AIM To summarize the experience in the clinical treatment of the biliary ductal strictures complicating localized left hepatolithiasis in recent two decades.
Goals: To assess the outcome differences following different precut biliary sphincterotomy needle-knife techniques. Background: Precut biliary needle-knife sphincterotomy (NKS) allows biliary access when standard cann...Goals: To assess the outcome differences following different precut biliary sphincterotomy needle-knife techniques. Background: Precut biliary needle-knife sphincterotomy (NKS) allows biliary access when standard cannulation techniques fail. Little comparative data exist on the outcome of precut NKS. Study: Retrospective comparison of outcome differences of three NKS techniques performed by three pancreaticobiliary endoscopists at a tertiary referral center. Results: A total of 139 consecutive biliary NKS were performed. In 44 cases (technique A), NKS was performed using a precut fistulotomy technique avoiding the papillary orifice, with pure cutting current, and occasional pancreatic duct (PD) stenting (6 of 44). In 47 cases (technique B), NKS was performed starting from the papillary orifice cutting upward with blended current, and no PD stenting. In 48 cases (technique C), NKS was performed as B but using pure cutting current and frequent PD stenting (15 of 48).NKS was successful in 95.5% ,95.7% , and 89.6% at initial endoscopic retrograde cholangiopancreatography and 100% , 97.8% , and 95.6% after a second endoscopic retrograde cholangiopancreatography. Total complications were not significantly different between the three groups; however, a lower incidence of pancreatitis occurred using technique A compared with techniques B and C (not significant). Conclusions: NKS techniques result in a high success rate of biliary cannulation with a similar overall complication rate. Avoiding cutting at the papillary orifice may reduce the risk of pancreatitis. When cutting at the papillary orifice, pancreatic duct stenting, pure cutting current, or both may reduce the incidence of pancreatitis.展开更多
Purpose: To determine the efficacy, predictability, stability and safety of la ser in situ keratomileusis (LASIK) in treating patients with different degrees o f myopia. Methods: We enrolled 386 eyes of 200 consecutiv...Purpose: To determine the efficacy, predictability, stability and safety of la ser in situ keratomileusis (LASIK) in treating patients with different degrees o f myopia. Methods: We enrolled 386 eyes of 200 consecutive patients who underwen t LASIK and divided them into four groups according to their degree of preoperat ive spherical equivalent (SE). Group 1 eyes ranged between-1.00 and-3.99 diopt res (D) (low myopia). Group 2 eyes ranged between-4.00 and-5.99 D (moderate my opia). Group 3 eyes ranged between-6.00 and-9.99 D (high myopia). Group 4 eyes were over-9.99 D (extreme myopia). Follow-up was at 1 day, 1 we ek and 1, 3, 6, 12 and 18 months postoperatively. Results: Our study included 38 6 eyes of 200 patients with SE ranging from-3.00 to-16.00 D (mean-7.14±2.87 D). All eyes were seen at 1 day postoperatively. A total of 360 eyes (93%) were examined at 1 week, 330 eyes (85%) at 1 month, 281 eyes (73%) at 3 months, 24 7 eyes (64%) at 6 months, 199 eyes (52%) at 12 months and 142 eyes (37%) at 1 8 months. The postoperative data from 1 day to 12 months were used because of th e low follow-up rate at 18 months postoperatively. Group 1 consisted of 30 eyes . The mean SE was-3.52±0.43 D preoperatively and-0.40±0.58 D at 1 month,-0. 46±0.60 D at 6 months and-0.42±0.50 D at 12 months postoperatively. Uncorrect ed visual acuity (UCVA) was 20/40 or better in 95%of eyes at 1 day and in 100% of eyes at 6 and 12 months postoperatively. Group 2 consisted of 151 eyes. The m ean SE was-5.36±0.67 D preoperatively and-0.54±0.78 D at 1 month,-0.56±0.9 0 D at 6 months and-0.55±0.82 D at 12 months postoperatively. Uncorrected VA w as 20/40 or better in 95%of eyes at 1 day and in 100%of eyes at 6 and 12 month s postoperatively. Group 3 consisted of 167 eyes. The mean SE was-8.15±0.94 D preoperatively and-0.58±0.90 D at 1 month,-0.67±1.00 D at 6 months and-0.64 ±0.95 D at 12 months postoperatively. Uncorrected VA was 20/40 or better in 90 %of eyes at 1 day and in 98%of eyes at 6 and 12 months postoperatively. Group 