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Berke CN, Naik A, Majmundar N, Munier S, Rahman R, Sattar A, Khandelwal P, Liu JK. Microsurgical versus endovascular treatment of ethmoidal dural arteriovenous fistulas: systematic review and meta-analysis with a single-center case series. Neurosurg Focus 2024; 56:E15. [PMID: 38428011 DOI: 10.3171/2023.12.focus23801] [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] [Received: 11/02/2023] [Accepted: 12/27/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Ethmoidal dural arteriovenous fistulas (DAVFs) are often associated with cortical venous drainage (CVD) and a higher incidence of hemorrhage compared with DAVFs in other locations. They may be treated with open surgical disconnection or with endovascular treatment (EVT). In this systematic review and meta-analysis, the authors compare the outcomes of ethmoidal DAVFs treated with open microsurgery versus EVT and report four additional cases of ethmoidal DAVFs treated with open microsurgery in their institution. METHODS A literature search of the PubMed and Scopus databases was conducted between December 2021 and May 2022 to identify relevant articles published between 1990 and 2021 using the PRISMA guidelines. References were reviewed and screened by two authors independently, and disagreements were resolved through consensus. Exclusion criteria included non-English-language studies, those with an incorrect study design, those reporting DAVFs in a nonethmoidal location, and studies whose outcomes were not stratified based on DAVF location. Inclusion criteria were any studies reporting on ethmoidal DAVFs treated by either microsurgery or EVT. A risk of bias assessment was performed using the Newcastle-Ottawa Scale. The authors performed a pooled proportional meta-analysis to compare patient outcomes. RESULTS Twenty studies were included for analysis. Of 224 patients, 142 were treated with surgery, while 103 were treated with EVT. Seventy percent (148/210) of the patients were symptomatic at presentation, with hemorrhage being the most common presentation (48%). CVD was present in 98% of patients and venous ectasia in 61%. The rates of complete DAVF obliteration with surgery and EVT were 89% and 70%, respectively (95% CI -30% to -10%, p < 0.03). Twenty percent (21/103) of endovascularly treated fistulas required subsequent surgery. Procedure-related complications occurred in 10% of the surgical cases, compared with 13% of the EVT cases. The authors' case series included 4 patients with ethmoidal DAVFs treated surgically with complete obliteration, without any postoperative complications. CONCLUSIONS The complete obliteration rates of ethmoidal DAVF appear to be higher and more definitive with microsurgical intervention than with EVT. While complication rates between the two procedures seem similar, patients treated with EVT may require further interventions for definitive treatment. The limitations of this study include its retrospective nature, the quality of studies included, and the continued evolving technologies of EVT. Future studies should focus on the association between venous drainage pattern and the proclivity toward venous ectasia or rate of hemorrhage at presentation.
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Affiliation(s)
- Chandler N Berke
- 1Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- 2Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Anant Naik
- 3Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota
| | - Neil Majmundar
- 1Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sean Munier
- 1Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Raphia Rahman
- 4Department of Neurosurgery, Riverside University Health System, Riverside, California
| | - Ahsan Sattar
- 5NYU Langone Neurosurgery Network, Neurosurgeons of New Jersey, Livingston, New Jersey; and
- 6Department of Neurosurgery, Cooperman Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey
| | - Priyank Khandelwal
- 1Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- 6Department of Neurosurgery, Cooperman Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey
| | - James K Liu
- 5NYU Langone Neurosurgery Network, Neurosurgeons of New Jersey, Livingston, New Jersey; and
- 6Department of Neurosurgery, Cooperman Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey
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Lv Y, Liu N, Wu H, Li Z. Etiological classification and treatment strategies for secondary bile duct dilatation. Exp Biol Med (Maywood) 2021; 246:281-285. [PMID: 33167690 PMCID: PMC7876649 DOI: 10.1177/1535370220966767] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Secondary intra- and extrahepatic bile duct dilatation is a very common condition that can be caused by several diseases. However, it has been rarely discussed in the specialized literature. Moreover, no distinct etiology can be determined in some cases, which hampers the diagnosis and treatment. Here, we discuss the etiological classification and treatment strategies of secondary intra- and extrahepatic bile duct dilatation based on an extensive literature review, as well as our experimental research and clinical experience. The etiology of secondary intra- and extrahepatic bile duct dilatation can be classified in different ways. From a clinicopathological perspective, it can be classified into obstruction-, lesion-, and compression-induced dilatation. Treatment varies depending on the cause. For example, endoscopic dilation or stenting is used for biliary strictures, laparoscopic choledochectomy for stone removal, and resection for cholangiocarcinoma.
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Affiliation(s)
- Yunfu Lv
- Department of General Surgery, Hainan General Hospital (Hainan Medical College Affiliated People's Hospital), Haikou 570311, China
| | - Ning Liu
- Department of General Surgery, Hainan General Hospital (Hainan Medical College Affiliated People's Hospital), Haikou 570311, China
| | - Hongfei Wu
- Department of General Surgery, Hainan General Hospital (Hainan Medical College Affiliated People's Hospital), Haikou 570311, China
| | - Zhuori Li
- Department of General Surgery, Hainan General Hospital (Hainan Medical College Affiliated People's Hospital), Haikou 570311, China
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Polster SP, Dougherty MC, Zeineddine HA, Lyne SB, Smith HL, MacKenzie C, Pytel P, Yang CW, Tonsgard JH, Warnke PC, Frim DM. Dural Ectasia in Neurofibromatosis 1: Case Series, Management, and Review. Neurosurgery 2020; 86:646-655. [PMID: 31350851 DOI: 10.1093/neuros/nyz244] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 04/06/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The natural history and management of dural ectasia in Neurofibromatosis 1 (NF1) is still largely unknown. Dural ectasias are one of the common clinical manifestations of NF1; however, the treatment options for dural ectasias remain unstudied. OBJECTIVE To investigate the natural history, diagnosis, management, and outcome of the largest case series of patients with NF1-associated dural ectasia to date. METHODS Records from our NF1 clinic were reviewed to identify NF1 patients with computed tomography or magnetic resonance imaging evidence of dural ectasia(s) to determine their clinical course. Demographics, symptoms, radiographic and histopathologic findings, treatment, and clinical course were assessed. RESULTS Thirty-four of 37 patients were managed without surgery. Of the 18 initially asymptomatic patients, 5 (27.8%) progressed to symptoms attributable to a dural ectasia (onset of 2.7% per patient-year). Three patients required surgical intervention because of extraspinal mass effect. All 3 initially improved but had symptom recurrence within 2 yr. Reoperation involved shunt placement for cerebrospinal fluid (CSF) diversion. On imaging review, 26 (76.5%) of the nonsurgical patients harbored an associated nearby plexiform neurofibroma. Pathology of one surgical case revealed dural infiltration by diffuse neurofibroma. CONCLUSION Using the largest NF1-associated dural ectasia group to date, we report the first symptom-onset rate for nonsurgical patients. In the few cases requiring surgery for decompression, primary resection, and patching of ectasias failed, subsequently requiring CSF shunting. We demonstrate imaging evidence of nearby plexiform neurofibroma in a majority of cases, which, when combined with histopathology, provides a novel explanation for the formation of dural ectasias.
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Affiliation(s)
- Sean P Polster
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Mark C Dougherty
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Hussein A Zeineddine
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Seán B Lyne
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Heather L Smith
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Cynthia MacKenzie
- Ambulatory Program for Neurofibromatosis, Department of Pediatrics and Neurology, University of Chicago Medicine, Chicago, Illinois
| | - Peter Pytel
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois
| | - Carina W Yang
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
| | - James H Tonsgard
- Ambulatory Program for Neurofibromatosis, Department of Pediatrics and Neurology, University of Chicago Medicine, Chicago, Illinois
| | - Peter C Warnke
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - David M Frim
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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Barba E, Sánchez B, Burri E, Accarino A, Monclus E, Navazo I, Guarner F, Margolles A, Azpiroz F. Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging. Neurogastroenterol Motil 2019; 31:e13703. [PMID: 31402544 PMCID: PMC6899808 DOI: 10.1111/nmo.13703] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Some patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by evidence. METHODS An in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas-releasing substrate, to meat, a low gas-releasing substrate, and to a nutrient-free negative control. A clinical study in patients complaining of abdominal distention after eating lettuce (n = 12) measured the amount of intestinal gas and the morphometric configuration of the abdominal cavity in abdominal CT scans during an episode of lettuce-induced distension as compared to basal conditions. KEY RESULTS Gas production by microbiota fermentation of lettuce in vitro was similar to that of meat (P = .44), lower than that of beans (by 78 ± 15%; P < .001) and higher than with the nutrient-free control (by 25 ± 19%; P = .05). Patients complaining of abdominal distension after eating lettuce exhibited an increase in girth (35 ± 3 mm larger than basal; P < .001) without significant increase in colonic gas content (39 ± 4 mL increase; P = .071); abdominal distension was related to a descent of the diaphragm (by 7 ± 3 mm; P = .027) with redistribution of normal abdominal contents. CONCLUSION AND INFERENCES Lettuce is a low gas-releasing substrate for microbiota fermentation and lettuce-induced abdominal distension is produced by an uncoordinated activity of the abdominal walls. Correction of the somatic response might be more effective than the current dietary restriction strategy.
