102,391 research outputs found
New endoscopic technique for intragastric balloon removal
No full textBACKGROUND: Placement and removal of the intragastric balloon for obesity are performed endoscopically often under general anesthesia. We propose a safer and faster technique for endoscopic removal of the intragastric balloon using standard sedation. METHODS: In 87 obese patients, we performed 3 removal techniques: 1) standard gastroscope and foreign body forceps, 2) standard gastroscope and retrieval snare, 3) double-channel gastroscope and foreign body forceps plus symmetrical "shark model" polypectomy snare. Balloon retrieval time, number of times the grasping devices lost the balloon, amount of antispasmodic drug, symptoms cumulative score and VAS score for discomfort were evaluated. RESULTS: The technique by double-channel gastroscope and foreign body forceps plus symmetrical polypectomy shark retrieval snare showed a significantly lower balloon retrieval time, number of lost balloons, total number of ampoules used, symptoms cumulative score and VAS score compared to the other two techniques (Dunn's P<0.05). Number of lost balloons was positively associated with number of antispasmodic ampoules used, balloon retrieval time and VAS score. CONCLUSIONS: Technique by double-channel gastroscope and foreign body forceps plus symmetrical polypectomy shark retrieval snare, allows balloon removal safely, quickly and easily, avoiding loss of the balloon, with good patient endurance
Which stent stenosis of the esophagus which [Quale stent in quale stenosi dell'esofago].
No full textSelf expandable esophageal prosthesis
today represent an effective palliative
treatment in esophageal cancer and
in cases of stenosis or fistula into the
trachea or in the mediastinum, with a
limited number of complications. Covered
metal ones are preferable, while the
plastic stents present a more difficult
position and higher incidence
of migration. Results in benign stenosis
are less successful: their use is
recommended only in selected cases.
Further long-term prospective data are
awaited before biodegradable stents can
be recommended for the management
of benign esophageal lesions
Diagnosis and therapeutic management of cystic dystrophy of the duodenal wall in heterotopic pancreas. A case report and revision of the literature.
No full textContext Cystic dystrophy in heterotopic
pancreas is a rare and serious condition.
Diagnosis is difficult because of non-specific
clinical manifestations and radiologic and
endoscopic imaging are pivotal. Therapeutic
management is still under debate.
Case report We describe a case of cystic
dystrophy of the duodenal wall in heterotopic
pancreas complicated with chronic
pancreatitis and pancreatic cystadenoma.
Discussion Computed tomography and
magnetic resonance are very useful in
demonstrating the presence of cysts in a
thickened duodenal wall but, for the most
part, endoscopic ultrasonography is the most
useful imaging examination. The choice of
different therapeutic options is still under
debate; although some authors have proposed
a medical approach using octreotide or
endoscopic treatment for selected patients, a
pancreaticoduodenectomy is usually proposed
for symptomatic patients.
