scholarly journals Use of Over-the-Scope Clip as First Choice to Treat Gastric Dieulafoy Lesions

2021 ◽  
Vol 13 (2) ◽  
pp. 163-165
Author(s):  
Attila Onmez ◽  
Serkan Torun
Keyword(s):  
Vascular Lesion ◽  
Recurrent Bleeding ◽  
Large Artery ◽  
Endoscopic Injection ◽  
Thermal Methods ◽  
First Choice ◽  
Choice Of Treatment ◽  
Life Threatening ◽  
Over The Scope Clip ◽  
Dieulafoy Lesion

Dieulafoy lesion is a rarely seen, superficial vascular lesion of the gastric mucosa that can lead to severe and recurrent bleeding which can be life-threatening. It is characterized by massive hemorrhages that can occur as a result of protrusion of a large artery from a submucosal defect. Endoscopic injection and mechanical and thermal methods are frequently used in traditional treatment. Herein, we presented a 61-year-old women who was admitted with upper gastrointestinal hemorrhage owing to Dieulafoy lesion who was successfully treated with over-the-scope clip as the first choice of treatment.

Uveitis associated with Systemic Diseases: Clinical, Diagnosis, and Treatment

2020 ◽  
pp. 267-276
Keyword(s):  
Visual Loss ◽  
Treatment Options ◽  
Systemic Diseases ◽  
Immunomodulatory Drugs ◽  
Immune Mediator ◽  
First Choice ◽  
Choice Of Treatment ◽  
Life Threatening ◽  
Eye Involvement

Uveitis is a frequently seen entity with systemic immune mediator related diseases. Among these diseases, Behçet's disease, sarcoidosis, spondyloarthropathies, and juvenile idiopathic arthritis are relatively common. In this group of patients, uveitis may result in visual loss. Additionally, eye involvement may also be the presenting sign of these life-threatening systemic diseases. Therefore, early diagnosis and proper treatment of these diseases are important. Corticosteroids are the first choice of treatment in this group of patients. However, their use is limited due to potential side effects in the long-term. In recent years, an increasing number of immunomodulatory drugs and biological agents are being used more effectively to reduce complications related to these diseases. In this review, clinical features, diagnostic dilemmas, and treatment options of uveitis associated with noninfective systemic diseases were evaluated.

scholarly journals Massively bleeding Dieulafoy lesion and unique rescue: a video based case report from National Liver Institute, Menoufia University

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Omkolsoum Alhaddad ◽  
Maha Elsabaawy ◽  
Ahmed Elfaioumy ◽  
Ashraf Eljaky
Keyword(s):  
Case Report ◽  
Gastrointestinal Tract ◽  
Lamina Propria ◽  
Endoscopic Hemostasis ◽  
The Other ◽  
Endoscopic Management ◽  
Case Presentation ◽  
Life Threatening ◽  
Over The Scope Clip ◽  
Dieulafoy Lesion

Abstract Background Dieulafoy arteriole is a lamina propria vessel that unlike the other arterioles is getting bigger and bending into the mucosa of the gastrointestinal tract. Such anatomic aberration is unusual cause for life threatening gastrointestinal bleeds. Case presentation Herein, we report a case of an elderly gentleman, who had massively bleeding Dieulafoy lesion and endoscopic hemostasis of the spurting Dieulafoy by the use of the over-the-scope clip (OVESCO, Tübingen, Germany) has been successfully undertaken. Conclusion The endoscopic management of Dieulafoy related bleeds can be enriched by the use of over-the-scope clip, OVESCO, technique.

Nonsurgical Therapies for Hepatocellular and Cholangiocellular Carcinoma

Swiss Surgery ◽  
1999 ◽  
Vol 5 (3) ◽  
pp. 116-121 ◽  
Author(s):  
Schmassmann
Keyword(s):  
Current Trend ◽  
Percutaneous Ethanol Injection ◽  
Cholangiocellular Carcinoma ◽  
Multidisciplinary Therapy ◽  
Term Survival ◽  
Ethanol Injection ◽  
First Choice ◽  
Tumor Stages ◽  
Choice Of Treatment ◽  
Advanced Stages

