute for MIUR in adult patients. Conclusions The safety and feasibility of MIUR and endoscopic management in patients from all age groups still need further investigation.
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Affiliation(s)
- Zhenyu Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Silu Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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13
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de Beaufort HWL, Vos JA, Heijmen RH. Initial Single-Center Experience With the Knickerbocker Technique During Thoracic Endovascular Aortic Repair to Block Retrograde False Lumen Flow in Patients With Type B Aortic Dissection. J Endovasc Ther 2022:15266028221134889. [PMID: 36342189 DOI: 10.1177/15266028221134889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Effectiveness of thoracic endovascular aortic repair in type B aortic dissection is impaired by persistent retrograde false lumen flow via distal re-entry tears. Controlled, stentgraft-assisted balloon dilatation of the true lumen at its lower end, or Knickerbocker technique, may block retrograde false lumen flow and consequently improve effectiveness by inducing immediate thrombosis along the entire descending thoracic aorta. MATERIALS AND METHODS A single-center retrospective analysis was performed for all consecutive patients with aortic dissection treated with the Knickerbocker technique to block retrograde false lumen flow. RESULTS Eleven patients were included for analysis. Intraoperative control angiography showed successful occlusion of the false lumen at the level of balloon dilatation in 9 out of 11 patients (82%). There was one perioperative mortality (9%), due to stroke. There were 2 early reinterventions, due to retroperitoneal bleeding and due to chyle leakage in the neck after left subclavian artery bypass. Median clinical follow-up duration was 6 (interquartile range [IQR] 2-11] months. There were 2 deaths during follow-up, one at 2 months after TEVAR from unknown cause of death, and one after 11 months due to rupture of an ascending aortic pseudoaneurysm. The Knickerbocker technique led to positive aortic remodeling. At 3 months follow-up, 100% of patients showed complete false lumen thrombosis in the thoracic aorta proximal to the level of balloon dilatation, with decreasing false lumen diameters (100%) and stable (44%) or decreasing (56%) total aortic diameters. In most patients, the false lumen distal to the stentgraft (i.e. at visceral level) remained patent (11% false lumen thrombosis rate), leading to ≥2 mm dilatation at this level (78% of patients) and in the infrarenal abdominal aorta (56% of patients) at 3 months postoperatively. No distal stent-graft-induced new entry tears were noticed during follow-up. CONCLUSION The Knickerbocker technique is feasible and effective, leading to positive aortic remodeling of the aorta covered by stentgraft in all of a small cohort of patients. CLINICAL IMPACT Persistent, retrograde false lumen perfusion from distal re-entries following thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection, may lead to progressive, aneurysmal dilatation. Controlled, stent graft-assisted balloon dilatation of the true lumen in the distal descending aorta (i.e. Knickerbocker technique) during TEVAR effectively excludes the false lumen from persistent flow resulting in positive aortic remodeling in our small cohort of patients, and hence potentially eliminates the risk of late post-dissection aneurysm formation in the descending thoracic aorta.
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Affiliation(s)
| | - Jan Albert Vos
- Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, Radboud university medical center, Nijmegen, The Netherlands
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14
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Gao Z, Wang L, Liu H, Zhang X. Congenital esophageal stenosis caused by tracheobronchial remnants: a case report. J Int Med Res 2022; 50:3000605221132704. [PMID: 36271607 PMCID: PMC9597040 DOI: 10.1177/03000605221132704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a case of congenital esophageal stenosis in which the patient underwent ineffective balloon dilatation twice and eventually required surgery. The case was initially misdiagnosed as achalasia. Pathological findings revealed tracheobronchial remnants (TBRs) in the muscular layer of strictured esophageal tissue. Most TBR strictures are located in the middle and lower thirds of the esophagus. Esophagography is the main examination method for esophageal stricture, and the appearance of the "rat tail sign" is a key diagnostic indicator. Endoscopic ultrasonography can reveal hypoechoic cartilaginous structures. The gold standards for TBR treatment include esophageal stricture resection, end-to-end esophageal anastomosis, and the construction of structures to prevent reflux. At present, endoscopic longitudinal resection and transverse anastomosis of the anterior esophageal wall with partial cartilage resection without pyloroplasty are novel and practical TBR procedures. To avoid further complications, patients with congenital esophageal stenosis should be promptly treated surgically if balloon dilatation is ineffective.
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Affiliation(s)
- Zhihong Gao
- Health Management Center, The Second Hospital of Hebei Medical
University, Shijiazhuang, Hebei, China
| | - Lingyan Wang
- Department of Pathology, Hebei Children’s Hospital,
Shijiazhuang, Hebei, China
| | - Huaijun Liu
- Department of Radiology, The Second Hospital of Hebei Medical
University, Shijiazhuang, Hebei, China
| | - Xia Zhang
- Department of Radiology, Hebei Children’s Hospital,
Shijiazhuang, Hebei, China,Xia Zhang, No. 133, Jianhua South Street,
Yuhua District, Shijiazhuang City, Hebei Province, 050031, P. R. China.
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15
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Hofmeyr R, McGuire J, Park K, Proxenos M, Peer S, Lehmann M, Lubbe D. Prospective Observational Trial of a Nonocclusive Dilatation Balloon in the Management of Tracheal Stenosis. J Cardiothorac Vasc Anesth 2022; 36:3008-3014. [PMID: 35337744 DOI: 10.1053/j.jvca.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Tracheal stenosis is a debilitating condition that often presents as an emergency and is challenging to treat. Dilatation may avoid tracheostomy or costly tracheal resection and reconstruction. Traditional dilators cause complete occlusion, preventing oxygenation and ventilation, limiting the safe duration of dilatation, and increasing the risk of hypoxic injury or barotrauma. The study authors here assessed an innovative nonocclusive tracheal dilatation balloon, which may improve patient safety by allowing continuous gas exchange. DESIGN A prospective observational study of 20 discrete dilatation procedures performed in 13 patients under general anesthesia. The primary outcomes were the ability to ventilate during dilatation and the preservation of peripheral oxygen saturation. Secondary outcomes included a measured reduction in stenosis, improvement in Cotton-Myer grading, and procedure-related adverse events. SETTING At a single university (academic) hospital. PARTICIPANTS Consenting adult patients with acquired tracheal stenosis. INTERVENTIONS Access to the airway was maintained by a rigid bronchoscope or supraglottic airway device, as deemed appropriate. Continuous conventional ventilation was provided during 3-minute balloon dilatations. MEASUREMENTS AND MAIN RESULTS Heart rate, airway pressure, end-tidal carbon dioxide partial pressure, and peripheral oxygen saturation were measured, and adverse events were recorded. Ventilation was satisfactory in all patients. Peripheral saturation remained greater than 94% in 19 of the 20 (95%) procedures. Stenosis internal diameter and grading were improved. Two patients had minor reversible adverse events (coughing and laryngospasm), which did not prevent completion of the procedure. CONCLUSIONS The authors report the first human trial of the device, in which continuous conventional ventilation could be provided during all tracheal balloon dilatation procedures. Larger trials are needed to confirm improved patient safety and comparative efficacy.
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Affiliation(s)
- Ross Hofmeyr
- Associate Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Jessica McGuire
- Department of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kenneth Park
- (formerly) DISA Medinotec, Johannesburg, South Africa
| | | | - Shazia Peer
- Department of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Darlene Lubbe
- Department of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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16
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Wang S, Li X, Zhang C, Yin M, Ma Y, Tong Y, Wang M, Liu C, Zhu M, Wu G. Balloon dilatation complications during esophagogastric anastomotic stricture treatment under fluoroscopy: Risk factors, prevention, and management. Thorac Cancer 2022; 13:1570-1576. [PMID: 35481875 PMCID: PMC9161329 DOI: 10.1111/1759-7714.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Balloon dilatation (BD) is a common treatment for esophagogastric anastomotic stricture (EAS), but with complications. This study investigates the risk factors, prevention, and management of BD complications to provide clinical guidance. METHODS We retrospectively analyzed the clinical data of 378 patients with EAS treated by BD from March 2011 to June 2021. The association between esophagogastric anastomotic rupture outcome and patient and stricture characteristics and treatment were analyzed by logistic regression. RESULTS BD was performed 552 times and technical success, 98.0%; overall clinical success, 97.8%; major adverse events, 1.3%; minor adverse events, 9.4%; mortality, 0.3%. Logistic regression showed that age (p = 0.080), sex (p = 0.256), interval from surgery to stricture development (p = 0.817), number of dilatations (p = 0.054), cause of stricture (p ≥ 0.168), and preoperative chemotherapy (p = 0.679) were not associated with anastomotic rupture. Balloon diameter (p < 0.001), preoperative radiotherapy (p = 0.003), and chemoradiotherapy (p = 0.021) were correlated with anastomotic rupture. All patients with type I and II ruptures resumed oral feeding without developing into type III rupture. Type III rupture occurred in six cases, who resumed oral feeding after 7-21 days of nasal feeding and liquid feeding. One patient died of massive bleeding after BD. CONCLUSIONS Symptomatic treatment for type I and II ruptures and transnasal decompression and jejunal nutrition tubes for type III rupture, are suggested pending rupture healing. Tumor recurrence, preoperative radiotherapy, and balloon diameter affected the anastomotic rupture outcome.