4 consisted of 38 eyes. The mean SE was-11.09±1.10 D preoperatively and-1.25 ±1.20 D at 1 month,-1.13±1.30 D at 6 months and-1.20±1.25 D at 12 months po stoperatively. Uncorrected VA was 20/40 or better in 78%of eyes at 1 day, in 94 %at 6 months and in 90%at 12 months postoperatively. Intraoperative complicati ons (free cap) occurred in two eyes and postoperative complications were observe d in three eyes, making the total complications rate 1.29%(5/386). Seven eyes l ost one Snellen line of BCVA, five lost two lines and two lost more than two lin es (total: 3.64%, 14/386). Conclusion: In conclusion, LASIK is effective, predi ctable and safe for correcting myopia but is more accurate for correcting myopia up to-10.00 D. With more improvement in algorithms and ablation profile, we be lieve that LASIK can offer better results for higher myopia.展开更多
Background Very elderly patients （age 〉 85 years） are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneou...Background Very elderly patients （age 〉 85 years） are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneous coronary intervention （PCI）. However, the relationship between bleeding and mortality in the very elderly is unknown. Methods Retrospective review was performed on 17,378 consecutive PCI procedures from 2000 to 2015 at Dartmouth-Hitchcock Medical Center. Incidence of bleeding during the index PCI admission （bleeding requiring transfusion, access site hematoma 〉 5 cm, pseudoaneurysm, and retroperitoneal bleed） and in-hospital mortality were reported for four age groups （〈 65 years, 65-74 years, 75-84 years, and ≥ 85 years）. The mortality of patients who suffered bleeding complications and those who did not was calculated and multivariate analysis was performed for in-hospital mortality. Lastly, known predictors of bleeding were compared between patients age 〈 85 years and age ≥85 years. Results Of 17,378 patients studied, 1019 （5.9%） experienced bleeding and 369 （2.1%） died in-hospital following PCI. Incidence of bleeding and in-hospital mortality increased monotonically with increasing age （mortality： 0.94%, 2.27%, 4.24% and 4.58%; bleeding： 3.96%, 6.62%, 10.68% and 13.99% for ages 〈 65, 65-4, 75-84 and ≥ 85 years, respectively）. On multivariate analysis, bleeding was associated with increased mortality for all age groups except patients age ≥85 years [odds ratio （95% CI）： age 〈 65 years, 3.65 （1.99-6.74）; age 65-74 years, 2.83 （1.62-4.94）; age 75-84 years, 3.86 （2.56-5.82）, age ≥ 85 years 1.39 （0.49-3.95）]. Conclusions Bleeding and mortality following PCI increase with increasing age. For the very elderly, despite high rates of bleeding, bleeding is no longer predictive of in-hospital mortality following PCI.展开更多
Simultaneous thrombosis affecting more than one coronary artery has been reported to occur in about 4.8% of the cases at the time primary percutaneous coronary intervention （PCI）. Simultaneous multiple coronary arte...Simultaneous thrombosis affecting more than one coronary artery has been reported to occur in about 4.8% of the cases at the time primary percutaneous coronary intervention （PCI）. Simultaneous multiple coronary arteries throm-bosis is uncommon and can lead to a fatal outcome. Careful attention should be given to identification of abnormal ECG and coronary angiography （CAG） results. The affected ves- sel should be opened timely and efficiently in an effort to save the myocardium and reduce serious complications such as congestive heart failure, ventricular arrhythmia, cardiogenic shock, or sudden cardiac death.展开更多
Atrial fibrillation （AF） is an important health problem due to its association with serious complications.Ill Stroke is one of the most serious complications and is the leading cause of death and disabilities in thi...Atrial fibrillation （AF） is an important health problem due to its association with serious complications.Ill Stroke is one of the most serious complications and is the leading cause of death and disabilities in this population. AF in- creases the risk of embolic stroke five times compared to general population. The prevalence of AF varies from 0.5%-15% depending on studied populations such as age,展开更多
文摘AIM To summarize the experience in the clinical treatment of the biliary ductal strictures complicating localized left hepatolithiasis in recent two decades.
