scholarly journals Percutaneous Transhepatic Flexible Ureteroscope-Guided Frequency-Doubled Dual Pulse ND:YAG Laser Lithotripsy for Refractory Choledocholithiasis

2021 ◽  
Author(s):  
Wei Wang ◽  
Wujie Wang ◽  
Yunming Jia ◽  
Chao Chen ◽  
Shilin Tian ◽  
...  
Keyword(s):  
Bile Duct ◽  
Nd:Yag Laser ◽  
Thermal Damage ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Laser Lithotripsy ◽  
Gelatin Sponge ◽  
Laser Safety ◽  
Flexible Ureteroscope ◽  
The Mean

Abstract ObjectivesTo evaluate the safety and efficiency of percutaneous transhepatic flexible ureteroscope-guided frequency-doubled dual pulse ND:YAG laser lithotripsy (PTFU-FREDDY) for refractory choledocholithiasis.MethodsFrom December 2017 to October 2018, 24 refractory choledocholithiasis patients with large common bile duct stones, anatomic variations, multiple stones or stones at difficult locations (impacted, above a biliary stricture) were admitted to two centers. Four patients were considered intolerant to surgery or endoscopic retrograde cholangiopancreatography (ERCP), and 2 had ERCP failure, the others refused. All patients underwent PTFU-FREDDY. Clinical success rate, recurrence of calculus, laser safety, and related complications, such as fever, haematoma, and local thermal damage were recorded. ResultsPatients’ mean age was 66.0±12.1 (43-89) years. Sex ratio was 1:1.2 (male: female). The mean diameter of stones was 21.8±2.4 mm. All stones were successfully broken and pushed into the duodenum. The mean lithotripsy frequency and procedure time of Bilirubin stones was higher than cholesterol stones, and the mixed were in middle，P<0.01. One patient（4.2%）had haemobilia, requiring immediate transarterial embolisation with 100mg 300-500um gelatin sponge particles. No pancreatitis, sepsis, or serious local thermal damage, such as bile duct perforation, was observed. The rates of Grade A/B of fever, abdominal pain, nausea, and vomiting were 12.5%, 12.5%, 8.3%, and 4.2% during follow-up, respectively. The recurrence was none at the endpoint of 12 months.Conclusion PTFU-FREDDY is a safe and effective alternative treatment for refractory choledocholithiasis, especially when traditional treatments fail or are difficult to perform.

scholarly journals Revascularization versus apical barrier technique with mineral trioxide aggregate plug: A systematic review

2018 ◽  
Vol 32 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Luiz Alexandre Chisini ◽  
Guillermo Grazioli ◽  
Alejandro Francia ◽  
Alissa Schmidt San Martin ◽  
Flavio Fernando Demarco ◽  
...  
Keyword(s):  
Clinical Success ◽  
Mineral Trioxide Aggregate ◽  
Clinical Success Rate ◽  
Permanent Teeth ◽  
Radiographic Outcomes ◽  
Bias Risk ◽  
Radiographic Measurements ◽  
High Bias ◽  
The Mean

Aim: To compare the clinical and radiographic outcomes observed in Necrotic Immature Permanent Teeth (NIPT) after revascularization or apexification with MTA-apical plug. Methodology: PubMed/MEDLINE, Web of science and Scopus were the databases used, up to July 30th, 2017, for article research. Independent reviewers read the titles and abstracts of all reports that met inclusion/exclusion criteria: prospective or retrospective clinical studies comparing the revascularization of root canal and apexification. Clinical success of therapies, deposition and thickening of lateral dentinal walls (root width) and the continuation of root development (root length) were investigated. Bias risk of included studies was assessed using the Cochrane risk of bias. Results: From 1642 records, five papers fulfilled all inclusion criteria. Overall, 91 teeth were submitted to revascularization and 64 teeth to apexification with MTA. The mean follow-up was 23.2 months in revascularization and 21.8 in apexification. Clinical success rate was of 87.9% in the revascularization group and 90.6% in the apexification group. An increase on lateral dentinal walls thickening was observed in most revascularization cases (13%) while MTA as apical plug suggest a mild resorption of the root (1.3%). High bias risk was observed on included studies. Conclusions: Apexification with MTA-apical plug provides similar clinical success to revascularization. However, radiographic measurements showed an improvement in thickening of lateral dentinal walls in most of the revascularization cases in addition to a higher dental development. However, these results should be interpreted with caution.

scholarly journals Elective Percutaneous Coronary Interventions (PCI) in 100 Cases in a Centre Without On-site Cardiac Surgery Support

2013 ◽  
Vol 24 (1) ◽  
pp. 8-11
Author(s):  
Md Nurul Afsar Badrul ◽  
Kamal Ahmed ◽  
Sufia Rahman
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Hospital Death ◽  
Percutaneous Coronary Interventions ◽  
Vessel Disease ◽  
Coronary Interventions ◽  
Percutaneous Coronary ◽  
The Mean