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Affiliation(s)
- Shuai Wang
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityHenanChina
| | - Xiaobing Li
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityHenanChina
| | - Chenchen Zhang
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityHenanChina
| | - Meipan Yin
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityHenanChina
| | - Yaozhen Ma
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityHenanChina
| | - Yalin Tong
- Department of GI MedicineThe First Affiliated Hospital of Zhengzhou UniversityHenanChina
| | - Meng Wang
- Department of GI MedicineThe First Affiliated Hospital of Zhengzhou UniversityHenanChina
| | - Chao Liu
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityHenanChina
| | - Ming Zhu
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityHenanChina
| | - Gang Wu
- Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityHenanChina
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17
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Akodad M, Blanke P, Chuang MYA, Duchscherer J, Sellers SL, Chatfield AG, Gulsin GG, Lauck S, Leipsic JA, Meier D, Moss RR, Cheung A, Sathananthan J, Wood DA, Ye J, Webb JG. Late Balloon Valvuloplasty for Transcatheter Heart Valve Dysfunction. J Am Coll Cardiol 2022; 79:1340-1351. [PMID: 35393014 DOI: 10.1016/j.jacc.2022.01.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transcatheter heart valve (THV) dysfunction with an elevated gradient or paravalvular leak (PVL) may be documented late after THV implantation. Medical management, paravalvular plugs, redo THV replacement, or surgical valve replacement may be considered. However, late balloon dilatation is rarely utilized because of concerns about safety or lack of efficacy. OBJECTIVES We aimed to evaluate the safety and efficacy of late dilatation in the management of THV dysfunction. METHODS All patients who underwent late dilatation for symptomatic THV dysfunction at 2 institutions between 2016 and 2021 were identified. Baseline, procedural characteristics, and clinical and echocardiographic outcomes were documented. THV frame expansion was assessed by multislice computed tomography before and after late dilatation. RESULTS Late dilatation was performed in 30 patients a median of 4.6 months (IQR: 2.3-11.0 months) after THV implantation in the aortic (n = 25; 83.3%), mitral (n = 2; 6.7%), tricuspid (n = 2; 6.7%) and pulmonary (n = 1; 3.3%) position. THV underexpansion was documented at baseline, and frame expansion substantially improved after late dilatation. The mean transvalvular gradient fell in all patients. For aortic THVs specifically, mean transaortic gradient fell from 25.4 ± 13.9 mm Hg to 10.8 ± 4.1 mm Hg; P < 0.001. PVL was reduced to ≤mild in all 11 patients with a previous >mild PVL. Embolic events, stroke, annular injury, and bioprosthetic leaflet injury were not observed. Symptomatic benefit was durable at 19.6 months (IQR: 14.8-36.1 months) follow-up. CONCLUSIONS Balloon dilatation late after THV implantation appears feasible and safe in appropriately selected patients and may result in THV frame expansion resulting in improvements in hemodynamic performance and PVL.
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Affiliation(s)
- Mariama Akodad
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ming-Yu A Chuang
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jade Duchscherer
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie L Sellers
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Andrew G Chatfield
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Gaurav G Gulsin
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandra Lauck
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jonathon A Leipsic
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Meier
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Rob R Moss
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - David A Wood
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - John G Webb
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.
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18
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Szerlip M, Mack MJ. The Management of Transcatheter Heart Valve Dysfunction: Another Tool in the Box. J Am Coll Cardiol 2022; 79:1352-1355. [PMID: 35393015 DOI: 10.1016/j.jacc.2022.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/09/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Molly Szerlip
- Departments of Cardiology and Cardiac Surgery, Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA.
| | - Michael J Mack
- Departments of Cardiology and Cardiac Surgery, Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
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19
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Liu C, Wu J, Jia H, Lu C, Yan J, Li W, Guo M. Efficacy and safety of drug-coated balloon versus non-drug-coated balloon combined with bare metal stent implantation in treatment of patients with occlusions of the superficial femoral artery: a retrospective study in clinical practice. Am J Transl Res 2022; 14:1305-1314. [PMID: 35273732 PMCID: PMC8902537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/25/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of drug-coated balloon and non-drug-coated balloon combined with bare metal stent implantation for the treatment of patients with occlusions of the superficial femoral artery. METHODS In this retrospective study, 83 patients with occlusions of the superficial femoral artery were included. Among them, 41 patients received paclitaxel drug coated balloon treatment combined with bare metal stent implantation treatment (experimental group), the remaining 42 received non-drug-coated balloon treatment (control group). Patients were followed up at 1, 6, and 12 months after surgery. The primary clinical assessments, including ankle brachial index (ABI), RutherFord grade, Doppler ultrasound, or CT angiography (CTA), were used to observe the patency of target vessels, perioperative and postoperative complications. RESULTS All the diseased vessels were successfully opened. There were no serious intraoperative complications such as vascular rupture or acute thrombosis. There was no significant difference in ankle brachial index, RutherFord grade, and total score between the two groups at one month and six months after operation (P>0.05). There was no significant difference in mortality, amputation rate, or thrombosis between the two groups (P>0.05). Twelve months after the operation, the ankle brachial index, Rutherford grade and total score of the experimental group were better than those of the control group (P<0.05). There was no significant difference in mortality, amputation rate, or thrombosis between the two groups (P>0.05). CONCLUSION Paclitaxel coated balloon is safe and effective in the treatment of superficial femoral arteriosclerosis occlusion. It can significantly improve the ABI and Rutherford grades of patients, and it had a higher patency rate and lower reconstruction rate, but it may affect the healing ability of foot ulcer.
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Affiliation(s)
- Cheng Liu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
| | - Jiang Wu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
| | - Haiyun Jia
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
| | - Caixia Lu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
| | - Junwei Yan
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
| | - Wei Li
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
| | - Mingjin Guo
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
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陈 兰, 程 超, 刘 大. [Low temperature plasma ablation and drug stent implantation for laryngotracheal atresia: a case report]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:142-144. [PMID: 35172554 PMCID: PMC10128310 DOI: 10.13201/j.issn.2096-7993.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Indexed: 04/30/2023]
Abstract
This paper reports a case of acquired laryngosis stenosis treated by arc plasma ablation, drug stent implantation and balloon dilatation. The patient with difficulty in pulling out the tube after intubation 3 years ago was diagnosed with laryngotracheal stenosis and treated with tracheotomy, in order to extubation. Physical examination showed that the metal trachea cannula in front of the neck was in position, unobstructed, and can be seen slightly inspiratory three concave sign when moving. CT and laryngoscope showed subglottic stenosis or atresia. After the operation, the children successfully removed the tracheal tube, after half a year, the laryngotracheal was unobstructed, the children had smooth breathing, no shortness of breath, and normal activities and diet.
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Affiliation(s)
- 兰 陈
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518101)
| | - 超 程
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518101)
| | - 大波 刘
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518101)
- 刘大波,
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21
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Kanzara T, Rotman A, Kinshuck A, Al Yaghchi C, Tan MY, Yu C, Sandu G. Endoscopic management of idiopathic subglottic stenosis in pregnancy. Obstet Med 2021; 14:225-229. [PMID: 34880935 DOI: 10.1177/1753495x21991407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/30/2020] [Indexed: 11/15/2022] Open
Abstract
Aims To describe the use of laser, endoscopic balloon dilatation with jet ventilation anaesthesia in the treatment of pregnant women with idiopathic subglottic stenosis. Materials and methods This is a case review of pregnant women with idiopathic subglottic stenosis, presenting to a tertiary referral centre with worsening breathlessness. Data were extracted from patient case notes. Results Four women underwent surgical management of subglottic stenosis in pregnancy. One patient required two procedures during the course of their pregnancy due to restenosis. All women had improvement in symptoms post-operatively and went on to deliver healthy babies at term. Conclusion Endoscopic balloon dilatation of idiopathic subglottic stenosis is a safe and viable treatment option in pregnancy and should be offered as first-line treatment in symptomatic women.
