scholarly journals Utility of the Novel SpyGlassTM DS II System and Laser Lithotripsy for Choledocholithiasis in Pregnancy

2021 ◽  
pp. 1-6
Author(s):  
Ankit Dalal ◽  
Gaurav Patil ◽  
Nagesh Kamat ◽  
Rajen Daftary ◽  
Sehajad Vora ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Laser Lithotripsy ◽  
Therapeutic Modality ◽  
The Novel ◽  
Care Needs ◽  
Endoscopic Retrograde ◽  
Adequate Care ◽  
Procedural Complications ◽  
Balloon Extraction ◽  
Spyglass Ds

<b><i>Background and Aim:</i></b> Endoscopic retrograde cholangiopancreatography (ERCP) is considered a safe therapeutic modality even in pregnant women; however, adequate care needs to be taken. The utility of the SpyGlass<sup>TM</sup> DS II system in choledocholithiasis among pregnant women is unexplored. <b><i>Methods:</i></b> We retrospectively analyzed patients who underwent<b><i></i></b>ERCP for choledocholithiasis in the absence of fluoroscopy using the SpyGlass DS II system from October 2019 to November 2020. Depending on the size and location of the stones, we used laser lithotripsy (LL) for large impacted stones, the balloon extraction technique for multiple stones, and the SpyGlass retrieval basket for single solitary stones. <b><i>Results:</i></b> A total of 10 (100% female) patients with a mean (±SD) age of 29.5 (±2.5) years underwent ERCP. Abdominal pain was the commonest presenting symptom in all patients. Four (40%) patients had cholangitis and 3 (30%) had pancreatitis. The majority of the patients (9; 90%) were in the second trimester. MRCP was the commonest radiological entity, used in 9 (90%) patients. ERCP was technically successful and the stones were removed from all of the patients in a mean (±SD) time of 30 (±3.5) min. LL was used successfully in 4 (40%) patients, balloon extraction in 3 (30%) patients, and the SpyGlass retrieval basket in 3 (30%) patients. There were no pre- or post-procedural complications. All of the patients had an uneventful childbirth, after which they underwent cholecystectomy and subsequent stent removal 2 weeks later. <b><i>Conclusions:</i></b> Use of the SpyGlass DS II system and LL during ERCP appears safe and effective for the treatment of choledocholithiasis among pregnant women.

scholarly journals Percutaneous Transhepatic Laser Lithotripsy for Biliary Stones in Patients with Altered Biliary Anatomy

2021 ◽  
Author(s):  
Jacob Indu ◽  
Vikrama Amitha Kheda ◽  
Deepak Bolbandi ◽  
Sanjay Govil ◽  
Ravisankar Bhat
Keyword(s):  
Bile Duct ◽  
Current Treatment ◽  
Laser Lithotripsy ◽  
Safe Procedure ◽  
Bile Duct Stones ◽  
Biliary Stones ◽  
Endoscopic Retrograde ◽  
Difficult Cases ◽  
Transhepatic Biliary Drainage ◽  
Variant Anatomy

AbstractEndoscopic retrograde cholangiopancreatography (ERCP) is the current treatment of choice in bile duct stones. Several factors such as variant anatomy of ampulla and surgical procedures like hepaticojejunostomy limit the success of ERCP in treating bile duct stones. Percutaneous transhepatic laser lithotripsy using interventional radiologic and endourologic techniques, which is uncommon, is a reasonable treatment option in such difficult cases. It is a minimally invasive, safe procedure accompanied by a high success rate, minimal morbidity, and a short hospital stay. We report our technique and experience in a series of three patients who underwent percutaneous transhepatic biliary drainage (PTBD) followed by percutaneous transhepatic laser lithotripsy in an attempt to avoid open surgery when ERCP was technically difficult.

scholarly journals DIAGNOSTIC FEATURES OF COMPLICATED CHOLELITHIASIS IN PREGNANT WOMEN

