PURPOSE: This study involved a prospective evaluation of the results of the ba lloon catheter dilation of lower gastrointestinal stenoses. METHODS: First a gui de-wire was introduced into the stenosis followed under x...PURPOSE: This study involved a prospective evaluation of the results of the ba lloon catheter dilation of lower gastrointestinal stenoses. METHODS: First a gui de-wire was introduced into the stenosis followed under x-ray control by a dou ble-lumen balloon catheter, or directly through the endoscope a balloon cathete r, with progressive dilation under pressures of 1.5 to 3 atm. The result was ass essed via the decreased indentation of the balloon and the increased diameter of the stenosis. RESULTS:Between January 1985 and November 2002, 133 dilations wer e performed on 57 patients. The cause of the stenosis was postoperative stenosis in 44 patients, Crohn’s disease in 6, ulcerative colitis in 2, postirradiative stenosis in 1, ischemic stenosis in 1, and scarring of the anus in 3 patients. Four of the st enoses were localized to the anus, 45 to the rectum, 7 to the colon, and 1 to th e terminal ileum. The average diameter of the stenosis was increased from 7.2 (r ange, 1-14) mm to 19.7 (range, 14-25) mm. Colostomies were closed in 11 of 17 cases. In five patients, the ileus state ceased, and the three colocutaneous fis tulas healed rapidly. In 17 of 57 patients, reoperation was proposed. In one pat ient, fever as a complication was treated with antibiotics. CONCLUSIONS: The dil ation of benign stenoses of the lower gastrointestinal tract with a balloon cath eter is an effective and safe method, which in most cases (70 percent) results i n long-term elimination of the obstructive symptoms, so that surgery can be avo ided.展开更多
Background-Angiotensin-converting enzyme(ACE) inhibitors have been shown to attenuate left ventricular(LV) enlargement in association with reducing mortality after myocardial infarction(MI). Preclinical data suggest t...Background-Angiotensin-converting enzyme(ACE) inhibitors have been shown to attenuate left ventricular(LV) enlargement in association with reducing mortality after myocardial infarction(MI). Preclinical data suggest that angiotensin receptor blockers(ARBs) may have similar structural and functional effects after MI. The Valsartan in Acute Myocardial Infarction(VALIANT) Echo study was designed to test the hypothesis that the ARB valsartan, either alone or in combination with captopril, could attenuate progressive LV enlargement or improve LV ejection fraction to a greater extent than captopril alone. Methods and Results-Six hundred ten patients enrolled in the main VALIANT study who experienced MI and evidence of LV dysfunction, heart failure, or both were enrolled in the VALIANT Echo study. Patients were randomized to receive valsartan 160 mg PO BID, captopril 50 mg PO TID, or valsartan 80 mg PO BID plus captopril 50 mg PO TID between 1 and 10 days after MI. Six hundred three patients had echocardiograms of sufficient quality for quantitative analysis. Echocardiograms were digitized, and endocardial borders were traced manually from 2 short-axis and 2 apical views. Ventricular volumes, ejection fractions, combined areas, and infarct segment length were measured, and changes in echocardiographic measures from baseline to 20 months were compared between treatment groups. Baseline clinical and echocardiographic characteristics were similar in the 3 treatment arms. The changes from baseline to 20 months in all echocardiographic parameters were similar in all 3 treatment arms. Baseline echocardiographic measures of ejection fraction, end-diastolic volume, and infarct segment length were highly predictive of outcomes including total mortality, death or hospitalization for heart failure, or death or any cardiovascular event(heart failure, MI, stroke, resuscitated sudden death), even after adjustment for known covariates. Conclusions-Treatment with the ACE inhibitor captopril, valsartan, or the combination of captopril plus valsartan resulted in similar changes in cardiac volume, ejection fraction, and infarct segment length between baseline and 20 months after MI. Baseline echocardiographic measures were powerfully and independently predictive of all major outcomes.展开更多
文摘PURPOSE: This study involved a prospective evaluation of the results of the ba lloon catheter dilation of lower gastrointestinal stenoses. METHODS: First a gui de-wire was introduced into the stenosis followed under x-ray control by a dou ble-lumen balloon catheter, or directly through the endoscope a balloon cathete r, with progressive dilation under pressures of 1.5 to 3 atm. The result was ass essed via the decreased indentation of the balloon and the increased diameter of the stenosis. RESULTS:Between January 1985 and November 2002, 133 dilations wer e performed on 57 patients. The cause of the stenosis was postoperative stenosis in 44 patients, Crohn’s disease in 6, ulcerative colitis in 2, postirradiative stenosis in 1, ischemic stenosis in 1, and scarring of the anus in 3 patients. Four of the st enoses were localized to the anus, 45 to the rectum, 7 to the colon, and 1 to th e terminal ileum. The average diameter of the stenosis was increased from 7.2 (r ange, 1-14) mm to 19.7 (range, 14-25) mm. Colostomies were closed in 11 of 17 cases. In five patients, the ileus state ceased, and the three colocutaneous fis tulas healed rapidly. In 17 of 57 patients, reoperation was proposed. In one pat ient, fever as a complication was treated with antibiotics. CONCLUSIONS: The dil ation of benign stenoses of the lower gastrointestinal tract with a balloon cath eter is an effective and safe method, which in most cases (70 percent) results i n long-term elimination of the obstructive symptoms, so that surgery can be avo ided.
文摘Background-Angiotensin-converting enzyme(ACE) inhibitors have been shown to attenuate left ventricular(LV) enlargement in association with reducing mortality after myocardial infarction(MI). Preclinical data suggest that angiotensin receptor blockers(ARBs) may have similar structural and functional effects after MI. The Valsartan in Acute Myocardial Infarction(VALIANT) Echo study was designed to test the hypothesis that the ARB valsartan, either alone or in combination with captopril, could attenuate progressive LV enlargement or improve LV ejection fraction to a greater extent than captopril alone. Methods and Results-Six hundred ten patients enrolled in the main VALIANT study who experienced MI and evidence of LV dysfunction, heart failure, or both were enrolled in the VALIANT Echo study. Patients were randomized to receive valsartan 160 mg PO BID, captopril 50 mg PO TID, or valsartan 80 mg PO BID plus captopril 50 mg PO TID between 1 and 10 days after MI. Six hundred three patients had echocardiograms of sufficient quality for quantitative analysis. Echocardiograms were digitized, and endocardial borders were traced manually from 2 short-axis and 2 apical views. Ventricular volumes, ejection fractions, combined areas, and infarct segment length were measured, and changes in echocardiographic measures from baseline to 20 months were compared between treatment groups. Baseline clinical and echocardiographic characteristics were similar in the 3 treatment arms. The changes from baseline to 20 months in all echocardiographic parameters were similar in all 3 treatment arms. Baseline echocardiographic measures of ejection fraction, end-diastolic volume, and infarct segment length were highly predictive of outcomes including total mortality, death or hospitalization for heart failure, or death or any cardiovascular event(heart failure, MI, stroke, resuscitated sudden death), even after adjustment for known covariates. Conclusions-Treatment with the ACE inhibitor captopril, valsartan, or the combination of captopril plus valsartan resulted in similar changes in cardiac volume, ejection fraction, and infarct segment length between baseline and 20 months after MI. Baseline echocardiographic measures were powerfully and independently predictive of all major outcomes.