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Affiliation(s)
- Todd Kanzara
- ENT Department, Aintree University Hospital, Liverpool, UK
| | - Anthony Rotman
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | | | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Min Yi Tan
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Christina Yu
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Guri Sandu
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
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22
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Yang J, Yuan H. Application of transcranial direct current stimulation in cricopharyngeal dysfunction with swallowing apraxia caused by stroke: A case report. Medicine (Baltimore) 2021; 100:e27906. [PMID: 35049192 PMCID: PMC9191296 DOI: 10.1097/md.0000000000027906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Dysphagia is a common complication after stroke. The 2 types of dysphagia with cricopharyngeal dysfunction and swallowing apraxia after stroke are relatively rare and difficult to treat; however, there are few clinical case reports of cricopharyngeal dysfunction and swallowing apraxia after stroke. PATIENT CONCERNS A case of cricopharyngeal dysfunction and swallowing apraxia due to cerebral infarction caused by atrial fibrillation in a 63-year-old woman who was followed up for 1 year. DIAGNOSES The patient was diagnosed with cricopharyngeal dysfunction and swallowing apraxia caused by stroke based on the clinical course and imaging findings. INTERVENTIONS Pharmacotherapy and rehabilitation therapy. OUTCOME The patient's swallowing function returned to normal, and her nasal feeding tubes were removed, and oral feeding was resumed. LESSONS The 2 types of dysphagia with cricopharyngeal dysfunction and swallowing apraxia after stroke are relatively rare and difficult to treat after stroke. Only by improving swallowing apraxia can patients perform mandatory swallowing and balloon dilatation treatment. However, transcranial direct current stimulation has a good therapeutic effect on the primary motor and sensory cortex of the tongue in patients with cricopharyngeal dysfunction and swallowing apraxia.
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Jan IA, AlShehhi M, Rathenvelu BB, Patel S, Saqi ZL. Management of Cervix Atresia with Hematometra by "Genitoscopic Ultrasound-Guided Cervix Fenestration and Balloon Dilatation": A Novel Approach. J Laparoendosc Adv Surg Tech A 2021; 31:1471-1474. [PMID: 34846940 DOI: 10.1089/lap.2021.0344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Cervix atresia causing hematometra usually presents at puberty with cyclic abdominal pain. The management depends upon the type and severity of cervix atresia. We present a novel technique of managing a case of cervix atresia in a 13 years old girl. Case report: A 13 years old girl presented with severe cyclic abdominal pain. Examination revealed normal external genitalia with a palpable tender mass in the suprapubic area. Ultrasonography and MRI suggested a large hematometra with a 1.5 cm long cervix atresia. Vaginoscopy performed under anesthesia showed a normal-looking vagina and a blind cervix. During vaginoscopy and dynamic ultrasound (US) guidance, a spinal needle was passed through the vagina and center of the atretic cervix into the uterine cavity containing the hemolyzed blood. Aspiration of the hemolyzed blood and US visualization confirmed the location of the needle in the uterine cavity. A three-stage (esophageal) balloon dilator was passed over a guidewire through the atretic area. The balloon dilator was dilated up to 10 mm using pressure-controlled dilatation. A satisfactory dilatation was achieved, and all the retained hemolyzed blood was drained through the newly created channel. A size 24 Foleys catheter was retained in the uterine cavity and removed after 1 week. A repeat ultranography before subsequent periods showed a recurrent collection and obliteration of the cervix. US-guided balloon dilatations were repeated. A third dilatation was required after an interval of few months. The child remained well after the third dilatation, having regular periods, and is symptom free at 8 months follow-up, however, may need more sessions of cervix dilatations. Conclusion: Genitoscopic US-guided cervix fenestration and balloon dilatation is an effective technique for treatment of cervix atresia. It is a safe technique, avoids major surgical reconstructions, is a minimally invasive procedure, and can be used in selected cases of cervix atresia.
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Affiliation(s)
- Iftikhar Ahmad Jan
- Department of Pediatric Surgery and Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Muna AlShehhi
- Department of Pediatric Surgery and Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Shahbazali Patel
- Department of Clinical Imaging, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Zahid L Saqi
- Department of Pediatric Surgery and Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
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Grewal R, Tantichirasakul N, Miller BJ, Watson N, Karagama Y. Office-based transnasal oesophagoscopy: Evaluating the safety, efficacy and application in head and neck cancer patients. Clin Otolaryngol 2021; 47:218-223. [PMID: 34581024 DOI: 10.1111/coa.13868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/09/2021] [Accepted: 09/05/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Ravneet Grewal
- GKT School of Medical Education, King's College London, London, UK
| | | | | | - Natalie Watson
- ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Yakubu Karagama
- ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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25
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Wang S, Yin M, Wang M, Tong Y, Zhao Y, Ma Y, Li X, Xie P, Wu G. Safety and efficacy of large balloon dilatation under fluoroscopy. Ann N Y Acad Sci 2021; 1503:102-109. [PMID: 34533853 DOI: 10.1111/nyas.14682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022]
Abstract
The maximum diameter of the balloon used for balloon dilatation(BD) of esophagogastric anastomotic stricture (EAS) is generally 20 millimeters. This study aimed to evaluate the safety and efficacy of BD under fluoroscopy, using balloons with a diameter of 25-30 millimeters. We retrospectively analyzed the data of patients with benign EAS treated by large BD (balloon diameter, 25-30 mm) under fluoroscopy. The Cox proportional hazards model (PHM) was used to identify the factors associated with stricture-free survival. The results show that a total of 127 patients were included in this study, and 204 BDs were performed. The technical success rate was 96.6%, and the clinical success rate was 99.2%. The incidence of serious adverse events was 3.4% (7/204). One patient died of massive hemorrhage during BD, and nine patients were lost to follow-up. For the remaining 117 patients, the median stricture-free survival period was 14.9 months. In multivariable analysis using the Cox PHM, only balloon diameter was significantly associated with stricture-free survival. The stricture-free survival period tended to increase as balloon diameter increased. Large BD under fluoroscopy appears to be safe and effective for the treatment of benign EAS after esophagectomy.
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Affiliation(s)
- Shuai Wang
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Meipan Yin
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Meng Wang
- Department of GI Medicine, the First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yalin Tong
- Department of GI Medicine, the First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yue Zhao
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yaozhen Ma
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Xiaobing Li
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Pengfei Xie
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Gang Wu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Henan, China
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26
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Gao X, Chen J, Wang W, Peng L, Di X, Xiao K, Li H, Wei X. Step-by-step technique for the endoscopic treatment of ureteric stricture. BJU Int 2021; 128:692-696. [PMID: 34322987 DOI: 10.1111/bju.15558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/18/2021] [Accepted: 07/25/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To outline our step-by-step technique for the endoscopic treatment of ureteric stricture. MATERIALS AND METHODS Between January 2019 and June 2020, 25 patients with ureteric strictures underwent ureteric bypass and were included in this study. The ureteric bypass surgery included three key steps. First, holmium laser endoureterotomy was used to establish a small channel. Then, balloon dilatation was performed to create a large channel. Finally, an Allium stent was inserted. RESULTS Over a median follow-up time of 12 months, the success rate of ureteric bypass surgery was 92.0% (23/25). The median operating time was 78 min. The incidence of pain was 16% (4/25), and the incidence of fever was 4.0% (1/25). The preoperative hydronephrosis volume and urea nitrogen levels decreased significantly after surgery. CONCLUSIONS We performed ureteric bypass for patients with ureteric strictures. This technique was found to be safe and effective over a short follow-up time. For patients who are not suitable for surgical reconstruction, the ureteric bypass technique is a good choice.
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Affiliation(s)
- Xiaoshuai Gao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jixiang Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liao Peng
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingpeng Di
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiwen Xiao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Wei
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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27
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Cheng H, Saxby A, Jufas N, Kong J, Patel N. Balloon dilation eustachian tuboplasty for dilatory dysfunction: Safety and efficacy analysis in an Australian cohort. ANZ J Surg 2021; 91:1480-1484. [PMID: 34075678 DOI: 10.1111/ans.16980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/19/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Eustachian tube dysfunction (ETD) is a common clinical condition encountered by otolaryngologists. The severity and duration of symptoms range from the mild and transient to the chronic and severe along with secondary pathologies. Balloon dilation eustachian tuboplasty (BDET) as a treatment, was first described in 2010 and has been studied extensively. This study evaluates the efficacy and safety of BDET in an Australian cohort. METHODS Retrospective chart review on all patients who underwent BDET from September 2016 to March 2020 was performed. The Eustachian Tube Dysfunction Patient Questionnaire (ETDQ-7) was chosen as the primary outcome measure. Secondary outcome measures included subjective global assessment of presenting symptoms, ability to perform Valsalva maneuver and tympanometry. Any complications related to the procedures were reported. RESULTS One hundred and nineteen eustachian tube operations were included in this study. The patient cohort showed statistically significant improvement of mean EDTQ-7 score from 0.7 to 2.9. Improvement in EDTQ-7 was achieved in 83.9% of the cases. All patients in the baro-challenge-induced subgroup achieved improvement in ETDQ-7 score. Complete resolution of symptoms with an ETDQ <2.1 was achieved in 37.1% of the cohort. There were no adverse safety events associated with the procedures. CONCLUSION BDET resulted in improvement of the EDTQ-7 score in most of patients in this Australian cohort with no reported complications. BDET was most successful in baro-challenge-induced subgroup with universal improvement. Lower success rates were seen in patients with secondary pathology from their ETD.
