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Balloon Dilatation (balloon + dilatation)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Cardiovascular Disease	38%
Gastroenterology	14%
Respiratory Medicine	8%
Urology	5%
4 Other Subdomains	21%

Selected Abstracts

COMPARING BALLOON DIAMETER ON PERFORMING ENDOSCOPIC PAPILLARY BALLOON DILATATION WITH ISOSORBIDE DINITRATE DRIP INFUSION FOR REMOVAL OF BILE DUCT STONES

DIGESTIVE ENDOSCOPY, Issue 4 2004
Hiroshi Nakagawa
Background:, Endoscopic papillary balloon dilatation (EPBD) is one of the methods to remove bile duct stones. EPBD might preserve the function of the sphincter of Oddi despite the potential risk of acute pancreatitis. There are only a few reports of EPBD reducing the risk of acute pancreatitis and, at same time, preserving the function of the sphincter of Oddi. Methods:, We performed EPBD for bile duct stone removal in 60 patients using two balloons with different diameters. Patients were randomized to EPBD with a 6 mm balloon (n = 30) or an 8 mm balloon (n = 30). In both groups, isosorbide dinitrate (ISDN) was infused in a rate of 5 mg/h while low pressure EPBD were being performed. The pressure of the sphincter of Oddi was observed before and after the EPBD procedures. Also, serum amylase level after EPBD was observed for both groups. Results:, Serum amylase level of the 6 mm group was signi,cantly higher than that of the 8 mm group (P < 0.05). Acute pancreatitis occurred in two patients ( 6.7%) in the 6 mm group whereas no case was observed for the 8 mm group. The rates of duct clearance were 93% in the 6 mm group and 100% in the 8 mm group. Stone removals were dif,cult in seven cases with 6 mm balloon dilatations due to the narrow ori,ces of the papilla. In the 6 mm group, there was no signi,cant difference between the basal sphincter of Oddi pressure (BSOP) and the phasic sphincter of Oddi pressure (PSOP) before and after EPBD. However in the 8 mm group, the BSOP observed after the EPBD procedure was signi,cantly higher than BSOP before the treatments. Within this group, BSOP values after EPBD were preserved by approximately 80% of the BSOP values before the treatments. In contrast, there was no signi,cant difference in PSOP before and after the treatments. Regarding the stone numbers, no signi,cant difference was observed in BSOP before and after the treatments for the 6 mm group with less than two stones. Also, as for stone size, no signi,cant difference was observed in BSOP before and after the treatments for the 6 mm group with stones of less than 6 mm in diameter. Conclusion:, We are now conducting EPBD with ISDN infusion using a 6 mm balloon for a patient who has less than two stones with size not exceeding 6 mm in diameter. An 8 mm balloon is used for a patient with more than two stones or a stone greater than 6 mm in size. [source]

Early Results of Balloon Dilatation of the Stenotic Bovine Jugular Vein Graft in the Right Ventricular Outflow Tract in Children

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2008
J. STEINBERG M.D.
The aim of this study was to evaluate the early results of interventional balloon dilatation of stenotic bovine jugular vein (BJV) grafts implanted for reconstruction of the right ventricular outflow tract (RVOT) in children. Methods: From May 2001 to December 2005, 153 BJV grafts were implanted in children in our institution. An average of 16.9 (7.6,41.1) months after implantation, 17 balloon dilatations in a significant stenosis proximal (n = 1), distal anastomosis (n = 8), BJV valve (n = 3), or at multiple sites (n = 5) were performed in 15 children (male:female = 9:6) with a mean age of 3.9 (0.8,13.0) years. Balloon diameter was 75,133.3% (mean 100.3) of the original BJV size. Mean follow-up was 8.8 (2 days to 22.8 months) months. Results: In 10 interventions (58.8%) the instantaneous peak gradient was reduced below 50 mmHg. A balloon diameter ,100% of the original BJV size correlated significantly with a successful intervention. No major complications, two minor (nonobstructive floating membranes at the dilatation site and one septicemia) occurred afterward. Freedom from reintervention after 6 months was 58.2% for all, 77.8% for dilatations of the proximal anastomosis and mixed stenotic lesions, and 33.3% for the distal anastomosis. Conclusion: Balloon dilatation of stenotic BJV grafts is safe and can significantly reduce the pressure gradient in two-thirds of interventions. Balloon diameters above the original graft size should be aimed for. The most frequent stenosis of the distal anastomosis tends to renarrow early after dilatation. Nevertheless, balloon dilatation should be considered in nearly every stenotic graft to gain time until a surgical or interventional graft exchange. [source]

