scholarly journals Endoscopic ultrasound-guided pancreatic pseudocyst drainage with lumen-apposing metal stents or plastic double-pigtail stents: A multifactorial analysis

2017 ◽  
Vol 5 (4) ◽  
pp. 213-219 ◽  
Author(s):  
Nan Ge ◽  
Jinlong Hu ◽  
Siyu Sun ◽  
Enqiang Linghu ◽  
Zhendong Jin ◽  
...  

Abstract Objective To compare the efficiency of plastic and metal stents for symptomatic pancreatic pseudocyst (PP) drainage and analyze other main associated factors that affect the outcome of drainage therapy. Method Rates of technical and clinical success, procedure-related side effects (hemorrhage, stent migration, and cyst rupture), reinterventions, and duration of hospital stay. Results There were 52 patients, 40 patients underwent plastic stent placement and 12 patients underwent lumen-apposing metal stent (LAMS) placement. The total rate of technical success was 100%. The total rate of clinical success was 100%. The total rate of adverse events was 7.7% (4/52). On multiple logistic regression analysis, the use of plastic stents (P < 0.05, Exp B = 12.168) and the presence of a large cyst (P < 0.05, Exp B = 1.036) were shown to significantly increase the risk of reintervention. On multivariate linear regression analysis, etiology of pseudocyst (P < 0.05, B = −8.427, −9.785, −5.514) was associated with prolonged hospital stent, while stent type was not shown be a factor (P > 0.05). Conclusion Both plastic and LAMSs are proven to be highly efficient in PP drainage. The LAMS is superior in preventing complications such as migration and cyst leakage and reducing the rate of reintervention.

Biomechanics ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 190-201
Author(s):  
Pathmanathan Cinthuja ◽  
Graham Arnold ◽  
Rami J. Abboud ◽  
Weijie Wang

There is a lack of evidence about the ways in which balance ability influences the kinematic and kinetic parameters and muscle activities during gait among healthy individuals. The hypothesis is that balance ability would be associated with the lower limb kinematics, kinetics and muscle activities during gait. Twenty-nine healthy volunteers (Age 32.8 ± 9.1; 18 males and 11 females) performed a Star Excursion Balance test to measure their dynamic balance and walked for at least three trials in order to obtain a good quality of data. A Vicon® 3D motion capture system and AMTI® force plates were used for the collection of the movement data. The selected muscle activities were recorded using Delsys® Electromyography (EMG). The EMG activities were compared using the maximum values and root mean squared (RMS) values within the participants. The joint angle, moment, force and power were calculated using a Vicon Plug-in-Gait model. Descriptive analysis, correlation analysis and multivariate linear regression analysis were performed using SPSS version 23. In the muscle activities, positive linear correlations were found between the walking and balance test in all muscles, e.g., in the multifidus (RMS) (r = 0.800 p < 0.0001), vastus lateralis (RMS) (r = 0.639, p < 0.0001) and tibialis anterior (RMS) (r = 0.539, p < 0.0001). The regression analysis models showed that there was a strong association between balance ability (i.e., reaching distance) and the lower limb muscle activities (i.e., vastus medialis–RMS) (R = 0.885, p < 0.0001), and also between balance ability (i.e., reaching distance) and the lower limb kinematics and kinetics during gait (R = 0.906, p < 0.0001). In conclusion, the results showed that vastus medialis (RMS) muscle activity mainly contributes to balance ability, and that balance ability influences the lower limb kinetics and kinematics during gait.


2021 ◽  
Vol 09 (06) ◽  
pp. E888-E894
Author(s):  
Nichol S. Martinez ◽  
Sumant Inamdar ◽  
Sheila N. Firoozan ◽  
Stephanie Izard ◽  
Calvin Lee ◽  
...  

Abstract Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.


2021 ◽  
pp. 039156032110637
Author(s):  
Valerio Di Paola ◽  
Angelo Totaro ◽  
Giacomo Avesani ◽  
Benedetta Gui ◽  
Andrea Boni ◽  
...  