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Affiliation(s)
- Horace Cheng
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Kolling Deafness Research Centre, Royal North Shore Hospital, Macquarie University and University of Sydney, Sydney, New South Wales, Australia
| | - Alex Saxby
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nicholas Jufas
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Kolling Deafness Research Centre, Royal North Shore Hospital, Macquarie University and University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Kong
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nirmal Patel
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Kolling Deafness Research Centre, Royal North Shore Hospital, Macquarie University and University of Sydney, Sydney, New South Wales, Australia
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Abstract
Objective: Eustachian tube function is of central importance for the ventilation of the middle ear. A dysfunction can be associated with chronic otitis media, and cholesteatoma. Balloon Eustachian tube dilatation (BET) is a treatment option used to solve eustachian tube dysfunction. Although BET is widely performed, little is known about the occurrence rate of the complications associated with BET. The aim of the present study was to observe the rate of sensorineural hearing loss (SNHL) after BET. Methods: We retrospectively evaluated in a chart review 1,547 patients and 2,614 procedures of BET performed in a single center between 2015 and 2019 using the Spiggle and Theis, Overath, Germany eustachian tube dilatation system. Results: We observed seven cases of SNHL after BET. In two cases, the SNHL persisted, and in five cases, the SNHL was transient. In two cases of SNHL, a simultaneous tympanoplasty was performed. The overall rate of SNHL per procedure is 0.3%. The rate of permanent SNHL is 0.08%. Conclusion: BET has a low rate of SNHL. Rapid middle ear pressure changes are assumed to cause BET-related hearing loss.
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Affiliation(s)
- Ingo Todt
- Medical School OWL, Bielefeld University, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - Felix Oppel
- Medical School OWL, Bielefeld University, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - Holger Sudhoff
- Medical School OWL, Bielefeld University, Klinikum Bielefeld Mitte, Bielefeld, Germany
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29
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El-Asmar KM, Youssef AA, Abdel-Latif M. The Effectiveness of Combined Balloon and Bougie Dilatation Technique in Children with Impassable Esophageal Stricture. J Laparoendosc Adv Surg Tech A 2021; 31:724-728. [PMID: 33650883 DOI: 10.1089/lap.2020.0926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Impassable caustic esophageal strictures (CES) can be rendered passable through sophisticated dilatation techniques, hence avoiding the esophageal replacement surgery and its complications. Patients and Method: Patients with impassable CES who were presented to our hospital between January 2015 and April 2020 underwent a combined balloon and bougie dilatation. This technique aims at doing an initial partial dilatation of the proximal segment of the stricture, using a balloon catheter to pave the way for the endoscope to be advanced more distally. Therefore, a guide wire could be passed down to the stomach to complete the dilatation session using bougie dilators. Results: Seven patients out of 138 patients who underwent endoscopic dilatation for CES at the pediatric surgery department were enrolled in this study. Their ages ranged from 2.5 to 6 years. This technique was successful in 6 patients indicating technique reproducibility of 85.7%. These 6 patients continued their next dilatation sessions using bougie dilator only, whereas 4 patients were completely cured from dysphagia indicating technique efficiency of 57%, 1 is still on dilatation, and 1 patient had a resistant stricture. The dilatation through the proposed technique failed in 1 patient, who was referred for a replacement surgery. Conclusion: Combined dilatation is safe and effective to preserve the native esophagus in some difficult CES.
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Formánek M, Formánková D, Školoudík L, Zeleník K, Chrobok V, Komínek P. Effect of Balloon Eustachian Tuboplasty in Adults That Only Have Symptoms of Chronic Eustachian Tube Dysfunction, With a 1-Year Follow-Up: Prospective Clinical Trial. Ear Nose Throat J 2020:145561320980199. [PMID: 33297745 DOI: 10.1177/0145561320980199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Balloon eustachian tuboplasty (BET) is a promising therapeutic option for eustachian tube (ET) dysfunction. However, data are lacking on the effect of BET in adults with symptoms of chronic ET dysfunction but without a contributing pathology. This study investigated the effect of BET in adult patients with only symptoms of chronic ET dysfunction. METHODS This prospective clinical trial included adult patients with aerated physiological middle ears and symptoms of ET dysfunction for more than 6 months. Compliance with follow-up was 93.3%. We evaluated the effects of BET with tympanometry, assessment of the Valsalva or Toynbee maneuver with tympanometry verification, a Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and pure-tone audiometry. Data were recorded 1 day before surgery and 2, 6, and 12 months after BET. Therapy was considered successful when the patient exhibited a newly acquired ability to perform the Valsalva or Toynbee maneuver or when the ETDQ-7 score improved by 20% or more. RESULTS We included 14 ears in the analysis. After 2, 6, and 12 months, therapy was successful, according to the ETDQ-7, in 11/14 (78.6%; 95% CI: 48.8-94.3), 13/14 (92.9%; 95% CI: 64.2-99.6), and 12/14 (85.7%; 95% CI: 56.2-97.5) ears, respectively. These results were statistically significant. The ETDQ-7 scores also significantly decreased at 2, 6, and 12 months after the BET, when any change was observed. All patients experienced improvement. Only 1 patient reported temporary deterioration after 2 months. Treatment was more frequently successful in patients without nasal polyps or pollinosis. CONCLUSIONS Adults with only symptoms of chronic ET dysfunction benefitted more and had longer lasting results from BET, compared to patients with pathologies caused by ET dysfunction. Balloon eustachian tuboplasty could be recommended for these patients.
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Affiliation(s)
- Martin Formánek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Debora Formánková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Lukáš Školoudík
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Karol Zeleník
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Viktor Chrobok
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
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Li TF, Fu PJ, Han XW, Ma J, Zhu M, Li Z, Ren JZ. Repeated balloon dilatation with long-term biliary drainage for treatment of benign biliary-enteric anastomosis strictures: A STROBE-compliant article. Medicine (Baltimore) 2020; 99:e22741. [PMID: 33126311 PMCID: PMC7598877 DOI: 10.1097/md.0000000000022741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Percutaneous balloon dilatation for benign biliary-enteric anastomosis stricture has been the most widely used alternative to endoscopic treatment. However, patency results from the precedent literature are inconsistent.The objective of this study was to evaluate the safety and feasibility of repeated balloon dilatation with long-term biliary drainage for the treatment of benign biliary-enteric anastomosis strictures.Data from patients with benign biliary-enteric anastomosis strictures who underwent percutaneous transhepatic cholangiography (PTC), repeated balloon dilatation with long-term biliary drainage (repeated-dilatation group; n = 23), or PTC and single balloon dilatation with long-term biliary drainage (single-dilatation group; n = 26) were reviewed. Postoperative complications, jaundice remission, and sustained anastomosis patency were compared between the groups.All procedures were successful. No severe intraoperative complications, such as biliary bleeding and perforation, were observed. The jaundice remission rate in the first week was similar in the 2 groups. During the 26-month follow-up period, 3 patients in the repeated-dilatation group had recurrences (mean time to recurrence: 22.84 ± 0.67 months, range: 18-26 months). In the single-dilatation group, 15 patients had recurrences (mean time to recurrence = 15.28 ± 1.63 months, range: 3-18 months). The duration of patency after dilatation was significantly better in the repeated-dilatation group (P = .01). All patients with recurrence underwent repeat PTC followed by balloon dilatation and biliary drainage.Repeated balloon dilatation and biliary drainage is an effective, minimally invasive, and safe procedure for treating benign biliary-enteric anastomosis strictures, and provides significantly higher patency rates than single dilatation.