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Affiliation(s)
- Elizabeth Barba
- Digestive System Research UnitUniversity Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd)BarcelonaSpain
- Departament de MedicinaUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Borja Sánchez
- Departamento de Microbiología y BioquímicaInstituto de Productos Lácteos de Asturias (IPLA), Consejo Superior de Investigaciones Científicas, Asturias (CSIC)VillaviciosaSpain
- Instituto de Investigación Sanitaria del Principado de Asturias–ISPAOviedoSpain
| | | | - Anna Accarino
- Digestive System Research UnitUniversity Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd)BarcelonaSpain
- Departament de MedicinaUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Eva Monclus
- Departamento de Lenguajes y Sistemas InformáticosUniversidad Politécnica de CatalunyaBarcelonaSpain
| | - Isabel Navazo
- Departamento de Lenguajes y Sistemas InformáticosUniversidad Politécnica de CatalunyaBarcelonaSpain
| | - Francisco Guarner
- Digestive System Research UnitUniversity Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd)BarcelonaSpain
- Departament de MedicinaUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Abelardo Margolles
- Departamento de Microbiología y BioquímicaInstituto de Productos Lácteos de Asturias (IPLA), Consejo Superior de Investigaciones Científicas, Asturias (CSIC)VillaviciosaSpain
- Instituto de Investigación Sanitaria del Principado de Asturias–ISPAOviedoSpain
| | - Fernando Azpiroz
- Digestive System Research UnitUniversity Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd)BarcelonaSpain
- Departament de MedicinaUniversitat Autònoma de BarcelonaBellaterraSpain
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Saraswat A, Rahman A, Batra R. Intracoronary Administration of Thrombolysis for Severe Coronary Artery Ectasia Presenting as an Acute Inferior ST-Segment Elevation Myocardial Infarction. J Invasive Cardiol 2017; 29:E153. [PMID: 28974667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We present a 75-year-old male with acute inferior ST-elevation myocardial infarction, severe coronary artery ectasia, and large thrombus burden in the right coronary artery to support the use of intracoronary thrombolysis as a second-line therapy for a large thrombus burden in primary percutaneous coronary intervention.
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Affiliation(s)
- Avadhesh Saraswat
- Gold Coast University Hospital - Cardiology Department, 1 Hospital Boulevard, Southport, Queensland, Australia.
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Rubenwolf P, Herrmann-Nuber J, Schreckenberger M, Stein R, Beetz R. Primary non-refluxive megaureter in children: single-center experience and follow-up of 212 patients. Int Urol Nephrol 2016; 48:1743-1749. [PMID: 27492776 DOI: 10.1007/s11255-016-1384-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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] [Received: 06/13/2016] [Accepted: 07/22/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Primary non-refluxing megaureter (pMU) is a multifaceted and challenging congenital pathology of the urinary tract. We report our 23-year experience with this anomaly in terms of presentation, diagnostic work-up and management. MATERIALS AND METHODS We retrospectively reviewed the medical records of 212 children diagnosed with pMU between 1986 and 2009 at our institution. Mean follow-up was 45.17 (0-192) months. RESULTS Of the total, 168 (79 %) children presented with upper urinary tract dilation on perinatal ultrasound screening. In 44 (21 %) patients, the diagnosis was made following diagnostic work-up of a urinary tract infection (UTI, 18 %) or flank pain (3 %). In total, 203 of 254 pMUs (79.9 %) were successfully treated conservatively during the 23-year observation period. Forty-eight children (23 %) underwent ureteric reimplantation. UTIs occurred in 91 of 212 children (43 %). Of these, 41 (45 %) occurred despite antibacterial infection prophylaxis. Within the past three decades, there has been a marked shift from surgical toward conservative therapy at our institution. CONCLUSION Neonatal renal ultrasound is the method of choice to timely identify children with pMU and, alongside dynamic renography, to monitor the clinical course. Nowadays, only a minor subset of children with asymptomatic course requires surgical correction. Antibacterial prophylaxis has the potential to reduce the risk of febrile UTIs. Prospective randomized studies are warranted to provide evidence of the beneficial effect of antibacterial prophylaxis.
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Affiliation(s)
- P Rubenwolf
- Department of Urology, Division of Pediatric Urology, Mainz University Medical Center, Mainz, Germany.
| | - J Herrmann-Nuber
- Department of Pediatrics, Division of Pediatric Nephrology, Mainz University Medical Center, Langenbeckstr.1, 55131, Mainz, Germany
| | - M Schreckenberger
- Department of Nuclear Medicine, Mainz University Medical Center, Mainz, Germany
| | - R Stein
- Department of Urology, Division of Pediatric Urology and Reconstructive Urology, Mannheim University Medical Center, Mannheim, Germany
| | - R Beetz
- Department of Pediatrics, Division of Pediatric Nephrology, Mainz University Medical Center, Langenbeckstr.1, 55131, Mainz, Germany
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Qin V, Saad A, Gatinel D. Unilateral Post-LASIK Ectasia and Contralateral Spontaneous Ectasia. J Refract Surg 2016; 32:127-30. [PMID: 26856430 DOI: 10.3928/1081597x-20151119-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/10/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To report a case of iatrogenic unilateral post-LASIK corneal ectasia with contralateral spontaneous ectatic evolution. METHODS Case report with preoperative and postoperative measurements including uncorrected visual acuity, corrected distance visual acuity, refraction, slit-scanning topographic and pachymetric maps, and differential maps. RESULTS Six months after unilateral LASIK, the operated eye progressively developed signs of post-LASIK ectasia with increased inferior corneal steepening and corneal thinning and decrease in corrected distance visual acuity. Five years later, the unoperated eye also developed signs of spontaneous ectatic evolution with increased inferior steepening and corneal thinning. CONCLUSIONS LASIK accelerates occurrence of ectasia in ectasia-susceptible and biomechanically fragile eyes.
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Affiliation(s)
- Meraf A. Wolle
- Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA
| | - J. Bradley Randleman
- Department of Ophthalmology, Emory University, Atlanta, GA, USA
- Emory Vision, Emory Eye Center, Atlanta, GA
| | - Maria A. Woodward
- Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA
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9
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Okada T, Endo A, Ito S, Nakamura T, Sugamori T, Takahashi N, Yoshitomi H, Tanabe K. Acute Coronary Syndrome in a Puerperal Patient with Coronary Artery Ectasia due to a Coronary Artery Fistula. Intern Med 2016; 55:2635-8. [PMID: 27629959 DOI: 10.2169/internalmedicine.55.6597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Coronary artery fistulas are rare and the feeding artery is ectatic and tortuous. It is not well-known whether coronary artery ectasia (CAE) is a risk factor of acute coronary syndrome (ACS) in the puerperal periods. A 40-year-old woman with a coronary artery fistula and an ectatic right coronary artery (RCA) had delivered twins. A month later, she had chest pain and coronary angiography revealed thrombogenesis in the RCA. She had no risk factors of cardiovascular disease or thrombogenesis. We should recognize that CAE is a risk factor for ACS in women in the perinatal and puerperal periods.
