Safety and efficacy of biodegradable stents in octogenarian patients with esophageal achalasia

Abstract Backgrounds and study aims Treatment of octogenarian patients with achalasia with conventional treatments is effective but with compromised safety. Biodegradable stents (BS) are promising. We aimed to evaluate their safety, efficacy and clinical outcomes at early, mid and long-term in this population. Patients and methods Naïve or previously-treated achalasic octogenarian patients underwent to BS placement (BSP) between December, 2010 and November, 2011, and were followed-up for 9-years. A strict follow-up was performed. Results Thirty-two patients were included, (17 men [53.1 %]; median age 82 years [78–92]). BSP was performed in all patients. At 9y, 18/32 (56.2 %) completed protocol. Mean BSP time was 37.5±12.1 min and 34.4 % presented thoracic pain. At 1 m, six BS were migrated (18.7 %), requiring a second BSP fixed with hemoclips. At 3 m, twenty-three (72.8 %) completed degradation process. At 6 m, eighteen (56.2 %) presented clinical dysphagia, of whom 5/32 (15.6 %) presented stenotic-tissue hyperplasia, responding to balloon dilation in all cases. Pre-BSP Eckardt, Timed barium esophagram and integrated relaxation pressure improved post-BSP 6 m values (9 vs 2, p = 0.001; < 50 % = 93.8 % vs > 80 % = 81.5 %, p = 0.003 and 18.8 ± 3.2 vs 11.1 ± 2.6 mmHg, p = 0.001, respectively), and there were no significant changes up to 9y post-BSP. Esophagitis grade A or B was presented between 4.7 % to 11.2 % and controlled with PPI. After 9 years we had clinical success rates of 94.4 %, 72 %, and 65.4 % for time point evaluation, per protocol and intention to treat analysis, respectively. Conclusions BSP represents a feasible alternative option in octogenarian patients with achalasia who are high risk with other treatments, presenting acceptable early, mid-, and long-term outcomes.

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Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease

Vascular and Endovascular Surgery ◽

10.1177/1538574418824444 ◽

2019 ◽

Vol 53 (4) ◽

pp. 284-291

Author(s):

Hirokazu Onishi ◽

Toru Naganuma ◽

Koji Hozawa ◽

Tomohiko Sato ◽

Hisaaki Ishiguro ◽

...

Keyword(s):

Subclavian Artery ◽

Stent Implantation ◽

De Novo ◽

Clinical Success ◽

Primary Patency ◽

Success Rates ◽

Long Term Outcomes ◽

Procedural Success

Introduction: The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. Material and Methods: We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. Results: There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). Conclusion: Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.

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Safety and effectiveness of a novel generator algorithm for bipolar vessel sealing: a randomised controlled chronic animal study

BMC Surgery ◽

10.1186/s12893-019-0625-2 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Bernhard Kraemer ◽

Christos Tsaousidis ◽

Stephan Kruck ◽

Martin Schenk ◽

Marcus Scharpf ◽

...

Keyword(s):

Animal Study ◽

Clinical Success ◽

Lateral Spread ◽

Histological Evaluation ◽

Vascular Bundles ◽

The Novel ◽

Success Rates ◽

Vessel Sealing ◽

Thermal Spread

Abstract Background Electrosurgical vessel sealers are gradually replacing conventional techniques such as ligation and clipping. Algorithms that control electrosurgical units (ESU), known as modes, are important for applications in different surgical disciplines. This chronic porcine animal study aimed to evaluate the safety and effectiveness of the novel thermoSEAL electrosurgical vessel sealing mode (TSM). The BiClamp® mode (BCM) of the renowned VIO® 300 D ESU served as control. BCM has been widely available since 2002 and has since been successfully used in many surgical disciplines. The TSM, for the novel VIO® 3 ESU, was developed to reduce sealing time and/or thermal lateral spread adjacent to the seal while maintaining clinical success rates. The primary aim of this study was to investigate the long-term and intraoperative seal quality of TSM. Methods The BiCision® device was used for vessel sealing with TSM and BCM in ten German Landrace pigs which underwent splenectomy and unilateral nephrectomy during the first intervention of the study. The seals were cut with the BiCision® knife. Ninety-nine arteries, veins and vascular bundles were chronically sealed for 5 or 21 days. Thereafter, during the second and terminal intervention of the study, 97 additional arteries and veins were sealed. The carotid arteries were used for histological evaluation of thermal spread. Results After each survival period, no long-term complications occurred with either mode. The intraoperative seal failure rates, i.e. vessel leaking or residual blood flow after the first sealing activation, were 2% with TSM versus 6% with BCM (p = 0.28). The sealing time was significantly shorter with TSM (3.5 ± 0.69 s vs. 7.3 ± 1.3 s, p < 0.0001). The thermal spread and burst pressure of arteries sealed with both modes were similar (p = 0.18 and p = 0.61) and corresponded to the histological evaluation. The measured tissue sticking parameter was rare with both modes (p = 0.33). Tissue charring did not occur. Regarding the cut quality, 97% of the seals were severed in the first and 3% in the second attempt (both with TSM and BCM). Conclusions The novel TSM seals blood vessels twice as fast as the BCM while maintaining excellent tissue effect and clinical success rates. Trial registration Not applicable.

