Foley Balloon Catheter versus Oral Misoprostol for Induction of Labour after Prelabour Rupture of Membranes: A Retrospective Data Analysis

Objectives: The Foley balloon catheter (FC) is a viable method for cervical ripening, but concerns about infection risk restrict its use in cases of prolonged prelabour rupture of membranes (PROM). This study aims to evaluate the efficacy and safety of the FC compared to oral misoprostol for cervical ripening after PROM. Study Design: A retrospective data-analysis of 128 pregnant women was conducted. Of these, 49 underwent cervical ripening with an FC and 79 with oral misoprostol. We included all women with a vital singleton pregnancy at 37 - 42 weeks of gestation who underwent cervical ripening after ≥ 24 hours of PROM in specific time frames in two Dutchsecondary care and teaching hospitals. The primary outcome was the incidence of intrapartum infection, a composite of maternal and neonatal infection. In addition, we evaluated the mode of delivery, duration of priming and priming-to-delivery interval. Secondary endpoints included uterine hyperstimulation, umbilical cord prolapse, birth weight, Apgar scores, length of admission to the neonatal low dependency unit, admission to the (neonatal) Intensive Care Unit (ICU) and mortality. Statistical analyses included bivariate and multivariate techniques. Results: Cervical ripening with FC, compared with oral misoprostol, showed a higher incidence of intrapartum infection, respectively 32.7% (n = 16) vs. 12.7% (n = 10) (p = 0.006). However, after adjusting for epidural anaesthesia and pregestational BMI, the association was no longer significant. No difference was found in mode of delivery and total priming-to-delivery interval (median 21.3 hours vs. 22.0, p = 0.897). Furthermore, FC, compared with oral misoprostol, showed a longer duration of cervical ripening and hence a shorter duration of active labour (p 0.001). Apart from the 1-min Apgar score, secondary maternal and neonatal outcomes did not differ between the groups. Conclusion: In women who require cervical ripening after prolonged PROM at term, the FC and oral misoprostol are similar in terms of efficacy and safety. Advantages associated with the FC are its safe application in women with a history of caesarean section, although we did not study these women, and an implied shorter duration of active labour. Our study adds to the limited available data on the use of the FC after the rupture of membranes and a large randomized controlled trial is needed to strengthen our findings.

A New Application of Balloon Catheter in TAE

We report a new embolization method with cobra catheter and balloon catheter in TAE for aneurysms and arterioportal fistula. Embolization for one aneurysm and one arterioportal fistula was performed using a cobra catheter, and the target vessel was temporarily blocked using a balloon catheter during the intervention. 2 cases of aneurysms and arterioportal fistula were treated successfully without coils reflux. Application of both cobra catheter with balloon catheter in TAE is effective without complication.

Balloon catheterization for hemostasis during the operation of ruptured femoral artery pseudoaneurysm

Pseudoaneurysms of the femoral artery usually progress and can rupture if left untreated. Therefore,intraoperative hemostasis is of the paramount importance in the management of these emergent situations, especially for the patients with poor general health. We present an efficient method of stopping massive bleeding occurring in this patient by balloon catheter.

Safety and efficacy of the SeparGateTM balloon-guiding catheter in neurointerventional surgery:A prospective,multicenter,single-arm clinical trial

Objective:To evaluate the safety and efficacy of the SeparGateballoon-guiding catheter(BGC)for blocking flow and delivering devices in neurointerventional surgery.Method:This prospective multicenter single-arm trial enrolled patients who received BGC adjuvant therapy to provide temporary blood flow arrest of the supra-aortic arch arteries and their branch vessels in interventional therapy.The primary endpoint was immediate procedural success rate in flow arrest,device delivery,and withdrawal.The efficacy endpoints were intraoperative product performance,including rigidity,smoothness,fracture resistance of the catheter wall,catheter push performance,compatibility and radiopaque display,integrity,adhesion thrombus after withdrawal and balloon rupture.The safety endpoints were adverse and serious adverse events associated with the test device and serious adverse events resulting in death or serious health deterioration.Result:A total of 129 patients were included;of them,128 were analyzed in the full analysis set(FAS)and per protocol set(PPS).Immediate procedural success was achieved in 97.7%of patients with FAS and PPS.The lower bound of the 95%confidence interval was 94.6%,higher than the preset efficacy margin of 94%.Device-related adverse events occurred in 2(1.6%)cases.One was mild adverse event of vasospasm,which resolved spontaneously.The other was serious adverse event of dissection aggravation,which was treated with stenting angioplasty.No device defects were observed.Conclusion:In neurointerventional surgery,the SeparGateBGC can be used to temporarily block the flow of the supra-aortic arch arteries and their branch vessels and guide the interventional device to the target vascular position.