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Affiliation(s)
- Taiji Okada
- Division of Cardiology, Shimane University Faculty of Medicine, Japan
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Yahya S, Zarkar A, Southgate E, Nightingale P, Webster G. Which bowel preparation is best? Comparison of a high-fibre diet leaflet, daily microenema and no preparation in prostate cancer patients treated with radical radiotherapy to assess the effect on planned target volume shifts due to rectal distension. Br J Radiol 2013; 86:20130457. [PMID: 23995876 PMCID: PMC3830438 DOI: 10.1259/bjr.20130457] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We evaluated and compared a high-fibre diet leaflet, daily microenema and no preparation to establish how best to achieve consistent bowel preparation in prostate cancer patients being treated with radical radiotherapy. METHODS 3 cohorts of 10 patients had different dietary interventions: no bowel preparation, high-fibre diet information leaflet and daily microenemas. The available cone beam CT (CBCT) scans of each patient were used to quantify interfractional changes in rectal distension (measured using average cross-sectional area-CSA), prostate shifts relative to bony anatomy compared with that at CT planning scan and rates of geometric miss (i.e. shifts of ≥5 mm). 85 CBCT scans were available in the pre-leaflet cohort, 89 scans in the post-leaflet, and 89 scans in the post-enema group. RESULTS Mean rectal CSA in the post-enema group was reduced compared with both pre-leaflet (p=0.010) and post-leaflet values (p=0.031). The magnitude of observed mean prostate shifts was significantly reduced in the post-enema group compared with the pre-leaflet group (p=0.014). The proportion of scans showing geometric miss (i.e. shift >5 mm) in the post-enema group (31%) was significantly lower than in the pre-leaflet (62%, p<0.001) or post-leaflet groups (56%, p<0.001). CONCLUSION This study indicates microenema to be an effective measure to achieve reduction in rectal CSA, prostate shift and reduce geometric miss of ≥5 mm. A further prospective randomised study is advocated to validate the results. ADVANCES IN KNOWLEDGE The use of microenema is effective in reducing prostate shift and rectal CSA, consequently decreasing the incidence of geographical miss.
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Affiliation(s)
- S Yahya
- Hall-Edwards Radiotherapy Research Group, The Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
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11
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Shopov A, Malinova M. [Ovarian vein syndrome during pregnancy--diagnostic and treatment]. Akush Ginekol (Sofiia) 2013; 52:37-40. [PMID: 24283078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To access the presence of Ovarian Vein Syndrome in second trimester pregnancy and safety and effectiveness of stents insertion in symptomatic hydronephrosis during pregnancy. MATERIAL AND METHODS From 01.01.2007 to 30.12.2011, 66 women were hospitalized in the Urology Clinic at the University Hospital "St. George" Plovdiv. Sixty six patients presented acute pyelonephritis and painful hydronephrosis. 61 cases were with right hydronephrosis (92%), 2 (3%) on the left side and 3 (5%) with hydronephrosis in both sides. On the Ultrasound Doppler investigation, 61 cases with right hydronephrosis were with varicose right ovarian vein anomalies, which cause unilateral ureteral obstructions. Using ultrasound guidance, 66 retrograde ureteral stents were successfully placed under local anesthesia. RESULTS In 66 patients with urinary infection, we observed remission of fever during the first 24-48 hours after the placement of the ureteral stents. CONCLUSIONS Ovarian vein syndrome is a ureteral dilatation secondary to ovarian vein dilatation. The majority of cases are diagnosed during pregnancy, with a 90% predominance on the right side. Retrograde ureteral stenting is an effective, simple and safe method in treating symptomatic hydronephrosis during pregnancy.
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Dong YF, Li QY. [Case of abdominal distension and foul breath]. Zhongguo Zhen Jiu 2012; 32:223. [PMID: 22471134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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13
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Mace S, Shelton GD, Eddlestone S. Megaesophagus. Compend Contin Educ Vet 2012; 34:E1. [PMID: 22488663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Megaesophagus is a disorder of the esophagus characterized by diffuse dilation and decreased peristalsis. It is classified into congenital and acquired forms. Gastrointestinal, endocrine, immune-mediated, neuromuscular, paraneoplastic, and toxic disorders have been associated with acquired megaesophagus. Common clinical signs of megaesophagus are regurgitation, weight loss, coughing, and halitosis. Most cases of megaesophagus can be diagnosed using thoracic radiography; however, diagnosing the underlying cause requires a thorough history and additional diagnostics. The treatment, management, and prognosis of megaesophagus vary greatly depending on the underlying cause.
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Affiliation(s)
- Sacha Mace
- Veterinary Specialty Center of the Hudson Valley, USA
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Popiela TJ, Urbanik A, Brzegowy P, Dobrowolski Z, Lipczyński W. [Baloon dilatation of benign ureteroileal anastomotic strictures]. Przegl Lek 2010; 67:275-278. [PMID: 20687359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The study is presenting own experience with the use of percutaneous balloon angioplasty in the patients with the strictures of ureteroenteric anastomoses. A study group consisted of 11 patients with urinary bladder cancer in whom ureteroenteric anastomosis was performed. All patients developed in the postoperative period ureter strictures or the stenosis at the junction point of ureteroenterostomy resulting in retention of urea in the ureter and pyelocalyceal system requiring percutaneous nephrostomy. High-pressure balloon catheter inserted through the nephrostomy was placed centrally in the point of stenosis. The catheter was insufflated with physiological saline solution and contrast agent until ballon waisting disappeared. Subsequently temporary double-J catheter with diameter of 9 F or 12F was inserted and remained in place for the period of 1-6 months. All patients were followed-up for 2 years, and underwent control USG and CT examinations. Fourteen urethral dilatations of bilateral strictures were performed in 3 patients and in 9 patients with unilateral strictures. In 10 (71%) cases the symptoms of stenosis disappeared for the period of 1 year. Procedure of ballon dilatation follow by introduction of the double-J catheter should be method of first choice in all cases of benign ureteroileal anastomotic strictures.
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Affiliation(s)
- Tadeusz J Popiela
- Katedra Radiologii Uniwersytet Jagiellońliski Collegium Medicum, Zakład Diagnostyki Obrazowej Szpitala Uniwersyteckiego w Krakowie.
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15
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Sørensen HB, Brofeldt S. [Two cases of laryngocele]. Ugeskr Laeger 2008; 170:3141-3142. [PMID: 18823607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A laryngocele is a rare benign dilatation of the anterior part of Ventriculus Laryngis. The symptoms are either hoarseness, a tumor on the neck or a combination. In the literature a link between laryngocele and carcinoma of the larynx is well described. For this reason a careful clinical examination together with MRI or CT scans is of outmost importance. None of the patients described had larynx cancer. Of the two patients described, one underwent surgery, the other was treated conservatively due to general health.
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Ma X, Tittiger M, Knutsen RH, Kovacs A, Schaller L, Mecham RP, Ponder KP. Upregulation of elastase proteins results in aortic dilatation in mucopolysaccharidosis I mice. Mol Genet Metab 2008; 94:298-304. [PMID: 18479957 PMCID: PMC3775334 DOI: 10.1016/j.ymgme.2008.03.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [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: 02/27/2008] [Revised: 03/26/2008] [Accepted: 03/27/2008] [Indexed: 11/23/2022]
Abstract
Mucopolysaccharidosis I (MPS I), known as Hurler syndrome in the severe form, is a lysosomal storage disease due to alpha-L-iduronidase (IDUA) deficiency. It results in fragmentation of elastin fibers in the aorta and heart valves via mechanisms that are unclear, but may result from the accumulation of the glycosaminoglycans heparan and dermatan sulfate. Elastin fragmentation causes aortic dilatation and valvular insufficiency, which can result in cardiovascular disease. The pathophysiology of aortic disease was evaluated in MPS I mice. MPS I mice have normal elastic fiber structure and aortic compliance at early ages, which suggests that elastin assembly is normal. Elastin fragmentation and aortic dilatation are severe at 6 months, which is temporally associated with marked increases in mRNA and enzyme activity for two elastin-degrading proteins, matrix metalloproteinase-12 (MMP-12) and cathepsin S. Upregulation of these genes likely involves activation of STAT proteins, which may be induced by structural stress to smooth muscle cells from accumulation of glycosaminoglycans in lysosomes. Neonatal intravenous injection of a retroviral vector normalized MMP-12 and cathepsin S mRNA levels and prevented aortic disease. We conclude that aortic dilatation in MPS I mice is likely due to degradation of elastin by MMP-12 and/or cathepsin S. This aspect of disease might be ameliorated by inhibition of the signal transduction pathways that upregulate expression of elastase proteins, or by inhibition of elastase activity. This could result in a treatment for patients with MPS I, and might reduce aortic aneurism formation in other disorders.