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Affiliation(s)
- Teng-Fei Li
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Pei-Ji Fu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Xin-Wei Han
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Ji Ma
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Ming Zhu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Zhen Li
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Jian-Zhuang Ren
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
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Ni Y, Xu Z. [Use of balloon catheter dilation and bioabsorbable steroid-releasing sinus implants in pediatric chronic rhinosinusitis]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:481-485;491. [PMID: 32842174 PMCID: PMC10128341 DOI: 10.13201/j.issn.2096-7993.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Indexed: 11/12/2022]
Abstract
Objective:To evaluate the effect of use of balloon catheter dilation (BCD) with bioabsorbable steroid-releasing sinus implants in pediatric chronic rhinosinusitis(PCRS). Method:A retrospective study was performed of 49 children with failed medical therapy, who underwent surgery, and children all accepted adenoidectomy.77 sides of sinus were performed with balloon catheter dilation sinuplasty. They were divided into two groups:the balloon group and the balloon with implant group. The balloon group included 26 cases, 16 cases of which accepted balloon catheter dilation sinuplasty of both maxillary sinuses, and 10 cases of which accepted one side. The balloon with implant group included 23 cases,12 cases of which accepted balloon catheter dilation sinuplasty of both maxillary sinuses plus positioning of bioabsorbable steroid-releasing sinus implants, and 11 cases of which accepted one side. VAS and SN-5 scales were completed by children and their parents to evaluate subjective symptoms. Children all accepted CT of sinus and CT score (Lund-Mackey) was completed by a doctor. We use the SPSS 23.0 with the way of Repeated measures ANOVA to analyze the data between two groups, aiming to identify the effect of the operation manners. Result:The procedures were successful in all patients in the balloon with implant group. No complications happened. No sinus implants moving and no detachment. In the balloon with implant group, VAS score declined from 6.9 before operation to 2.0 of six months after operation and SN-5 score declined from 2.397 to 1.376 and CT score of one side of operation declined from 9.628 to 1.314. VAS score, SN-5 score and CT score of the balloon with implant group all declined significantly after operation. The remission rate of the VAS and SN-5 score in the balloon with implant group were 100% and 95% respectively. The SN-5 score data of patients in two groups with SN-5 score <2.5 before operation was analyzed. There was no statistical significance between the data of two groups before operation(P=0.199), and there was no statistical significance between the data decline of SN-5 score of two groups after operation (F=2.336,P=0.14). The data of patients in two groups with SN-5 score ≥2.5 before operation was analyzed. There was no statistical significance between the data of two groups before operation(P=0.628), and, after operation, there was statistical significance between the data decline of SN-5 score of two groups (F=13.861,P=0.001).It meant the balloon with implant group declined more. The CT score data of patients in two groups with CT score (3-8) before operation was analyzed. There was no statistical significance between the data of two groups before operation(P=0.411),and there was no statistical significance between the data decline of CT score of two groups after operation(F=1.108,P=0.300).The data of patients in two groups with CT score (9-12) before operation was analyzed. There was no statistical significance between the data of two groups before operation(P=0.792), and, after operation, there was statistical significance between the data decline of CT score of two groups (F=13.059,P=0.001). It meant the balloon with implant group declined more. Conclusion:In our study, the use of balloon catheter dilation (BCD) with bioabsorbable steroid-releasing sinus implants made a clinical curative effect in the treatment of PCRS with failed medical therapy, and it was safety. In severe PCRS patients, balloon catheter dilation (BCD) with bioabsorbable steroid-releasing sinus implants was more effective than the use of balloon catheter sinuplasty (BCS) alone.
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Affiliation(s)
- Yihua Ni
- Department of Otorhinolaryngology Head and Neck Surgery,Children's Hospital of Fudan University,Shanghai,201102,China
| | - Zhengmin Xu
- Department of Otorhinolaryngology Head and Neck Surgery,Children's Hospital of Fudan University,Shanghai,201102,China
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Chen X, Xie L, Zeng H, Xu Y, Xiong H. Local Versus General Anesthesia for Balloon Dilation of the Eustachian Tube: A Single-Center Retrospective Study in a Chinese Population. Ear Nose Throat J 2020:145561320923172. [PMID: 32425122 DOI: 10.1177/0145561320923172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare local anesthesia (LA) versus general anesthesia (GA) for balloon dilation of the Eustachian tube (BDET) using the Bielefeld Dilation System in a Chinese population with obstructive Eustachian tube dysfunction (OETD). METHODS A total of 49 patients with OETD undergoing BDET under either LA or GA were included in the present study. Intraoperative blood pressure, heart rate, and pain sensation were recorded. The surgical outcome was assessed by Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) symptom scores and positive Valsalva maneuver at baseline, 1 day, 2-, 4-, 12-, 24-, and 52-week follow-up. RESULTS Balloon dilation of the Eustachian tube procedures were successfully completed in all patients without adverse effects. The visual analog scale score for maximal pain during the surgical procedure in the LA group was 6.1 ± 1.0. Intraoperative blood pressure and heart rate were higher in the LA group compared with the GA group. The duration and costs of surgery were significantly reduced in the LA group compared with the GA group. Normalization of ETDQ-7 scores at 12-week and 52-week follow-up was observed in 71.9% (23/32) and 63.3% (19/30) of patients in the LA group, respectively, which was comparable to that of the GA group. Although improvement in positive Valsalva maneuver was observed in both groups after BDET, more patients reported positive Valsalva maneuver in the GA group compared with the LA group at 12-week and 52-week follow-up. In total, 96.0% (24/25) of patients in the LA group and 95.8% (23/24) of patients in the GA group would choose LA if BDET was needed again. CONCLUSION Balloon dilation of the Eustachian tube under LA is safe and feasible in a Chinese population. The surgical outcome of BDET is comparable between under LA and GA during 52-week follow-up. Further studies are needed to address management of intraoperative pain and determine longer follow-up outcome for BDET under LA.
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Affiliation(s)
- Xiaoxin Chen
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Lingwen Xie
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Haicang Zeng
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Yaodong Xu
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Hao Xiong
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
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Shen ZY, Wang JJ, Lu LG, Wan R, Wan XJ, Cai XB. The efficacy and safety of balloon dilation for unresectable malignant biliary obstruction before placement of self-expanding metal stents. J Dig Dis 2020; 21:293-300. [PMID: 32279460 DOI: 10.1111/1751-2980.12864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/16/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate whether patients with malignant biliary obstruction (MBO) benefit from balloon dilation before the placement of a self-expanding metal stent (SEMS) for palliative biliary drainage. METHODS Consecutive patients who underwent endoscopic retrograde cholangiopancreatography with SEMS placement for palliative management of MBO were retrospectively included. Comparative analyses of serum bilirubin levels, post-procedural adverse events, stent patency time, stent dysfunction, and patient survival were performed between the dilation and non-dilation groups. RESULTS A total of 221 patients underwent palliative endoscopic SEMS implantation for MBO from January 2014 to June 2018. Dilation significantly improved the percentage of serum bilirubin improvement (37.0% vs 14.3%, P = 0.001), with a decreasing trend in the incidence of post-procedural cholangitis (2.5% vs 7.8%, P = 0.075), while the rates of other complications such as pancreatitis and bleeding were not increased. The patency time of SEMS and patient survival did not significantly differ between patients with and without dilation. Patients had endoscopic nasobiliary drainage (ENBD) but not dilation showed similar short-term outcomes as patients underwent dilation but without ENBD. CONCLUSIONS Dilation with a small-caliber balloon catheter before the placement of SEMS is a safe and effective approach for MBO. Balloon dilation may improve the short-term efficacy of SEMS placement, while long-term outcomes are not obviously affected. The short-term effect of stricture dilation may be achieved by ENBD. Further studies are needed to confirm our results.
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Affiliation(s)
- Zhen Yang Shen
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Jun Wang
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lun Gen Lu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Wan
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Jian Wan
- Department of Gastroenterology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao Bo Cai
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
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Abstract
BACKGROUND Paranasal sinus balloon catheter dilation (BCD) represents a tool that has been shown to be safe in the management of pediatric chronic rhinosinusitis (pCRS); however, its efficacy compared to standard treatment regimens has not been well established. OBJECTIVE The purpose of this meta-analysis was to evaluate the clinical utility of BCD in pCRS. METHODS Articles reporting BCD for pCRS in patients under 18 years of age were identified via the following search terms: sinusitis OR rhinosinusitis AND balloon dilatation OR balloon dilation OR balloon sinuplasty OR sinuplasty AND adolescent OR children OR infant OR pediatric OR toddler. The primary outcome analyzed includes quality of life improvement as measured via Sinus and Nasal Quality of Life Survey (SN-5) or Sino-nasal Outcome Test (SNOT-22) scores. RESULTS Eighty studies were abstracted; 10 studies were included for final qualitative analysis after dual investigator screening. Three studies described BCD with surgical controls, including adenoidectomy, saline irrigation, or maxillary antrostomy. Noninferiority was not demonstrated (ie, BCD is inferior) in 2 of 3 studies. Pooled analysis utilizing a random effects model revealed a decreased effect size yet no statistically significant difference between BCD and standard operative techniques as measured by quality of life measures (g = -0.04, I2 = 41%). CONCLUSION This work highlights a lack of published evidence regarding the role of BCD in pCRS. Two of the 3 included studies demonstrated the inferiority of BCD when compared to other standard surgical interventions, whereas meta-analysis was unable to detect any statistically significant difference between standard treatment regimens. Future scientific investigations are necessary to assess the comparative effectiveness of BCD in pCRS.