Surgical resection is the first choice of treatment for patients with hepatocellular (HCC) and cholangiocellular carcinomas. Prolongation of survival is, however, the only realistic goal for most patients, which can be often achieved by nonsurgical therapies. Inoperable patients with large or multiple HCCs are usually treated with transarterial chemoembolization (TACE) with lipiodol in combination with a chemotherapeutic drug and gelfoam. Three-year survival depends on the stage of the disease and is about 20%. Patients with earlier tumor stages (one or two tumor nodules less than 3cm in size) are suitable for treatment with percutaneous ethanol injection (PEI) alone or in combination with TACE. Several studies have shown that in these early stages, the 3-year survival rate is approximately 55%-70% in the actively treated patients which is significantly higher than in untreated patients. In advanced stages of the disease, TACE and PEI have no effect on survival and should not be performed. Some of these patients have been successfully treated with octreotide. Patients with inoperable cholangiocellular carcinoma are treated by endoscopic or percutaneous stent placement. If stenting does not achieve adequate biliary drainage, multidisciplinary therapy including internal / external radiotherapy or photodynamic therapy should be considered in patients with potential long-term survival. In conclusion, nonresectional therapies play an essential role in the therapy of inoperable hepato- and cholangiocellular carcinomas as they lead to satisfactory survival. Multidisciplinary therapy appears to be the current trend of management.

Surgery of ulcus cruris venosum

Phlebologie ◽  
2010 ◽  
Vol 39 (03) ◽  
pp. 156-162 ◽  
Author(s):  
C. Schwahn-Schreiber
Keyword(s):  
Subcutaneous Tissue ◽  
Ulcus Cruris ◽  
Healing Time ◽  
Ulcus Cruris Venosum ◽  
Venous Stasis ◽  
Morphological Alterations ◽  
First Choice ◽  
Choice Of Treatment ◽  
Chronic Compartment Syndrome ◽  
Shave Therapy

SummaryAdvanced chronic venous stasis syndrome is characterized by irreversible and self-perpetuating morphological alterations in the lower leg. A chronic inflammatory process results in sclerosis, which progresses from the skin to the subcutaneous tissue and ultimately the fascia, sometimes including muscle and ankle joint and leading to chronic compartment syndrome. To cure these severe alterations with non healing ulcers decompression of the compartments like paratibial fasciotomy with SEPS and crural fasciectomy or removal of sclerosis like shave therapy are successful surgical procedures. Indication should be adapted to the extension of ulcer. Indications of the operations and the techniques are described, complications and results are discussed. Due to ulcer extension especially shave therapy (removal of the sclerotic tissue epifascial) and crural fasciectomy (removal of sclerosis including fascia) are very successful with up to 80% healing rate, even in severe cases and even after long term (up to 8 years). Since shave therapy is easy, short and simple with short healing time, few complications and good aesthetical result it is the first choice of treatment for non healing leg ulcers. Fasci ectomy is reserved for special indications such as deep transfascial necrosis or failure of shave therapy.

scholarly journals Spontaneous rupture of the pancreatic pseudocyst into the duodenum with massive upper gastrointestinal bleeding: case report and literature review

2020 ◽  
Vol 7 (11) ◽  
pp. 3792
Author(s):  
Alaa Sedik ◽  
Meriem Touheria ◽  
Ahmed Fathi ◽  
Uzair Ilyas ◽  
Ahmed Wahdan ◽  
...  
Keyword(s):  
Spontaneous Rupture ◽  
Pancreatic Pseudocyst ◽  
Bile Leak ◽  
Recurrent Bleeding ◽  
Upper Gi ◽  
Life Threatening ◽  
Upper Gi Endoscopy ◽  
The Common ◽  
Life Threatening Complication ◽  
Acute And Chronic Pancreatitis

Pancreatic pseudocyst is one of the common complications of both acute and chronic pancreatitis. While most pseudocysts resolve spontaneously with conservative treatment, larger pseudocysts are more likely to cause complications, such as, spontaneous rupture into the gastrointestinal tract and are usually associated with life-threatening bleeding, which is life threatening complication. Endoscopic or surgical drainage may be necessary for uncomplicated persistent large cysts. We present a case of 32 year old Indian male, admitted to our department, who was a known case of alcoholic acute pancreatitis treated conservatively and developed massive upper GI bleeding and shock. CT angiography and upper GI endoscopy failed so he was taken to theatre several time due to bleeding, recurrent bleeding and a major bile leak. Unfortunately, he was expired. Current study highlights this serious rare life-threatening complication.