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Affiliation(s)
- Xiucui Ma
- Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Mindy Tittiger
- Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Russell H. Knutsen
- Department of Cell Biology, Washington University School of Medicine, St. Louis, MO, USA
| | - Attila Kovacs
- Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Laura Schaller
- Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
- Department of Cell Biology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert P. Mecham
- Department of Cell Biology, Washington University School of Medicine, St. Louis, MO, USA
| | - Katherine P. Ponder
- Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA
- Corresponding author. Address: Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA. Fax: +1 314 362 8813. (K.P. Ponder)
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Kühl M, Varma C. A case of acute coronary thrombosis in diffuse coronary artery ectasia. J Invasive Cardiol 2008; 20:E23-E25. [PMID: 18174626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A 75-year-old Afro-Caribbean male presented with a non-ST-elevation myocardial infarction. Coronary angiography showed generally grossly dilated coronary arteries with a large lobular thrombus in the distal right coronary artery. We briefly review this case and discuss the definition, pathophysiology and treatment for coronary artery ectasia.
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Affiliation(s)
- Michael Kühl
- Cardiology Department, City Hospital Birmingham, Dudley Road, West Midlands, B18 7QH United Kingdom
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Baek JH, Chung JW, Jae HJ, Lee W, Park JH. A new technique for superselective catheterization of arteries: preshaping of a micro-guide wire into a shepherd's hook form. Korean J Radiol 2007; 8:225-30. [PMID: 17554190 PMCID: PMC2627416 DOI: 10.3348/kjr.2007.8.3.225] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective We wanted to introduce a new technique for superselective catheterization of arteries with preshaping of a micro-guide wire into a shepherd's hook form, and this is useful for superselection of small arteries branching at an acute angle from a large parent artery for the treatment of tumors and hemorrhages. Materials and Methods We developed a superselective catheterization technique by using preshaping of a micro-guide wire into a shepherd's hook form. We encountered six patients in our practice for whom we failed to catheterize the small tumor-feeding arteries that branched at an acute angle from wide parent arteries during chemoembolization of hepatocellular carcinoma; the parent arteries were the right inferior phrenic artery (n = 4) and the left gastric artery (n = 1) from the celiac axis with celiac stenosis due to compression by the median arcuate ligament and the proper hepatic artery from the gastroduodenal artery (n = 1) in a patient who had celiac axis occlusion with collateral circulation via the pancreaticoduodenal arcade from the superior mesenteric artery. In these consecutive six patients, we tested the usefulness of this new technique with employing preshaping of a micro-guide wire into a shepherd's hook form for superselective catheterization of targeted vessels. Results The target arteries were successfully catheterized and satisfactory transcatheter arterial chemoembolization was performed in all six patients. There were no significant complications such as arterial dissection. Conclusion We developed a technique that is effective for superselection of vessels with preshaping of micro-guide wire into a shepherd's hook form, and we successfully applied it during chemoembolization of hepatocellular carcinoma. This technique can be useful for superselection of small arteries that branch from a large parent artery at acute angles for the treatment of tumors and hemorrhages.
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Affiliation(s)
- Jee Hyun Baek
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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Keeling AN, Davis JL, Williams A, Sabharwal T, Adam A. Fluoroscopically guided balloon dilation of NSAID-induced colonic diaphragm. J Vasc Interv Radiol 2007; 18:1060-2. [PMID: 17675630 DOI: 10.1016/j.jvir.2007.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Tatli E, Surucu H, Aktoz M, Buyuklu M. Coronary artery ectasia in a patient with Behcet's disease. Saudi Med J 2007; 28:1281-2. [PMID: 17676219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Behcet's disease is a multisystemic disease of unknown etiology. Disease manifestations consist of recurrent oral and genital ulceration, skin lesions, and relapsing ocular inflammation. Arterial involvement is an uncommon complication of Behcet's disease, and it most frequently affects the abdominal aorta followed by femoral artery, and the pulmonary artery. Coronary lesions in Behcet's disease have been little reported in the literature. A-36-year-old female with 6-year history of Behcet's disease was hospitalized with ectasia of the left main coronary artery. This unusual vascular complication Behcet's disease is presented.
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Affiliation(s)
- Ersan Tatli
- Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey.
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Anzai T, Shimizu H, Yozu R, Hashimoto S, Kuribayashi S, Inoue K. Repeated transluminal endovascular Inoue stent graft placement for progressive dilatation of prosthetic graft that had been repaired with Inoue stent graft placement for dilatation 23 years after extraanatomical bypass. Gen Thorac Cardiovasc Surg 2007; 55:76-9. [PMID: 17444182 DOI: 10.1007/s11748-006-0079-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A 76-year-old man had undergone aneurysm exclusion and ascending abdominal aortic extraanatomical bypass for a thoracoabdominal aortic aneurysm in 1978. In 1983 hemoptysis occurred, and resection and closure of the central stump of the aorta and a left lower lobectomy were performed. Dilatation (phi50 mm) of a prosthetic graft (Cooley Graft phi18 mm) used for extraanatomical bypass was noted in 2001 and was repaired by placement of an Inoue stent graft. However, the aneurysm diameter increased further (phi70 mm), although no endoleak was noted: Placement of an Inoue stent graft covering the whole length of the prosthetic graft was repeated in 2006. The postoperative course was smooth, no endoleak occurred, and the patient was discharged 2 weeks after surgery.
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Affiliation(s)
- Tomohiro Anzai
- Department of Cardiovascular Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, Japan.
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25
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Kucukarslan N, Ozal E, Temizkan V, Tatar H. Diagnostic and surgical approach to a descending thoracic aorta saccular aneurysm case. J Card Surg 2007; 22:142-4. [PMID: 17338750 DOI: 10.1111/j.1540-8191.2007.00373.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Descending aorta saccular aneurysms are seen less than fusiform aneurysms. All symptomatic saccular aneurysms must be operated. In this study, we present a saccular aneurysm case developed at the descending aorta 1 year after a motor vehicle crash. Following an aorta-LAD saphenous vein graft anastomosis performed in beating heart, the aneurysm neck was closed with a Dacron patch under deep hypothermic circulatory arrest. All signs and symptoms removed dramatically after the operation. Regarding this case, we recommend that the surgical treatment must be performed in accordance with localization and specialties of aortic aneurysms.
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Affiliation(s)
- Nezihi Kucukarslan
- Department of Cardiovascular Surgery, Gata Military Medical Faculty, Etlik, Ankara, Turkey.
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26
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Zimpfer D, Schoder M, Gottardi R, Lammer J, Wolner E, Grimm M, Czerny M. Treatment of Type V Endoleaks by Endovascular Redo Stent-Graft Placement. Ann Thorac Surg 2007; 83:664-6. [PMID: 17258007 DOI: 10.1016/j.athoracsur.2005.06.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Revised: 06/15/2005] [Accepted: 06/20/2005] [Indexed: 11/23/2022]
Abstract
Continuous enlargement of the aneurysmal sac after endovascular stent-graft treatment of thoracic aortic aneurysms due to graft wall porosities (type V endoleak) is a novel problem. Two patients having undergone prior endovascular stent-graft placement of a thoracic aortic aneurysm presented with a continuous enlargement of the aneurysmal sac without a detectable endoleak. Both patients underwent redo stent-graft placement. Subsequently, shrinkage of the aneurysmal sac could be observed. Therefore endovascular redo stent-graft placement may represent an effective means in treating type V endoleaks.
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Affiliation(s)
- Daniel Zimpfer
- Department of Cardiothoracic Surgery and Angiography, University of Vienna Medical School, Vienna, Austria
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27
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Tsiba JB, Mpemba-Loufoua AB, Makosso E, Nzingoula S. [Hydrocholecystis, a rare etiology of painful abdominal crisis in sickle cell disease. About two cases]. Bull Soc Pathol Exot 2007; 100:26-7. [PMID: 17402689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The authors report two cases of hydocholecystis causing abdominal pains in the sickle cell child. The patients were two girls aged respectively 4 and 12. Hydrocholecystis is defined by acute distension of the gallbladder The diagnosis was made by scan which allowed to follow the evolution in the two sickle cell children. After two crises, no more recurrence was noted in the first patient, on the other hand in the second child recurrences became more frequent. Some authors indicate surgery systematically while others recommend it only after several recurrences.