Conclusion When surgery is needed, a
pancreaticoduodenectomy is preferred,
reserving by-pass procedures for high risk
patients. Because of the non-specific clinical
manifestation and the very difficult diagnosis
and therapeutic management, these patients
should be studied and treated in specialized
and dedicated centers
Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia
No full textAbstract: Incidence of esophageal cancer (EC) is rising more rapidly in the Western world than that of any other cancer. Despite advances in therapy, more than 50% of patients have incurable disease at the time of presentation. This precludes curative treatment and makes palliative treatment a more realistic option for most of these patients. Dysphagia is the predominant symptom in more than 70% of patients with EC and although several management options have been developed in recent years to palliate this symptom, the optimum management is not established. Self-expanding metal stents (SEMS) are a well-established palliation modality for dysphagia in such patients. Health-related quality of life (HRQoL) is becoming a major issue in the evaluation of any therapeutic or palliative intervention. To date, only a few published studies can be found on Medline examining HRQoL in patients with advanced EC treated with SEMS implantation. The aim of this study was to review the impact on HRQoL of SEMS implantation as palliative treatment in patients with EC. All Medline articles regarding HRQoL in patients with advanced EC, particularly those related to SEMS, were reviewed. In most studies, relief of dysphagia was the only aspect of HRQoL being measured and SEMS implantation was compared with other palliative treatments such as brachytherapy and laser therapy. SEMS insertion provides a swift palliation of dysphagia compared to brachytherapy and no evidence was found to suggest that stent implantation is different to laser treatment in terms of improving dysphagia, recurrent dysphagia and better HRQoL, although SEMS insertion has a better technical success rate and also reduces the number of repeat interventions. (C) 2011 Baishideng. All rights reserve
Esperienza persomale nel trattamento per via endoscopica delle pseudocisti pancreatiche
No full textThe aim of this study was to assess the safety and utility of endoscopic treatment of pancreatic pseudocysts. Prognostic factors for the outcome of endoscopic drainage were assessed in a prospective analysis. Methods. Forty-nine consecutive symptomatic patients were included in the study. Transmural drainage was used in 30 patients and transpapillary drainage in 19 patients. Results. Successful drainage was achieved in 27/30 (90%) of patients after transmural drainage and in 16/19 (84.2%) patients after transpapillary drainage. Twelve (24.5%) patients had complications; 2 patients had bleeding, 2 had mild pancreatitis, 8 had cyst infection, in relation to the presence of necrosis (5 patients) or stent clogging (3 patients). Nine patients (20.9%) had recurrence of pseudocyst. Endoscopic drainage was a definitive treatment in 37 out of 49 (75.5%) patients (median follow-up: 25.9 months). Presence of necrosis was the only significant prognostic factor for infectious complication. Conclusions. Endoscopic drainage provides a successful and safe minimally invasive approach to the management of pancreatic pseudocysts
Overvoltages and critical backflashover current of a 150 kV overhead line: influence of lightning current waveform and tower grounding system modeling
No full textThis study investigates lightning current waveform effects on the fast-front overvoltages and critical currents that cause backflashover of the insulation of a 150 kV overhead line by means of ATP-EMTP simulations, considering frequency- and current-dependent effects of tower grounding systems. The CIGRE waveform is used to simulate negative first return-strokes. Several cases are investigated by employing front time, maximum steepness, and time to half value statistical distributions. Various approaches to model concentrated and extended ground electrode configurations are applied. The first one uses a resistor with a fixed resistance. The second approach considers the frequency-dependent (FD) response of the grounding system with fixed electrical properties of soil. The third approach the FD response with soil properties varying with frequency. The fourth is a soil ionization model. A hybrid method is used to yield the tower grounding systems FD responses. This method combines electromagnetic field analysis with circuit theory. The modeling approach of the grounding system influences more the critical backflashover current for shorter and steeper wavefronts, as well as longer wavetails. The impact of lightning current waveform parameters is quantified and discussed for the 150 kV line under investigation
Energy stress of non-gapped line arresters due to lightning strikes to a 150 kV line: concentrated tower grounding system modeling effects
No full textThis study investigates the impact of the frequency-and current-dependent behavior of concentrated tower grounding systems on the computed fast-front overvoltages across overhead transmission line (OHTL) insulation, the current flowing through line surge arresters (LSAs), and the energy absorbed by LSAs. This investigation is performed via ATP-EMTP simulations of a 150 kV double-circuit OHTL equipped with non-gapped line arresters (NGLAs). Two NGLA installation configurations are studied: 3 and 6 NGLAs at each tower. Four models are used for the concentrated tower grounding systems: (1) a resistor with a fixed resistance (ground resistance of towers), (2) frequency-dependent (FD) response with fixed and (3) FD soil electrical properties, and (4) the CIGRE model for soil ionization. A hybrid code was used to produce the FD grounding system responses. The tower ground resistance was a parameter and low-frequency soil resistivity was varied accordingly. The energy stressing NGLAs decreases notably when soil ionization is included in simulations. The adoption of the tower ground resistance (fixed value) in simulations yields conservative results in terms of NGLA energy stress
- …
