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Successful Placement (successful + placement)
Selected AbstractsSUCCESSFUL PLACEMENT OF SELF-EXPANDABLE METALLIC STENTS FOR DOUBLE COLORECTAL CANCERSDIGESTIVE ENDOSCOPY, Issue 4 2006Tsuyoshi Abe Stent placement for the palliation of unresectable colon cancer is an alternative to surgical treatment that has recently become popular. A dedicated stent for colorectal cancer is not available in Japan. We report a patient with two colonic obstructions who underwent a successful palliative treatment using two stents. He was admitted to Toho University Ohashi Medical Center because of ileus. A colonoscopy revealed two advanced lesions with stenosis in the sigmoid and transverse colon. Because he had multiple liver metastases and severe Alzheimer dementia, we selected palliative stent placement for the treatment of both strictures. We placed a covered stent in the sigmoid colon stricture and subsequently attempted to place a second stent in the transverse colon stricture. However, the second stent could not be placed in the transverse colon because the modified delivery system could not pass through the first stent in the sigmoid colon. This probably led to a twisting of the stent in the sigmoid colon. We next used the 24 F introducer sheath that is included in Keller-Timmermans Introducer Sets. This strategy allowed the modified delivery system to be easily passed through the initial stent in the sigmoid colon and then advanced into the transverse colon stricture, enabling both stents to be positioned properly. [source] Evaluation of tracheal tube introducers in simulated difficult intubation,ANAESTHESIA, Issue 3 2009C. Janakiraman Summary In a randomised cross-over study, 72 anaesthetists attempted to place Pro-Breathe, new Portex, and Frova single-use tracheal tube introducers and an Eschmann multiple-use introducer in the trachea of a manikin set to simulate a grade 3 laryngeal view. Successful placement (proportion, 95% confidence interval) of either the Frova (78%, 67,86%) or the Eschmann introducer (64%, 52,74%) was significantly more likely (p < 0.0001) than with the Pro-Breathe (4%, 1,12%) or the new Portex introducer (13%, 7,22%). The difference between the success rates for the Frova and the Eschmann introducers (p = 0.08) was not significant. A separate experiment revealed that the peak force that could be exerted by the Pro-Breathe, new Portex and Frova single-use introducers were three to six times greater than that which could be exerted by the Eschmann introducer (p < 0.0001). The single-use introducers are more likely to cause tissue trauma during placement, particularly if held close to the tip. [source] Balloon sizing and transcatheter closure of acute atrial septal defects guided by magnetic resonance fluoroscopy: Assessment and validation in a large animal model,JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 3 2005Simon Schalla MD Abstract Purpose To quantitatively assess atrial septal defects (ASDs) with small shunts using MRI followed by transcatheter closure monitored by MR fluoroscopy. Materials and Methods Acute ASDs were created in 14 pigs under x-ray fluoroscopy. Six animals were studied in order to select MR-compatible delivery systems and imaging strategies. ASDs in eight animals were examined with balloon sizing under MR fluoroscopy, flow measurements, and contrast media injections, after which transcatheter closure was performed under MR fluoroscopy. The delivery system was assembled from commercially available materials. Results The ratio of pulmonary to systemic flow (Qp/Qs) was reduced from 1.23 ± 0.15 before ASD closure to 1.07 ± 0.11 after ASD closure (P < 0.001). In two out of eight animals Qp/Qs was close to 1.0 before closure despite the presence of defects >15 mm. The ASDs were measurable with MR balloon sizing in all of the animals. Balloon sizing was identical with MR (16.9 ± 2.3 mm) and x-ray fluoroscopy (17.1 ± 1.3 mm). The in-house-assembled delivery system allowed successful placement of closure devices under MR guidance. Conclusion Assessment and closure of small shunts with MR fluoroscopy is feasible. A barrier to the rapid implementation of transcatheter closure in patients is uncertainty about the MR safety of guidewires and device delivery systems. J. Magn. Reson. Imaging 2005;21:204,211. © 2005 Wiley-Liss, Inc. [source] Influence of orientations of guidewire tip on the placement of subclavian venous cathetersACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2005H-P. Park Background:, The role of a J-type guidewire tip has been known to prevent vascular or cardiac wall damage. We hypothesized that the course of the guidewire may be influenced by the initial orientations of the J-type guidewire tip during the subclavian approach. The purpose of this study was to investigate the influence of the direction of the needle bevel and J-wire tip on successful placement of subclavian catheters. Methods:, A total of 140 adult patients of either sex were studied. Patients were randomly divided by the direction of the needle bevel (neutral vs. downward) and