191 research outputs found
Complete trauma disruption of the left hepatic duct: endoscopic treatment after failure of surgical repair
No full textNo Abstract
Notch Effect on the Fatigue Behavior of a Hot-Dip Galvanized Structural Steel
No full textWe investigate the effect of a galvanizing coating on the fatigue strength of S355 structural steel. Although some results on fatigue tests of unnotched specimens are available, those on notched components are scarce. A comparison is carried out between hot-dip galvanized specimens weakened by a central hole and untreated specimens of the same geometry for two nominal load ratios R = 0 and R = −1. In total, over 60 new experimental data are summarized and analyzed in the present contribution
Santorinicele and recurrent acute pancreatitis in pancreas divisum: diagnosis with dynamic stimulated magnetic resonance pancreatography and endoscopic treatment
No full textEndotherapy of early onset idiopathic chronic pancreatitis: results with long-term follow-up.
No full textBackground: Idiopathic chronic pancreatitis that presents at age 35 years or younger has been classified as early onset type and is often characterized by chronic severe pain. Endotherapy, with drainage of the main pancreatic duct, can lead to control of pain if ductal hypertension is an important cause. Long-term results of endotherapy in patients with early onset idiopathic chronic pancreatitis are reported herein. Methods: This retrospective study consists of 11 patients (6 men, 5 women; mean age 24.2 years, range 16-34 years) treated endoscopically in a 6.5-year period. The indication for treatment was pain in all patients and all had a dilated main pancreatic duct on pancreatography. The objectives of endoscopic treatment were to obtain good drainage of the pancreatic duct and complete clearance of ductal stones. Results: Treatment was successful in all patients with no procedure-related mortality and with mild complications. Seven patients remained free of pain relapses after a mean follow-up of 78.3 months (37-116 months). Seven relapses of pain were recorded in the remaining 4 patients. Endoscopic retreatment was successful in all cases. The difference between the number of hospitalizations during the year before treatment (mean 2.2, range 1-9) and the year after (mean 0.3, range 0-2) was statistically significant (p < 0.01). Statistical significance was maintained at 3 and 6 years' follow-up. Conclusions: Endoscopic treatment could be regarded as the initial management of choice for patients with early onset idiopathic chronic pancreatitis
Covered versus uncovered metal stents for malignant gastric outlet obstruction : A systematic review and meta-analysis of RCTs
No full textBackground and aim: Self expandable metal stent are used for palliation of malignant gastric outlet obstruction (GOOD) in patients with gastric or pancreatic malignancy. Studies comparing C-SEMS and U-SEMS have led to inconclusive results. To date only a previous meta-analysis assessing together prospective and randomized studies with statistical criticism was published.
Aims: comparing efficacy and safety of FCSEMS vs USEMS in patients with GOOD.
Material and methods: A computerized medical search was performed by using MEDLINE, EMBASE, Cochrane Library, from 2000 to September 2017 aimed at identifying available randomized trials comparing C-SEMS versus U-SEMS in patients with GOOD. Primary outcomes were stent survival and patient survival, while secondary outcomes were clinical and technical success, adverse events, stent occlusion and migration Pooled estimates were computed using the random effects models.
Results: Overall 7 RCTs were identified including 635 patients were included. Stent and patient survival did not statistically significantly differ between C-SEMS and U-SEMS groups (HR=0.93, 95% CI: 0.66–1.31; HR=0.87, 95% CI: 0.64–1.19, respectively). Clinical success and technical success were not statistical difference between two groups (OR=1.44 95%, CI: 0.68–3.05, OR=1.17, 95% CI: 0.39–3.52). U-SEMS was associated with lower risk of adverse events (OR=2.20, 95% CI: 1.37–3.54) but with higher risk of tumor ingrowth (OR=0.30, 95% CI: 0.18–0.49). C-SEMS was associated with higher risk of migration (OR=5.24, 95% CI: 2.26–2.12).
Conclusions: C-SEMS did not show statistically significant differences in terms of stent and patient survival as compared to U-SEMS although U-SEMS was associated with higher risk of tumor ingrowth and C-SEMS with migration. Further studies using new C-SEMS with anti migration system are needed
Novel methods of management of trapped dormia baskets in the pancreatic and biliary ducts
No full textno abstract available; lette
A cumulative meta-analysis of endoscopic papillary balloon dilation versus endoscopic sphincterotomy for removal of common bile duct stones
No full textBackground Endoscopic papillary balloon dilation (EPBD)
was introduced to overcome the risk of adverse events
associated with endoscopic sphincterotomy in the removal
of common bile duct (CBD) stones. We performed a metaanalysis
of randomized controlled trials (RCTs) comparing
efficacy and safety of EPBD vs. endoscopic sphincterotomy,
focusing on stone size, balloon diameter, and balloon dilation
time.