Successful Balloon Dilatation of the Valve of Vieussens for Left Ventricular Lead Placement

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2009
CAN HASDEMIR M.D.
Successful balloon dilatation of an obstructive valve of Vieussens for left ventricular lead placement is described in a case with severe left ventricular systolic dysfunction. [source]

Endoscopic ureteral incision using the holmium:YAG laser

INTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2001
HATSUKI HIBI
Abstract Background: We reviewed the results of endoscopic ureteral incision for benign ureteral stricture, ureteropelvic junction obstruction and ureteroenteroanastomotic stricture using the holmium laser. Methods: We carried out endoscopic ureteral incision using the holmium laser through an 8-Fr semirigid or 6.9-Fr flexible ureteroscope on 17 ureters in 15 patients. Balloon dilatation was not necessary before insertion of the ureteroscope. The stricture was incised with the holmium laser using a 200,365 ,m fiber through the working channel of the ureteroscope. After completion of the incision, a 12-Fr double-J catheter was left for 6 weeks. Thereafter patients were followed by renal scan and/or ultrasound and excretory urography at 3,6 month intervals. Results: The mean operative time was 65 min (18,135 min). The stricture resolved completely in 86.7% of cases at an average follow up of 20.5 months (11,32 months). Conclusions: The holmium laser endoscopic ureteral incision was associated with a good outcome in our series. We recommend this procedure to be employed initially because it is less invasive and has a favorable outcome. [source]

Short- and long-term effects of balloon dilatation on esophageal motility in achalasia

JOURNAL OF DIGESTIVE DISEASES, Issue 1 2003
Zhi Feng WANG
OBJECTIVE: To explore the effect of balloon dilatation on esophageal motility in patients with achalasia. METHODS: In 48 patients diagnosed with achalasia based on clinical observations, barium radiography, endoscopy and esophageal manometry, the following parameters were evaluated before dilatation, and 4 and 12,24 weeks after dilatation: symptom score, maximal width of esophagus (MWE), lower esophageal sphincter pressure (LESP), lower esophageal sphincter relaxation rate (LESRR), and contraction amplitude of esophageal body. RESULTS: The symptom score and MWE decreased significantly after dilatation (P < 0.05). The LESP decreased (P < 0.05) and LESRR increased (P < 0.05) significantly 4 weeks and 12,24 weeks after dilatation. The percentages of patients with LESP <2.67 kPa were 45.41% before dilatation, and 82.48% and 85.87% 4 weeks and 12,24 weeks after dilatation, respectively (P < 0.05). The percentages of patients with LESRR ,80% were 6.74% before dilatation, and 55.97% and 43.78% 4 weeks and 12,24 weeks after dilatation, respectively (P < 0.05). Peristaltic waves were not observed after dilatation in any patient. CONCLUSIONS: Balloon dilatation may significantly improve the symptoms of achalasia and reduce esophageal distention by decreasing LESP and increasing LESRR. The mechanism by which balloon dilatation increases LESRR needs to be further studied. [source]

Early Results of Balloon Dilatation of the Stenotic Bovine Jugular Vein Graft in the Right Ventricular Outflow Tract in Children

Management of cor triatriatum dexter by balloon dilatation in three dogs

JOURNAL OF SMALL ANIMAL PRACTICE, Issue 1 2004
M. Stafford Johnson
Two dogs, one immature and one adult, were presented with a history of progressive ascites. In a third, immature dog, increasing exercise intolerance had been noted. Echocardiography demonstrated a partition in the right atrium (cor triatriatum dexter) and echocontrast studies documented normal flow from the cranial vena cava into the right atrium and ventricle. A saphenous vein contrast study demonstrated flow from the caudal vena cava into an accessory right atrial chamber (sinus venarum). The sinus venarum communicated with the true right atrium via a small defect in the atrial membrane in one dog, and additionally with the left atrium via a right-to- left shunting foramen ovale in the other dogs. All defects were visualised on angiographic studies by selective catheterisation of the caudal vena cava via the femoral vein. Balloon dilatation of the defect was then performed using a small followed by a larger balloon angioplasty catheter to enlarge the defect in the atrial membrane. Clinical signs improved within days and were sustained in the long term in all cases. [source]

COMPARING BALLOON DIAMETER ON PERFORMING ENDOSCOPIC PAPILLARY BALLOON DILATATION WITH ISOSORBIDE DINITRATE DRIP INFUSION FOR REMOVAL OF BILE DUCT STONES

Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer

DISEASES OF THE ESOPHAGUS, Issue 7 2009
H. Mizuta
SUMMARY Endoscopic submucosal dissection (ESD) has been utilized as an alternative treatment to endoscopic mucosal resection for superficial esophageal cancer. We aimed to evaluate the complications associated with esophageal ESD and elucidate predictive factors for post-ESD stenosis. The study enrolled a total of 42 lesions of superficial esophageal cancer in 33 consecutive patients who underwent ESD in our department. We retrospectively reviewed ESD-associated complications and comparatively analyzed regional and technical factors between cases with and without post-ESD stenosis. The regional factors included location, endoscopic appearance, longitudinal and circumferential tumor sizes, depth of invasion, and lymphatic and vessel invasion. The technical factors included longitudinal and circumferential sizes of mucosal defects, muscle disclosure and cleavage, perforation, and en bloc resection. Esophageal stenosis was defined when a standard endoscope (9.8 mm in diameter) failed to pass through the stenosis. The results showed no cases of delayed bleeding, three cases of insidious perforation (7.1%), two cases of endoscopically confirmed perforation followed by mediastinitis (4.8%), and seven cases of esophageal stenosis (16.7%). Monovalent analysis indicated that the longitudinal and circumferential sizes of the tumor and mucosal defect were significant predictive factors for post-ESD stenosis (P < 0.005). Receiver operating characteristic analysis showed the highest sensitivity and specificity for a circumferential mucosal defect size of more than 71% (100 and 97.1%, respectively), followed by a circumferential tumor size of more than 59% (85.7 and 97.1%, respectively). It is of note that the success rate of en bloc resection was 95.2%, and balloon dilatation was effective for clinical symptoms in all seven patients with post-ESD stenosis. In conclusion, the most frequent complication with ESD was esophageal stenosis, for which the sizes of the tumor and mucosal defect were significant predictive factors. Although ESD enables large en bloc resection of esophageal cancer, practically, in cases with a lesion more than half of the circumference, great care must be taken because of the high risk of post-ESD stenosis. [source]

Randomized controlled trial of intrasphincteric botulinum toxin A injection versus balloon dilatation in treatment of achalasia cardia

DISEASES OF THE ESOPHAGUS, Issue 3-4 2001
U. C. Ghoshal
As the few randomized controlled trials available in the literature comparing botulinum toxin (BT) injection with established endoscopic treatment of achalasia cardia, i.e. pneumatic dilatation, showed conflicting results, we conducted a prospective randomized trial. Seventeen consecutive patients with achalasia cardia diagnosed during a period between December 1997 and February 2000 were randomized into two treatment groups [pneumatic dilatation by Rigiflex dilator (n=10), BT injection by sclerotherapy needle into four quadrants of lower esophageal sphincter (LES) (n=7) 80 units in five cases, 60 units in two cases] after dysphagia grading, endoscopy, barium esophagogram, and manometry, all of which were repeated 1 week after treatment. Patients were followed up clinically for 35.2 ± 14 weeks. Chi-squares, Wilcoxon rank-sum test, Kaplan,Meier method and log-rank tests were used for statistical analysis. After 1 week, 6/7 (86%) BT-treated vs. 8/10 (80%) dilatation-treated patients improved (P=NS). There was no difference in LES pressure and maximum esophageal diameter in the barium esophagogram in the two groups before therapy. Both therapies resulted in significant reduction in LES pressure. The cumulative dysphagia-free state using the Kaplan,Meier method decreased progressively in BT-treated compared with dilatation-treated patients (P=0.027). Two patients with tortuous megaesophagus, one of whom had failed dilatation complicated by perforation previously, improved after BT. One other patient in whom pneumatic dilatation had previously failed improved in a similar manner. BT is as good as pneumatic dilatation in achieving an initial improvement in dysphagia of achalasia cardia. It is also effective in patients with tortuous megaesophagus and previous failed pneumatic dilatation. However, dysphagia often recurs during 1-year follow up. [source]

Oestrogen attenuates coronary vasoconstriction after angioplasty: role of endothelin-1