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Transarterial embolization for renal angiomyolipomas: A single centre experience in 79 patients

Journal of International Medical Research ◽

10.1177/0300060516684251 ◽

2017 ◽

Vol 45 (2) ◽

pp. 706-713 ◽

Cited By ~ 10

Author(s):

Chengen Wang ◽

Min Yang ◽

Xiaoqiang Tong ◽

Jian Wang ◽

Haitao Guan ◽

...

Keyword(s):

Medical Records ◽

Clinical Success ◽

Tumour Size ◽

Transarterial Embolization ◽

Arterial Embolization ◽

Success Rates ◽

Single Centre Experience ◽

Computed Tomography Scans

Objective To evaluate the long-term efficacy and safety of selective arterial embolization (SAE) in the treatment of renal angiomyolipomas (AMLs). Methods This was a retrospective review of medical records and imaging findings from patients with renal AMLs who attended our clinic and received SAE between January 2007 and January 2014. Only patents with complete medical records, preoperative computed tomography scans using typical imaging and follow-up data were included. Results A total of 79 patients were enrolled in the study. Technical and clinical success rates were 100% and 91% ( n = 72), respectively. Only two patients experienced major complications. Post-embolization syndrome (i.e. fever, abdominal pain, nausea or vomiting) was reported in 68 (86%) patients, but all symptoms were mild and resolved with conservative measures. Mean radiological and clinical follow-up periods were 16.8 and 35.9 months, respectively. In 75 (95%) patients, tumours decreased in size; mean ± SD tumour size significantly decreased from 8.4 ± 3.5 cm pre-embolization to 6.7 ± 3.0 cm post-embolization . Conclusions This study provides long-term evidence that SAE is a safe and effective method in the treatment of patients with renal AMLs.

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Fluoroscopy-guided percutaneous antegrade approach for ureteral stent placement in children: a single-center experience

Acta Radiologica ◽

10.1177/02841851211030782 ◽

2021 ◽

pp. 028418512110307

Author(s):

Nevzat Herdem ◽

Guven Kahriman ◽

Aytac Dogan ◽

Cenk Hosgecin ◽

Cuneyt Turan ◽

...

Keyword(s):

Stent Placement ◽

Clinical Success ◽

Demographic Data ◽

Contrast Material ◽

Balloon Dilation ◽

Percutaneous Nephrostomy ◽

Ureteral Stent ◽

Success Rates ◽

Antegrade Approach ◽

Underlying Diseases

Background Although there are many studies on percutaneous nephrostomy in urinary obstruction management in pediatric patients, there is a limited number of studies on percutaneous antegrade ureteral stenting (PAUS) on this issue. Purpose To evaluate the results of fluoroscopy-guided percutaneous antegrade approach for ureteral stent placement through the nephrostomy route in children. Material and Methods Between October 2005 and June 2019, the medical records of children who underwent PAUS through the nephrostomy route were reviewed retrospectively. Demographic data of the patients, technical and clinical success rates, technical details, and complications of the procedure were recorded. Patients were divided and evaluated into groups according to etiology. Categorical data were analyzed by using the Pearson chi-square test. Results In total, 31 patients (19 boys, 12 girls; age range = 2 months–18 years; mean age = 7.4 ± 6.01 years) and 42 procedures were included in the study. The most common underlying diseases were ureteropelvic junction obstruction (16 stents, 38.1%) and vesicoureteral reflux (13 stents, 31%). The technical and clinical success rates were 97.6% and 90%, respectively. Clinical failure (10%) was not related to gender, underlying diseases, and stent size ( P > 0.05). Mean stent dwelling time was 96.43 ± 58.1 days. Complications were urinary tract infection (two procedures), stent migration (two procedures), early occlusion (one procedure), and contrast material leak after balloon dilation (one procedure). The complication rate was 14.6%. No procedure-related death was observed. Conclusion PAUS through the nephrostomy route in children is an effective and reliable method when surgical treatment is not feasible.