A simple practical balloon anchoring technique within the guide catheter for chronic total occlusion (CTO) of the coronary artery

Dear Editor： Chronic total occlusions （CTOs） of the coronary artery are commonly encountered complex lesionst11. Percutaneous coronary intervention （PCI） for CTO is technically challenging due to low procedural success ratesTM. Microcatheter is one of the important devices for treatment of CTOTM. It has been widely used attributed to the excellent crossability whenever angula- tion and tortuousity of the coronary artery is encoun- tered. In the process, the microcatheter has to be withdrawn from the guide wire after the wire is proved to locate in the true lumen.

Cervical Ripening for Induction of Labor: A Randomized Comparison between Vaginal Misoprostol versus Foley’s Catheter Placement in a Nigeria Tertiary Hospital

Background: Cervical ripening is prerequisite of successful induction of labor. Vaginal misoprostol and Foley’s catheter placement have been widely used for this purpose but the data are not always sufficient. We attempted to determine which (misoprostol versus Foley’s catheter) is more effective/safer in Nigerian setting. Methods: A randomized controlled trial was performed at Federal Teaching Hospital Abakaliki, Nigeria, involving 135 term pregnant women requiring cervical ripening and labor induction. Participants were randomly allocated to misoprostol versus catheter group. The following were recorded/measured/analyzed: Bishop’s score, age, parity, body mass index, gestational age, labor duration, indication, oxytocin use, mode of delivery, and Apgar score. Chi square test and t test were used where appropriate. Results: At 24 hours, all of misoprostol group were either in labor, had ripe cervix, or had delivered, whereas 35.4% of catheter group had still unripe cervix (x2 = 29.856, P = 0.0001). Misoprostol group was less likely to require oxytocin infusion (x2 = 52.600, P = 0.0001) and less likely to require cesarean delivery (cesarean: misoprostol versus catheter: 11% versus 34% (x2 = 9.800, P = 0.001)). Total medical cost for misoprostol was less than that of catheter (x2 = 14.703, P = 0.0001). Conclusion: 50 μg vaginal misoprostol, compared with catheter placement, was more effective, cheaper, and safe as a procedure of cervical ripening before induction of labor.

A Novel, Safe Way of Removing Non-Deflatable Bladder Catheter

Non-deflated balloon of a transurethral inserted bladder catheter is a problem that could be difficult to manage, especially in males. A variety of methods have been described to puncture the balloon and remove the catheter, though these can be associated with complications. We illustrate a simple and a safe method to overcome this problem using a flexible cystoscope under local anaesthesia.

标准化咽鼓管球囊扩张术联合鼓膜置管术对难治性分泌性中耳炎的治疗效果

目的:探讨在难治性分泌性中耳炎患者的治疗中联合采用标准化咽鼓管球囊扩张术与鼓膜置管术的临床效果。方法:选取2021年1月至2022年12月甘肃省白银市第一人民医院收治的80例患者,随机数字表法将患者分成对照组(n=40,仅采用鼓膜置管术)与研究组(n=40,在鼓膜置管术的同时联合标准化咽鼓管球囊扩张术),对比咽鼓管功能障碍评分、气骨导差值、纯音听阈水平、总疗效、并发症及复发率。结果:研究组ETQD-7评分、气骨导差值、纯音听阈均值均较低,P<0.05;研究组治疗总有效率较高,P<0.05;研究组并发症及复发率均较低,P<0.05。结论:采用标准化咽鼓管球囊扩张术联合鼓膜置管术治疗难治性分泌性中耳炎可改善咽鼓管功能障碍,提高听力,减少复发率,建议推广应用。