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 3 2002
T-M. Lee
Abstract Background and aims There were controversies as to whether endothelin-1 is released after coronary angioplasty. We sought to determine whether endothelin-1 is released after coronary angioplasty and whether oestrogen administration can affect coronary vasomotor tone by reducing endothelin-1 concentrations. Methods The study was designed to prospectively investigate 24 consecutive patients scheduled for elective coronary angioplasty. Patients were randomized into two groups according to whether they did not (group 1, n = 12) or did (group 2, n = 12) have intracoronary treatment with oestrogen. Quantitative coronary angiography was monitored at baseline, immediately after successful angioplasty, and 15 min after the last deflation. Blood samples for measuring the levels of endothelin-1 were drawn from the ascending aorta and the coronary sinus simultaneously before angioplasty and 15 min after balloon dilatation. Results The diameters of the coronary artery at the dilated segments were significantly reduced 15 min after dilation compared with those immediately after dilation in group 1 from 3·20 ± 0·22 to 2·30 ± 0·23 mm (P < 0·001), respectively. The vasoconstriction was significantly blunted in group 2. The endothelin-1 levels from the coronary sinus rose significantly, by 29%, 15 min after angioplasty in group 1, which was attenuated after administering oestrogen. Significant correlation was found between the changes of coronary vasomotion of the dilated segment and endothelin-1 levels (r = 0·70, P = 0·01). Conclusion Endothelin-1 is released into the coronary circulation after angioplasty, and this vasoactive substance may contribute to the occurrence of vasoconstriction. The vasoconstriction is attenuated by oestrogen by reducing the endothelin-1 levels. This finding provided a new strategy to treat coronary vasoconstriction after angioplasty. [source]

Short- and long-term effects of balloon dilatation on esophageal motility in achalasia

Early Results of Balloon Dilatation of the Stenotic Bovine Jugular Vein Graft in the Right Ventricular Outflow Tract in Children

Transcatheter Closure of Congenital Ventricular Septal Defects: Experience with Various Devices

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2003
RAMESH ARORA D.M.
Transcatheter closure of congenital ventricular septal defect (VSD) using various devices is gaining acceptance in selected cases of perimembranous and muscular defects, avoiding the inherent risks of cardiopulmonary bypass. The procedure was attempted in 137 patients having congenital defects using Rashkind Umbrella Device (RUD) in 29 patients, Amplatzer ventricular septal occluder (AVSO) in 107 patients, and Detachable Coil in one. All patients were selected using stringent criteria by detailed transthoracic echocardiography and/or transesophageal echocardiography. The location of VSD was perimembranous in 91 patients and was muscular trabecular in 46 patients. Seven patients had left ventricle (LV) to right atrium (RA) communication. Thirty-five patients with perimembranous and two with muscular VSD had aneurysm formation. The patients were 3 to 33 years old, and the diameter of VSD ranged from 3 to 12 mm. The pulmonary to systemic flow ratio was ,2:1 in 47 (34.3%) patients. The procedure was successful in 130 (94.8%) patients, with a success rate of 86.2% with RUD and 97.1% with AVSO. Residual shunt at 24 hours was seen in eight (32%) patients with RUD and in one patient (0.9%) with AVSO. Three (2.8%) developed transient bundle branch block, and two (1.9%) patients had complete heart block. New tricuspid stenosis and tricuspid regurgitation was observed in one patient each with AVSO. After immediate balloon dilatation, the mean pressure gradient across tricuspid valve decreased from 11 to 3 mmHg in the patient with tricuspid stenosis. On a follow-up of 1 to 66(mean 35.2 ± 10.7)months, the device was in position in all. None developed late conduction defect, aortic regurgitation, infective endocarditis, or hemolysis. At 9-month follow-up, the mean pressure gradient across the tricuspid valve was 3 mmHg in the patient with tricuspid stenosis. Complete occlusion of the shunt was achieved in 129 (99.2%) patients. One patient with RUD having persistent residual shunt underwent a second procedure with AVSO. Three out of 107 patients with AVSO had an unsuccessful procedure where the defect was perimembranous with a superior margin of defect less than 3 mm away from the aortic valve, and the specially designed perimembranous AVSO had to be retrieved because of hemodynamic compromise due to significant acute aortic regurgitation, whereas in all others, the defect was either ,3 mm away from the aortic valve or had aneurysm formation. All seven patients with LV to RA communication showed complete abolition of the shunt. Thus, in properly selected cases of perimembranous and muscular ventricular septal defects, the transcatheter closure is safe and efficacious using appropriate devices. The success rate is higher with AVSO compared with the previously used devices, as well as more successful for the muscular defects than those that are perimembranous in location. (J Interven Cardiol 2003;16:83,91) [source]

Immediate and Long-Term Outcome of Recanalization of Chronic Total Coronary Occlusions