the direction of the J-wire tip (upward vs. downward). Under general anesthesia, right infraclavicular subclavian catheterization was attempted using the Seldinger technique. Results:, There was no statistically significant difference among the successful and unsuccessful placements in relation to factors including sex, body mass index, and needle bevel direction. The success rate was high when the J-wire tip was directed downward (P = 0.001). Conclusion:, These data suggest that the orientation of the J-wire tip downward can increase successful placement rates of right subclavian venous catheterization. [source] Catheter closure of moderate to large sized patent ductus arteriosus using the simultaneous double or triple coil techniquePEDIATRICS INTERNATIONAL, Issue 5 2001Teiji Akagi AbstractBackground: Although the clinical experience with transcatheter closure of the patent ductus arteriosus using the coils has grown rapidly, one important complication of this procedure using the conventional Gianturco coil was the migration of coils into peripheral vessels. This is especially for patients with a relatively larger size ductus and the risk for such complications could be increased. In this situation, the detachable coil may have some technical benefits to perform coil occlusion and reduce the incidence of complications. Methods: We describe the clinical efficacy of a simultaneous double or triple coil occlusion technique using the Cook detachable coil or bioptome delivered 0.052 inch Gianturco coil to close the ductus arteriosus. This was performed in patients whose ductus diameter was greater than 3.0 mm. Results: From February 1995 to December 2000, 118 patients with patent ductus arteriosus were treated by coil occlusion using Cook detachable coils, of whom 58 patients whose minimum diameter of ductus , 3.0 mm were reviewed. All patients had successful placement of coils. According to the evaluation by color flow mapping, a trivial shunt was observed in 17 patients (29%) within 24 h after the procedure. In 11 out of 17 patients, a residual shunt was not detected 1 month after the procedure. At 6 months after the procedure, the residual shunt was detected only in three patients. Conclusions: Although this study did not calculate the statistical significance between detachable and non-detachable coils in term of occlusion rate, our institutional experience suggests that the simultaneous double or triple coil technique using the detachable or 0.052 inch Gianturco coils can reduce the prevalence of coil migration or complications. [source] Fibreoptic intubation through the laryngeal mask airway: effect of operator experience,ANAESTHESIA, Issue 10 2009I. Hodzovic Summary In a randomised crossover study, we compared times and success rates for tracheal placement of a fibrescope and railroading of a tracheal tube through the classic laryngeal mask airway by anaesthetists with limited experience in fibreoptic intubation (trainees) and those who were experts. Thirty-two patients, 32 trainees and three experts took part. The median (IQR [range]) times to fibrescope placement for trainees and experts were 21 (18,30 [12,58]) s and 17 (14,24 [9,55]) s, respectively (95% CI for the difference 2,8 s; p = 0.023). There were no significant differences between trainees and experts in the times to placement of the laryngeal mask airway (41 (33,47 [31,105]) s and 36 (33,43 [30,52]) s, respectively; p = 0.24), railroading times (43 (40,58 [33,87]) s and 44 (38,57 [31,83]) s, respectively; p = 0.96) and total intubation time (114 (97,127 [80,213]) s and 95 (89,116 [74,139]) s, respectively; p = 0.13). There was no significant difference in the number of attempts needed for successful placement of the fibrescope (p = 0.12) and railroading the tracheal tube (p = 0.22). The differences between experts and trainees when using fibrescope assisted intubation via the classic laryngeal mask airway were not clinically important. [source] Tracheal tube fixation: the effect on depth of insertion of midline fixation compared to the angle of the mouth,ANAESTHESIA, Issue 4 2009K. Sharma Summary Following successful placement of a tracheal tube (TT), it is frequently moved from the midline to the angle of the mouth. This study investigates the tracheal tube tip position in the two fixation positions in 200 adult patients. Following tracheal intubation, a fibreoptic bronchoscope (FOB) was introduced through a swivel connector and the distances from the swivel connector to the lips, carina, tip of TT and the crico-tracheal membrane were measured with the TT in the midline and at the right angle of the mouth. The mean (SD) TT tip to carinal distance decreased from 3.60 (1.50) cm to 2.28 (1.55) cm in female patients, and 5.04 (1.43) cm to 3.69 (1.65) cm in male patients on moving the tracheal tube to the angle of the mouth. We conclude that there is a significant movement of the tracheal tube towards the carina on moving the TT from midline to angle of mouth and the depth of insertion of the tube should be adjusted accordingly. [source] A comparison of the intubating laryngeal mask airway