scholarly journals Innovative method for Amplatzer device implantation in patients with bronchopleural fistulas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jisong Zhang ◽  
Huihui Hu ◽  
Li Xu ◽  
Shan Xu ◽  
Jihong Zhu ◽  
...  

Abstract Background Bronchopleural fistula (BPF) is a relatively rare complication after various types of pulmonary resection. The double-sided mushroom-shaped occluder (Amplatzer device, AD) has been gradually used for BPF blocking due to its reliable blocking effect. We have improved the existing AD implantation methods to facilitate clinical use and named the new approach Sheath-free method (SFM). The aim of the present report was to explore the reliability and advantages of the SFM in AD implantation. Methods We improved the existing implantation methods by abandoning the sheath of the AD and using the working channel of the bronchoscope to directly store or release the AD without general anesthesia, rigid bronchoscopy, fluoroscopy, or bronchography. A total of 6 patients (5 men and 1 woman, aged 66.67 ± 6.19 years [mean ± SD]) had BPF blocking and underwent the SFM in AD implantation. Results AD implantation was successfully performed in all 6 patients with the SFM, 4 persons had a successful closure of the fistula, one person died after few days and one person did not have a successful closure of the fistula. The average duration of operation was 16.17 min (16.17 ± 4.67 min [mean ± SD]). No patients died due to operation complications or BPF recurrence. The average follow-up time was 13.2 months (range 10–17 months). Conclusion We observed that the SFM for AD implantation—with accurate device positioning and a clear field of vision—is efficient and convenient. The AD is effective in BPF blocking, and could contribute to significantly improved symptoms of patients.

2020 ◽  
Author(s):  
Jisong Zhang ◽  
Huihui Hu ◽  
Li Xu ◽  
Shan Xu ◽  
Jihong Zhu ◽  
...  

Abstract Background: Bronchopleural fistula (BPF) is a relatively rare complication after various types of pulmonary resection. The double-sided mushroom-shaped occluder (Amplatzer device, AD) has been gradually used for BPF blocking due to its reliable blocking effect. We have improved the existing AD implantation methods to facilitate clinical use and named the new approach the Sheath-free method (SFM the aim of the present report was to explore the reliability and advantages of SFM for AD implantation.Methods: We improved the existing placement methods by abandoning the sheath of the AD and using the working channel of the bronchoscope to directly store or release the AD without the use of general anesthesia, rigid bronchoscopy, fluoroscopy, or bronchography. A total of 6 patients (5 men and 1 woman, aged 66.67±6.19 years [mean ± SD]) had bronchopleural fistulas sealed using the SFM for AD implantation. Results: Closure was successfully performed in all 6 patients with the SFM, and the average duration of operation was 16.17 minutes (16.17±4.67 minutes [mean ± SD]). Five patients achieved complete occlusion after the operation, and 1 patient who had multiple fistulas did not. No patients died due to operation complications and BPF recurrence. The average follow-up time was 13.2 months (range: 10-17 months).Conclusion: We observed that the SFM for AD implantation—with accurate device positioning and a clear field of vision—is efficient and convenient. The AD is effective in BPF sealing, and patient symptoms significantly improved after sealing.


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yongyong Wu ◽  
Zhongliang He ◽  
Weihua Xu ◽  
Guoxing Chen ◽  
Zhijun Liu ◽  
...  

Abstract Background Bronchopleural fistula (BPF) refers to an abnormal channel between the pleural space and the bronchial tree. It is a potentially fatal postoperative complication after pulmonary resection and a complex challenge for thoracic surgeons because many patients with BPF ultimately develop refractory empyema, which is difficult to manage and has a major impact on quality of life and survival. Therefore, an operative intervention combined with conservative and endoscopic therapies may be required to control infection completely, to occlude BPF, and to obliterate the empyema cavity during treatment periods. Case presentation Two patients who suffered from BPF complicated with chronic empyema after lobectomy were treated in other hospitals for a long time and did not recover. In our department, we performed staged surgery and creatively combined an Amplatzer Septal Occluder (ASO) device (AGA Medical Corp, Golden Valley, MN, USA) with pedicled muscle flap transposition. First, open-window thoracostomy (OWT), or effective drainage, was performed according to the degree of contamination in the empyema cavity after the local infection was controlled. Second, Amplatzer device implantation and pedicled muscle flap transposition was performed at the same time, which achieved the purpose of obliterating the infection, closing the fistula, and tamponading the residual cavity. The patients recovered without complications and were discharged with short hospitalization stays. Conclusions We believe that the union of the Amplatzer device and pedicle muscle flap transposition seems to be a safe and effective treatment for BPF with chronic empyema and can shorten the length of the related hospital stay.


Cephalalgia ◽  
2013 ◽  
Vol 33 (15) ◽  
pp. 1229-1237 ◽  
Author(s):  
Yuji Kato ◽  
Toshiki Kobayashi ◽  
Hirotaka Ishido ◽  
Takeshi Hayashi ◽  
Daisuke Furuya ◽  
...  