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2002
FEDERICO PISCIONE M.D.
Eighty-three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was<30 days (subacute total occlusion [STO]: 25 patients; range 1,30 days) or>30 days (chronic total occlusion [CTO]: 58 patients; range 3,144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complication, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow-up of 24 ± 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success. [source]

Percutaneous Retrieval of a Wallstent from the Pulmonary Artery Following Stent Migration from the Iliac Vein

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2002
RAJIV M. ASHAR M.D.
Wallstents are being used increasingly in conjunction with balloon dilatation for treatment of iliac vein stenosis. Stent misplacement or migration is a complication of the procedure, and may be symptomatic and warrant repositioning or removal. We report the case of a patient whose iliac vein stenosis was managed with two overlapping Wallstents and was complicated by embolization of one stent into the right ventricle (RV) and the other to the pulmonary artery (PA). This article illustrates percutaneous endovascular removal of a migrated stent from the PA using a jugular and femoral approach. [source]

Management of cor triatriatum dexter by balloon dilatation in three dogs

Strategy to prevent recurrent portal vein stenosis following interventional radiology in pediatric liver transplantation

LIVER TRANSPLANTATION, Issue 3 2010
Yukihiro Sanada
Portal vein complications after liver transplantation (LT) are serious complications that can lead to graft liver failure. Although the treatment of interventional radiology (IVR) by means of balloon dilatation for portal vein stenosis (PVS) after LT is an effective method, the high rate of recurrent PVS is an agonizing problem. Anticoagulant therapy for PVS is an important factor for preventing short-term recurrence following IVR, but no established regimen has been reported for the prevention of recurrent PVS following IVR. In our population of 197 pediatric patients who underwent living donor liver transplantation (LDLT), 22 patients (22/197, 11.2%) suffered PVS. In the 9 earliest patients, unfractionated heparin was the only anticoagulant therapy given following IVR. In the 13 more recent patients, 3-agent anticoagulant therapy using low-molecular-weight heparin, warfarin, and aspirin was employed. In the initial group of 9 patients, 5 patients (55.6%) suffered recurrent PVS and required repeat balloon dilatation. Among the 13 more recent patients, none experienced recurrent PVS (P = 0.002). In conclusion, our 3-agent anticoagulant therapy following IVR for PVS in pediatric LDLT can be an effective therapeutic strategy for preventing recurrent PVS. Liver Transpl 16:332,339, 2010. © 2010 AASLD. [source]

Balloon dilatation vs. balloon dilatation plus bile duct endoprostheses for treatment of anastomotic biliary strictures after liver transplantation

LIVER TRANSPLANTATION, Issue 1 2006
Thomas Zoepf
Biliary strictures after liver transplantation are a therapeutic challenge for endoscopy. Anastomotic strictures occur in 10% of patients after liver transplantation, leading untreated to mortality and ultimately to graft failure. Despite of successful reports, to date, there is no defined endoscopic therapy regimen for these cases. Therefore the aim of this study was to determine the most suitable concept for endoscopic treatment of post-liver transplant anastomotic strictures (PTAS). A total of 72 patients post-liver transplantation, who received endoscopic retrograde cholangiography (ERC) as a consequence of suspected biliary complications were retrospectively screened for the presence of PTAS. In all patients graft rejection or bile duct ischemia were excluded prior to ERC by liver biopsy or Doppler ultrasound respectively. We compared either balloon dilatation (BD) alone or dilatation plus placement of an increasing number of bile duct endoprostheses (BD + endoprostheses) in a retrospective analysis. A total of 25 of 75 patients showed PTAS. Overall, endoscopic therapy was successful in 22 of 25 patients (88%). BD was initially successful in 89% but showed recurrence in 62%. BD + endoprostheses was initially successful in 87%, and recurrence was observed only in 31%. All recurrences were successfully retreated by BD + endoprostheses. During 22 of 109 (20%) treatment sessions stone extraction was necessary. Complication rate was low with bacterial cholangitis in 8 of 109 (7.3%) sessions, mild pancreatitis in 10 of 109 (9%) sessions and minor bleeding in 2 of 25 (8%) sphincterotomies. Median follow-up after conclusion of endoscopic therapy is 6 months (range 1,43). In conclusion, our data confirm that endoscopic therapy of PTAS is highly effective and safe. As primarily successful BD shows a high rate of recurrence, we recommend a combination of BD followed by an increasing number and diameter of endoprostheses. Therapy sessions are effective at short intervals of every 2,3 months. Liver Transpl 12:88,94, 2006. © 2005 AASLD. [source]

