scholarly journals Controversial issues of biliary stenting in patients with proximal biliary obstruction

2021 ◽  
Vol 26 (3) ◽  
pp. 79-88
Author(s):  
J. V. Kulezneva ◽  
O. V. Melekhina ◽  
A. B. Musatov ◽  
M. G. Efanov ◽  
V. V. Tsvirkun ◽  
...  
Keyword(s):  
Biliary Obstruction ◽  
Radical Surgery ◽  
Expert Consensus ◽  
Controversial Issues ◽  
Biliary Stenting ◽  
Biliary Decompression ◽  
Consensus Conferences ◽  
Hilar Carcinoma ◽  
Selection Of

The management of biliary decompression in malignant hilar carcinoma remains controversial. This review shows the most relevant aspects of endoprosthetics for proximal biliary obstruction, including necessity of stenting and morphological verification before radical surgery, selection of approach to drain etc. The main contradictions and ways to solve them are presented in this article, based on evidence researches, international and expert consensus conferences.

Selection of Candidates for Lung Transplantation and Controversial Issues

2018 ◽  
Vol 39 (02) ◽  
pp. 117-125 ◽  
Author(s):  
Christian Merlo ◽  
Jonathan Orens
Keyword(s):  
Lung Transplantation ◽  
Lung Disease ◽  
Significant Loss ◽  
Candidate Selection ◽  
Therapeutic Interventions ◽  
Controversial Issues ◽  
Successful Transplantation ◽  
Transplant Candidates ◽  
End Stage ◽  
Selection Of

AbstractLung transplantation is a widely accepted treatment to manage the advanced stages of many lung diseases that have failed to respond to all other therapeutic interventions. There have been ever-expanding indications for lung transplantation as a treatment for lung disease. The International Society for Heart and Lung Transplantation (ISHLT) updated guidelines for candidate selection in 2014. This document was published to serve as a guide in selecting appropriate candidates for lung transplantation. Ideal candidates for lung transplantation are those with near-end stage disease, limited life expectancy due to their lung disease, and who experience significant loss in quality of life. At the same time, candidates should be free of significant comorbidities that might negatively impact successful transplantation. Despite well thought out published guidelines for candidate selection, many controversial issues surrounding selection of lung transplant candidates remain. This review will focus on some of the more common controversial issues and explain how most centers approach these issues when choosing candidates for lung transplantation.

scholarly journals Usefulness of a Cannula with a Flexible Tip (Swing Tip) for Managing Severe Biliary Stricture

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Daisuke Uchida ◽  
Hironari Kato ◽  
Yosuke Saragai ◽  
Saimon Takada ◽  
Shinichiro Muro ◽  
...  
Keyword(s):  
Biliary Stricture ◽  
Biliary Stenting ◽  
Registration System ◽  
Technical Success Rate ◽  
Percutaneous Procedures ◽  
Institutional Review ◽  
Protocol Registration ◽  
Alternative Approaches ◽  
Surgical Treatments ◽  
Selection Of

Background and Aims. Biliary stenting for the treatment of biliary stricture is the most common indication of ERCP, but the procedure is sometimes unsuccessful because of severe strictures. The Swing Tip is useful for passing through severe strictures because it has a manually operable tip. The efficacy of using a Swing Tip was retrospectively evaluated. Methods. The 2353 patients who underwent ERCP for biliary stenting at our facility between January 2012 and July 2018 were enrolled. In all patients, procedures were begun using tapered tip-catheters, and Swing Tips were used if the procedure was found to be difficult with other devices. The indication for switching to the Swing Tip and the technical success rate were retrospectively evaluated. Results. A total of 99 patients (4.2%) underwent ERCP using the Swing Tip, including 49 patients for the selection of biliary branches and 50 for exchanging guidewires for rigid ones. In these patients, biliary stenting was successful in 22 patients (44.9%) and 45 patients (90%), respectively. The other 32 patients with failed endoscopic biliary drainage were treated via alternative approaches, such as percutaneous procedures, surgeries, or conservative treatments. There were no adverse events associated with the Swing Tip. Conclusion. The Swing Tip was technically feasible especially for exchanging guidewires during ERCP. Percutaneous procedures or surgical treatments can be avoided by using the Swing Tip. Ethical Statements. This study was approved by the institutional review board of Okayama University. All subjects provided informed consent. The study was registered in the UMIN protocol registration system (identification number UMIN 000033692).

Neurological Grades of Patients with Poor-grade Subarachnoid Hemorrhage Improve after Short-term Pretreatment

Neurosurgery ◽  
2000 ◽  
Vol 47 (5) ◽  
pp. 1098-1105 ◽  
Author(s):  
Michiyasu Suzuki ◽  
Yasunari Otawara ◽  
Mamoru Doi ◽  
Kuniaki Ogasawara ◽  
Akira Ogawa
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Radical Surgery ◽  
Mass Effect ◽  
Short Term ◽  
Systemic Complications ◽  
Poor Grade ◽  
Neurological Condition ◽  
Neurological Improvement ◽  
Diuretic Agents ◽  
Selection Of

Abstract OBJECTIVE Short-term pretreatment of patients with subarachnoid hemorrhage, but without hematomas causing mass effect, who presented in poor neurological condition at admission was evaluated as a protocol for the selection of candidates for radical surgery. METHODS One hundred-three patients were pretreated for 12 hours with control of blood pressure and intracranial pressure, using diuretic agents and/or ventricular drainage. RESULTS Neurological improvement was observed for 32 of 47 patients in Grade IV at admission and 23 of 56 patients in Grade V (P < 0.01). Hydrocephalus requiring drainage was more common (P < 0.05) and the interval between onset and admission was shorter (P < 0.01) for the improved group. Clipping surgery was performed for all patients in Grade III or better and for patients in Grade IV who were less than 75 years of age and without systemic complications, i.e., 38 of 47 patients in Grade IV and 16 of 56 patients in Grade V at admission. Good outcomes (defined as moderately disabled or better on the Glasgow Outcome Scale) were achieved by 34 of 38 patients in Grade IV and 10 of 16 patients in Grade V (P < 0.01). The proportion of patients in Grade IV after pretreatment was lower for Grade IV (2 of 38 patients) than for Grade V (9 of 16 patients) (P < 0.00001). However, none of the 49 patients who underwent nonsurgical treatment achieved good outcomes. CONCLUSION Our protocol may be beneficial for the selection of candidates for radical surgery among patients with subarachnoid hemorrhage but without hematomas who are in poor neurological condition at admission and for the improvement of postoperative outcomes.

Controversial Issues in the Management of Multiple Pregnancies

Twin Research ◽  
2001 ◽  
Vol 4 (3) ◽  
pp. 165-167 ◽  
Author(s):  
Isaac Blickstein
Keyword(s):  
Mode Of Delivery ◽  
Controversial Issues ◽  
Multiple Pregnancies ◽  
Perinatal Medicine ◽  
Genetic Studies ◽  
Special Cases ◽  
Definition Of ◽  
Multifetal Pregnancy ◽  
Selection Of ◽  
Multifetal Pregnancy Reduction

AbstractThe management of multiple pregnancies represents a true challenge for all sub-specialties concerned with perinatal medicine. Many issues were neglected over the years merely because they were rare and therefore considered not sufficiently important to merit clinical trials. This paper discusses a personal selection of controversial issues, such as multifetal pregnancy reduction of triplets and twins, special cases in multifetal preganncy reduction, need for invasive genetic studies, management of twin-twin transfusion, discordant fetal conditions, the definition of “term” in multiples, and the controversy about the mode of delivery.

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