Objective The purpose of our study was to evaluate the effect of atrial septal defect (ASD) closure on migraine headache attacks (MHA). Methods A total of 247 patients who underwent percutaneous ASD closure at our facilities were sent a structured questionnaire. We diagnosed MHA according to the criteria of the International Headache Society. Results A total of 207 patients were included in the study. New-onset MHA occurred in 23 patients and persisted in 15 at a mean follow-up of 45 months. Of the 29 patients who had MHA prior to ASD closure, 11 reported exacerbation of MHA, 11 reported no change and seven reported improvement within three months after ASD closure. Compared with the patients who had no MHA, patients with de novo MHA were younger and patients with MHA improvement tended to be older. Switching from aspirin to ticlopidine or clopidogrel rapidly aborted frequent MHA in nine patients who had severe symptoms after ASD closure. Conclusions These results indicate that Amplatzer device implantation can act as a permanent trigger of MHA in not a few patients, and that age may be an important predictive factor of the influence of ASD closure on MHA.


2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Raquel Rosa ◽  
Dionísio Maia ◽  
Nídia Caires ◽  
Rita Gerardo ◽  
Inês Gonçalves ◽  
...  

Pleural involvement is the most frequent thoracic complication of rheumatoid arthritis (RA), usually occurring in patients with known RA. Typical rheumatoid pleural effusion is an exudate characterized by low pH and glucose levels and high LDH activity. Rarely, it has features of pseudochylothorax. Other uncommon complications are pneumothorax, hydropneumothorax, empyema, and bronchopleural fistula. The case of a 51-year-old man with a spontaneous, small, and asymptomatic hydropneumothorax with features of pseudochylothorax is presented. After careful clinical and laboratory evaluation, he was diagnosed with rheumatoid arthritis, and we admitted that the pleural changes were secondary to the connective tissue disease. He started immunosuppressive treatment and maintained stability during follow-up, without need of specific pleural treatment. We hypothesized that the pleural nodule found on the chest computed tomography scan was related with the simultaneous occurrence of pleural effusion and pneumothorax. This is a rare presentation and complication of RA, highlighting the utility of a comprehensive clinical and laboratory evaluation and focusing on the importance of pleural rheumatoid nodules in the pathogenesis of RA pleural disease.


Author(s):  
Yimin Xie ◽  
Jinbo Ning

Abstract Background/Purpose The Nuss procedure is the most common surgical repair for pectus excavatum (PE). Surgical steel wires are used in some modifications of the Nuss procedure to attach one or both ends of a support bar to the ribs. During follow-up, wire breakage was found in some cases. Patients with wire breakage may undergo prolonged bar removal surgery and may be exposed to excessive radiation.In this study, we had a series of patients who received polydioxanone suture (PDS) fixations instead of steel wires. This retrospective study was conducted to explore the differences between these two fixation materials in the incidence of related complications and efficacies. Furthermore, we attempted to observe whether the two materials lead to similar surgical efficacy in the Nuss procedure, whether they have divergent effects on the bar removal surgery, and whether PDS can reduce the risks due to steel wire breakage as expected. Methods We retrospectively studied PDS and surgical steel wires as fixation materials for the Nuss procedure in children with congenital PE and reviewed the outcomes and complications. A total of 75 children who had undergone Nuss procedure repairs and bar removals from January 2013 to December 2019 were recruited to participate in this study. They were divided into three groups: the PDS group, the unbroken wire (UBW) group, and the broken wire (BW) group, according to the fixation materials and whether the wires had broken or not. Moreover, we selected the duration of operation (DO), intraoperative blood loss (BL), bar displacement (BD), postoperative pain score (PPS), and incision infection as the risk indicators and the postrepair Haller index (HI) as the effectiveness indicator. These indicators were statistically compared to determine whether there were differences among the three groups. Results One BD occurred in the PDS and BW groups while none took place in the UBW group. No incision infection was found in any of the groups. The PDS group had the shortest DO, while the DO in the UBW group was shorter than that in the BW group (p < 0.05). BL in the PDS group was less than that in the other two groups (p < 0.05). Additionally, no difference was observed in BL between the BW and UBW groups (p > 0.05). The PPS of the PDS group was less than that of the BW group (p < 0.05), whereas no differences were found between the other two groups. No statistical difference emerged in HI among the groups (p > 0.05). Conclusion PDS fixation results in a similar repair outcome and shows certain advantages in the DO, BL, and PPS; also, PDSs are safe and effective in the Nuss procedure. Level of evidence Level III.


2021 ◽  
Vol 13 (1) ◽  
pp. 233-238
Author(s):  
Seyed Mohammad Mousavi Mirzaei ◽  
Zahra Ahmadi

Drug-induced aseptic meningitis (DIAM) is a rare complication of certain drugs, most commonly reported with ibuprofen use. The present study reports on a male adolescent with intracranial hypertension and visual impairment accompanied by DIAM. We present a 16-year-old male patient who after ibuprofen consumption displayed headache, fever, photophobia, and blurred vision following heavy exercises. Examination of cerebrospinal fluid showed a mononuclear pleocytosis and an increase in protein concentration. Other examinations had normal results. The development of common clinical signs following ibuprofen use reflected DIAM. The patient’s vision was found to improve with supportive care and stopping of the drug during follow-up. Given the widespread use of nonsteroidal anti-inflammatory drugs and the fact that these drugs are the most common cause of DIAM, the probability of occurrence of this event should be always kept in mind, and screening for autoimmune diseases in these patients is of great importance.