Since its introduction in 1977, Percutaneous Coronary  Interventions (PCI) is an important tool in the treatment of  coronary artery disease (CAD). It is a retrospective analysis  of data of 100 cases (132 vessels). The mean age was 50.9  years (range 30-70) with 90 (90%) male and 10 (10%) female.  Indication of PCI includes acute and old MI, Chronic stable  angina and unstable angina were 48 (48%), 33 (33%) and  19(19%) respectively. Procedure done in total 132 vessels  among 100 patients. most of the cases were single vessels  disease (SVD) {68 (68%} followed by double vessel disease  (DVD) {30(30%)} , triple vessel disease (TVD) {02 (02%)}  and chronic total occlusion (CTO) {02 (02%)}.Cobalt  chromium was commonly used stent (117 (88.6%) followed by  drug illuting stent (DES) 12 (9.1%) and bare metal stent  (BMS) 3 (2.3%). Among the site of the stent insertion left  anterior descending (LAD) 62 (47%), right coronary lesion  (RCA) 37 (28), left circumplex artery (LCX) 33  (25%).Maximum stent length was 35 mm, minimum 10mm.  Maximum stent diameter was 3.5 mm whereas minimum  diameter 2.5 mm. The mean pretreatment reference diameter  was 2.55 ± 0.20 mm and post treatment diameter 2.70 ± 0.45  mm. Angiographic, procedural and clinical success rate were  100%, 98% and 98% respectively. Major adverse  cardiovascular event (MACE) {periprocedural MI} occurred  in 2 (02 %) cases. Minor cardiovascular complications  revealed vascular haematoma 2 (02%), bleeding from access  site in 1 (01%), transient ventricular fibrillation (VF) in 3  (03%) cases. There was no hospital death, emergency CABG  before discharge from hospital. Angiographic, procedural and  clinical success rate were excellent with a little MACE and  event free survival within 30 days follow up. So, PCI is a safe  and effective method of myocardial revascularization  irrespective of lesion morphology and type of stents used at  immediate and 30 days follow up. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.14106 Medicine TODAY Vol.24(1) 2012 pp.8-11

scholarly journals Salvage therapy using self-expandable metal stents for recalcitrant anastomotic strictures after living-donor liver transplantation

2017 ◽  
Vol 10 (3) ◽  
pp. 297-309 ◽  
Author(s):  
Sung Ill Jang ◽  
Se Yong Sung ◽  
Hyunsung Park ◽  
Kwang-Hun Lee ◽  
Seung-Moon Joo ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Clinical Success ◽  
Anastomotic Stricture ◽  
Clinical Success Rate ◽  
Metal Stents ◽  
Success Rates ◽  
Donor Liver Transplantation ◽  
Percutaneous Procedure ◽  
Anastomotic Strictures ◽  
The Mean

Background: Recently, there has been an increase in clinical success rates using nonsurgical methods to resolve anastomotic biliary strictures (ABSs) that develop after liver transplantation (LT). However, some strictures are particularly refractory and cannot be completely resolved by an endoscopic or percutaneous procedure. Consequently, the aim of this study was to examine the feasibility and efficacy of using a newly designed fully covered self-expandable metal stent (FCSEMS) to resolve refractory ABS. Methods: A total of 35 patients with an ABS that developed after LT, but could not be resolved by an endoscopic or percutaneous procedure, were included in this study. FCSEMSs were positioned endoscopically and removed after 2–3 months. After stent removal, the patients were followed to assess complications, including re-stenosis. Results: The mean period from LT to stricture was 13.7 months, and the mean duration of the stricture was 31.8 months. The type and mean number of procedures previously attempted were endoscopic retrograde cholangiopancreatography (ERCP) (9.1 ± 5.1) in 19 patients and percutaneous transhepatic biliary drainage (9.2 ± 4.8) in 16 patients. All patients had successful FCSEMS insertions and removals; the mean stent indwelling time was 3.2 months. The mean follow-up period was 18.7 months (range: 6.4–37.8 months). Stricture recurrence was observed in 6 of 29 patients (recurrence rate: 20.7%). The anastomotic stricture resolved with the FCSEMS insertion in 29 of 35 patients (clinical success rate: 82.9%). Conclusions: The newly designed FCSEMS is a potentially feasible and effective treatment for anastomotic strictures that develop after LT but are not amenable to treatment by conventional procedures.

Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience

2021 ◽  
Author(s):  
S Bomman ◽  
J S Klair ◽  
M Ashat ◽  
R El Abiad ◽  
H Gerke ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Clinical Success ◽  
Botulinum Toxin Injection ◽  
Clinical Success Rate ◽  
Peroral Endoscopic Myotomy ◽  
Pneumatic Dilation ◽  
Type I ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
The Mean

Summary Peroral endoscopic myotomy (POEM) in patients with achalasia who are status post bariatric surgery may be technically challenging due to postsurgical scarring and altered anatomy. The aim of the study was to assess the efficacy and safety of POEM for achalasia in patients with prior bariatric surgery. A review of prospectively maintained databases at three tertiary referral centers from January 2015 to January 2021 was performed. The primary outcome of interest was clinical success, defined as a post-treatment Eckardt score ≤ 3 or improvement in Eckardt score by ≥ 1 when the baseline score was &lt;3, and improvement of symptoms. Secondary outcomes were adverse event rates and symptom recurrence. Sixteen patients status post Roux-en-Y gastric bypass (n = 14) and sleeve gastrectomy (n = 2) met inclusion criteria. Indications for POEM were achalasia type I (n = 2), type II (n = 9), and type III (n = 5). POEM was performed either by anterior or posterior approach. The pre-POEM mean integrated relaxation pressure was 26.2 ± 7.6 mm Hg. The mean total myotomy length was 10.2 ± 2.7 cm. The mean length of hospitalization was 1.4 ± 0.7 days. Pre- and postprocedure Eckardt scores were 6.1 ± 2.1 and 1.7 ± 1.8, respectively. The overall clinical success rate was 93.8% (15/16) with mean follow-up duration of 15.5 months. One patient had esophageal leak on postprocedure esophagram and managed endoscopically. Dysphagia recurred in two patients, which was successfully managed with pneumatic dilation with or without botulinum toxin injection. POEM appears to be safe and effective in the management of patients with achalasia who have undergone prior bariatric surgery.

scholarly journals Evaluation of the clinical efficiency of rotary and manual files for root canal instrumentation in primary teeth pulpectomies: A comparative randomized clinical trial

2021 ◽  
pp. 21-34
Author(s):  
KL Girish Babu ◽  
◽  
Guraj Hebbar Kavyashree ◽  
Keyword(s):  
Root Canal ◽  
Clinical Success ◽  
File Systems ◽  
Clinical Success Rate ◽  
Mean Difference ◽  
Primary Molars ◽  
Success Rates ◽  
Primary Molar ◽  
The Mean

Aim: To evaluate and compare the instrumentation time, obturation time, quality of obturation, and clinical and radiological success of pulpectomized teethfollowing root canal preparation of primary molars with rotary and manual file system. Methods: A total of 150 primary molars requiring pulpectomy were selected from children aged four to seven years. These teeth were divided into three groups of 50 teeth each. In Groups 1, 2, and 3, cleaning and shaping were carried out with Kedo-S pediatric rotaryfiles, HERO Shaper rotary files, and manual NiTi K-files, respectively. Obturation was carried out with zinc oxide eugenol cement and an engine-driven Lentulo spiral. The instrumentation and obturation times were recorded. A radiographic assessment of thequality of the root filling was carried out immediately after obturation. Finally, the pulpectomized teeth were clinically and radiographically evaluated over a two-year period. Results: The mean instrumentation times for Groups 1, 2, and 3 were 14.56 ± 2.89 min, 17.93 ± 3.51 min, and 29.00 ± 2.08 min, respectively. The mean obturation times for Groups 1, 2, and 3 were 8.11 ± 1.7 min, 7.93 ± 1.3 min, and 9.64 ± 17.61 min, respectively. The mean difference in the quality of obturation was not statistically significant in primary molars instrumented with Kedo-S pediatricand HERO Shaper rotary file systems (p = 0.16). However, this mean difference was significant when compared between primary molar instrumented with rotary file systems and manual NiTi files (p = <0.001). At two years, the clinical success rate was 100% and the radiological success rates were 95.3%, 97.9%, and 89.5% in Groups 1, 2, and 3, respectively. Conclusions: The rotary file systems took significantly less instrumentation and obturation time than the manual NiTi files. There were no significant differences in obturation quality or success rates after two years.

scholarly journals Laser Lithotripsy — The New Wave

1990 ◽  
Vol 4 (9) ◽  
pp. 632-636 ◽  
Author(s):  
J Hochberger ◽  
C Ell
Keyword(s):  
Shock Wave ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Tissue Damage ◽  
Nd:Yag Laser ◽  
Laser Lithotripsy ◽  
Endoscopic Retrograde ◽  
Endoscopic Papillotomy ◽  
Nanosecond Pulses ◽  
Extracorporeal Shock Wave