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MESH Headings
- Abdomen, Acute/etiology
- Analgesics/therapeutic use
- Anemia, Sickle Cell/complications
- Anti-Bacterial Agents/therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy
- Dilatation, Pathologic/diagnostic imaging
- Dilatation, Pathologic/drug therapy
- Dilatation, Pathologic/etiology
- Dilatation, Pathologic/therapy
- Drug Therapy, Combination
- Female
- Fluid Therapy
- Gallbladder Diseases/diagnostic imaging
- Gallbladder Diseases/drug therapy
- Gallbladder Diseases/etiology
- Gallbladder Diseases/therapy
- Hepatitis B, Chronic/complications
- Humans
- Recurrence
- Ultrasonography
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Affiliation(s)
- J B Tsiba
- Service de pédiatrie générale et de néonatologie, Hôpital de Loandjili, Pointe-Noire, BP 8122, République du Congo.
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28
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Tessier G, Bories E, Arvanitakis M, Hittelet A, Pesenti C, Le Moine O, Giovannini M, Devière J. EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc 2007; 65:233-41. [PMID: 17258981 DOI: 10.1016/j.gie.2006.06.029] [Citation(s) in RCA: 178] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 06/05/2006] [Indexed: 12/13/2022]
Abstract
BACKGROUND EUS-guided pancreatogastrostomy (EPG) is described as an alternative to surgery for ductal decompression in symptomatic patients when endoscopic transpapillary access of the main pancreatic duct (MPD) is impossible. OBJECTIVE To present the midterm clinical response and follow-up of a larger group of patients treated with EPG and a new transbulbar approach, EUS-guided pancreatobulbostomy (EPB). DESIGN Retrospective case review. SETTING Two tertiary referral centers in Brussels and Marseille. PATIENTS From 2000 to 2004, 36 patients (51 years old; range, 14-71 years) were seen. INTERVENTION EPG or EPB. MAIN OUTCOME MEASUREMENTS Pain relief, technical aspects, complications, and clinical follow-up. RESULTS Indications were chronic pancreatitis, with complete obstruction (secondary to a tight stenosis, a stone, or MPD rupture); inaccessible papilla or impossible cannulation (n = 20); anastomotic stenosis after a Whipple procedure (n = 12); complete MPD rupture after acute pancreatitis (AP); or trauma (n = 4). EPG or EPB was unsuccessful in 3 patients; 1 was lost to follow-up. Major complications occurred in 2 patients and included 1 hematoma and 1 severe AP. The median follow-up was 14.5 months (range, 4-55 months). Pain relief was complete or partial in 25 patients (69%, intention to treat). Eight patients treated had no improvement of their symptoms (4 were subsequently diagnosed with cancer). Stent dysfunction occurred in 20 patients (55%) and required a total of 29 repeat endoscopies. LIMITATIONS Technically demanding and requires careful pretherapeutic evaluation. CONCLUSIONS EPG or EPB appears to be an effective and relatively safe treatment for the management of pain secondary to pancreatic ductal hypertension in patients with an MPD not accessible by a transpapillary route.
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Affiliation(s)
- Geneviève Tessier
- Department of Gastroenterology, Université Libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
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29
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Mariappan P, Smith G, Moussa SA, Tolley DA. One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. BJU Int 2007; 98:1075-9. [PMID: 17034608 DOI: 10.1111/j.1464-410x.2006.06450.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate whether 1 week of ciprofloxacin before percutaneous nephrolithotomy (PCNL) in patients with stones of > or = 20 mm or pelvicalyceal dilatation, reduces urosepsis, as we previously reported that such patients have four times the risk of urosepsis after PCNL. PATIENTS AND METHODS Patients undergoing PCNL, and who fulfilled strict selection criteria, were recruited prospectively into a study which was conducted in two phases. The study methods were similar to those previously described; patients with dilated pelvicalyceal systems and/or stones of > or = 20 mm from phase 1 (previously published) acted as controls. In the subsequent phase, the same selection criteria applied and only those with stones of > or = 20 mm and/or dilated pelvicalyceal systems were given ciprofloxacin 250 mg twice daily for 1 week before PCNL and comprised the treatment arm. Midstream urine samples, renal pelvic urine and fragmented stones were collected to assess culture and sensitivity. Systemic inflammatory response syndrome (SIRS) was used to define urosepsis after PCNL. The urologists monitoring the patients after PCNL and conducting the analysis were all unaware of the characteristics of the stones or intravenous urography findings before PCNL. In all, 115 patients (54 in phase 1 and 61 in phase 2) were recruited, of whom 46 in phase 1 and 52 in phase 2 had stones of > or = 20 mm and/or a dilated pelvicalyceal system, and became the control and treatment arms, respectively. RESULTS The patient demographics were similar in both arms. There was three times less risk of upper tract infection (relative risk 3.4, 95% confidence interval 1.0-11.8, P = 0.04) and SIRS (2.9, 1.3-6.3, P = 0.004) in the patients receiving ciprofloxacin (treatment arm). CONCLUSIONS The administration of oral ciprofloxacin for 1 week before PCNL in patients with stones of > or = 20 mm or dilated pelvicalyceal systems significantly reduced the risk of urosepsis.
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Turhan H, Yetkin E. What is the plausible strategy for the management of patients with isolated coronary artery ectasia and myocardial ischemia? Int J Cardiol 2006; 117:285-6. [PMID: 16893580 DOI: 10.1016/j.ijcard.2006.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 05/26/2006] [Indexed: 11/19/2022]
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El-Matary W, Casson D, Hodges S, Davison S, McClean P, Elbadri A, Stringer MD. Successful conservative management of idiopathic fibrosing pancreatitis in children. Eur J Pediatr 2006; 165:560-5. [PMID: 16552545 DOI: 10.1007/s00431-006-0115-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 02/15/2006] [Indexed: 10/24/2022]
Abstract
UNLABELLED Idiopathic fibrosing pancreatitis, a rare cause of obstructive jaundice and abdominal pain in children, which has certain features in common with the emerging entity of autoimmune pancreatitis as described in adults, has frequently been managed surgically. We present our experience of successful conservative management of this condition in children. Three children (6-12 years; two girls, one boy) presented with a short history of abdominal pain followed by obstructive jaundice. Abdominal ultrasonographic examination in each case showed dilated intrahepatic and common bile ducts with a bulky pancreas, predominantly the head. These findings were confirmed by magnetic resonance imaging. In two cases, the diagnosis of fibrosing pancreatitis was made by exclusion after extensive investigation. The third case had a percutaneous ultrasound-guided pancreatic needle biopsy. Two patients were managed by supportive medical therapy alone, whilst the third, with symptomatic obstructive jaundice, underwent temporary endoscopic stenting of the common bile duct. Cases have been followed-up for 12-49 months. There was complete clinical and biochemical resolution of obstructive jaundice in all three cases. Plasma bilirubin concentrations decreased to normal within 3-8 weeks. Serial abdominal imaging showed a gradual resolution of biliary dilatation and abnormal pancreatic morphology with subsequent pancreatic atrophy. Two children developed steatorrhoea that responded to pancreatic enzyme supplements, and one patient developed diabetes mellitus. None of the cases needed invasive surgery for diagnosis or management. CONCLUSION With careful radiological and biochemical assessment and monitoring, invasive surgery can be avoided in the management of fibrosing pancreatitis. The eventual outcome is no different from reported surgically treated cases.