Successful Balloon Dilatation of the Valve of Vieussens for Left Ventricular Lead Placement

Coronary Vein Angioplasty with Noncompliant Balloon for Resistant Coronary Vein Stenosis During Left Ventricular Lead Implantation

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2008
KETUL CHAUHAN M.D.
This report describes a patient who underwent cardiac resynchronization therapy (CRT) in the setting of a severe stenosis in the lateral coronary vein that prevented passage of a left ventricular lead. The stenosis was unresponsive to standard compliant balloon dilatation but was successfully treated with a noncompliant balloon. Venoplasty with noncompliant balloon should be considered for resistant coronary vein stenosis encountered during CRT device implantation. [source]

Use of balloon-expandable metallic stent in a premature infant with congenital tracheobronchial stenosis

PEDIATRIC PULMONOLOGY, Issue 4 2008
Birgin Törer MD
A congenital tracheobronchial stenosis is a rare obstructive lesion of the airway characterized by intrinsic narrowing of a segment of the trachea and bronchi. In this report, we present the smallest premature infant with a congenital tracheobronchial stenosis who has been successfully treated with balloon dilatation and placement of a balloon-expandable metallic stent. Pediatr Pulmonol. 2008; 43:414,417. © 2008 Wiley-Liss, Inc. [source]

Changing patterns in interventional bronchoscopy

RESPIROLOGY, Issue 4 2009
Nikolaos ZIAS
ABSTRACT Background and objective: Many interventional tools for airway disorders can now be delivered via flexible bronchoscopy (FB), including neodymium-yttrium aluminium garnet laser, electrocautery, argon plasma coagulation, cryotherapy, balloon dilatation and metal or hybrid stents. Comparison of outcomes for patients undergoing rigid bronchoscopy (RB) with those treated using FB highlights the usefulness of the FB approach. Methods: A retrospective medical record review of all interventional bronchoscopy procedures performed at Lahey Clinic over the past 8 years was conducted. Patients were categorized into two groups according to the procedure used, that is, RB (251 patients), and FB (161 patients) groups. Patients with malignancies were included as a separate subgroup, comprising 178 RB and 117 FB patients. For every procedure, the location of the lesion, patient survival from the first interventional procedure performed, and in patients with malignancy, additional treatments received such as chemotherapy and radiation were recorded. Results: Ninety per cent of RB procedures were performed in patients with tracheal or main stem lesions, while over half the patients undergoing FB had more distal lesions. A trend towards increasing use of FB for interventional procedures in recent years was noted. Conclusions: FB is a valuable alternative to RB for treating less advanced malignant disease or distal airway lesions. [source]

Bronchoscopy in Japan: A survey by the Japan Society for Respiratory Endoscopy in 2006

RESPIROLOGY, Issue 2 2009
Hiroshi NIWA
ABSTRACT Background and objective: In order to obtain information on the clinical application of bronchoscopy in Japan, the Japan Society for Respiratory Endoscopy (JSRE) conducted a postal survey. Methods: A questionnaire was sent to 526 authorized institutes of the JSRE. The subject was bronchoscopy procedures performed during 2006. Results: The response rate was 71.3%. The total number of bronchoscopies performed was 74 770. Of these, 74 412 were flexible bronchoscopies and 358 were rigid bronchoscopies. At least one JSRE-authorized specialist had worked with 97% of respondents. Eighty-five per cent of respondents performed bronchoscopy under topical anaesthesia for almost all patients. Seventy-five per cent of respondents routinely used the oral route. The reported numbers of diagnostic bronchoscopies was 12 509 for simple bronchoscopy, 25 971 for forceps biopsy, 26 289 for brush biopsy, 25 659 for bronchial washing, 1387 for transbronchial needle aspiration and 6716 for BAL. Three deaths were caused by forceps biopsy (0.012%). The morbidity rates for these diagnostic procedures ranged from 0.14% to 2.5%. The reported numbers of therapeutic bronchoscopies was 476 for tracheobronchial stent, 164 for neodymium (Nd): yttrium-aluminium garnet (YAG) laser photoresection (LPR), 40 for photodynamic therapy, 81 for balloon dilatation, 145 for endobronchial electrocautery, 120 for argon plasma coagulation, 109 for microwave coagulation (MWC), 116 for ethanol injection, 110 for foreign body removal and 89 for bronchial occlusion. Deaths occurred only as a consequence of Nd : YAG LPR (0.61%). The morbidity rates for these therapeutic procedures ranged from 0% to 5%. Conclusions: The preparation for, and practice of, bronchoscopy varied greatly between respondents. Diagnostic bronchoscopy was well tolerated and safe. Therapeutic procedures did not appear to be practised widely or frequently. [source]