and the Bonfils intubation fibrescope in patients with predicted difficult airways,ANAESTHESIA, Issue 7 2004B. Bein Summary Tracheal intubation with the intubating laryngeal mask airway or the Bonfils intubation fibrescope was performed in 80 patients with predicted difficult airways. Mallampati score, thyromental distance, mouth opening and mobility of the atlanto-occipital joint were used to predict difficult airways. The overall success rate, time to the first adequate lung ventilation and time taken for the successful placement of the tracheal tube were recorded, as well as a subjective assessment of the handling of the device and the incidence of postoperative sore throat and hoarseness. The median [range] time to the first adequate ventilation was significantly shorter with the intubating laryngeal mask airway than with the Bonfils intubation fibrescope (28 [6,85] s vs. 40 [23,77] s, p < 0.005). Tracheal intubation was significantly slower with the intubating laryngeal mask airway than with the Bonfils intubation fibrescope (76 [45,155] s vs. 40 [23,77] s, p < 0.0001. Patients in the Bonfils group suffered less sore throat and hoarseness than those in the other group. [source] Use of a retrievable inferior vena cava filter in term pregnancy: Case report and review of literatureAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2009William MILFORD Venous thromboembolism is a significant cause of morbidity and mortality in obstetrics. Management with anticoagulation can be problematic, especially peripartum. We report the successful placement and retrieval of an inferior vena cava filter as prophylaxis for peripartum pulmonary embolism in a woman with a large, proximal, deep venous thrombosis at term. [source] Office ultrasound should be the first-line investigation for confirmation of correct ESSURE placementAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2005Gareth WESTON Abstract Background:, Hysteroscopic options for permanent birth control (PBC), such as the ESSURE device, are becoming increasingly popular as an alternative to laparoscopic tubal ligation. The success of the technique hinges upon correct device placement within the intramural portion of the fallopian tube. Objective:, To determine the utility of office ultrasound for confirming correct ESSURE PBC device placement at the 3-month check in a general gynaecology practice. Study population:, The first 99 patients in a single centre following ESSURE PBC device placement. Type of study:, Prospective cohort study. Methods:, Clinical data was reviewed from patient records, both from the time of the initial procedure and from the follow-up at 3 months. All women underwent an ultrasound at the 3-month check. Results:, The ESSURE PBC devices were placed successfully in 84.8% of cases. Of those cases with apparently successful placement, office ultrasound alone confirmed correct device placement at the 3-month check in 94% of cases. Further imaging was needed in only 6% of cases. Discussion:, Office ultrasound performed by the general gynaecologist at the 3-month check is more convenient for the patient, and is sufficient to confirm ESSURE PBC device placement in the vast majority of cases. We propose that the protocol for ESSURE PBC device follow-up should be altered to replace X-ray with ultrasound as the first-line investigation. [source] Self expanding wall stents in malignant colorectal cancer: is complete obstruction a contraindication to stent placement?COLORECTAL DISEASE, Issue 8 2009G. J. A. Stenhouse Abstract Objective, Technical failures have previously been associated with complete clinical obstruction and complete block to the retrograde flow of gastrograffin is considered by some to be a contraindication to the procedure. We report on the technical and clinical success rates of self-expanding metallic stents (SEMS) in both complete and incomplete obstruction in a prospective series of malignant colorectal obstructions. Method, A prospective study of all patients undergoing attempted palliative and bridge to surgery SEMS placement for malignant colorectal obstruction over a 7-year period (April 1999,October 2006) was undertaken. Results, Seventy-two patients (49 males) with a mean age of 71 years (range 49,98) were included. Technical success was achieved in 27 of 32 patients (84%) with complete obstruction and 33 of 36 patients (92%) with incomplete obstruction, P < 0.46, Fishers exact test. Clinical success was achieved in 17 of 26 patients (65%) with complete obstruction and 24 of 33 patients (73%) with incomplete obstruction, P < 0.58, Fishers exact test. Although placed correctly in 89% cases, relief of symptoms occurred in only 71%, P = 0.002, matched pairs test. There were two colonic perforations in the series with one procedure related death. Conclusion, Placement of SEMS for obstructing colorectal cancer is technically successful in a high proportion of cases. Complete radiological obstruction is not a contraindication to stent placement. The relief of obstructive symptoms following successful placement of a wall stent is less predictable. [source] | ||||||||||