1,720,980 research outputs found
Recurrent benign biliary strictures: management with self-expanding metallic stents
No full textSelf-expanding metallic stents of a modified Gianturco design were used to treat benign strictures of the biliary tree in 17 patients. Thirteen patients had undergone several unsuccessful surgical repairs, and four had not undergone surgery because of their clinical status. All patients had already undergone multiple percutaneous balloon dilations without success. Stents were placed percutaneously, through a transhepatic approach, without complications. Adequate caliber of the strictured segment, stable relief of symptoms, and normalization of liver function tests were achieved in 14 patients (82.4%). Partial primary success was obtained in one patient; initial success was achieved in two patients, but strictures recurred after 5 months. The average follow-up period was 8 months. Results suggest that placement of these stents might represent a permanent therapeutic solution for intractable recurrences. Extended follow-up and experimental studies to clarify long-term patency and biotolerance are needed
New ePTFE/FEP-covered stent in the palliative treatment of malignant biliary obstruction
No full textTo determine the technical efficacy and safety of an expanded polytetrafluoroethylene and fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent in the management of malignant biliary obstruction and to evaluate its clinical efficacy by estimating stent patency and patient survival rates
Early and midterm results after endovascular treatment of atherosclerotic descending thoracic aortic aneurysms: a single-centre experience
No full textAim. Despite significant improvement in anesthetic, surgical techniques and postoperative care, the mortality and morbidity rate in thoracic aortic aneurysms (TAA) open repair remains high. Endovascular stent-graft repair may provide an alternative treatment in these patients. The aim of this retrospective study was to evaluate short and mid-term morbidity and mortality rate after endovascular stent-graft treatment of degenerative non dissecting TAA.
Methods. Between June 2000 and December 2005,22 consecutive patients with degenerative TAAs, underwent endovascular stent-graft treatment in elective procedure. Follow-up investigations were performed after 1, 3,6 months and annually thereafter.
Results. Perioperative mortality rate was 4.5% (1/22). Primary technical success, defined as successful deployment and exclusion of the lesion without evidence of type I or III endoleak, was achieved in 20 (91%) patients. One perioperative type-I and two perioperative type-II endoleaks were observed. No ischemic complications (paraplegia, visceral or peripheral ischaemia) or open surgical conversion were recorded. In one patient an 18-month computed tomography-scan showed dilatation of distal thoracic aorta below the graft. Mean follow-up was 34 months (range 5-66 months).
Conclusion. Elective endovascular therapy of degenerative thoracic aortic aneurysms seems to be a feasible procedure allowing good results and a low incidence of complications in a mid-term follow up
Complete transection of the main bile duct: minimally invasive treatment with an endoscopic-radiologic rendezvous
No full textBackground: Complete transection of the common bile duct (CBD) is a dramatic and often extremely difficult-to-repair event after surgery. Abdominal biliary fluid collection or jaundice is the initial symptom, and ERCP is the determinant for diagnosis.
Objective: To evaluate the safety and efficacy of a combined endoscopic-radiologic technique for the reconstruction of the CBD.
Design: Single-center retrospective study.
Setting: Tertiary-care center for biliary surgery.
Patients: This study involved 22 patients with complete transection of the CBD after cholecystectomy.
Intervention: A guidewire is passed in the subhepatic space through the endoscopic approach. A snare loop is advanced from the percutaneous entry site to catch the free end of the wire and then pulled outside the body: a percutaneous biliary-duodenal (PTBD) drainage is put in place. After a new contralateral PTBD, 4 plastic stents are inserted. The stents are removed endoscopically after 8 to 12 months.
Main outcome measurements: Success of the rendezvous maneuver, patient recovery, and patient mortality.
Results: After a mean follow-up period of 4 years, 16 patients are asymptomatic. Two patients are still under treatment, and 4 patients underwent surgery, as was the surgeon's choice.
Limitations: Single-center, retrospective study with a small population.
Conclusion: Interruption of the biliary tree does not represent an indication for an often-difficult surgical treatment, because the CBD is often thin in the presence of biliary peritonitis. However, the condition can be treated with a rendezvous technique. Surgery can be performed in elective conditions or completely avoided when conservative therapy is selected
Peripheral and Splanchnic Indole and Oxindole Levels in Cirrhotic Patients: A Study on the Pathophysiology of Hepatic Encephalopathy.
No full textOBJECTIVES:
Intestinal bacteria metabolize tryptophan into indole, which is then further metabolized into oxindole, a sedative compound putatively involved in the pathophysiology of hepatic encephalopathy (HE). The aim of this study was to measure indole and oxindole levels in patients with cirrhosis with or without HE and to establish whether an intestinal production and a hepatic metabolism of these substances exist.
METHODS:
We studied 10 healthy subjects (controls) and 51 cirrhotic patients: 17 without HE, 14 with a minimal HE, 8 with overt HE, and 12 who had undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure. In the last group, blood was collected from the artery, and the portal and hepatic veins during TIPS construction and from the peripheral veins before, immediately after, and at weekly intervals during the first month after TIPS.
RESULTS:
Plasma indole levels were significantly higher in patients with overt HE. Oxindole levels were higher in cirrhotics than in controls. Indole and ammonia were significantly correlated (r=0.66). Peripheral and splanchnic determinations showed that indole was produced in the intestine and cleared by the liver, similar to ammonia. TIPS implantation increased both indole and ammonia levels. After TIPS, the psychometric performance worsened in 4 of the 12 patients. The increase in indole plasma concentrations in these four patients was higher than in those who remained stable after undergoing TIPS.
CONCLUSIONS:
Indole correlates with HE and has a significant intestinal production and hepatic extraction; its level increases after TIPS and is related to psychometric performance. These data suggest that indole may be involved in the pathophysiology of HE
Re-TEVAR for complications after blunt aortic traumatic injury stenting
No full textWe report an endovascular approach that was used to treat two patients with previous thoracic aortic repair or endovascular repair (TEVAR) for blunt thoracic aortic injury. The first patient was a 38-year-old man who presented with distal intragraft thrombosis 24 months after TEVAR. The second patient, a 32-year-old man, developed a symptomatic distal device collapse at 39th month follow-up, associated with buttock claudication. Both patients were offered an endograft relining, complicated in the first case by distal embolizatio
Radiologia interventistica nella terapia palliativa e nel trattamento delle lesioni iatrogene
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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