Purpose: Our aim was to explore the relation between FA and ADC, number and length of the periprostatic neurovascular fibers (PNF) by means of 1.5 T Diffusion Tensor Imaging (DTI) imaging through a multivariate linear regression analysis model. Methods: For this retrospective study, 56 patients (mean age 63.5 years), who underwent 1.5-T prostate MRI, including DTI, were enrolled between October 2014 and December 2018. Multivariate regression analysis was performed to evaluate the statistically significant correlation between FA values (dependent variable) and ADC, the number and the length of PNF (independent variables), if p-value <0.05. A value of 0.5 indicated poor agreement; 0.5–0.75, moderate agreement; 0.75–0.9, good agreement; 0.61–0.80, good agreement; and 0.9–1.00, excellent agreement. Results: The overall fit of the multivariate regression model was excellent, with R2 value of 0.9445 ( R2 adjusted 0.9412; p < 0.0001). Multivariate linear regression analysis showed a statistically significant correlation ( p < 0.05) for all the three independent variables. The r partial value was −0.9612 for ADC values ( p < 0.0001), suggesting a strong negative correlation, 0.4317 for the number of fiber tracts ( p < 0.001), suggesting a moderate positive correlation, and −0.306 for the length of the fiber tracts ( p < 0.05), suggesting a weak negative correlation. Conclusions: Our multivariate linear regression model has demonstrated a statistically significant correlation between FA values of PNF with other DTI parameters, in particular with ADC.


2014 ◽  
Vol 51 (3) ◽  
pp. 240-249 ◽  
Author(s):  
Lucas Souto NACIF ◽  
Wanderley Marques BERNARDO ◽  
Luca BERNARDO ◽  
Wellington ANDRAUS ◽  
Lucas TORRES ◽  
...  

Context Biliary strictures after liver transplantation are recognized as its Achilles’ heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results. Objectives The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation. Methods A systematic review of the literature was performed on the management of anastomotic biliary strictures post- orthotopic liver transplantation. The Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were electronically searched from January 1966 to April 2013. Results No well-designed randomized controlled trial was found. Most studies were retrospective or prospective comparisons in design. One study (86 patients) compared the endoscopic and the percutaneous accesses. The sustained clinical success rates were similar but the treatment duration was longer in the percutaneous group access. Two studies (56 patients) compared balloon dilation with balloon dilation and multiple plastic stents. There were no differences concerning sustained clinical success and complication rates. Conclusions Balloon dilation is as effective as balloon dilation plus multiple plastic stenting for the resolution of the anastomotic biliary strictures. Well-designed randomized trials are still needed to compare balloon dilation versus multiple plastic stenting versus metallic stenting.


2020 ◽  
Vol 45 (3) ◽  
pp. 442-454 ◽  
Author(s):  
Sang Hyuk Kim ◽  
Hyang Ki Min ◽  
Sung Woo Lee

Introduction: Thyroid function is evaluated by thyroid stimulating hormone (TSH) and free thyroxine (fT4). Although many studies have indicated an intimate relationship between thyroid hormones and kidney functions, reports about the simultaneous evaluation of TSH and fT4 are rare. Objective: We aimed to analyze the association between TSH and kidney function, with emphasis on a potential nonlinear relationship, and identify an independent relationship between fT4 and kidney function. Methods: We reviewed the data of 7,061 subjects in the Korea National Health and Nutrition Examination Surveys who were randomly subsampled for thyroid function evaluation between 2013 and 2015. A total of 5,578 subjects were included in the final analysis, after excluding people <18 years old, and those with a short fasting time, abnormal fT4 levels, and thyroid disease or related medications. Creatinine-based estimated glomerular filtration rate (eGFR) was used to define kidney function. Results: A 1 mmol/L increase of logarithmic TSH was associated with decreased eGFR (β: –1.8; 95% CI –2.3 to –1.2; p < 0.001), according to multivariate linear regression analysis. On the multivariate generalized additive model plot, TSH demonstrated an L-shaped relationship with eGFR, showing a steeper slope for 0–4 mIU/L of TSH. A 1 µg/dL increase of fT4 was also associated with decreased eGFR (β: –7.0; 95% CI –0.94 to –4.7; p < 0.001) on the multivariate linear regression analysis; this association was reversed after adjusting for age. On the mediation analysis, the indirect effect via age and direct effect per 1 µg/dL increase of fT4 on eGFR was 9.9 (8.1 to 11.7, p < 0.001) and –7.1 (–9.3 to –4.8, p < 0.001), respectively. Conclusions: Increased TSH was associated with decreased eGFR, particularly in the reference range. The direct effect of increased fT4 was decreased eGFR, which may be affected indirectly by age.


