alcohol injection
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2021 ◽  
Vol 16 ◽  
Author(s):  
Moisés Rodríguez-Mañero ◽  
Jose Luis Martínez-Sande ◽  
Javier García-Seara ◽  
Teba González-Ferrero ◽  
José Ramón González-Juanatey ◽  
...  

In this review, the authors describe evolving alternative strategies for the management of AF, focusing on non-invasive and percutaneous autonomic modulation. This modulation can be achieved – among other approaches – via tragus stimulation, renal denervation, cardiac afferent denervation, alcohol injection in the vein of Marshall, baroreceptor activation therapy and endocardial ganglionated plexi ablation. Although promising, these therapies are currently under investigation but could play a role in the treatment of AF in combination with conventional pulmonary vein isolation in the near future.


Polymers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 3480
Author(s):  
Houbu Li ◽  
Xuemin Zhang ◽  
Haohan Huang ◽  
Teng Zhou ◽  
Guoquan Qi ◽  
...  

Spoolable reinforced plastic line pipes (RTPs), exhibiting a series of advantages such as good flexibility, few joints, long single length, light weight, easy installation, etc., have been widely used in the onshore oil and gas industry such as oil and gas gathering and transportation, high pressure alcohol injection, water injection, sewage treatment, and other fields. However, due to the lack of clear standard specificationof the limit operating properties for RTPs, three typical failure modes, i.e., tensile, flexure, and torsion, frequently occur in terrain changes,construction operation, and subsequent application, which seriously affects the promotion and use of RTPs. In this paper, the stress distribution of a non-bonded polyester fiber reinforced high-density polyethylene (HDPE) pipe (DN 150, PN 2.5 MPa) was systematically studied by the finite element method (FEM),and then the limit operating values under the axial tensile, coiled bending, and torsion load were determined.The corresponding experiments were conducted to validate the reliability and accuracy of the FEM model. The FEM results showed that the critical strain for axial tensile was 3%, the minimum respooling bend radius was 1016.286 mm, and the limit torsion angle of this RTP was 58.77°, which are very close to the experimental results. These limit values will be useful to establish normative guidelines for field construction and failure prevention of onshore RTP.


2021 ◽  
Author(s):  
Gopinath Srinivasan ◽  
Vinu Moses ◽  
Aswin Padmanabhan ◽  
Munawwar Ahmed ◽  
Shyamkumar N. Keshava ◽  
...  

2021 ◽  
Vol 12 (1) ◽  
pp. 346-350
Author(s):  
Min Cheol Chang ◽  
Gyu-Sik Choi ◽  
Mathieu Boudier-Revéret

Abstract Hand spasticity with a flexor pattern is a common problem affecting stroke patients and can result in pain, contractures, esthetic concerns, skin maceration, and overall loss of function. Poststroke (≥6 months) hemiparetic adult patients having a Modified Ashworth Scale (MAS) score of ≥1 for metacarpophalangeal flexion and thumb adduction spasticity were selected to receive an ultrasound-guided 20% ethyl alcohol block performed perineurally at the level of the deep branch of the ulnar nerve. Their MAS scores were evaluated pretreatment at 1 month and the change in MAS scores was assessed using Wilcoxon’s test. The threshold for statistical significance was set at p < 0.05. The mean MAS score for the flexor muscles of the 5 MCP joints and for thumb adduction was reduced from 3.3 ± 0.5 at pretreatment to 0.9 ± 0.5 at 1 month after the injection for the 10 patients. One month after the injection, the MAS scores were significantly reduced compared with those at pretreatment (p < 0.001), without complications. These are encouraging results showing that ultrasound-guided alcohol blocks of the deep branch of the ulnar nerve are safe and can help chronic stroke patients with metacarpophalangeal flexion and thumb adduction spasticity at 1 month.


2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Michael A. Jantz ◽  
Mohamed Omballi ◽  
Bashar N. Alzghoul ◽  
Sebastian Fernandez Bussy ◽  
David Becnel ◽  
...  

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Courtney Kramer ◽  
Matthew C Evans ◽  
Andrew Dorsey ◽  
Chris Nielsen ◽  
VALERIAN Fernandes

Background: LVEDP is a representation of left ventricular diastolic function. An increased LVEDP correlates to decreased compliance and increased left ventricular workload, which can be seen in HOCM. In HOCM, the interventricular septum is hypertrophied creating a LVOT obstruction and elevated LVEDP. ASA induces a targeted septal infarction to reduce the size of the septum and relieve the LVOT obstruction. Non-targeted infarction in a MI can increase LVEDP. Our study aims to determine the immediate effect of ASA on LVEDP in HOCM patients. It is hypothesized that ASA immediately reduces LVEDP. Methods: Retrospective study of 113 patients where pre and post-ablation LVEDP were compared. LVEDP was measured at the end-expiratory R wave of the ECG tracing during the procedure. LVEDP measurements were recorded at the post-“a” wave points at the immediate start of the procedure (Group A), prior to the alcohol injection under mild sedation (Group B), and at the conclusion of the successful ablation (Group C). Results: Groups A, B, and C were compared using two-tailed t-tests. We found no statistical difference between groups A and B (mean A=31.34 vs. mean B=31.54; p=0.695). LVEDP was significantly lower in group C when compared to group A (mean A=31.34 vs. mean C=25.82; p=6.525E-9). LVEDP was also significantly lower in group C when compared to group B (mean B=31.54 vs. mean C=25.82; p=4.047E-9). A linear regression model showed no significant correlation between LVEDP and LVOT gradient reduction following ASA (R 2 =0.0258, Significance F=0.0891). Conclusion: This data supports our hypothesis that ASA immediately reduces LVEDP despite inducing an infarct of the septal myometrium. There is no effect of sedation on LVEDP during the procedure. Since LVEDP reduction does not seem to correlate with LVOT gradient reduction, the reduction in LVEDP is likely related to other hemodynamics improvements including reduction in mitral regurgitation and immediate improvement in diastolic function. Future studies can include evaluating a correlation between LVEDP reduction and immediate hemodynamic changes. They could also evaluate a correlation between the immediate drop in LVEDP and long-term outcomes to predict the prognosis of HOCM patients based on their ASA outcomes.