文摘Goals: To assess the outcome differences following different precut biliary sphincterotomy needle-knife techniques. Background: Precut biliary needle-knife sphincterotomy (NKS) allows biliary access when standard cannulation techniques fail. Little comparative data exist on the outcome of precut NKS. Study: Retrospective comparison of outcome differences of three NKS techniques performed by three pancreaticobiliary endoscopists at a tertiary referral center. Results: A total of 139 consecutive biliary NKS were performed. In 44 cases (technique A), NKS was performed using a precut fistulotomy technique avoiding the papillary orifice, with pure cutting current, and occasional pancreatic duct (PD) stenting (6 of 44). In 47 cases (technique B), NKS was performed starting from the papillary orifice cutting upward with blended current, and no PD stenting. In 48 cases (technique C), NKS was performed as B but using pure cutting current and frequent PD stenting (15 of 48).NKS was successful in 95.5% ,95.7% , and 89.6% at initial endoscopic retrograde cholangiopancreatography and 100% , 97.8% , and 95.6% after a second endoscopic retrograde cholangiopancreatography. Total complications were not significantly different between the three groups; however, a lower incidence of pancreatitis occurred using technique A compared with techniques B and C (not significant). Conclusions: NKS techniques result in a high success rate of biliary cannulation with a similar overall complication rate. Avoiding cutting at the papillary orifice may reduce the risk of pancreatitis. When cutting at the papillary orifice, pancreatic duct stenting, pure cutting current, or both may reduce the incidence of pancreatitis.
文摘Purpose: To determine the efficacy, predictability, stability and safety of la ser in situ keratomileusis (LASIK) in treating patients with different degrees o f myopia. Methods: We enrolled 386 eyes of 200 consecutive patients who underwen t LASIK and divided them into four groups according to their degree of preoperat ive spherical equivalent (SE). Group 1 eyes ranged between-1.00 and-3.99 diopt res (D) (low myopia). Group 2 eyes ranged between-4.00 and-5.99 D (moderate my opia). Group 3 eyes ranged between-6.00 and-9.99 D (high myopia). Group 4 eyes were over-9.99 D (extreme myopia). Follow-up was at 1 day, 1 we ek and 1, 3, 6, 12 and 18 months postoperatively. Results: Our study included 38 6 eyes of 200 patients with SE ranging from-3.00 to-16.00 D (mean-7.14±2.87 D). All eyes were seen at 1 day postoperatively. A total of 360 eyes (93%) were examined at 1 week, 330 eyes (85%) at 1 month, 281 eyes (73%) at 3 months, 24 7 eyes (64%) at 6 months, 199 eyes (52%) at 12 months and 142 eyes (37%) at 1 8 months. The postoperative data from 1 day to 12 months were used because of th e low follow-up rate at 18 months postoperatively. Group 1 consisted of 30 eyes . The mean SE was-3.52±0.43 D preoperatively and-0.40±0.58 D at 1 month,-0. 46±0.60 D at 6 months and-0.42±0.50 D at 12 months postoperatively. Uncorrect ed visual acuity (UCVA) was 20/40 or better in 95%of eyes at 1 day and in 100% of eyes at 6 and 12 months postoperatively. Group 2 consisted of 151 eyes. The m ean SE was-5.36±0.67 D preoperatively and-0.54±0.78 D at 1 month,-0.56±0.9 0 D at 6 months and-0.55±0.82 D at 12 months postoperatively. Uncorrected VA w as 20/40 or better in 95%of eyes at 1 day and in 100%of eyes at 6 and 12 month s postoperatively. Group 3 consisted of 167 eyes. The mean SE was-8.15±0.94 D preoperatively and-0.58±0.90 D at 1 month,-0.67±1.00 D at 6 months and-0.64 ±0.95 D at 12 months postoperatively. Uncorrected VA was 20/40 or better in 90 %of eyes at 1 