AIM: To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection. METHODS: Contrast-free endoscopic biliary drainage was attempted in 20 patients with ma...AIM: To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection. METHODS: Contrast-free endoscopic biliary drainage was attempted in 20 patients with malignant obstruction, unsuitable for resection on the basis of tumor extent or medical illness. MRCP images were used to confirm the diagnosis of tumor, to exclude other biliary diseases and to demonstrate the stenoses as well as dilation of proximal liver segments. The procedure was carried out under conscious sedation. Patients were placed in the left lateral decubitus position. The endoscope was inserted, the papilla identified and cannulated by a papiUotome. A guide wire was inserted and guided deeply into the biliary tree, above the stenosis, by fluoroscopy. A papillotomy approximately 1 cm. long was performed and the papillotome was exchanged with a guiding-catheter. A 10 Fr' Amsterdam-type plastic stent, 7 to 15 cm long, was finally inserted over the guide wire/ guiding catheter by a pusher tube system. RESULTS: Successful stent insertion was achieved in all patients. There were no major complications. Successful drainage, with substantial reduction in bilirubin levels, was achieved in all patients. CONCLUSION: This new method of contrast-free endoscopic stenting in malignant biliary obstruction is a safe and effective method of palliation. However' a larger, randomized study comparing this new approach with the standard procedure is needed to confirm the findings of the present study.展开更多
A 55-year-old man was admitted for transcatheter closure because of pulmonary arteriovenous fistula by magnetic resonance angiography (MRA). He had a history of occasional chest pain more than one year. Angiography ...A 55-year-old man was admitted for transcatheter closure because of pulmonary arteriovenous fistula by magnetic resonance angiography (MRA). He had a history of occasional chest pain more than one year. Angiography didn't reveal significant stenosis at coronary artery. The patient was found a continuous grade 2/6 murmur over the left upper parastenal area one month ago. Chest MRA revealed a possible left superior pulmonary arteriovenous fistula. For diagnosis and localization of the fistula, aortography and selective angiography of the intemal mammary artery was performed and presented a left internal mammary artery-to-pulmonary artery fistula. The fistula was successfully closed using an 12 mm domestic vascular plug. Chest MRA showed that the fistula disappeared at two-month follow-up展开更多
Based on the pioneer work of Konishi et al,a new control method is proposed to suppress the trafficcongestion in the coupled map (CM) car-following model under open boundary condition.The influence of the followingcar...Based on the pioneer work of Konishi et al,a new control method is proposed to suppress the trafficcongestion in the coupled map (CM) car-following model under open boundary condition.The influence of the followingcar to the system has been considered.Our method and that presented by Konishi et al.[Phys.Rev.E 60 (1999) 4000]are compared.Although both the methods could suppress the traffic jam,the simulation results show that the temporalbehavior obtained by ours is better than that proposed by the Konishi's et al.The simulation results are consistent withthe theoretical analysis.展开更多
Objective To explore the efficacy of transcatheter closure of patent ductus arteriosus (PDA) with detachable coil and Amplatzer duct occluder (ADO). Methods Transcatheter colsure of PDA was performed in 160 case...Objective To explore the efficacy of transcatheter closure of patent ductus arteriosus (PDA) with detachable coil and Amplatzer duct occluder (ADO). Methods Transcatheter colsure of PDA was performed in 160 cases, aged 4.56±2.67 years, of whom 3 had residual shunt after surgical ligation, 2 had pulmomary stenosis (PS), 1 had coarctation of aorta (COA), 1 had right aortic arch, and 2 had atrial septal defect (ASD). Results Detachable coils (Duct Occlude pfm or Cook Inc) were successfully used in 51 patients with a smallest PDA diameter of 1.86±0.78mm. Amplatzer duct occluders were also successfully performed in other 109 with a moderate to large PDA diameter of 3.89±1.32mm, of whom 3 with PS or COA were performed balloon dilation firstly, and 2 with ASD were performed PDA occlusion firstly; 1 month to 4.8 years follow-up coil or Amplatzer device closure of PDA showed that neither residual shunt nor any complication. Conclusion It is suggested that the detachable coil and Amplatzer duct occluder are simple and safe for the catheter closure from small to large sized PDA.展开更多