咽鼓管球囊扩张术对分泌性中耳炎的疗效及睡眠质量的影响

目的:探讨咽鼓管球囊扩张术对分泌性中耳炎的疗效及睡眠质量的影响。方法:选取2022年1月至2022年12月福建医科大学附属泉州第一医院收治的分泌性中耳炎患者76例作为研究对象,按照随机数字表法分为对照组和观察组,每组38例。对照组行鼓膜置管术治疗,观察组行咽鼓管球囊扩张术治疗。比较2组治疗疗效、术后7项咽鼓管功能障碍症状评分量表(ETDQ-7)、并发症率、睡眠质量、生命质量评分。结果:观察组治疗总有效率(94.74%)高于对照组(76.32%),差异有统计学意义(P<0.05)。术前2组ETDQ-7比较差异无统计学意义(P>0.05);术后3个月、6个月观察组ETDQ-7评分低于对照组,差异均有统计学意义(均P<0.05)。观察组并发症发生率(7.89%)低于对照组(15.79%),但比较差异无统计学意义(P>0.05)。术前2组患者阿森斯睡眠质量量表(AIS)比较差异无统计学意义(P>0.05);术后观察组AIS评分低于对照组,差异有统计学意义(P<0.05)。术前2组世卫组织生命质量评分(WHOQOL)比较,差异无统计学意义(P>0.05);术后观察组WHOQOL评分高于对照组,差异有统计学意义(P<0.05)。结论:咽鼓管球囊扩张术在治疗分泌性中耳炎中取得理想的治疗效果,能够改善患者的咽鼓管功能,同时控制并发症的发生,使患者的睡眠质量、生命质量得到改善。

先天性主动脉缩窄的诊断与治疗:附75例报告

为探讨小儿先天性主动脉缩窄的临床特点及治疗方法选择。选取1985年1月～1998年1月主动脉缩窄75例,行左、右心导管及升、降主动脉造影,23例行心导管主动脉缩窄球囊扩张术。发生反复呼吸道感染47例,心功能不全45例,75例均可在胸骨左缘Ⅱ～Ⅳ肋间闻及收缩期杂音。血压:上肢>下肢60例,接近10例,正常5例;股动脉搏动减弱60例,正常15例。结果:23例心导管球囊扩张术中除3例主动脉弓发育不良效果不佳再行外科手术外,均获很好疗效。结果表明,先天性主动脉缩窄其上、下肢血压差异及心导管检查具有重要临床价值。除外科手术外,心导管球囊扩张术对外科手术后再狭窄及单纯隔膜型主动脉缩窄有肯定疗效。

Clinical usefulness of transpapillary removal of common bile duct stones by frequency doubled double pulse Nd:YAG laser

AIM: To study the efficacy and the safety of laser lithotripsy without direct visual control by using a balloon catheter in patients with bile duct stones that could not be extracted by standard technique. METHODS: The seventeen patients (7 male and 10 female; mean age 67.8 years) with difficult common bile duct (CBD) stones were not amenable for conventional endoscopic maneuvers such as sphincterotomy and mechanical lithotripsy were included in this study. Laser wavelengths of 532 nm and 1064 nm as a double pulse were applied with pulse energy of 120 mJ. The laser fiber was advanced under fluoroscopic control through the ERCP balloon catheter. Laser lithotripsy was continued until the fragment size seemed to be less than 10 mm. Endoscopic extraction of the stones and fragments was performed with the use of the Dormia basket and balloon catheter. RESULTS: Bile duct clearance was achieved in 15 of 17 patients (88%). The mean number of treatment sessions was 1.7 ± 0.6. Endoscopic stone removal could not be achieved in 2 patients (7%). Adverse effects were noted in three patients (hemobilia, pancreatitis, and cholangitis). CONCLUSION: The Frequency Doubled Double Pulse Nd:YAG (FREDDY) laser may be an effective and safe technique in treatment of difficult bile duct stones.