scholarly journals Dieulafoy Lesion of Ileum: A Case Report

2020 ◽  
Vol 3 (1) ◽  
pp. 64-66
Author(s):  
Prakash Poudel ◽  
Ramesh Dhakwa
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Gastrointestinal Bleeding ◽  
Gastrointestinal Haemorrhage ◽  
Definitive Diagnosis ◽  
Gi Bleeding ◽  
Mucosal Defect ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Dieulafoy Lesion

Dieulafoy lesion is a rare cause of massive GI bleeding. It’s an abnormal sub-mucosal artery protruding from a minute mucosal defect (≤3 mm). A 31 yearold male presented with complaints of hematochezia. Preliminary investigations failed to locate the exact source of bleed. Enteroscopy suggested distal ileal bleed. At laparotomy, an ulcerated nodular lesion, approximately 0.5 cm was identified in distal ileum. 30 cm of ileum along with mesentery was resected. Histology revealed it to be Dieulafoy lesion. Dieulafoy lesion is uncommon but one of the causes of obscure gastrointestinal bleeding that could result in treacherous and life-threatening gastrointestinal haemorrhage. This lesion is difficult to identify and high index of suspicion is required to make diagnosis. Hence, it should be considered in the differential diagnosis of active GI bleeding. The definitive diagnosis is based only on histopathology.

scholarly journals Not All Embolizations Are Created Equally in the Management of Posterior Epistaxis: Discussion of Safety Measures Avoiding Neurological Complications

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Mareike Franke ◽  
Jasper Franke ◽  
Christian Saager ◽  
Sven Barthel ◽  
Randolf Riemann ◽  
...  
Keyword(s):  
Neurological Complication ◽  
Neurological Complications ◽  
Surgical Approaches ◽  
Success Rates ◽  
Artery Ligation ◽  
Retrospective Data Analysis ◽  
First Choice ◽  
Surgical Methods ◽  
Choice Of Treatment ◽  
Meta Analyses

Today, there are still no uniform guidelines for the treatment of epistaxis. Furthermore, it is widely debated whether embolization or surgical approaches should be the first choice of treatment for intractable posterior epistaxis after conservative measures have failed. In several meta-analyses, it is reported that endoscopic sphenopalatine artery ligation and embolization have similar success rates, but embolization was associated with more severe neurological complications. Regarding existing literature, there are many comparative analyses of surgical methods but none for embolization protocols. Against this backdrop of a lack of uniform standards in embolization techniques, we present a retrospective evaluation of what has emerged to be best procedural practice for endovascular treatment of epistaxis in our department using microsphere particles and microcoils, in particular regarding precaution measures to avoid neurological complications. In our retrospective data analysis of 141 procedures in 123 patients, performed between 2008 and 2019, we find success rates very similar to those reported in other studies (95.1% immediate-stop-of-bleeding success and 90.2% overall embolization success) but did not encounter any major neurological complication opposed to other reports. We suggest some aspects of our protocol as precaution measure to avoid neurological complications. More generally and perhaps even more importantly, we make a strong case for standardization for embolization techniques to the level of details in surgical procedure standardization to enable an apples to apples comparison of embolization techniques to each other and of intervention vs. surgery.

scholarly journals Treatment of Intramedullary Arteriovenous Malformations of the Spinal Cord

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 203-207 ◽  
Author(s):  
S. Ushikoshi ◽  
K. Hida ◽  
Y. Kikuchi ◽  
Y. Iwasaki ◽  
K. Miyasaka ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Radical Excision ◽  
Arteriovenous Fistulas ◽  
First Choice ◽  
Choice Of Treatment ◽  
Technical Complication ◽  
Surgical Manipulation ◽  
Residual Lesions

We retrospectively reviewed our treatment results for spinal intramedullary arteriovenous malformations (AVMs). Fifteen consecutive patients were included in this syudy. Five patient underwent particulate embolization. Surgery was performed in ten patients (including two patient who were treated embolization initially). Five patients, at the beginning of our experience, underwent radical excision of the nidus via the posterior myelotomy. Recent five patients underwent interruption of the feeding pedicles on the surface of the spinal cord. Especially when arteriovenous fistulas (AVFs) or aneurysms were demonstrated, accurate obliteration of them were performed. Four patients, including two with residual AVM after the surgery, underwent irradiation therapy. Anatomically, four AVMs disappeared completely and the other 11 patients have a residual lesions after the treatment. Clinically, three patients improved, six remained unchanged, and six worsened. The causes of neurological deterioration after the treatment were technical complication of embolization in one patient and surgical manipulation in five. There was no patient who experienced hemorrhage during the follow-up period ranged from 6 months to 17 years, with a mean of 7.5 years. In conclusion, particulate embolization should be considered as the first choice of treatment if feasible. Surgical treatment is indicated for the dangerous anatomical features such as AVFs or aneurysms.