Robot-assisted laparoscopic adrenalectomy: preliminary UK results

BJU INTERNATIONAL, Issue 3 2004
S. Undre
Authors from London describe the early results from the UK in the use of robot-assisted laparoscopic adrenalectomy. In a small group of patients they found that patients could be treated early, with early discharge from hospital. The use of retrograde balloon dilatation of PUJ obstruction is revisited by authors from Plymouth, who review their 10 years of experience with this technique. They found that the procedure gave good symptomatic relief in 76% of their patients, but found no relationship between symptom relief and renographic improvement. In a few patients with a long-term follow-up there was symptomatic improvement and good maintenance of split renal function. OBJECTIVE To describe the results of our first two cases of laparoscopic adrenalectomy using the da VinciTM surgical system (Intuitive Surgical, Inc., Mountain View, CA, USA). PATIENTS AND METHODS Amongst 75 robot-assisted procedures performed at our institution, two patients underwent robot-assisted laparoscopic adrenalectomy. The set-up time, procedure time, hospital stay, complications and outcomes were recorded. RESULTS Both operations were completed successfully using the robot; the mean (range) set-up time was 31 (25,37) min and mean procedure time 118.5 (107,130) min. One patient had a postoperative pulmonary embolus and was discharged 5 days after surgery; the second patient was discharged after 3 days. There were no intraoperative complications; both patients were well at the 1-year follow-up CONCLUSIONS Robot-assisted laparoscopic adrenalectomy is technically feasible and can be conducted efficiently and safely with the da Vinci surgical system. [source]

Prospective assessment of hemodialysis access patency after percutaneous intervention: Cox proportional hazards analysis

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2005
John A. Bittl MD
Abstract Vascular access failure is the greatest limitation of successful hemodialysis, but the factors associated with long-term patency have not been fully elucidated. Outcomes in a consecutive series of 294 thrombosed or failing accesses [128 fistulas (43.5%) and 166 grafts (56.5%) in 179 patients] were analyzed with life table and multivariable Cox proportional hazards analysis. Initial success was achieved in 275 of 294 accesses (95.6%). The median patency after intervention was 206 days (interquartile range, 79,457 days). Fistulas had longer median patency after intervention than grafts (286 vs. 170 days). Nonthrombosed accesses had longer median patency than thrombosed accesses (238 vs. 136 days), but thrombosed fistulas had similar median patency as thrombosed grafts (140 vs. 136 days). The selective use of stents as a bailout for failed balloon dilatation did not significantly reduce long-term patency (196 days for stented accesses vs. 210 days for unstented accesses). Long-term patency was inversely related to final access pressure, but access patency was not related to the presence of central venous occlusions, graft age, patient age, sex, or diabetes. Catheter-based intervention of thrombosed and failing dialysis accesses significantly prolongs patency and usefulness of dialysis accesses. The expanding use of fistulas, improved detection of early access failure, and selective use of bailout stents should enhance long-term access patency. © 2005 Wiley-Liss, Inc. [source]

Immediate and late clinical and angiographic outcomes after GFX coronary stenting: Is high-pressure balloon dilatation necessary?

CLINICAL CARDIOLOGY, Issue 8 2000
Ph.D., Seong-Wook Park M.D.
Abstract Background: The GFX stent is a balloon-expandable stent made of sinusoidal element of stainless steel. The adjunct high-pressure balloon dilatations were usually recommended in routine stenting procedure. Hypothesis: The aim of this study was to evaluate the immediate and long-term clinical and angiographic outcomes and to investigate the necessity of high-pressure balloon dilatation during GFX stenting. Methods: In all, 172 consecutive patients underwent single 12 or 18 mm GFX stent implantation in 188 native coronary lesions. Two types of stenting technique were used: (1) stent size of a final stent-to-artery ratio of 1:1 (inflation pressure > 10 atm, high-pressure group), and (2) stent size of 0.5 mm bigger than reference vessel (inflation pressure , 10 atm, low-pressure group). The adjunct high-pressure balloon dilatations were performed only in cases of suboptimal results. Results: The adjunct high-pressure balloon dilatation was required in 11 of 83 lesions (13%) in the high-pressure group and in 7 of 105 lesions (7%) in the low-pressure group (p = 0.203). Procedural success rate was 100%. There were no significant differences of in-hospital and long-term clinical events between the two groups. The overall angiographic restenosis rate was 17.7%; 18.4% in the high-pressure group and 17.1% in the low-pressure group (p = 0.991). Conclusions: The GFX stent is a safe and effective device with a high procedural success rate and favorable late clinical outcome for treatment of native coronary artery disease. Further randomized trials may be needed to compare stenting techniques in GFX stent implantation. [source]