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Affiliation(s)
- Vijay A Patel
- Department of Otolaryngology-Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Daniel C O'Brien
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia
| | - Jad Ramadan
- West Virginia University Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia
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Abstract
Background: Balloon Eustachian Tuboplasty (BET) is used as a second-line treatment in cases in which adenoidectomy, paracentesis, and VT have failed. However, studies have not investigated the efficacy of this procedure as a first-line treatment.Objectives: To evaluate the quality of life in children with chronic Eustachian tube dysfunction (ETD) after BET using the Otitis Media-6 (OM-6) questionnaire.Methods: We retrospectively evaluated the data of 62 children with chronic dysfunction ETD and divided patients into the following groups: 30 cases underwent BET (group 1), and 32 cases underwent ventilation tube (VT) insertion from July 2016 to April 2018. The children's parents were instructed to complete the OM-6 questionnaire preoperatively and at 6 weeks and 1 year postoperatively.Results:. The average preoperative scores were higher than the postoperative scores, and the average 6-week postoperative scores were higher than the average 1-year postoperative scores for both groups 1 and 2. Further, the average 6-week postoperative scores from patients in group 2 were significantly higher than those in group 1.Conclusion and significance: Our results demonstrate that BET may be a safe, first-line intervention that positively effects the quality of life in children with chronic ETD.
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Affiliation(s)
- Berat Demir
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
| | - Caglar Batman
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
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Oktaviono YH, Hutomo SA, Al-Farabi MJ. No-reflow phenomenon during percutaneous coronary intervention in a patient with polycythemia vera: A case report. Medicine (Baltimore) 2020; 99:e19288. [PMID: 32118741 PMCID: PMC7478610 DOI: 10.1097/md.0000000000019288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Acute myocardial infarction is the leading cause of mortality and morbidity in a patient with polycythemia vera (PV). However, the benefit of various percutaneous coronary intervention (PCI) technique on the patient with PV is relatively unexplored. PATIENT CONCERN A 46-year-old woman presented to the primary hospital complained about new-onset typical chest pain. Echocardiography examination showed inferior ST-elevation myocardial infarction (STEMIs) and increased cardiac markers. Complete blood count showed elevated hemoglobin, white blood cell, and platelet. DIAGNOSIS Coronary angiography revealed simultaneous total occlusion at proximal right coronary artery (RCA) and also at proximal left anterior descending (LAD) artery. Elevated hemoglobin and hematocrit with JAK2 mutation establish the diagnosis of PV. INTERVENTIONS We performed multi-vessel primary PCI by using direct stenting in RCA and aspiration thrombectomy in LAD after failed with balloon dilatation and direct stenting method. This procedure resulted in thrombolysis in myocardial infarction (TIMI)-3 flow in both coronary arteries. However, the no-reflow phenomenon occurred in the LAD, followed by ventricular fibrillation. After several attempts of resuscitation, thrombus aspiration, and low-dose intracoronary thrombolysis, the patient was returned to spontaneous circulation. The patient then received dual antiplatelet and cytoreductive therapy. OUTCOMES The patient clinical condition and laboratory finding were improved, and the patient was discharged on the 7th day after PCI. LESSONS Cardiologist should be aware of the no-reflow phenomenon risk in the patient with PV and STEMI. Direct stenting, intracoronary thrombectomy, and thrombolysis are preferable instead of balloon dilatation for PCI technique in this patient.
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Affiliation(s)
- Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
| | - Suryo Ardi Hutomo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
| | - Makhyan Jibril Al-Farabi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
- School of Healthcare Managemenent, University College London, Bloomsbury, London, United Kingdom
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Abstract
Introduction and Objectives: Reconstructive surgery for benign ureteric strictures and long term nephrostomy are often invasive and lead to poor quality of life. Balloon dilatation has the potential to bridge this gap. We present the outcome of our series and examine the risk factors of stricture recurrence.Materials and Methods: There were 109 strictures in our series from August 2012 to July 2018 in our single center retrospective cohort analysis. All strictures were dilated retrogradely or antegradely and followed by stenting. Follow-up imaging was done to assess stricture recurrence.Results: Mean patient age was 57.7-years-old (SD ± 12.6). Mean follow-up was 20.2 months (SE ± 1.8). All strictures were successfully dilated and stented. Overall, mean patency rate was 63.7% at mean follow-up of 20.2 months (SE ± 1.8). Strictures caused by stone/inflammation had 28.0% (21/75) risk of recurrence compared to iatrogenic causes, 63.6% (7/11), and radiotherapy, 100.0% (5/5) (p = 0.001). Non-incidental strictures also had significantly higher risk of recurrence at 57.4% (27/47) vs. incidental strictures at 13.6% (6/44) (p = 0.000). The mean length of strictures was 12.5 mm (SE ± 1.7) in the recurrence group vs. 9.6 mm (SE ± 0.7) in those without recurrence (p = 0.001). The presence of ipsilateral atrophic kidney was associated with 72.2% (13/18) risk of recurrence vs. non-atrophic kidney 27.4% (20/73) (p = 0.000). The mean age of stricture was 14.5 months (SE ± 4.6) and 5.2 months (SE ± 2.1) in the recurrence and non-recurrence groups, respectively (p = 0.013).Conclusions: Balloon dilatation of benign ureteric stricture is a feasible option. Its effect can be long-lasting in selected patients, that is, non-irradiated, incidental, short strictures with normal kidneys. This will benefit patients unfit for reconstructive surgery.
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Affiliation(s)
- Wai Loon Yam
- Department of Urology, Changi General Hospital, Singapore, Singapore
| | | | - Keng Sin Ng
- Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - Foo Cheong Ng
- Department of Urology, Changi General Hospital, Singapore, Singapore
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Pal N, Jones D, Rice G, Sinhal A. Case report describing late balloon dilatation as a treatment for paravalvular leak with intuity elite rapid deployment valve. Catheter Cardiovasc Interv 2019; 96:E292-E294. [PMID: 31859442 DOI: 10.1002/ccd.28659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/22/2019] [Accepted: 12/08/2019] [Indexed: 11/11/2022]
Abstract
Use of sutureless bioprostheses for aortic valve replacement has increased in recent years as compared to conventional prostheses, though with the potential issue of paravalvular leak, which requires close follow-up. We present this case report describing the successful treatment of paravalvular leak in a 65 year old man, who had NYHA class III symptoms post implantation of a 21 mm Intuity Elite rapid deployment bioprosthesis (Edwards Lifesciences, Irvine, CA). Diagnosis was established using TTE, TOE, and Cardiac MRI. Performing balloon dilatation using an Atlas Gold balloon (BARD Peripheral Vascular Inc., Tempe, AZ) treated the likely inadequate expansion of the subvalvular stent, leading to significant reduction in the paravalvular leak. At one month follow-up patient reported complete resolution of his symptoms. Successful percutaneous treatment of paravalvular leak following implantation of rapid deployment sutureless bioprosthesis provides a new treatment strategy for these patients; this strategy requires further validation.
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Affiliation(s)
- Nikhil Pal
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Dylan Jones
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Gregory Rice
- Cardiothoracic Surgery Unit, Flinders Medical Centre, Adelaide, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia.,Department of Cardiology, College of Medicine and Public Health, Flinders University
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Goussard P, Mfingwana L, Morrison J, Ismail Z, Wagenaar R, Janson J. Corrosive injury of the trachea in children. Clin Case Rep 2019; 7:1999-2003. [PMID: 31624626 PMCID: PMC6787853 DOI: 10.1002/ccr3.2395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/02/2019] [Accepted: 07/11/2019] [Indexed: 12/30/2022] Open
Abstract
The secondary injury may present weeks to months after the initial insult and repeat bronchoscopy, and long-term follow-up is required for the respiratory complications of CSI.Ingestion of caustic fluid may cause severe tracheal stenosis. Repeated airway dilatation may be a lifesaving intervention until such point that surgery can be performed.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch University and Tygerberg HospitalCape TownSouth Africa
| | - Lunga Mfingwana
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch University and Tygerberg HospitalCape TownSouth Africa
| | - Julie Morrison
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch University and Tygerberg HospitalCape TownSouth Africa
| | - Zane Ismail
- Department of Cardiothoracic SurgeryFaculty of Medicine and Health SciencesStellenbosch University and Tygerberg HospitalCape TownSouth Africa
| | - Riegart Wagenaar
- Department of Cardiothoracic SurgeryFaculty of Medicine and Health SciencesStellenbosch University and Tygerberg HospitalCape TownSouth Africa
| | - Jacques Janson
- Department of Cardiothoracic SurgeryFaculty of Medicine and Health SciencesStellenbosch University and Tygerberg HospitalCape TownSouth Africa
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Kirakosyan EV, Lokhmatov MM, Budkina TN, Tupylenko AV, Oldakovsky VI, Dyakonova EY. [Staged endoscopic balloon dilatation for cicatricial pyloric stenosis in children]. Khirurgiia (Mosk) 2019:85-90. [PMID: 31464281 DOI: 10.17116/hirurgia201908185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Secondary pyloric stenosis quickly leads to homeostatic and nutritional disorders that determines the importance of early diagnosis and surgical treatment. In two clinical cases, we have shown that staged endoscopic balloon dilatation of the pylorus is devoid of the most of the known problems and shortcomings of conventional surgery and makes it possible to restore effectively gastrointestinal passage and to improve child's quality of life. This procedure has a high diagnostic and curative value and is followed by positive dynamics of condition of the child with pyloric stenosis.