经动脉入路栓塞硬脑膜动静脉瘘中的辅助超选技术

目的探讨经动脉入路栓塞治疗颅内硬脑膜动静脉瘘(DAVF)过程中,微导管常规技术超选失败情况下的辅助超选技术。方法 4例前颅底DAVF、1例天幕区DAVF采用球囊临时阻断颈内动脉以辅助微导管超选;1例天幕区DAVF采用弹簧圈闭塞枕动脉远端以辅助微导管超选。结果采用辅助技术后,6例患者微导管均成功超选到达或接近瘘口,注射Onyx-18胶后,栓塞材料均顺利穿透瘘口,进入并闭塞近端引流静脉。6例患者均一次性获得影像学治愈,术后未发生手术相关并发症。结论初步经验表明,在经动脉入路栓塞颅内DAVF治疗中,对常规技术超选难以到达或接近瘘口的病例,球囊临时阻断颈内动脉和弹簧圈闭塞瘘供血动脉远端分支动脉以辅助微导管超选的技术安全、有效,可作为微导管超选的辅助方法。

冠脉导丝联合球囊在处理冠脉介入桡动脉痉挛时的应用价值

目的探讨应用冠脉导丝联合球囊在处理冠脉介入桡动脉痉挛时的有效性及安全性。方法将经桡动脉入径行冠脉造影或冠脉介入治疗术发生桡动脉痉挛的患者,按照随机数字表法于两种不同处理策略中随机采用一种处理策略,共计60例。导丝联合球囊组(WAB组,n=28)采用冠脉导丝联合球囊的方法处理桡动脉痉挛,完成经桡动脉入径的冠脉造影或冠脉介入治疗;药物组(Drug组,n=32)采用沿鞘管侧或造影导管、指引导管中注入硝酸甘油200μg,等待5 min后再次行桡动脉入径行冠脉造影或冠脉介入治疗,观察两组经桡动脉入径行冠脉造影或冠脉介入治疗的成功率及并发症。结果 (1)WAB组重度痉挛占71.4%,弥散痉挛占42.9%;Drug组重度痉挛占68.8%,弥散痉挛占40.6%;两组痉挛严重及弥散程度比较,差异无统计学意义(P>0.05)。(2)WAB组在冠脉导丝联合球囊指引下操作5F造影导管或6F指引导管通过痉挛部位,完成冠脉造影或冠脉介入治疗的成功率达92.9%,Drug组完成冠脉造影或冠脉介入治疗成功率为68.5%,两组比较差异有统计学意义(P<0.05)。(3)WAB组出现血管并发症2例(7.1%);Drug组出现血管并发症3例(9.4%),两组比较差异无统计学意义(P>0.05)。结论冠脉造影或冠脉介入治疗发生桡动脉痉挛时,可尝试冠脉导丝联合球囊的方法辅助导管通过痉挛部位,以完成冠脉造影或冠脉介入治疗。该方法安全可行,尤其适合无其它血管路径可替代的患者。

Comparison of hepatic venous pressure gradient and endoscopic grading of esophageal varices

AIM: To determine the correlation between the hepatic venous pressure gradient and the endoscopic grade of esophageal varices.METHODS: From September 2009 to March 2013, a total of 176 measurements of hepatic venous pressure gradient (HVPG) were done in 146 patients. Each transjugular HVPG was measured twice, first using an end whole catheter (EH-HVPG), and then using a balloon catheter (B-HVPG). The HVPG was compared with the endoscopic grade of esophageal varices (according to the general rules for recording endoscopic findings of esophagogastric varices), which was recorded within a month of the measurement of HVPG.RESULTS: The study included 110 men and 36 women, with a mean age of 56.1 years (range, 43-76 years). The technical success rate of the pressure measurements was 100% and there were no complication related to the procedures. Mean HVPG was 15.3 mmHg as measured using the end hole catheter method and 16.5 mmHg as measured using the balloon catheter method. Mean HVPG (both EH-HVPG and B-HVPG) was not significantly different among patients with different characteristics, including sex and comorbid factors, except for cases with hepatocellular carcinoma (B-HVPG, P = 0.01; EH-HVPG, P = 0.02). Portal hypertension (&#x0003e; 12 mmHg HVPG) occurred in 66% of patients according to EH-HVPG and 83% of patients according to B-HVGP, and significantly correlated with Child&#x02019;s status (B-HVPG, P &#x0003c; 0.000; EH-HVGP, P &#x0003c; 0.000) and esophageal varies observed upon endoscopy (EH-HVGP, P = 0.003; B-HVGP, P = 0.006). One hundred and thirty-five endoscopies were performed, of which 15 showed normal findings, 27 showed grade 1 endoscopic esophageal varices, 49 showed grade 2 varices, and 44 showed grade 3 varices. When comparing endoscopic esophageal variceal grades and HVPG using univariate analysis, the P value was 0.004 for EH-HVPG and 0.002 for B-HVPG.CONCLUSION: Both EH-HVPG and B-HVPG showed a positive correlation with the endoscopic grade of esophageal varices, with B-HVPG showing a stronger correlation than EH-HVPG.