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Emerging Antibacterial Coated Dental Implants: A Preventive Measure for Peri-implantitis

World Journal of Dentistry ◽

10.5005/jp-journals-10015-1395 ◽

2016 ◽

Vol 7 (4) ◽

pp. 195-198 ◽

Cited By ~ 2

Author(s):

Varun Yarramaneni ◽

Dhanasekar Balakrishnan ◽

IN Aparna ◽

Akanksha Sachdeva ◽

Nayana Prabhu

Keyword(s):

Dental Implants ◽

Bacterial Adhesion ◽

Antimicrobial Agents ◽

Clinical Success ◽

Preventive Measure ◽

Titanium Implant ◽

Success Rates ◽

Permeable Barrier ◽

Short And Long Term

ABSTRACT Dental implants are the modern marvel and are widely accepted as a reconstructive treatment modality for tooth replacement. In recent times, there has been a marked progress in the clinical success rates of dental implants, but implant failures as a result of infections are continuing at an alarming rate of 8% per year, translating into 1 million failures worldwide. Perimucositis and peri-implantitis are the chief complications reported postimplant surgery that effects its short- and long-term success. Peri-implantitis is characterized by clinical and radiological bone loss around the implant accompanied with an inflammatory reaction of the peri-implant mucosa and is an irreversible condition, whereas perimucositis is a reversible inflammatory change. Implant surfaces provide an ideal substrate for bacterial adhesion forming a biofilm. Biofilm performs vast functions ranging from physical defensive barrier against phagocytic predation to working as a selective permeable barrier. This limits the diffusion of systemic antimicrobial agents that are capable of damaging the bacterial complexes. These rapidly growing bacteria give rise to a chronic infection which is difficult to eradicate by conventional antibiotic therapy. To inhibit peri-implant infections, various functional modifications in the implant surfaces have been suggested. The coatings on the titanium implant are incorporated with disinfectants, antibiotics as well as antimicrobial peptides AMPs. This paper is an attempt to review all the antibiotic coatings available for a titanium implant and discuss their prospective future to prevent peri-implant infections. How to cite this article Yarramaneni V, Aparna IN, Sachdeva A, Balakrishnan D, Prabhu N. Emerging Antibacterial Coated Dental Implants: A Preventive Measure for Peri-implantitis. World J Dent 2016;7(4):195-198.

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Success Rates of Ankaferd Blood Stopper and Ferric Sulfate as Pulpotomy Agents in Primary Molars

International Scholarly Research Notices ◽

10.1155/2014/819605 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Kenan Cantekin ◽

Hüsniye Gümüş

Keyword(s):

Primary Teeth ◽

Clinical Success ◽

Ferric Sulfate ◽

Hemostatic Agent ◽

Radiographic Evaluation ◽

Primary Molars ◽

Success Rates ◽

Radiographic Findings ◽

Ankaferd Blood Stopper

Purpose. The purpose of this study was to evaluate clinical and radiographic findings of treatments using a new hemostatic agent (Ankaferd blood stopper (ABS)), as compared to ferric sulfate (FS), when used as a pulpotomy medicament in primary teeth. Materials and Methods. The primary molars (70) were selected from 35 children aged 4 to 6 years. The teeth were randomized into two groups for pulpotomy with the ABS (n=35) and the FS (n=35) agents. The patients were recalled for clinical and radiographic evaluation at 3-, 6-, 9-, and 12-month intervals. Results. At the 3- and 6-month clinical and radiographic evaluations, total success rates of 100% were observed in each group. In ABS and FS groups, the clinical success rates, however, reduced to 90.9% and 93.9% at the 9-month examination and 84,8% and 90.9% at the 12-month examination, respectively. Similarly, the teeth in the ABS and FS groups had radiographic success rates of 90.9% and 93.9% at 9 months and 84.8% and 87.8% at 12 moths, respectively. Conclusion. Although the findings indicated that ABS agents may be useful agents for pulpotomy medicament, further long-term and comprehensive histological investigations of ABS treatments are necessary.