Currently more than 90% of all common bile duct concrements can he removed via the endoscopic retrograde route by means of endoscopic papillotomy, stone extraction by baskets and balloon catheters, or mechanical lithotripsy. Oversized, very hard or impacted stones however often st ill resist conventional endoscopic therapy. Laser lithotripsy represents a promising new endoscopic approach to the nonsurgical treatment of those common bile duct stones. Currently only short-pulsed laser systems with high power peaks but low potential for thermal tissue damage are used for stone fragmentation. Systems in clinical applications are the pulsed free-running-mode neodymium YAG (Nd:YAG) laser (1064 nm, 2 ms) and the dye laser (504 nm, 1 to 1.5 μs). Energy transmission via highly flexible 200 ìm quartz fibres allows an endoscopic retrograde approach to the stone via conventional duodenoscope or mother-baby-scope systems. New systems currently in preclinical and first clinical testing are the Q-switched Nd:YAG laser (1064 nm, 20 ns) and the Alexandrite laser (700 to 815 nm, 30 to 500 ns). By means of extremely short nanosecond pulses (10-9s) for the induction of local shock waves at the stone surface, possible tissue damage is even more reduced. No complications have been reported so far after applying laser lithotripsy clinically in about 120 patients worldwide. Compared to extracorporeal shock wave treatment, laser lithotripsy can be executed in any endoscopy unit in the scope of the endoscopic pretreatment and does not require general anesthesia, which is often necessary for extracorporeal shock wave lithotripsy.

The Treatment of Post-Partum Bleeding With Embolization

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Anna Maria Ierardi ◽  
Enrico Maria Fumarola ◽  
Antonio Pinto ◽  
Mariano Scaglione ◽  
Gianpaolo Carrafiello
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Post Partum ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Transcatheter Embolization ◽  
Gelatin Sponge ◽  
Intensive Care Treatment ◽  
Technical Success Rate

Aim: To assess safety and efficacy of transcatheter embolization in the treatment of post-partum bleedings. Materials and Methods: In a single institution, the outcome of 15 patients who underwent trans arterial embolization (TAE) for post-partum hemorrhages (PPH) were retrospectively reviewed. Eleven patients presented with hemodynamic instability requiring blood transfusion (73 %), four patients were hemodynamically stable (27 %). Arterial embolization was performed with gelatin sponge, particles and coils. Results: Mean follow-up time was 21.2 months (range 12-48 months). Technical success rate was 100%. The overall clinical success rate was 100%. No major complications that required intensive care treatment were registered during or after the procedures. No patient required emergency surgery and subsequent hysterectomy. During follow-up, four patients become pregnant after transcatheter arterial embolization, and delivered full-term and healthy infants. Conclusions: TAE is a safe method that allows to avoid surgery and hysterectomy for uncontrollable post-partum hemorrhage; a future normal pregnancy after embolization may be hypothesized.

scholarly journals International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction

2017 ◽  
Vol 05 (04) ◽  
pp. E275-E281 ◽  
Author(s):  
Mouen Khashab ◽  
Majidah Bukhari ◽  
Todd Baron ◽  
Jose Nieto ◽  
Mohamad El Zein ◽  
...  
Keyword(s):  
Success Rate ◽  
Gastric Outlet Obstruction ◽  
Clinical Success ◽  
Outlet Obstruction ◽  
Clinical Success Rate ◽  
Comparative Trial ◽  
Metal Stents ◽  
Technical Success ◽  
Malignant Gastric Outlet Obstruction ◽  
The Mean

Abstract Background and study aims EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers long-lasting luminal patency without the risk of tumor ingrowth/overgrowth. This study compared the clinical success, technical success, adverse events (AEs), length of hospital stay (LOHS) and symptom recurrence in EUS-GE versus SGJ. Methods This was a multicenter international retrospective comparative study of EUS-GE and SGJ in patients with malignant gastric outlet obstruction (GOO) who underwent either EUS-GE or SGJ. EUS-GE was performed using lumen apposing metal stents. Results A total of 93 patients with malignant GOO treated with either EUS-GE (n = 30) or SGJ (n = 63) were identified. Peritoneal carcinomatosis was present in 13 (43 %) patients in the EUS-GE group and 7 (11 %) patients in the SGJ group (P < 0.001). Although the technical success rate was significantly higher in the SGJ group as compared to the EUS-GE group (100 % vs. 87 %, P = 0.009), the clinical success rate was not different (90 % vs. 87 %, P = 0.18, OR 0.8, 95 %CI 0.44 – 7.07). The rate of AEs was lower in the EUS-GE group, but the difference was not statistically significant (16 % vs 25 %, P = 0.3). The mean LOHS was similar in the EUS-GE group compared to SGJ (P = 0.35). The rate of recurrent GOO was not different between the two groups (3 % vs. 14 %, P = 0.08). Similarly, the mean time to reintervention was similar (88 days vs. 121 days, P = 0.83). Conclusions EUS-GE is associated with equivalent efficacy and safety as compared to surgical GJ. This is the first comparative trial between both techniques and suggests EUS-GE as a non-inferior but less invasive alter to surgery.

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