2019 ◽  
Vol 26 (1) ◽  
pp. 168-174
Author(s):  
Karen D. Antinyan ◽  
Evgenii S. Babenko ◽  
Vladimir M. Durleshter
Keyword(s):  
Pregnant Women ◽  
Conflict Of Interest ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Abdominal Ultrasound ◽  
Perinatal Complications ◽  
Laparoscopic Ultrasonography ◽  
Endoscopic Retrograde ◽  
Diagnostic Features ◽  
Ultrasound Diagnostics ◽  
Long Time

The aimis to describe modern approaches used in the diagnostics of cholelithiasis in pregnant women.Results.Cholelithiasis diagnostics in pregnant women is a rather difficult task, frequently taking a long time and significantly worsening the prognosis for both the mother and the fetus. Abdominal ultrasound is the “gold standard” for the diagnosis of cholelithiasis in pregnant women, allowing the diagnosis to be clarified and the treatment tactics to be adjusted. The possibilities of such modern methods as endoscopic ultrasound diagnostics, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and laparoscopic ultrasonography used in difficult diagnostic cases are presented.Conclusion.The use of a maximal range of diagnostic studies in pregnant women makes it possible to establish the diagnosis as soon as possible and to reduce the frequency of surgical and related perinatal complications. As a result, the prolongation of pregnancy and a decrease in maternal and intrauterine mortality can be achieved.Conflict of interest: the authors declare no conflict of interest.

Dilation catheter-guided mini-forceps biopsy improves the diagnostic accuracy of malignant biliary strictures

Endoscopy ◽  
2018 ◽  
Vol 50 (08) ◽  
pp. 809-812 ◽  
Author(s):  
Ying-Chun Ren ◽  
Chun-Lan Huang ◽  
Su-Min Chen ◽  
Qiu-Yan Zhao ◽  
Xin-Jian Wan ◽  
...  
Keyword(s):  
Biliary Stricture ◽  
The Novel ◽  
Biliary Strictures ◽  
Brush Cytology ◽  
Accuracy Rate ◽  
Endoscopic Retrograde ◽  
Tissue Samples ◽  
Forceps Biopsy ◽  
Positive Rate ◽  
Malignant Biliary Stricture

Abstract Background Tissue sampling for biliary stricture is important for differential diagnosis and further treatment. The aim of this study was to assess a novel dilation catheter-guided mini-forceps biopsy (DCMB) method in the diagnosis of malignant biliary strictures. Methods 42 patients with malignant biliary stricture who underwent both brush cytology and DCMB during endoscopic retrograde cholangiopancreatography between October 2014 and November 2015 were retrospectively included. During DCMB, the mini biopsy forceps was introduced into the biliary stricture through the dilation catheter, and then the position and direction of the forceps were adjusted to obtain tissue samples. Results The positive rate of DCMB was significantly higher than that of brush cytology (81.0 % [34/42] vs. 38.1 % [16/42]; P < 0.001). No severe complications occurred; three patients (7.1 %) experienced mild procedure-related acute pancreatitis. Conclusions The novel DCMB technique was a practical, safe, efficient, and low-costing method for diagnosing malignant biliary stricture with a high accuracy rate.

scholarly journals Care needs of pregnant women with a private health insurance: a comprehensive social phenomenology approach

2007 ◽  
Vol 15 (5) ◽  
pp. 914-921 ◽  
Author(s):  
Miriam Aparecida Barbosa Merighi ◽  
Renata Tavares Franco Rodrigues ◽  
Selisvane Ribeiro da Fonseca Domingos
Keyword(s):  
Qualitative Research ◽  
Health Professional ◽  
Pregnant Women ◽  
Private Health Insurance ◽  
Health Plans ◽  
Private Institutions ◽  
Inclusion Criteria ◽  
Care Needs ◽  
Special Situation ◽  
Social Phenomenology