scholarly journals Trans-Olecranon Fracture-Dislocations of the Elbow: A Systematic Review

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1058
Author(s):  
Chul-Hyun Cho ◽  
Du-Han Kim ◽  
Sang Soo Na ◽  
Byung-Chan Choi ◽  
Beom-Soo Kim
Keyword(s):  
Systematic Review ◽  
Positive Outcome ◽  
Olecranon Fracture ◽  
Dash Score ◽  
Eligibility Criteria ◽  
First Choice ◽  
Retrospective Clinical Study ◽  
Flexion Extension ◽  
Choice Of Treatment ◽  
Fracture Dislocations

The purpose of this study is to provide a systematic review of the definition, ideal surgical method, complications, and prognosis of trans-olecranon fracture dislocations. An electronic search was performed in the PubMed, EMBASE, Scopus, and MEDLINE databases. The eligibility criteria included retrospective clinical study and review article in subjects older than 18 years with trans-olecranon fracture dislocations. Trans-olecranon fracture dislocations are defined as fractures in which the stability of the ulnohumeral joint is lost due to the intra-articular fracture of the olecranon without disruption of the proximal radioulnar joint. The seven papers were included that met the eligibility criteria for the quantitative synthesis. Findings indicate that a pre-contoured plate was used in 88.3% of cases (68 of 77 reports), with no reports of complications, suggesting that the pre-contoured 3.5 mm plate is the first choice of treatment. Postoperative mean elbow range of motion for the flexion–extension arc was 121.1° and 146.5° for the pronation-supination arc. Methods for postoperative clinical scores included the Broberg/Morrey rating with a result of excellent or good in 82.9% of cases, the ASES score with a mean of 88.7, and the DASH score with a mean of 11.75. Complications included heterotopic ossification in 21.9% (23/105) of cases, arthrosis in 25.7% (27/105) of cases, nerve damage in 18.1% (19/105) of cases, and osteoarthritis in 14.3% (15/105). With better understanding of the mechanism of injury and proper diagnosis and treatment, findings of the current review suggest a positive outcome. PROSPERO registration No.: CRD42019126568.

scholarly journals How to evaluate diagnosis and management of biliary atresia in the era of liver Transplantation in China

2018 ◽  
Vol 1 (1) ◽  
pp. e000002
Author(s):  
Jianghua Zhan ◽  
Yajun Chen ◽  
Kenneth K Y Wong
Keyword(s):  
Liver Transplantation ◽  
Survival Rate ◽  
Early Diagnosis ◽  
Biliary Atresia ◽  
Further Education ◽  
Monitoring Methods ◽  
Kasai Operation ◽  
First Choice ◽  
Choice Of Treatment ◽  
Hepatobiliary Diseases

BackgroundBiliary atresia (BA) is one of the most challenging hepatobiliary diseases in children. Notwithstanding the reasonable outcome of liver transplantation (LT), portoenteral anastomosis (Kasai operation) is still the first choice of treatment for patients with BA. How to improve the survival rate of the patients with BA in the era of LT is a new challenge.Data sourcesBased on recent original publications and the experience with the BA in China, we review many factors that influence BA survival situation, including early diagnosis and screen plan, defects of early treatment, Kasai operation, and LT and indicate present questions about BA diagnosis and treatment in China.ResultsBA diagnosis may also be delayed due to insufficient understanding of BA and lack of jaundice monitoring methods at different levels of the hospitals in China. Further education of the physicians at smaller city hospitals about BA, neonatal jaundice and cholestasis would be helpful in improving early diagnosis of BA. Early surgical intervention is still the only guarantee to improve the survival rate of BA with native liver.ConclusionsIn the era of LT, especially in China, Kasai operation can provide waiting time for living donor LT and improve the success rate of LT and minimize the rapid deterioration of liver function of the children with BA and decrease the mortality in patients with BA.

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