Cook MOB-15三腔气囊导管在内镜逆行胰胆管造影操作中的应用

目的:探讨Cook MOB-15三腔气囊导管引导内镜下逆行胰胆管造影(ERCP)操作中导丝插入的价值。方法:回顾性分析2005年1月～2007年12月51例在加用Cook MOB-15三腔气囊导管引导下行ERCP操作患者的临床资料,与2002年1月～2004年12月间40例采用常规ERCP术恶性阻塞性黄疸患者进行对照,并比较两组患者导丝插入成功率。结果:加用Cook MOB-15三腔气囊导管组导丝插入的成功率为90.2%(46/51),明显高于对照组72.5%(29/40),差异具有统计学意义(P<0.05)。结论:ERCP操作中采用Cook MOB-15三腔气囊导管可以明显提高导丝插入的成功率。

球囊扩张成形术在带cuff血液透析导管再置管中的临床应用分析

目的探讨球囊扩张术在中心静脉狭窄的患者中行带cuff的血液透析导管再置管的应用价值及安全性评价。方法回顾2014年10月至2017年12月期间因颈内静脉带cuff的血液透析导管透析流量不足在华中科技大学同济医学院附属武汉中心医院肾病内科就诊的16例患者,其术前造影检查均提示中心静脉狭窄。所有患者术中拔管后沿导丝置入球囊在狭窄部位全程行球囊扩张成形术,重新置入新的导管。有患者带cuff的血液透析导管嵌顿无法拔出,在球囊辅助下拔除导管。经新的导管静脉端造影,以了解导管位置及肺动脉有无栓塞征象。结果术中有3例患者导管粘连嵌顿,行导管内球囊扩张术后拔管成功,所有患者均成功更换带cuff的血液透析导管,但术后仍有2例患者导管流量不佳,重新调整导管末端位置至下腔静脉后流量正常。所有患者术后均未发现肺动脉栓塞征象,未发生中心静脉破裂。分别将术后、术后3个月、术后6个月血流量与术前对比,行配对样本的t检验,差异均有统计学意义(P <0. 05)。结论在对中心静脉狭窄的患者行带cuff的血液透析导管再置管过程中,可以通过导管内球囊扩张解决原导管嵌顿无法拔除的问题,其能有效扩张狭窄的中心静脉,同时还可破坏原导管周围的纤维蛋白鞘,解决了再次置管后纤维蛋白鞘影响导管流量的问题,具有创伤小、成功率高及安全性相对较高的特点。

尿道外括约肌牵张治疗神经源性膀胱的临床观察

目的:观察尿道外括约肌牵张治疗神经源性膀胱排尿障碍的疗效。方法:选择存在神经源性膀胱的40例男性脊髓损伤患者,随机数字表法分为治疗组和对照组各20例,对照组患者仅进行单纯间歇导尿治疗,治疗组患者在单纯间歇导尿治疗的基础上加以球囊牵张尿道外括约肌治疗。观察治疗前后两组患者24 h间歇导尿次数、残余尿量、最大尿道压、排尿方式的变化。结果:经治疗后两组患者残余尿量、间歇导尿次数、最大尿道压及排尿方式等方面均有改善,但治疗组改善情况优于对照组,两组比较差异均有统计学意义(P<0.05)。结论:尿道外括约肌的牵张治疗神经源性膀胱可以减少间歇导尿次数、减小尿道流出道阻力、降低残余尿量,有利于自主排尿恢复;该技术具有安全简便易于操作,副作用小、不良反应少、选择性高等优点,便于推广使用。