文摘AIM: To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection. METHODS: Contrast-free endoscopic biliary drainage was attempted in 20 patients with malignant obstruction, unsuitable for resection on the basis of tumor extent or medical illness. MRCP images were used to confirm the diagnosis of tumor, to exclude other biliary diseases and to demonstrate the stenoses as well as dilation of proximal liver segments. The procedure was carried out under conscious sedation. Patients were placed in the left lateral decubitus position. The endoscope was inserted, the papilla identified and cannulated by a papiUotome. A guide wire was inserted and guided deeply into the biliary tree, above the stenosis, by fluoroscopy. A papillotomy approximately 1 cm. long was performed and the papillotome was exchanged with a guiding-catheter. A 10 Fr' Amsterdam-type plastic stent, 7 to 15 cm long, was finally inserted over the guide wire/ guiding catheter by a pusher tube system. RESULTS: Successful stent insertion was achieved in all patients. There were no major complications. Successful drainage, with substantial reduction in bilirubin levels, was achieved in all patients. CONCLUSION: This new method of contrast-free endoscopic stenting in malignant biliary obstruction is a safe and effective method of palliation. However' a larger, randomized study comparing this new approach with the standard procedure is needed to confirm the findings of the present study.
文摘A 55-year-old man was admitted for transcatheter closure because of pulmonary arteriovenous fistula by magnetic resonance angiography (MRA). He had a history of occasional chest pain more than one year. Angiography didn't reveal significant stenosis at coronary artery. The patient was found a continuous grade 2/6 murmur over the left upper parastenal area one month ago. Chest MRA revealed a possible left superior pulmonary arteriovenous fistula. For diagnosis and localization of the fistula, aortography and selective angiography of the intemal mammary artery was performed and presented a left internal mammary artery-to-pulmonary artery fistula. The fistula was successfully closed using an 12 mm domestic vascular plug. Chest MRA showed that the fistula disappeared at two-month follow-up
基金Supported by the National Natural Science Foundation of China under Grant Nos.2006CB705500,10532060,and 60904068the Natural Science Foundation of NingBo under Grant Nos.2009B21003,2009A610154,2009A610014K.C.Wong Magna Fund in Ningbo University
文摘Based on the pioneer work of Konishi et al,a new control method is proposed to suppress the trafficcongestion in the coupled map (CM) car-following model under open boundary condition.The influence of the followingcar to the system has been considered.Our method and that presented by Konishi et al.[Phys.Rev.E 60 (1999) 4000]are compared.Although both the methods could suppress the traffic jam,the simulation results show that the temporalbehavior obtained by ours is better than that proposed by the Konishi's et al.The simulation results are consistent withthe theoretical analysis.
文摘Objective To explore the efficacy of transcatheter closure of patent ductus arteriosus (PDA) with detachable coil and Amplatzer duct occluder (ADO). Methods Transcatheter colsure of PDA was performed in 160 cases, aged 4.56±2.67 years, of whom 3 had residual shunt after surgical ligation, 2 had pulmomary stenosis (PS), 1 had coarctation of aorta (COA), 1 had right aortic arch, and 2 had atrial septal defect (ASD). Results Detachable coils (Duct Occlude pfm or Cook Inc) were successfully used in 51 patients with a smallest PDA diameter of 1.86±0.78mm. Amplatzer duct occluders were also successfully performed in other 109 with a moderate to large PDA diameter of 3.89±1.32mm, of whom 3 with PS or COA were performed balloon dilation firstly, and 2 with ASD were performed PDA occlusion firstly; 1 month to 4.8 years follow-up coil or Amplatzer device closure of PDA showed that neither residual shunt nor any complication. Conclusion It is suggested that the detachable coil and Amplatzer duct occluder are simple and safe for the catheter closure from small to large sized PDA.