2020 ◽  
Vol 183 (5) ◽  
pp. 489-495
Author(s):  
M Deandrea ◽  
P Trimboli ◽  
A Creanza ◽  
F Garino ◽  
A Mormile ◽  
...  

Background and aim: Cystic thyroid nodules (CNs), although generally benign, can cause compressive or aesthetic problems. Percutaneous ethanol injection (PEI) can represent an alternative to surgery. The present retrospective study evaluates: (i) the long-term outcome of CNs after PEI; (ii) the differences between two different PEI protocols; (iii) the CNs response according to the liquid component. Materials and methods: The study comprises 358 nodules post-PEI followed for at least 2 years. PEI was performed according to two different treatment protocols with a single (Foggia) or double (Turin) alcohol injection. CNs were divided according to their composition: cystic (CYS) >90%, mainly cystic (M-CYS) 75–90%, mixed (MIX) 50–75%, solid-mixed (S-MIX) 35-50%. The volume reduction rate (VRR) was defined as nodule volume (mL) after PEI/nodule volume (mL) before PEI x 100. Results: The 1-year VRR was significantly higher than that at 6 months (89.5% vs 72.9%, P = 0.0005), no differences were observed after 1 year. A significant difference between Turin and Foggia was observed only in VRR at early visit (79% vs 86%, respectively, P = 0.002) and recurrence rate (14% vs 24%, respectively, P = 0.001). Minor side-effects were infrequent. In 192 nodules with a 10-year follow-up CYS showed higher VRR than MIX and S-MIX nodules (P < 0.001). Conclusion: Our study reported that the long-term outcome of CNs treated with PEI is excellent regardless of the PEI technique utilized; the larger the cystic amount, the higher the VRR. Based on present results, PEI can be considered as the first-line choice for treating thyroid CNs.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Verdugo ◽  
P Cataldo ◽  
C Dauvergne ◽  
J Sandoval

Abstract Background Depending on the severity of septal hypertrophy and mitral valve derangements, patients with hypertrophic cardiomyopathy may develop left ventricular outflow tract (LVOT) obstruction and mitral regurgitation, which have major impact on symptoms and prognosis.Surgical myomectomy has been considered standard treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite medical therapy.Alcohol septal ablation (ASA), is a minimally invasive therapy for HOCM. Purpose Our aim was to assess short and long term outcomes and complications of ASA performed to symptomatic HOCM patients in our center. Methods We performed a retrospective observational study of patients undergoing ASA for HOCM between January 2002 and September 2018. According to local protocol, clinical evaluation and echocardiography were performed at baseline and 6 months after ASA. Local databases were reviewed, along with direct patient contact when required. Results ASA was performed in 73 patients with HOCM.Mean age was 57.5±12.8 years; 63% were male; 83.5% were on III-IV NYHA class, 32.9% had syncope; 12.3% had family history of sudden cardiac death, 93.6% received beta blockers, 6.8% had implantable cardioverter defibrillator.Mean alcohol injection per procedure was 2.45±1.03 cc. Invasive resting gradients were acutely reduced from 61.2±36.3 mmHg to 23.4±27.5 mmHg (p<0.001), and dynamic gradients from 106.5±37.3 mmHg to 31.0±28.0 mmHg (p<0.001). Hemodynamic success (reduction in resting gradient to <30 mmHg or dynamic gradient >50%) was achieved in 82.2% patients. We observed improvements in mitral regurgitation at ventriculography (Figure 1A, p<0.001), a decline of ≥1 severity degree was noticed in 53 patients (72.6%). Maximal creatine kinase after ASA was 2055±851 U/l. Average length of hospitalization was 4.4±5.0 days. Reablation was performed in 12 patients, 7 were planned staged procedures and 5 due to unsuccessful ASA. We observed no in-hospital mortality. Permanent pacemaker were implanted in 9 patients. Vascular access complications occurred in 3 patients. Coronary dissection and cardiac tamponade occurred in 1 patient respectively. Complications were more frequent after reablation (50% vs 17%, p<0.01).At 6 months, we observed improvements in NYHA class (Figure 1B, p<0.001), a decline of ≥1 NYHA class was found in 68 patients (93.2%). Echocardiographic assessment exposed reductions in septal thickness (25.0±5.5 vs 17.1±5.3 mm, p<0.001), LVOT gradients (86.7±27.3 vs 38.4±15.1 mmHg, p<0.001) and systolic anterior motion of the mitral valve prevalence (61.6% vs 27.4%, p=0.002). At 12 months, we detected only 1 death due to COPD.No cardiovascular deaths were noted in patients achieving 5 years of follow-up (n=49). Figure 1 Conclusion ASA was a safe and effective procedure in symptomatic HOCM, resulting in reductions of septal thickness, LVOT gradients and mitral regurgitation severity, as well as an improvement in NYHA class.


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