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Affiliation(s)
- Wael El-Matary
- Royal Victoria Infirmary, Newcastle upon Tyne, and Children's Liver Unit, St. James's University Hospital, Leeds, UK
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Kusaka N, Maruo T, Nishiguchi M, Takayama K, Maeda Y, Ogihara K, Nakagawa M, Gotoh M, Nishiura T. [Embolization for aneurismal dilatation associated with ruptured dissecting anterior inferior cerebellar artery aneurysm with preservation of the parent artery: case report]. No Shinkei Geka 2006; 34:729-34. [PMID: 16841709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We report a rare case of a ruptured dissecting anterior inferior cerebellar artery (AICA) aneurysm treated by endosaccular embolization with a Guglielmi detachable coil (GDC). An 85-year-old female presented with headache. Computed tomographic (CT) scan showed subarachnoid hemorrhage and intraventricular hemorrhage in the fourth ventricule. Cerebral angiography and 3D-CT angiography revealed an aneurysmal dilatation at the anterior pontine segment of the right AICA with a diagnosis of arterial dissection. The right posterior inferior cerebellar artery (PICA) was absent and the right AICA supplied the territory normally nourished by the right PICA. The aneurismal dilatation was occluded by endosacullar embolization with preservation of the AICA. The distal AICA aneurysm is rare and only seven cases treated with endovascular embolization have been reported. In these, six cases were treated by parent artery occlusion with coil and the subsequent three cases presented with ischemic complications. Only one case was treated by endosaccular embolization with GDC. To our knowledge, this is the second report of the distal AICA aneurysm treated by endosaccular embolization with GDC. Distal AICA aneurysms are briefly discussed while reviewing the literature.
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Affiliation(s)
- Noboru Kusaka
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, 2-5-1 Kuroiso-cho, Iwakuni, Yamaguchi 740-0041, Japan.
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Abdullah AF, Menahem S. Transcatheter closure of dilated left superior vena cava for resolution of late cyanosis following fontan palliation. Heart Lung Circ 2006; 15:393-6. [PMID: 16759911 DOI: 10.1016/j.hlc.2006.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Revised: 03/28/2006] [Accepted: 03/29/2006] [Indexed: 10/24/2022]
Abstract
We report two adolescents with late cyanosis post-Fontan palliation arising from a persistent and dilated left superior vena cava (LSVC) draining into the pulmonary venous circulation. One has undergone successful transcatheter closure of the left superior vena cava while the other is waiting closure. There is a need for long-term follow-up of Fontan patients including adequate clarification of increasing cyanosis which may be correctable.
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Affiliation(s)
- Al Furqani Abdullah
- Department of Cardiology, The Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Vic. 3052, Australia
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Abstract
Many advances have occurred in the management of varices over the years. Guidelines based on sound evidence have been developed to manage the esophageal variceal hemorrhage. Less is known about how best to manage some of the more difficult cases of bleeding related to portal hypertension. This article reviews evidence in the hypertensive gastropathy, ectopic varices, and management of patients who are intolerant of or have not responded to beta-blocker therapy. The goal of this article is to review the sparse available evidence and to suggest reasonable management options.
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Affiliation(s)
- Atif Zaman
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mailcode PV310, Portland, OR 97210, USA.
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35
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Binder PS, Lindstrom RL, Stulting RD, Donnenfeld E, Wu H, McDonnell P, Rabinowitz Y. Keratoconus and corneal ectasia after LASIK. J Cataract Refract Surg 2006; 31:2035-8. [PMID: 16412891 DOI: 10.1016/j.jcrs.2005.12.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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36
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Magovern JA, Teekell-Taylor L, Mankad S, Dasika U, McGregor W, Biederman RWW, Yamrozik J, Trumble DR. Effect of a Flexible Ventricular Restraint Device on Cardiac Remodeling after Acute Myocardial Infarction. ASAIO J 2006; 52:196-200. [PMID: 16557108 DOI: 10.1097/01.mat.0000199751.51424.78] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The effects of a flexible ventricular restraint device on left ventricular (LV) dilatation and hypertrophy after transmural infarction are examined in an ovine model. Left ventricular remodeling and dilatation occurs after extensive myocardial infarction. A flexible ventricular restraint made from a nitinol mesh was evaluated in adult female sheep (n=14). Cardiac magnetic resonance imaging scans and hemodynamic measurements were completed before and 6 weeks after anterior myocardial infarction. Treatment animals (n=7) received passive ventricular restraint concurrently with LV infarction; the others (n=7) served as controls. Increases in LV end-diastolic volume index were significantly less in the restraint group than in controls (0.20+/-0.41 vs 0.83+/-0.50 ml/kg, p<0.03). End-systolic volumes increased less in treatment animals (0.43+/-0.28 vs 0.90+/-0.38 ml/kg, p<0.03). Control hearts showed an increase in LV mass after infraction, whereas LV mass decreased in restrained hearts (0.14+/-0.19 vs -0.25+/-0.36 g/kg, p<0.03). Hemodynamic studies showed similar changes after infarction for the control and the device group. Gross and microscopic examination showed no device-induced epicardial injury. A flexible ventricular restraint device attenuated remodeling after acute myocardial infarction in sheep.
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Affiliation(s)
- James A Magovern
- Department of Cardiovascular and Thoracic Surgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA
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Seitz C, Fajkovic H, Waldert M, Tanovic E, Remzi M, Kramer G, Marberger M. Extracorporeal Shock Wave Lithotripsy in the Treatment of Proximal Ureteral Stones: Does the Presence and Degree of Hydronephrosis Affect Success? Eur Urol 2006; 49:378-83. [PMID: 16406241 DOI: 10.1016/j.eururo.2005.09.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2005] [Accepted: 09/19/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We investigated the relation between the presence and degree of stone induced hydronephrosis and the outcome of extracorporeal shock wave lithotripsy (SWL) in patients with solitary proximal ureteral stones. METHODS 130 patients with or without hydronephrosis were treated with SWL. The degree of hydronephrosis was defined by renal ultrasound. Patients were divided into four groups according to the degree of stone induced hydronephrosis. Group 0 (24%) had no urinary system dilatation, group 1 (31.2%) had a mild dilatation of the renal pelvis, group 2 (40%) had a moderate and group 3 (4.8%) a severe dilatation of the renal pelvis and calices. The stone size, number of shock waves applied and number of sessions required to achieve stone clearance were recorded. RESULTS Mean stone size was 8.2 mm+/-2.5 mm. Mean time to stone clearance was 13.7 days+/-16.3. In 74.4% of patients stone clearance was observed. Additional 4.8% harbored residual fragments < or =3 mm after 3 months. Differences among the four groups in terms of stone size, time to stone clearance and treatment failure were not significant. CONCLUSIONS The presence or degree of hydronephrosis caused by a proximal ureteral stone does not affect the time to stone clearance or success rate after SWL.
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Affiliation(s)
- Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria.
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Rastogi S, Gupta RC, Mishra S, Morita H, Tanhehco EJ, Sabbah HN. Long-term Therapy with the Acorn Cardiac Support Device Normalizes Gene Expression of Growth Factors and Gelatinases in Dogs with Heart Failure. J Heart Lung Transplant 2005; 24:1619-25. [PMID: 16210139 DOI: 10.1016/j.healun.2004.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2004] [Revised: 06/01/2004] [Accepted: 07/19/2004] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Passive mechanical containment of the failing left ventricle with the Acorn Cardiac Support Device (CSD) was shown to prevent progressive left ventricular dilation in dogs with heart failure and increase left ventricular ejection fraction. To examine possible mechanisms for improved cardiac function with a CSD, we examined the effect of CSD therapy on the mRNA gene expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), matrix metalloproteinases (MMP) 2 and 9, and tissue inhibitors of metalloproteinases (TIMP) 1 and 2. METHODS Heart failure was produced in 12 dogs by multiple sequential intracoronary microembolizations. Six dogs were implanted with the CSD and 6 served as concurrent controls. Left ventricular tissue from 6 normal dogs was used for comparison. RESULTS Compared with normal dogs, dogs with untreated heart failure showed downregulation of mRNA expression for VEGF and bFGF, whereas upregulation of mRNA expression for MMP-2 and MMP-9 was observed. Normalization of mRNA expression for all these genes was seen after treatment with the CSD. CONCLUSIONS This study shows that preventing left ventricular dilation and myocardial stretch with the CSD promotes normalization of growth factor and MMP gene expression. These results suggest that modulation of gene activity may, in part, contribute to the improvement of left ventricular function observed with CSD therapy.