This study aimed to understand the meanings women who possess health plans hold regarding pregnancy and get to know their care needs in this phase of the vital cycle. It was based on the qualitative research of phenomenological inspiration. The discourses analysis was based on the sociologist and fenomenologist Alfred Schutz's thought. Having health plans and being attended in private institutions were defined as inclusion criteria. The following categories emerged from the discourses: having new responsibilities; experiencing a special situation; experiencing insecurity, anxiety and expectations; feeling limited; trusting the health professional. It was found, through the analysis of categories, that the experience of the pregnant women who participated in the study is similar to those who do not possess health plans. However, in the category "trusting the health professional" it was possible to perceive the importance of possessing health plan, which allows the intersubjectivity between the woman and the health professional.

scholarly journals Crystal Structure and Characterization of Human Heavy-Chain Only Antibodies Reveals a Novel, Stable Dimeric Structure Similar to Monoclonal Antibodies

Antibodies ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. 66
Author(s):  
Carl Mieczkowski ◽  
Soheila Bahmanjah ◽  
Yao Yu ◽  
Jeanne Baker ◽  
Gopalan Raghunathan ◽  
...  
Keyword(s):  
Crystal Structure ◽  
Heavy Chain ◽  
Bond Formation ◽  
Therapeutic Modality ◽  
Light Chains ◽  
The Novel ◽  
Mechanism Of Formation ◽  
Disulfide Formation ◽  
Target Binding

We report the novel crystal structure and characterization of symmetrical, homodimeric humanized heavy-chain-only antibodies or dimers (HC2s). HC2s were found to be significantly coexpressed and secreted along with mAbs from transient CHO HC/LC cotransfection, resulting in an unacceptable mAb developability attribute. Expression of full-length HC2s in the absence of LC followed by purification resulted in HC2s with high purity and thermal stability similar to conventional mAbs. The VH and CH1 portion of the heavy chain (or Fd) was also efficiently expressed and yielded a stable, covalent, and reducible dimer (Fd2). Mutagenesis of all heavy chain cysteines involved in disulfide bond formation revealed that Fd2 intermolecular disulfide formation was similar to Fabs and elucidated requirements for Fd2 folding and expression. For one HC2, we solved the crystal structure of the Fd2 domain to 2.9 Å, revealing a highly symmetrical homodimer that is structurally similar to Fabs and is mediated by conserved (CH1) and variable (VH) contacts with all CDRs positioned outward for target binding. Interfacial dimer contacts revealed by the crystal structure were mutated for two HC2s and were found to dramatically affect HC2 formation while maintaining mAb bioactivity, offering a potential means to modulate novel HC2 formation through engineering. These findings indicate that human heavy-chain dimers can be secreted efficiently in the absence of light chains, may show good physicochemical properties and stability, are structurally similar to Fabs, offer insights into their mechanism of formation, and may be amenable as a novel therapeutic modality.

scholarly journals AYURVEDA FOR PREGNANT WOMEN DURING COVID-19 ERA – A REVIEW

2021 ◽  
pp. 221-223
Author(s):  
Dr. Supriya B ◽  
Dr. Savita S. Patil
Keyword(s):  
Pregnant Women ◽  
Specific Activity ◽  
Respiratory Infections ◽  
Virus Disease ◽  
The Body ◽  
Safe Motherhood ◽  
Mental Wellbeing ◽  
The Novel ◽  
Dietary Regimen ◽  
Increased Risk

The Novel corona virus disease (COVID-19) is highly communicable viral infection caused by SARS-CoV 2. WHO mentions that pregnant women or recently pregnant women seem to have an increased risk of developing severe COVID-19. Due to physiological changes in the body and immune system, pregnant women can be badly affected by respiratory infections. It is therefore important that they take precautions to protect themselves against COVID-19. Overall, 10% of pregnant women suffered from COVID-19. Ayurveda mentions Garbhini paricharya (antenatal care of the pregnant) which recommends ahara (dietary regimen) and vihara (specific activity for physical, emotional and mental wellbeing) that is required for the safe motherhood and healthy progeny. Here is an attempt to understand how Garbhini paricharya helps in preventing corona. KEY WORDS: Garbhini paricharya, COVID-19, Pregnancy

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