day and in 98%of eyes at 6 and 12 months postoperatively. Group 4 consisted of 38 eyes. The mean SE was-11.09±1.10 D preoperatively and-1.25 ±1.20 D at 1 month,-1.13±1.30 D at 6 months and-1.20±1.25 D at 12 months po stoperatively. Uncorrected VA was 20/40 or better in 78%of eyes at 1 day, in 94 %at 6 months and in 90%at 12 months postoperatively. Intraoperative complicati ons (free cap) occurred in two eyes and postoperative complications were observe d in three eyes, making the total complications rate 1.29%(5/386). Seven eyes l ost one Snellen line of BCVA, five lost two lines and two lost more than two lin es (total: 3.64%, 14/386). Conclusion: In conclusion, LASIK is effective, predi ctable and safe for correcting myopia but is more accurate for correcting myopia up to-10.00 D. With more improvement in algorithms and ablation profile, we be lieve that LASIK can offer better results for higher myopia.
文摘Background Very elderly patients （age 〉 85 years） are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneous coronary intervention （PCI）. However, the relationship between bleeding and mortality in the very elderly is unknown. Methods Retrospective review was performed on 17,378 consecutive PCI procedures from 2000 to 2015 at Dartmouth-Hitchcock Medical Center. Incidence of bleeding during the index PCI admission （bleeding requiring transfusion, access site hematoma 〉 5 cm, pseudoaneurysm, and retroperitoneal bleed） and in-hospital mortality were reported for four age groups （〈 65 years, 65-74 years, 75-84 years, and ≥ 85 years）. The mortality of patients who suffered bleeding complications and those who did not was calculated and multivariate analysis was performed for in-hospital mortality. Lastly, known predictors of bleeding were compared between patients age 〈 85 years and age ≥85 years. Results Of 17,378 patients studied, 1019 （5.9%） experienced bleeding and 369 （2.1%） died in-hospital following PCI. Incidence of bleeding and in-hospital mortality increased monotonically with increasing age （mortality： 0.94%, 2.27%, 4.24% and 4.58%; bleeding： 3.96%, 6.62%, 10.68% and 13.99% for ages 〈 65, 65-4, 75-84 and ≥ 85 years, respectively）. On multivariate analysis, bleeding was associated with increased mortality for all age groups except patients age ≥85 years [odds ratio （95% CI）： age 〈 65 years, 3.65 （1.99-6.74）; age 65-74 years, 2.83 （1.62-4.94）; age 75-84 years, 3.86 （2.56-5.82）, age ≥ 85 years 1.39 （0.49-3.95）]. Conclusions Bleeding and mortality following PCI increase with increasing age. For the very elderly, despite high rates of bleeding, bleeding is no longer predictive of in-hospital mortality following PCI.
文摘Simultaneous thrombosis affecting more than one coronary artery has been reported to occur in about 4.8% of the cases at the time primary percutaneous coronary intervention （PCI）. Simultaneous multiple coronary arteries throm-bosis is uncommon and can lead to a fatal outcome. Careful attention should be given to identification of abnormal ECG and coronary angiography （CAG） results. The affected ves- sel should be opened timely and efficiently in an effort to save the myocardium and reduce serious complications such as congestive heart failure, ventricular arrhythmia, cardiogenic shock, or sudden cardiac death.
文摘Atrial fibrillation （AF） is an important health problem due to its association with serious complications.Ill Stroke is one of the most serious complications and is the leading cause of death and disabilities in this population. AF in- creases the risk of embolic stroke five times compared to general population. The prevalence of AF varies from 0.5%-15% depending on studied populations such as age,