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Analysis of branch artery orifice angulation: Feasibility of the shelf technique for the treatment of wide-neck bifurcation aneurysms

Interventional Neuroradiology ◽

10.1177/1591019920976252 ◽

2020 ◽

pp. 159101992097625

Author(s):

Mehmet Onay ◽

Ali Burak Binboga ◽

Cetin Murat Altay

Keyword(s):

Excellent Agreement ◽

Clinical Success ◽

Success Rates ◽

Angle Measurements ◽

Long Term Follow Up ◽

Double Stent ◽

Α Angle ◽

Wide Neck

Background and purpose The aim of this study was to investigate the feasibility of the shelf technique by analyzing the angle between the two branch orifices and to present its safety and effectiveness compared with that of the double-stent technique. Materials and methods Patients with complex wide-neck bifurcation aneurysms (WNBAs) who underwent stent-assisted coiling (SAC) were reviewed. The study sample was divided into two groups: single SAC (shelf technique) and double SAC. The angle between the lines connecting the superior and inferior points of each branch orifice (α angle) was measured by two neurointerventional radiologists in both groups. The inter- and intraobserver repeatability and consistency of the α angle were assessed. The effect of the α angle on the feasibility of using the shelf technique to treat WNBA was analyzed. Technical and clinical success rates were investigated by comparing both groups. Results Forty-eight patients (32 shelf technique and 16 double-stent technique) were included. There was excellent agreement between the intra- and interobserver repeatability and consistency of α angle measurements. The α angle was smaller in the shelf technique group than in the double-SAC group (p < 0.001). The technical and clinical success rates of both groups were similar based on long-term follow-up (p > 0.05). Conclusion WNBA treatment with the shelf technique is safe and effective. The α angle is a useful parameter to evaluate the performance of the shelf technique. The shelf technique is more suitable for WNBAs with a narrow α angle.

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Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study

Endoscopy ◽

10.1055/a-1254-3942 ◽

2020 ◽

Author(s):

Thomas M. Runge ◽

Austin L. Chiang ◽

Thomas E. Kowalski ◽

Theodore W. James ◽

Todd H. Baron ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Ultrasound ◽

Clinical Success ◽

Success Rates ◽

Long Term Outcomes ◽

Gastrointestinal Series ◽

Objective Testing ◽

Endoscopic Closure ◽

Retrospective Multicenter Study

Abstract Background Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) is an alternative to enteroscopy- and laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Although short-term results are promising, the long-term outcomes are not known. The aims of this study were: (1) to determine the rates of long-term adverse events after EDGE, with a focus on rates of persistent gastrogastric or jejunogastric fistula; (2) to identify predictors of persistent fistula; (3) to assess the outcomes of endoscopic closure when persistent fistula is encountered. Methods This was a multicenter retrospective study involving 13 centers between February 2015 and March 2019. Adverse events were defined according to the ASGE lexicon. Persistent fistula was defined as an upper gastrointestinal series or esophagogastroduodenoscopy showing evidence of fistula. Results 178 patients (mean age 58 years, 79 % women) underwent EDGE. Technical success was achieved in 98 % of cases (175/178), with a mean procedure time of 92 minutes. Periprocedural adverse events occurred in 28 patients (15.7 %; mild 10.1 %, moderate 3.4 %, severe 2.2 %). The four severe adverse events were managed laparoscopically. Persistent fistula was diagnosed in 10 % of those sent for objective testing (9/90). Following identification of a fistula, 5 /9 patients underwent endoscopic closure procedures, which were successful in all cases. Conclusions The EDGE procedure is associated with high clinical success rates and an acceptable risk profile. Persistent fistulas after lumen-apposing stent removal are uncommon, but objective testing is recommended to identify their presence. When persistent fistulas are identified, endoscopic treatment is warranted, and should be successful in closing the fistula.