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Affiliation(s)
- Sharad Rastogi
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Heart and Vascular Institute, Detroit, Michigan 48202-2689, USA
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Niwa K. Aortic root dilatation in tetralogy of Fallot long-term after repair—histology of the aorta in tetralogy of Fallot: evidence of intrinsic aortopathy. Int J Cardiol 2005; 103:117-9. [PMID: 16080967 DOI: 10.1016/j.ijcard.2004.07.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2004] [Accepted: 07/05/2004] [Indexed: 10/26/2022]
Abstract
The ascending aorta or pulmonary trunk in congenital heart disease may dilate out of proportion to hemodynamic or morphogenetic expectations, may become aneurysmal, and may rupture. A bicuspid aortic valve and/or coarctation of the aorta are consistently associated with ascending aortic and para-coarctation medial abnormalities. Congenital heart diseases such as single ventricle, truncus arteriosus, transposition of the great arteries and tetralogy of Fallot are also associated with aortic medial abnormalities. Aortic regurgitation in unrepaired tetralogy of Fallot imposes volume overload on both ventricles. A significant subset of adults late after repair of tetralogy of Fallot exhibits progressive aortic root dilatation which may lead to regurgitation and predispose to dissection and rupture which can be fatal, and necessitating aortic valve and aortic root surgery. The aortic dilatation relates medial abnormalities coupled with previous long-standing volume overload of the ascending aorta. Risk factors for aortic dilatation and regurgitation in tetralogy of Fallot relate to specific hemodynamic abnormalities such as pulmonary atresia, right aortic arch and a history of an aorto-pulmonary shunt, and patient demographics such as male sex and the association of chromosome 22q11 deletion. There is no current consensus on beta-blocker administration for limiting progressive dilatation of the aortic root in patients with congenital heart disease and repaired tetralogy of Fallot. Aortic root surgery should be considered for these patients and address aortic regurgitation and or prevent the risk of aortic dissection. Meticulous follow-up of the aortic root after repair, tetralogy of Fallot are thus recommended.
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Hänisch KT, Neppert B, Geerling G. [Gas permeable scleral lenses as a conservative treatment option for extreme corneal ectasias and severe dry eye]. Ophthalmologe 2005; 102:387-92. [PMID: 15365747 DOI: 10.1007/s00347-004-1101-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Due to their exclusive scleral contact zone, non-ventilated gas permeable scleral contact lenses can be used to correct extreme keratectasia, even if corneal fitted contact lenses failed previously. As the gap between the scleral lens and the cornea is filled with fluid substitutes, they also can be used for patients with severe aqueous-deficient dry eyes. PATIENTS, MATERIAL AND METHOD: Scleral lens fitting was attempted in 13 eyes (9 patients, group I) of patients with extreme corneal ectasia and 9 eyes (5 patients, group II) with severe ocular surface disease. Best corrected visual acuity, keratometry, Schirmer's test, foreign body sensation, and total daily lens wearing time were recorded prior to and after scleral lens fitting. RESULTS Scleral lenses were successfully fitted and used on a long-term basis in 6 of 13 eyes (4 patients) of group I and 4 of 9 eyes of group II. In 9 eyes visual acuity increased by at least 2 lines, but long-term lens wear was not possible due to severe foreign body sensation or fornix shortening. CONCLUSIONS Modern gas permeable scleral lenses can successfully be used for nonsurgical rehabilitation of severe corneal ectasia and dry eyes.
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Affiliation(s)
- K T Hänisch
- Klinik für Augenheilkunde, Campus Lübeck des Universitätsklinikums Schleswig-Holstein, Lübeck.
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Bridges EJ, Dukes S. Cardiovascular aspects of septic shock: pathophysiology, monitoring, and treatment. Crit Care Nurse 2005; 25:14-6, 18-20, 22-4 passim; quiz 41-2. [PMID: 15871533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The care of patients with septic shock is exceedingly complex. New therapies and monitoring technologies are being rapidly developed. To create an effective plan of care that integrates these new therapies and technologies, critical care nurses must understand the underlying pathophysiology of septic shock, techniques to accurately monitor patients' status, and the rationale for care.
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MESH Headings
- Blood Circulation
- Blood Gas Monitoring, Transcutaneous/instrumentation
- Blood Gas Monitoring, Transcutaneous/methods
- Blood Gas Monitoring, Transcutaneous/nursing
- Cardiomyopathies/diagnosis
- Cardiomyopathies/etiology
- Cardiomyopathies/physiopathology
- Cardiomyopathies/therapy
- Cardiotonic Agents/therapeutic use
- Cardiovascular Diseases/blood
- Cardiovascular Diseases/diagnosis
- Cardiovascular Diseases/etiology
- Cardiovascular Diseases/physiopathology
- Cardiovascular Diseases/therapy
- Critical Care/methods
- Diagnostic Techniques, Cardiovascular/nursing
- Dilatation, Pathologic/diagnosis
- Dilatation, Pathologic/etiology
- Dilatation, Pathologic/physiopathology
- Dilatation, Pathologic/therapy
- Fluid Therapy/methods
- Fluid Therapy/nursing
- Humans
- Hypoxia/blood
- Hypoxia/diagnosis
- Hypoxia/etiology
- Hypoxia/physiopathology
- Hypoxia/therapy
- Male
- Manometry/methods
- Manometry/nursing
- Middle Aged
- Oxygen Consumption
- Shock, Septic/blood
- Shock, Septic/complications
- Shock, Septic/diagnosis
- Shock, Septic/physiopathology
- Shock, Septic/therapy
- Vasoconstrictor Agents/therapeutic use
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Milazzo D, Caramanno G, Innocente P, La Mantia R, Vaccaro I. An unpleasant surprise in the setting of primary percutaneous coronary intervention: diffuse and severe vessel ectasia with acute thrombosis of the distal right coronary artery in a patient with acute inferior myocardial infarction. Ital Heart J 2005; 6:353-6. [PMID: 15902937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Coronary artery ectasia is defined as a > 1.5-fold dilation of the coronary artery compared to the diameter of adjacent normal segments. It must be distinguished from discrete aneurysms that appear in areas adjacent to coronary artery stenosis. It is usually considered a variant of coronary atherosclerosis. Dilated segments are thought to modify the rheology of blood, sluggish or turbulent flow predisposing to myocardial ischemia and its sequelae, including myocardial infarction and sudden death. We report the case of a 52-year-old man, light smoker, with arterial hypertension and family history of coronary artery disease, who was referred to our coronary care unit for an inferior ST-elevation acute myocardial infarction and presented with severe and diffuse vessel ectasia and right coronary thrombosis at coronary angiography.
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Affiliation(s)
- Diego Milazzo
- Catheterization Unit, Division of Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy.
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Papila I, Acioğlu E, Karaman E, Akman C. Laryngeal chondroma presenting as a laryngopyocele. Eur Arch Otorhinolaryngol 2004; 262:473-6. [PMID: 15549338 DOI: 10.1007/s00405-004-0844-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Accepted: 07/15/2004] [Indexed: 11/29/2022]
Abstract
The abnormal dilatation of saccules in direct communication with the laryngeal lumen is termed laryngocele. A simple laryngocele is an air-filled dilatation of the saccule and is mostly asymptomatic. When the neck of the laryngocele is obstructed, the laryngocele becomes filled with mucus. If a mucus-filled laryngocele is infected, it is called a laryngopyocele. The etiology of laryngoceles is not well understood. However, there is an association between laryngoceles and carcinoma of the supraglottic larynx. The main reasons are probably obstruction and mucosal retention of the saccule, increasing intralaryngeal pressure due to airway obstruction or abnormal contraction of the involved laryngeal muscles due to tumoral spreading. We present a patient with laryngopyocele that arose because of a laryngeal chondroma.