2017 ◽  
Vol 141 (6) ◽  
pp. 846-850 ◽  
Author(s):  
You-Fan Peng ◽  
Yi-Bin Deng

Context.— Bilirubin has strong anti-inflammatory and antioxidative stress action. Progression of inflammation involving arteries is a crucial activator in pathogenesis of Takayasu arteritis (TA). Objective.— To investigate the relationship between serum bilirubin and TA. Design.— Our study involved 115 consecutive TA patients. Patients with active-phase disease were followed and received prednisone therapy. Results.— Lower concentrations of serum bilirubin were detected in TA patients compared with healthy subjects (0.6 ± 0.31 versus 0.7 ± 0.22 mg/dL, P = .02). Serum bilirubin concentrations in active TA patients were lower than those in inactive patients (0.5 ± 0.20 versus 0.8 ± 0.32 mg/dL, P &lt; .001). In all patients with TA, serum bilirubin correlated positively with total protein (r = 0.193, P = .04) and negatively with C-reactive protein and erythrocyte sedimentation rate (r = −0.213, P = .03, and r = −0.532, P &lt; .001, respectively). Multiple logistic regression analysis showed that each decrease of 1 mg/dL in serum bilirubin was associated with a 1.10 times increase in the odds for TA compared with the controls (odds ratio = 0.913, 95% CI, 0.856–0.974; P = .006). Serum bilirubin was correlated with erythrocyte sedimentation rate (β = −0.170, P &lt; .001) in multiple linear regression analysis. The area under the curve for serum bilirubin in predicting active TA patients was 0.802. Serum bilirubin levels were found to be significantly increased after prednisone treatment (0.5 ± 0.20 versus 0.7 ± 0.15 mg/dL, P = .002). Conclusions.— Lower serum bilirubin levels are associated with TA, and serum bilirubin may be influenced by prednisone therapy in active TA patients. Serum bilirubin levels in TA patients correlate negatively with erythrocyte sedimentation rate.


2020 ◽  
Vol 8 (1) ◽  
pp. e001153
Author(s):  
Leay Kiaw Er ◽  
Meng-Chun Lin ◽  
Yao-Chou Tsai ◽  
Jong-Kai Hsiao ◽  
Chung-Yi Yang ◽  
...  

IntroductionPrimary aldosteronism (PA) is a common form of secondary hypertension that has significant cardiovascular events and increased prevalence of metabolic syndrome and diabetics. Although plasma aldosterone concentration is positively correlated with visceral fat area (VFA) in non-PA individuals, the role of visceral adiposity associated with clinical success after surgery is not known.Research design and methodsWe analyzed patients who underwent adrenalectomy for aldosterone-producing adenoma (APA) at the Taiwan PA Investigator group. VFA was calculated from the abdominal CT scan at APA diagnosis, and all patients received adrenalectomy.ResultsThe study involved 100 consecutive patients with APA (42 males; mean age 49.3 years) matched with 41 essential hypertension (EH) patients. Patients with APA had smaller VFA (p=0.010) than their EH counterparts. Multiple linear regression analysis revealed that the duration of hypertension (p=0.007), but not plasma aldosterone, was negatively correlated with VFA in patients with APA. Logistic regression analysis showed that log VFA (OR=0.065, p<0.001) and duration of hypertension before PA diagnosis (OR=0.919, p=0.011) can predict complete clinical success after adrenalectomy. Multifactor-adjusted generalized additive model demonstrated that log VFA <9.2 was associated with complete cure of hypertension. Furthermore, VFA was increased at 6 months after adrenalectomy (p=0.045).ConclusionsPatients with APA had smaller VFA than their EH counterparts, and VFA increased after adrenalectomy. Clinical complete cure of hypertension after surgery was associated with smaller VFA and shorter duration of hypertension at PA diagnosis, suggesting a potential interplay of visceral adiposity and aldosterone of the patients with APA.


1986 ◽  
Vol 32 (7) ◽  
pp. 1279-1284 ◽  
Author(s):  
J Valsamis ◽  
J Van Peborgh ◽  
H Brauman

Abstract We evaluated the relative contribution to the diagnosis of hyperparathyroid disease from current laboratory indices of parathyroid function--plasma calcium (I), phosphate (II), carboxy-terminal (III) and predominantly amino-terminal (IV) radioimmunoassays of parathyrin, the urinary excretion ratios of cyclic adenosine monophosphate (cAMP) to creatinine (V) or to glomerular filtrate (VI), and the ratio of the nephrogenous fraction of cAMP to glomerular filtrate (VII)--in 224 subjects: 40 with surgically proven hyperparathyroid disease, the others normoparathyroid. The decreasing order of sensitivity was I greater than VI greater than VII greater than V greater than III greater than IV greater than II; all these indices differed significantly between normoparathyroid and hyperparathyroid patients. The decreasing order of specificity was VII, III greater than I greater than IV greater than V, II greater than VI. Discriminant multivariate linear regression analysis was performed in a subset of 58 subjects (17 hyper- and 41 normoparathyroid) from the population studied here, chosen because all of the laboratory indices were determined for each subject. The classification accuracy was 98.3% for combining I, VII, and III (r = 0.908), or I and V (r = 0.893), or I and VII (r = 0.889). The other variables did not add to the precision of classification.


Sign in / Sign up

Export Citation Format

Share Document