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BIODEGRADABLE BILIARY STENTS: A NEW APPROACH FOR THE MANAGEMENT OF HEPATICOJEJUNOSTOMY STRICTURES FOLLOWING BILE DUCT INJURY. PROSPECTIVE STUDY

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201600020012 ◽

2016 ◽

Vol 29 (2) ◽

pp. 112-116 ◽

Cited By ~ 15

Author(s):

Mariano E. GIMÉNEZ ◽

Mariano PALERMO ◽

Eduardo HOUGHTON ◽

Pablo ACQUAFRESCA ◽

Caetano FINGER ◽

...

Keyword(s):

Bile Duct ◽

Prospective Study ◽

Stent Placement ◽

Balloon Dilation ◽

Success Rates ◽

Biliary Stents ◽

Common Procedure ◽

Biodegradable Stents ◽

A Prospective Study

ABSTRACT Background: Once a biliary injury has occurred, repair is done by a hepaticojejunostomy. The most common procedure is to perform a dilatation with balloon with a success of 70 %. Success rates range using biodegradable stents is from 85% to 95%. Biodegradable biliary stents should change the treatment of this complication. Aim: To investigate the use of biodegradable stents in a group of patients with hepaticojejunonostomy strictures. Methods: In a prospective study 16 biodegradable stents were placed in 13 patients with hepaticojejunostomy strictures secondary to bile duct repair of a biliary surgical injury. Average age was 38.7 years (23-67), nine were female and four male. All cases had a percutaneous drainage before at the time of biodegradable stent placement. Results: In one case, temporary haemobilia was present requiring blood transfusion. In another, pain after stent placement required intravenous medication. In the other 11 patients, hospital discharge was the next morning following stent placement. During the patient´s follow-up, none presented symptoms during the first nine months. One patient presented significant alkaline phosphatase elevation and stricture recurrence was confirmed. One case had recurrence of cholangitis 11 months after the stent placement. 84.6% continued asymptomatic with a mean follow-up of 20 months. Conclusion: The placement of biodegradable stents is a safe and feasible technique. Was not observed strictures caused by the stent or its degradation. It could substitute balloon dilation in strictures of hepaticojejunostomy.

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Comparison of facemask therapy effects using skeletal and tooth-borne anchorage:

The Angle Orthodontist ◽

10.2319/032121-219.1 ◽

2021 ◽

Author(s):

Hyeon-Jong Lee ◽

Dong-Soon Choi ◽

Insan Jang ◽

Bong-Kuen Cha

Keyword(s):

Clinical Success ◽

Clinical Success Rate ◽

Skeletal Anchorage ◽

Success Rates ◽

Class Iii ◽

Pubertal Stage ◽

Mandibular Plane ◽

Lateral Cephalograms ◽

Cephalometric Changes

ABSTRACT Objectives To investigate long-term outcomes of dentoskeletal changes induced by facemask therapy using skeletal anchorage in Class III patients and compare them to those of conventional tooth-borne anchorage. Materials and Methods This retrospective study included 20 patients who received facemask (FM) therapy with miniplates as anchorage for maxillary protraction (Miniplate/FM group, 10.6 ± 1.1 years old [mean ± SD]) and 23 patients who were treated with facemask with rapid maxillary expander (RME/FM group, 10.0 ± 1.5 years old [mean ± SD]). Dentoskeletal changes were evaluated using lateral cephalograms at pretreatment (T1), after facemask therapy (T2), and at the post-pubertal stage (T3). Cephalometric changes were compared between groups and clinical success rates at T3 were evaluated. Results SNA and A to N perpendicular to FH increased significantly more in the Miniplate/FM group than in the RME/FM group when comparing short-term effects of facemask therapy (T1–T2). ANB, Wits appraisal, Angle of convexity, mandibular plane angle, and overjet decreased significantly more in the RME/FM group than in the Miniplate/FM group after facemask therapy (T2–T3). A more favorable intermaxillary relationship was observed in the Miniplate/FM group than in the RME/FM group in long-term observations (T1–T3). Clinical success rate at T3 was 95% in the Miniplate/FM group and 85% in the RME/FM group. Conclusions Facemask therapy with skeletal anchorage showed a greater advancement of the maxilla and more favorable stability for correction of Class III malocclusion in the long-term than conventional facemask therapy with tooth-borne anchorage.

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