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Affiliation(s)
- Irfan Papila
- Department of Otorhinolaryngology, Cerrahpaşa Medical Faculty of Istanbul University, Turkey
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A friend of mine was recently diagnosed with mammary duct ectasia. Can you tell me more about this condition? Mayo Clin Womens Healthsource 2004; 8:8. [PMID: 15295308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Abstract
PURPOSE To present a case in which rigid gas-permeable contact lenses were fit for a patient in whom keratectasia developed after laser in situ keratomileusis (LASIK). METHODS Case report. RESULTS A 21-year-old man underwent bilateral LASIK for myopia and astigmatism. The left eye was only partially corrected because of high myopia and corneal thickness restrictions. Eight months after LASIK, visual acuity was reduced in the right eye; the central cornea had steepened; and pachymetry showed central corneal thinning. Keratectasia was diagnosed, and rigid contact lenses were fitted. Four years later, the patient achieved satisfactory visual acuity and all-day lens wear with minimal complications. CONCLUSIONS The options for management of iatrogenic keratectasia include contact lenses, intracorneal ring segments, and penetrating keratoplasty. This case report shows that rigid contact lenses offer a safe, reversible option for improving visual acuity in such patients by delaying or avoiding the need for further surgical intervention.
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Affiliation(s)
- Clare O'donnell
- Department of Optometry and Neuroscience (C.O., L.W.), UMIST, PO Box 88, Manchester, M60 1QD, United Kingdom.
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Choi HJ, Kim MK, Lee JL. Optimization of contact lens fitting in keratectasia patients after laser in situ keratomileusis. J Cataract Refract Surg 2004; 30:1057-66. [PMID: 15130644 DOI: 10.1016/j.jcrs.2003.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of contact lens fitting in eyes with keratectasia after laser in situ keratomileusis (LASIK) to optimize the performance of the contact lenses. SETTING Contact Lens Clinic, Seoul National University Hospital, Seoul, Korea. METHODS Six eyes of 4 patients with keratectasia were examined. Keratectasia was diagnosed based on abnormal topographic findings, progressive myopic changes, and uncorrected visual acuity with glasses. A multicurve lens or reverse-geometry lens (RGL) was selected based on the anterior elevation map. The base curve radius and peripheral parameters were determined based on the axial map and the evaluation of the fluorescein pattern of the lens. The contact lens fitting characteristics and visual acuity were evaluated. Patients were interviewed about their level of comfort, daily contact lens wear time, and glare. RESULTS Multicurve lenses and RGLs were fitted in 4 eyes and 2 eyes, respectively. The base curve radius of the multicurve lenses ranged from 7.2 to 7.5 mm; the alignment curve radius of RGLs was 7.6 mm in both cases. The radii of peripheral curves were customized to enhance tear interchange. Visual acuity improved to 20/30 or better in all eyes. All patients were completely satisfied with the comfort of the fitting. The mean daily wearing time was 12.7 hours. One patient reported tolerable glare in the eye after being fitted with an RGL. CONCLUSION Proper contact lens fitting based on topographic data and slitlamp evaluation allowed good visual rehabilitation and comfortable extended daily wear in patients with keratectasia after LASIK.
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Affiliation(s)
- Hyuk-Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Korea
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Abstract
This article describes a simple yet effective method to catheterize the coronary arteries when the ascending aorta is very dilated. Two catheters are used in a coaxial fashion. It was possible to catheterize a patient with a 9 cm wide ascending aorta.
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Affiliation(s)
- Håkan Geijer
- Department of Radiology, Orebro University Hospital, Orebro, Sweden.
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Dibardino DJ, Fraser CD, Dickerson HA, Heinle JS, McKenzie ED, Kung G. Left ventricular inflow obstruction associated with persistent left superior vena cava and dilated coronary sinus. J Thorac Cardiovasc Surg 2004; 127:959-62. [PMID: 15052190 DOI: 10.1016/j.jtcvs.2003.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has previously been suggested that significant dilatation of the coronary sinus can contribute to left ventricular inflow obstruction and is amenable to surgical correction. The purpose of this study was to review our experience with this rare condition. METHODS Since 1995, 6 patients have undergone coronary sinus reduction for concerns of obstruction with other concomitant intracardiac repairs. Preoperative echocardiography identified a significantly dilated left superior vena cava to the coronary sinus in 5 patients (83%) and an abnormal mitral valve in 4 patients (67%); these resulted in abnormal Doppler inflow patterns. Preoperative cardiac catheterization was performed in 5 patients and revealed increased atrial "a" waves, with a gradient to the left ventricular end-diastolic pressure in each case. At the time of surgery, coronary sinus angioplasty was performed in all patients. RESULTS There were no deaths, and there was no major morbidity. Follow-up imaging revealed no significant left ventricular inflow obstruction in any patient. CONCLUSIONS We conclude that dilatation of the coronary sinus can become hemodynamically significant and that coronary sinus angioplasty is a safe and effective technique.
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Affiliation(s)
- Daniel J Dibardino
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Abstract
Post haemorrhagic ventricular dilatation is associated with a high rate of disability, multiple impairments and adverse effects of shunt surgery for hydrocephalus. Post haemorrhagic ventricular dilatation results initially from multiple small blood clots throughout the cerebrospinal fluid channels impeding circulation and re-absorption. Transforming growth factor beta is released into the cerebrospinal fluid and there is evidence that this cytokine stimulates the laying down of extracellular matrix proteins which produce permanent obstruction to the cerebrospinal fluid pathways. Prolonged raised pressure, pro-inflammatory cytokines and free radical damage from iron may contribute to periventricular white matter damage and subsequent disability. Interventions such as early lumbar punctures, diuretic drugs to reduce cerebrospinal fluid production and intraventricular fibrinolytic therapy have been tested and, not only fail to prevent shunt dependence, death or disability, but have significant adverse effects. Surgical interventions such as subcutaneous reservoir, external drain, choroid plexus coagulation and third ventriculostomy have not been subject to controlled trial. Ventriculoperitoneal shunt is not feasible in the early phase after intraventricular haemorrhage but, despite the problems with blockages and infections, remains the only option for infants with excessive head expansion over periods of weeks. We have piloted drainage, irrigation and fibrinolytic therapy as a way of removing blood early enough to stop the progressive deposition of matrix proteins, permanent hydrocephalus and shunt dependence.
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Affiliation(s)
- A Whitelaw
- Division of Child Health, University of Bristol Medical School, Southmead Hospital, Bristol, UK.
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Obara K, Komeyama T, Mizusawa T, Tsutsui T, Wakatsuki H, Arai K, Kosegawa E, Suzuki K, Takahashi K. [The consequence after introduction of clean intermittent catheterization (CIC) in children with neurogenic bladder dysfunction secondary to spina bifida--the comparison of patients with and without upper urinary tract dilation at the time CIC was introduced]. Nihon Hinyokika Gakkai Zasshi 2003; 94:664-70. [PMID: 14671996 DOI: 10.5980/jpnjurol1989.94.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The aim of current study was to review the consequence after introduction of clean intermittent catheterization (CIC) in children with neurogenic bladder dysfunction secondary to spina bifida. PATIENTS AND METHODS We retrospectively reviewed the records of 34 children (19 girls and 15 boys) presenting our clinic in a 18-year period. The patients were divided concentrating on the radiological upper urinary tract findings when CIC was introduced. 18 children had dilated upper urinary tract. In these patients, 10 children already had dilated upper urinary tract at first visiting to our clinic(group A). In remaining 8 patients, dilatation of upper urinary tract was found out in the course of followup (group B). 16 children had normal upper urinary tract when CIC was introduced. In 7 patients, CIC was applied for post-void residual and urinary tract infection (group C). In remaining 9 patients, CIC was introduced for urodynamically low compliance bladder (group D). RESULTS In group A, 5 patients underwent enterocystoplasty and 3 patients underwent anti-reflux surgery consequently. Two patients, including 1 patient who underwent enterocystoplasty, have chronic renal dysfunction. In group B, 3 patients underwent enterocystoplasty and 2 patients underwent anti-reflux surgery. In group C, all patients have normal upper urinary tract. In group D, 8 patients have normal upper urinary tract. However, 1 patients underwent enterocystoplasty for low compliance bladder with vesicoureteral reflux (VUR). CONCLUSION Some patients show the improvement of dilated upper urinary tract or VUR after introduction of CIC. However, enterocystoplasty or anti-reflux surgery was needed for many patients to prevent upper urinary tract deterioration. The patients whom CIC was introduced for postvoid residual and urinary tract infection have not shown any deterioration of upper urinary tract. The efficacy of CIC for incontinence was poor because many patients have urethral sphincter incompetence.
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Affiliation(s)
- Kenji Obara
- Division of Urology, Department of Regenerative and Transplant Medicine, Course of Biological Function and Medical Control, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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