2021 ◽  
pp. 112067212199575
Author(s):  
Lei Zhang ◽  
Mingyu Ren ◽  
Yuqing Yan ◽  
Wenjuan Zhai ◽  
Lihong Yang ◽  
...  

Purpose: To describe our experience with a modified frontal muscle advancement flap to treat patients with severe congenital ptosis. Methods: Analysis of the clinical charts of 154 patients who underwent a modified frontal muscle advancement flap. The FM was exposed by a crease incision. The FM flap was created by deep dissection between the orbicularis muscle and orbital septum from the skin crease incision to the supraorbital margin and subcutaneous dissection from the inferior margin of the eyebrow to 0.5 cm above the eyebrow. No vertical incision was made on the FM flap to ensure an intact flap wide enough to cover the entire upper tarsal plate. Contour, symmetry of height, marginal reflex distance (MRD1), and complications were assessed. Mean follow-up was 10 months. Results: The mean patient age was 7.6 ± 5.6 (range, 2–18) years. The mean MRD1 was 3.2 ± 1.3 mm after the operation. All bilateral cases achieved symmetry and optimal lid contour; 17 unilateral cases were under corrected, with a success rate of 89.0%. Complications such as entropion, exposure keratitis, FM paralysis, frontal hypoesthesia, severe haematoma, and entropion were not observed in our series. Conclusion: A modified frontal muscle advancement flap produced a high success rate with a clear field of vision, mild trauma, and few complications. This technique is relatively simple and should be considered for correcting severe congenital ptosis. Date of registration: 29-03-2020 Trial registration number: ChiCTR2000031364 Registration site: http://www.chictr.org/


Perfusion ◽  
2021 ◽  
pp. 026765912110248
Author(s):  
Gregory Reid ◽  
Constantin Mork ◽  
Brigita Gahl ◽  
Christian Appenzeller-Herzog ◽  
Ludwig K von Segesser ◽  
...  

Objectives: The main aim was a systematic evaluation of the current evidence on outcomes for patients undergoing right ventricular assist device (RVAD) implantation following left ventricular assist device (LVAD) implantation. Methods: This systematic review was registered on PROSPERO (CRD42019130131). Reports evaluating in-hospital as well as follow-up outcome in LVAD and LVAD/RVAD implantation were identified through Ovid Medline, Web of Science and EMBASE. The primary endpoint was mortality at the hospital stay and at follow-up. Pooled incidence of defined endpoints was calculated by using random effects models. Results: A total of 35 retrospective studies that included 3260 patients were analyzed. 30 days mortality was in favour of isolated LVAD implantation 6.74% (1.98–11.5%) versus 31.9% (19.78–44.02%) p = 0.001 in LVAD with temporary need for RVAD. During the hospital stay the incidence of major bleeding was 18.7% (18.2–19.4%) versus 40.0% (36.3–48.8%) and stroke rate was 5.6% (5.4–5.8%) versus 20.9% (16.8–28.3%) and was in favour of isolated LVAD implantation. Mortality reported at short-term as well at long-term was 19.66% (CI 15.73–23.59%) and 33.90% (CI 8.84–59.96%) in LVAD respectively versus 45.35% (CI 35.31–55.4%) p ⩽ 0.001 and 48.23% (CI 16.01–80.45%) p = 0.686 in LVAD/RVAD group respectively. Conclusion: Implantation of a temporary RVAD is allied with a worse outcome during the primary hospitalization and at follow-up. Compared to isolated LVAD support, biventricular mechanical circulatory support leads to an elevated mortality and higher incidence of adverse events such as bleeding and stroke.


2020 ◽  
Author(s):  
Hadi Rokni Yazdi ◽  
Niloofar Ayoobi Yazdi ◽  
Mohammad Mehdi Mehrabinejad ◽  
Habibollah Dashti ◽  
Morteza Ghassed ◽  
...  

2019 ◽  
Vol 47 (6) ◽  
pp. 2702-2708
Author(s):  
Chi-Chang Li ◽  
Wei Zhang ◽  
Xing-Jie Wu ◽  
Yang Bu ◽  
Zhi-Peng Zheng

Central vein perforation associated with a mediastinal lesion is a rare complication of catheterization. A 50-year-old woman was diagnosed with chronic kidney disease and required hemodialysis treatment. The patient developed central vein injury during attempted placement of a double-channel catheter. A computed tomographic scan and venography showed that the catheter had punctured the mediastinum from the central vein. After comprehensive assessment and multidisciplinary consultation, percutaneous catheter thrombin injection with follow-up balloon dilatation under fluoroscopy guidance successfully fixed the perforation. We summarize the therapeutic strategy of this complication and other treatment options, and discuss the related literature of central vein injury.


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