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Affiliation(s)
- E V Kirakosyan
- Sechenov First Moscow State Medical University of Ministry of Health of the Russia, Moscow, Russia
| | - M M Lokhmatov
- Sechenov First Moscow State Medical University of Ministry of Health of the Russia, Moscow, Russia; National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - T N Budkina
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - A V Tupylenko
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - V I Oldakovsky
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - E Yu Dyakonova
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
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Abstract
AIM To evaluate the efficacy of the most common endoscopic transpapillary interventions for choledocholithiasis in randomized controlled trial. MATERIAL AND METHODS There were 90 patients with choledocholithiasis who were randomized into 3 groups: main, clinical comparison 1, clinical comparison 2. In the main group A (n=30), patients underwent endoscopic partial papillosphincterotomy combined with balloon dilatation, in the group of clinical comparison 1 (n=30) - endoscopic papillosphincterotomy, in the group of clinical comparison 2 (n=30) - endoscopic papillosphincterotomy with mechanical lithotripsy. RESULTS The greatest number of complications (38%) was observed in the group of clinical comparison 2. Less morbidity was noted in the group of clinical comparison 1 (19%). Minimum number of complications was observed in the main group (6%). Acute pancreatitis was diagnosed in groups of clinical comparison 1 and 2 as a rule, whereas only 3% of patients had this complication in the main group. Cholangitis was predominantly observed in the group of clinical comparison 2, in other groups this complication occurred in 3% of patients. Bleeding was observed only in the groups of clinical comparison 1 and 2 (10 and 13%, respectively). Loss of the lithotripter rope (3%) was detected only in the group of clinical comparison 2. CONCLUSION Endoscopic partial papillosphincterotomy with balloon dilatation is advisable for choledocholithiasis due to minimal risk of intra- and postoperative complications.
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Affiliation(s)
- V B Rinchinov
- Semashko Republic Clinical Hospital, Ministry of Health of Republic of Buryatia, Ulan-Ude, Russia
| | - A N Plekhanov
- Buryat State University, Ulan-Ude, Russia; Irkutsk Research Center for Surgery and Traumatology, Irkutsk, Russia
| | - E Yu Ludupova
- Semashko Republic Clinical Hospital, Ministry of Health of Republic of Buryatia, Ulan-Ude, Russia
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Li L, Linghu E, Chai N, Xiang J, Wang Z, Zou J, Du C, Wang X. Clinical experience of using a novel self-help inflatable balloon to prevent esophageal stricture after circumferential endoscopic submucosal dissection. Dig Endosc 2019; 31:453-459. [PMID: 30825381 DOI: 10.1111/den.13385] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/26/2019] [Indexed: 12/24/2022]
Abstract
Although endoscopic submucosal dissection (ESD) is gradually becoming a first-line treatment for superficial esophageal neoplasms (SEN), strictures occur in almost 100% of cases after circumferential ESD. A standard method to prevent stricture has not been established. Thus, we propose a novel self-help inflatable balloon to prevent stricture. The new balloon was used by the patients themselves at home (4-5 times a day, duration of each procedure was approximately 15-20 min), and was removed when the defects were almost healed. From January 2018 to September 2018, eight patients who received circumferential ESD for SEN and underwent a novel self-help inflatable balloon to prevent stricture were enrolled. Median size of the mucosal defects was 76.3 mm (range: 50-90 mm). Median time for removing the self-help inflatable balloon was 94.6 days (range, 71-119 days). Only one (12.5%) patient experienced stricture, and three endoscopic balloon dilation sessions were carried out for this patient. All patients tolerated the balloon well, and none experienced perforation or delayed bleeding. The self-help inflatable balloon seems to show a high preventive effect against stricture in patients whose mucosal defect was no longer than 100 mm in length after esophageal circumferential ESD. This method is economic, feasible, and safe.
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Affiliation(s)
- Longsong Li
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Enqiang Linghu
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Ningli Chai
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Jingyuan Xiang
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Zantao Wang
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Jiale Zou
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Chen Du
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
| | - Xiangyao Wang
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, China
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Goussard P, Morrison J, Bekker A, Fourie B. Acquired neonatal bronchial stenosis after selective intubation: Successful managed with balloon dilatation. Clin Case Rep 2019; 7:917-919. [PMID: 31110714 PMCID: PMC6509923 DOI: 10.1002/ccr3.2112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/12/2019] [Accepted: 03/03/2019] [Indexed: 11/22/2022] Open
Abstract
Premature babies are prone to airway-related complications. Selective intubation for the management of pulmonary interstitial emphysema may cause acquired bronchial stenosis. Balloon dilatation under fluoroscopy is a safe minimal invasive and successful intervention for acquired bronchial stenosis. Follow-up bronchoscopy is needed due to risk of restenosis.
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Affiliation(s)
- Pierre Goussard
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child HealthStellenbosch University and Tygerberg HospitalCape TownSouth Africa
| | - Julie Morrison
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child HealthStellenbosch University and Tygerberg HospitalCape TownSouth Africa
| | - Adrie Bekker
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child HealthStellenbosch University and Tygerberg HospitalCape TownSouth Africa
| | - Barend Fourie
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child HealthStellenbosch University and Tygerberg HospitalCape TownSouth Africa
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Abstract
With increasing survival after esophagectomy for cancer, a growing number of individuals living with the functional results of a surgically altered anatomy calls for attention to the effects of delayed gastric conduit emptying (DGCE) on health-related quality of life and nutritional impairment. We here give an overview of the currently available literature on DGCE, in terms of epidemiology, pathophysiology, diagnostics, prevention and treatment. Attention is given to controversies in the current literature and obstacles related to general applicability of study results, as well as knowledge gaps that may be the focus for future research initiatives. Finally, we propose that measures are taken to reach international expert agreement regarding diagnostic criteria and a symptom grading tool for DGCE, and that functional radiological methods are established for the diagnosis and severity grading of DGCE.
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Affiliation(s)
- Magnus Konradsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) and Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) and Karolinska University Hospital, Stockholm, Sweden
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Lu C, Zhang W, Peng Y, Li L, Gao X, Liu M, Fang Z, Wang Z, Ming S, Dong H, Shen R, Xie F, Sun Y, Gao X. Endoscopic Balloon Dilatation in the Treatment of Benign Ureteral Strictures: A Meta-Analysis and Systematic Review. J Endourol 2019; 33:255-262. [PMID: 30628477 DOI: 10.1089/end.2018.0797] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Although balloon dilatation is one of the main endoscopic procedures used to treat benign ureteral strictures, its precise efficacy remains controversial. We aimed to identify, combine, and analyze existing published data to ascertain the efficacy of endoscopic balloon dilatation for benign ureteral strictures. METHODS In December 2018, a literature search was performed using Medline, Embase, and Web of Science databases. We included reports in which the study population consisted of patients who underwent endoscopic balloon dilatation for the treatment of benign ureteral strictures. Technical, short-term, and long-term success rates (expressed as mean ± standard error) were adopted as the outcome measures. RESULTS Using our search strategy, a total of 19 studies (all series reports) were included for analysis. Using a random-effects model, the pooled technical success rate of endoscopic balloon dilatation for benign ureteral strictures was found to be 89% ± 4%. Furthermore, the short-term success rate (i.e., 3 months after surgery) was 60% ± 10%, and the long-term success rate (i.e., 6-12 months after surgery) was 54% ± 14%. In the subgroup analysis, the success rate of endoscopic balloon dilatation for ≤2-cm benign ureteral strictures was significantly higher than that for >2-cm ones (odds ratio [OR]: 0.13; 95% confidence interval [CI]: 0.05-0.35). In addition, the success rate in cases with strictures of onset timing ≤3 months was relatively higher than that in cases with strictures of onset timing >3 months (OR: 0.46; 95% CI: 0.15-1.43). CONCLUSION Our study indicates that endoscopic balloon dilatation has a high success rate in the treatment of benign ureteral strictures with length ≤2 cm and onset timing ≤3 months. However, there is still no consensus on balloon type, dilatation pressure, expansion number, postoperative ureteral stent type, and stent retention time for the balloon dilatation technique.