医护一体化干预策略对主动脉内球囊反搏置管非计划性拔管的预防

目的探讨医护一体化干预策略对重症主动脉内球囊反搏(IABP)置管患者非计划性拔管(UEX)的预防。方法按随机数字表法,将156例IABP患者分为观察组和对照组,每组78例。观察组采用医护一体化干预策略,即予小剂量的艾贝宁并动态评估镇静效果、IABP外露导管的二次固定、IABP查检表规范化护理等综合干预。对照组在传统的健康教育基础上予约束带行防护性约束。比较2组治疗的依从性,穿刺点出血、血肿及UEX的发生率。结果对照组予约束带约束后出现6例UEX,穿刺处出血、血肿16例,治疗依从性差20例。观察组未发生UEX,均达到IABP的预期效果评估后拔管,穿刺处出血5例,未出现血肿,治疗依从性较差6例。观察组UEX、穿刺点出血或血肿、依从性差发生率低于对照组(P<0.05或P<0.01)。结论医护一体化干预策略预防IABP置管的UEX效果优于传统健康教育加约束带的护理。

不同路径经皮冠状动脉介入治疗术后患者舒适度的观察及分析

目的探讨经桡动脉、肱动脉、股动脉三种穿刺路径行经皮冠状动脉介入（PCI）治疗对患者舒适度的影响。方法65例行PCI术患者，根据穿刺动脉的不同分为桡动脉组（31例）、股动脉组（26例）和肱动脉组（8例），通过PCI术后焦虑失眠、尿潴留、腰背部不适、血液循环障碍、术肢疼痛和血管迷走神经反射等不良发应发生率评价3组患者的舒适度。结果股动脉组焦虑失眠、尿潴留、腰背部不适、血液循环障碍、术肢疼痛和血管迷走神经反射等不良发应发生例数分别为25例（96．2％）、21例（80．8％）、25例（96．2％）、8例（30．8％）、7例（26．9％）、11例（42．3％），桡动脉组无尿潴留及腰背部不适患者，焦虑失眠、血液循环障碍、术肢疼痛和血管迷走神经反射者分别为10例（32．3％）、2例（6．5％）、3例（9．7％）、1例（3．2％），肱动脉组无腰背部不适及术肢疼痛患者，焦虑失眠、尿潴留、血液循环障碍和迷走神经反射者分别为4例（50．0％）、1例（12．5％）、1例（12．5％）、1例（12．5％），股动脉组与桡动脉组和肱动脉组的差异均有统计学意义（P〈0．05）。结论经桡动脉或者肱动脉穿刺的舒适度明显优于经股动脉穿刺。

应用Forley导尿管建立兔反流性食管炎模型

目的探讨一种更安全有效且符合生理解剖的反流性食管炎动物模型的建立方法。方法健康5个月龄新西兰大白兔45只,随机均分为3组:贲门括约肌切开术组(A组),贲门括约肌部分切除术组(B组),Forley导尿管气囊扩张术组(C组)。建模前行食管造瘘术,3组兔分别采用各自方法建立反流性食管炎模型,术前及术后2周进行24hpH值监测,术后4周处死动物,观察大体标本及镜下标本。结果 B组死亡率较其余两组高(P=0.057)。B组兔24h内pH<4的时间百分比、反流次数及pH<4持续时间超过5min的反流次数均高于其余两组,C组略高于A组,但差异无统计学意义;三组造模成功率几近相同。造模成功的兔中,B组中重度反流性食管炎比例较高,但差异无统计学意义。结论贲门括约肌部分切除术造模效果较为理想,但死亡率高;气囊扩张术术式简单,安全性高,造模效果理想,且符合正常生理解剖结构,适合内镜治疗及其他新型治疗方法的基础研究。