Catheter-directed therapy for DVT after pancreas transplantation

CLINICAL TRANSPLANTATION, Issue 6 2007
Harish D Mahanty
Abstract:, Introduction:, Iliac vein deep venous thrombosis (DVT) ipsilateral to the pancreas transplant can lead to severe leg edema and compromise graft function. Treatment modalities for iliac vein DVT in the pancreas transplant recipient are limited. Methods:, Medical records of patients receiving pancreas transplants at a single center from November 1989 to July 2003 were reviewed retrospectively, identifying patients with iliac vein DVT. There were 287 pancreas transplants performed during this time. Pancreas transplantation in all recipients was performed in the right iliac fossa with the arterial supply consisting of a donor iliac artery Y interposition graft. Systemic venous drainage was to the iliac vein. Exocrine drainage was enteric or to the bladder. Results:, Four (1.4%) cases of iliac DVT were identified. All patients manifested lower extremity edema ipsilateral to the pancreas transplant. DVT was detected by ultrasound on days 4, 5, 13, and 60 post-transplant. In all cases, the iliac vein caudad to the pancreatic venous anastomosis was noted to be stenotic. Management involved balloon dilatation and endovascular stent placement in one patient, thrombolysis with tissue plasma antigen (t-PA) followed by stent placement in one patient, and percutaneous mechanical thrombectomy in two patients. All patients had improvement in leg edema and two patients continue to have good pancreatic allograft function. Conclusions:, Iliac DVT is a rare complication of pancreas transplantation that usually develops in an area of stenosis caudad to the pancreatic venous anastomosis. Catheter-based treatment modalities with use of endovascular stents for treatment of underlying stenoses can serve as an adjunct in treating these complications. [source]

Recurrent hepatitis C virus disease after liver transplantation and concurrent biliary tract complications: poor outcome

CLINICAL TRANSPLANTATION, Issue 4 2006
Lior H. Katz
Abstract:, Recurrent hepatitis C virus (HCV) infection is particularly aggressive in the post-liver transplantation setting, with rapid progression of liver fibrosis. Biliary complications remain a significant cause of morbidity following liver transplantation. Post-cholecystectomy biliary strictures are associated with advanced hepatic fibrosis. The aim of this retrospective study was to determine whether the presence of biliary complications affects survival in liver transplant recipients with recurrent HCV disease. The files of liver transplant recipients (53.7% male; mean age 52.7 ± 10.3 yr) were reviewed for incidence, type and treatment of biliary complications, and findings were compared between those who developed recurrent HCV disease (n = 47, 83.9%) and those who did not (n = 9). Twenty-one biliary complications developed in 12 patients with recurrent HCV (25.5%). Treatment with endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography with balloon dilatation and stent placement or surgical revision was successful in nine (75%). Three biliary complications developed in three patients with no recurrence (p = NS). There was no statistically significant association between recurrent HCV disease and biliary complications. However, among those with recurrent disease, the recurrence was severe in nine of 12 recipients with biliary complications (75%) but in only nine of 35 without biliary complications (26%) (p = 0.001). Death was documented in eight patients with severe recurrence (44.4%), including three (37.5%) with biliary complications and two (7%) with non-severe recurrence, neither of whom had biliary complications (p = 0.003). Antiviral treatment was successful in nine of 25 patients (36%) who received it. On multivariate analysis, biliary complications were a significant predictor of severe recurrence (OR 27.0, 95% confidence interval 2.07,351.4) (p = 0.012). Fibrosis stage in the second biopsy was significantly correlated with serum alanine aminotransferase (p = 0.01) and with duration of biliary obstruction (p = 0.07). In conclusion, biliary complications of liver transplantation strongly affect outcome in patients with recurrent HCV disease despite attempts to relieve the biliary obstruction and to treat the recurrent HCV disease. [source]

COMPARING BALLOON DIAMETER ON PERFORMING ENDOSCOPIC PAPILLARY BALLOON DILATATION WITH ISOSORBIDE DINITRATE DRIP INFUSION FOR REMOVAL OF BILE DUCT STONES