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Affiliation(s)
- Chaoyue Lu
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wei Zhang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yonghan Peng
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ling Li
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiaomin Gao
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Min Liu
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ziyu Fang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zeyu Wang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shaoxiong Ming
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hao Dong
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rong Shen
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fei Xie
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiaofeng Gao
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
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Abstract
The diagnosis of subglottic stenosis (SGS) is usually made by clinical assessment and definitively by a direct endoscopic examination. This study aimed to evaluate different spirometric values in relation to anatomical grading and severity of subglottic stenosis cases of upper airway obstruction. Cases of SGS that underwent dilatational procedures endoscopically at the otolaryngology department of the King Saud University Medical City, Riyadh, Saudi Arabia, from June 2015 to October 2017 were collected. Pulmonary function test (PFT) pre- and postoperative parameters and the grades of subglottic stenosis were extracted. We compared different spirometric values to the severity of SGS and compared the pre- and postoperative results for each patient. There were 19 cases with a valid PFT study within 7 days preoperatively in addition to a documented intraoperative grading according to the Myer-Cotton grading system; 7 (36.8%) were grade 1, 8 (42.1%) were grade 2, and 4 (21.1%) were grade 3. The actual preoperative ratio of forced expiratory volume (FEV1) in 1 second to peak expiratory flow (PEF) for all 19 patients ranged from 7.34 to 21.40 mL/L/min. We found a significant improvement in all spirometric parameters postdilatation including PEF ( P < .001), FEV1 ( P < .001), FEV1/PEF ( P = .001), forced expiratory flow (FEF) from 25%, 50%, and 75% of vital capacity, respectively, FEF25 ( P < .001), FEF50 ( P = .001), FEF75 ( P = .048), and maximum mid-expiratory flow ( P = .002). We did not find any correlation between the severity of stenosis and spirometric values. This study revealed that spirometry is a useful marker in following up patients with subglottic stenosis and is also a good indicator to determine postairway surgery outcomes. However, these markers do not correlate with anatomical grading and the severity of subglottic stenosis.
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Affiliation(s)
- Alhelali Abdullah
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - A Alrabiah
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Sayed S Habib
- 2 Department of Clinical Physiology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Y Aljathlany
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - A Aljasser
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - M Bukhari
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - A Y Al-Ammar
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
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Akinci D, Unal E, Ciftci TT, Kyendyebai S, Abbasoglu O, Akhan O. Endobiliary Radiofrequency Ablation in the Percutaneous Management of Refractory Benign Bilioenteric Anastomosis Strictures. AJR Am J Roentgenol 2019; 212:W83-91. [PMID: 30620674 DOI: 10.2214/AJR.18.19751] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the safety and efficacy of endobiliary radiofrequency ablation (RFA) in the percutaneous management of benign bilioenteric anastomosis strictures that are refractory to balloon dilatation and long-term drainage. MATERIALS AND METHODS Twenty-one patients (11 men) with a mean age of 47.9 years (range, 26-73 years) underwent percutaneous balloon dilatation and long-term drainage for benign bilioenteric anastomosis strictures. Endobiliary RFA was performed in six patients (four men; mean age, 53.1 years; range, 43-63 years) whose strictures did not respond to balloon dilatation and long-term drainage. RESULTS Presenting symptoms were jaundice (n = 21), pain (n = 19), pruritus (n = 17), and cholangitis (n = 15). The symptoms appeared 1384 days (range, 4-7592 days) after surgery. The technical success rate was 100%. The overall clinical success rate was 95.2% (20/21) with a mean follow-up of 67.3 months (range, 9-148 months) after catheter removal. In 15 patients, associated biliary stones were removed. Two patients with recurrent strictures were successfully retreated. Endobiliary RFA was successful and catheter removal could be achieved in all six patients (100%) whose disease did not respond to multiple balloon dilatation sessions and long-term drainage. The mean symptom-free period after endobiliary RFA and catheter removal was 430 days (range, 270-575 days). One patient with refractory disease (4.7%), for whom endobiliary RFA was not performed, underwent surgery. There were no major complications. CONCLUSION Endobiliary ablation may be used safely and effectively in the percutaneous management of benign bilioenteric anastomosis strictures that are refractory to balloon dilatation and long-term drainage, with promising results.
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Soynov I, Kornilov I, Zubritskiy A, Nichay N, Kulyabin Y, Gorbatykh A, Omelchenko A, Bogachev-Prokophiev A. Extracorporeal cardiopulmonary resuscitation after pulmonary artery rupture. Perfusion 2018; 34:345-347. [PMID: 30582417 DOI: 10.1177/0267659118815311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary artery rupture during pulmonary balloon valvuloplasty is a rare and life-threatening complication. Here, we present a pulmonary artery rupture in a 10-month-old infant. The patient had a tamponade, ineffective cardiac massage for 40 minutes and extreme hemodilution due to blood loss. Extracorporeal life support was used for three days. The patient was discharged without any neurological sequelae.
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Affiliation(s)
- Ilya Soynov
- 1 Department of Pediatric Cardiac Surgery, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Igor Kornilov
- 2 Department of Anesthesiology, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey Zubritskiy
- 1 Department of Pediatric Cardiac Surgery, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Nataliya Nichay
- 1 Department of Pediatric Cardiac Surgery, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Yuriy Kulyabin
- 1 Department of Pediatric Cardiac Surgery, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Artem Gorbatykh
- 1 Department of Pediatric Cardiac Surgery, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexander Omelchenko
- 1 Department of Pediatric Cardiac Surgery, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexander Bogachev-Prokophiev
- 1 Department of Pediatric Cardiac Surgery, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
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Li F, Qiao G, Liang P, Liu J. A case report regarding general anesthesia management of a patient with pulmonary vein stenosis that underwent balloon dilatation and stent implantation. Medicine (Baltimore) 2018; 97:e0429. [PMID: 29702994 PMCID: PMC5944473 DOI: 10.1097/md.0000000000010429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Pulmonary vein stenosis (PVS) is a rare cardiovascular deformity that can lead to high mortality if left untreated. Patients frequently experience multiple complications such as hemoptysis, pulmonary hypertension, bronchial venous rupture and cardiac insufficiency. Currently, pulmonary vein stenosis balloon dilatation (stent implantation) is the only treatment, and this can be performed under local or general anesthesia. However, a case report on the general anesthesia management of PVS has not been previously reported. In this case report, we discuss anesthetic considerations in patients with PVS, focusing specifically on perioperative airway and circulatory management as well as the risk evaluation, and the appropriate effective management of all potential complications intraoperatively. PATIENT CONCERNS A 58-year-old male patient was admitted because of coughing rusty sputum for during 2 years as well as experiencing dyspnea and chest distress after exertion or exercising. The difficulty breathing and chest distress had been going on for a year. This patient had undergone circumferential pulmonary vein isolation twice during the last 2 years. DIAGNOSES Based on the transthoracic echocardiography and computed tomography, this patient's diagnosis was considered as pulmonary vein stenosis, pulmonary hypertension (secondary), and pulmonary arteriovenous thrombosis. INTERVENTIONS We considered that such severe patients with PVS require respiratory and circulatory supports and perhaps emergency surgical interventions. Henceforth, we administered general anesthesia to the patient and had extracorporeal membrane oxygenation (ECMO) on standby. OUTCOMES The duration of the surgery was approximately 4 hours, the intraoperative vital signs were stable, no pericardial effusion was observed postoperatively, the blood flow in the pulmonary vein stent was smooth, and the patient was discharged 7 days later following rehabilitation. LESSONS This surgical procedure involving respiratory and circulatory supports requires the involvement of different medical personnel such as interventionists, anesthesiologists, and surgeons. Therefore, multidisciplinary cooperation under general anesthesia will undoubtedly benefit such patients.
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Affiliation(s)
- Fangzhou Li
- Department of Anesthesiology, West China Hospital, Sichuan University
| | - Guoyan Qiao
- Department of cadres medical care, ChengFei hospital, Chengdu, P.R. China
| | - Peng Liang
- Department of Anesthesiology, West China Hospital, Sichuan University
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University
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