Methods A multiple database search was performed, including
MEDLINE, EMBASE and Cochrane Library, from their
inception date until October 2017. RCTs comparing the efficacy
and safety of EPBD vs. endoscopic sphincterotomy in
the removal of CBD stones were included. Cumulative
meta-analyses over time, and subgroup analyses according
to stone size, and balloon diameter and dilation time were
carried out.
Results 25 RCTs met the inclusion criteria. Despite the cumulative
meta-analysis showing a trend over time in favor
of endoscopic sphincterotomy in studies published up to
2004, the conventional meta-analysis revealed that EPBD
was equally efficacious compared with endoscopic sphincterotomy
in stone removal at first attempt (odds ratio [OR]
0.95, 95% confidence interval [CI] 0.65 – 1.38). Endoscopic
sphincterotomy was superior to EPBD in terms of overall
stone clearance (OR 0.65, 95 %CI 0.43 – 0.99) in studies
published since 2002, but no differences emerged in studies
using large ( ≥ 10mm) balloons (OR 1.37, 95 %CI 0.72 –
2.62). No statistically significant difference in pancreatitis
occurrence emerged between EPBD and endoscopic
sphincterotomy (OR 1.35, 95 %CI 0.90 – 2.03). Pancreatitis
was more common with EPBD than with endoscopic sphincterotomy
in studies using balloons < 10mm (OR 1.78, 95%
CI 1.07 – 2.97), whereas no difference emerged in studies
using large balloons (OR 0.84, 95 %CI 0.46 – 1.53). EPBD
had lower rates of bleeding and cholecystitis.
Conclusions Our latest data confirm that EPBD is currently
inferior to endoscopic sphincterotomy in terms of overall
stone clearance. However, EPBD using large balloons
(≥ 10mm) was as effective as endoscopic sphincterotomy,
both in stone clearance and the need for endoscopic mechanical
lithotripsy, without carrying an increased risk of
pancreatitis
FATIGUE TESTS ON RIVETED CONNECTIONS
No full textTo estimate the fatigue strength of riveted joints represents a problem of primary importance both for the re-analysis of old bridges and the assessment of relatively recent structures. Even if the riveted solution is going to be progressively substituted by bolted and welded solutions, the behaviour of riveted members remains a matter of considerable economic importance. Technical specifications available in the Standards in force give to engineers engaged in fatigue design problems a reference curve relating to only one detail and the recommended values appear to be very different. In particular, recent re-analysis reported in the literature showed that the value suggested by the Eurocode 3 for shear splices that use non pre-loaded high strength bolts is strongly non-conservative when applied to riveted connections taken from old bridges. The paper presents the results of fatigue tests carried out on 3 different riveted joints and compares them to the design curves reported by some European and American Standards in force
Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents
No full textBACKGROUND: Endoscopic dilation with stents has been proposed as an alternative to hepaticojejunostomy for management of postoperative biliary strictures. Good long-term results with double 10F plastic stent insertion for 1 year have been reported in 74% to 90% of cases. This is a review of our experience with a more aggressive approach. METHODS: The technique, short-term results, and long-term results of placement of increasing numbers of stents until complete disappearance of the biliary stricture are reported. At each exchange, the maximum possible number of stents in relation to the tightness of the stricture and diameter of the bile duct were inserted. All stents were removed at the end of treatment. RESULTS: The records of 45 of 55 patients with postoperative biliary strictures treated in this manner and observed consecutively were reviewed retrospectively. By intention-to-treat analysis the success rate was 89% (40/45). Early complications developed in 4 (9%) patients (3 cholangitis, 1 pancreatitis) and stent occlusion that required early exchange occurred in 8 (18%) patients. There was 1 death caused by a stroke 2 months after a stent exchange. Forty-two patients completed the protocol (mean number of stents 3.2 +/- 1.3; range 1-6). Mean duration of treatment was 12.1 +/- 5.3 months (range 2-24 months). Two patients died of unrelated causes during follow-up. Among the remaining 40 patients there was no recurrence of symptoms caused by relapsing biliary stricture at a mean follow-up of 48.8 months (range 2-11.3 years). One patient sustained 2 episodes of cholangitis but without stricture recurrence. CONCLUSIONS: This more aggressive approach to endoscopic treatment with stents may improve long-term results for patients with postoperative biliary strictures
Multiple plastic stent (MPS) versus FCSEMS for managing post liver transplantation biliary stricture: a systematic review and meta-anlaysis of randomized controlled trial
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