Treatment of malignant digestive tract obstruction by combined intraluminal stent installation and intra-arterial drug infusion

AIM: To study the palliative treatment of malignant obstruction of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs. METHODS: A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus, stomach, duodenum and jejunum), per anal (colon and rectum) and percutaneous transhepatic (biliary) installation of metallic stent. Among them, 203 cases received drug infusion by cannulation of tumor supplying artery with Seldinger's technique. RESULTS: Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8-43 weeks among those with intra-arterial drug infusion, which was later than 4-26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3-105) weeks, which was significantly longer than 13 (3-24) weeks of the latter group. CONCLUSION: Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.

Tulip bundle technique and fibrin glue injection:Unusual treatment of colonic perforation

We report a case of a 63-year-old male who experienced an iatrogenic sigmoid perforation repaired combining three endoscopic techniques.The lesion was large and irregular with three discrete perforations,therefore,we decided to close it by placing one clip per perforation,and then connecting all the clips with two endoloops.Finally we chose to use a fibrin glue injection to obtain a complete sealing.Four days after the colonoscopy the patient underwent a laparoscopic right hemicolectomy due to evidence of a large polyp of the caecum with high grade dysplasia and focal carcinoma in situ.Inspection of the sigma showed complete repair of the perforation.This report underlines how a conservative approach,together with a combination of various endoscopic techniques,can resolve complicated iatrogenic perforations of the colon.

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum:A case series

AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.METHODSFrom November 2014 till December 2015 17 patients (8 female, 9 male, average age 69.8 years) with a symptomatic Zenker diverticulum (mean size 3.5 cm) were treated by inserting a new 5 mm fully rotatable surgical stapler (MicroCutter30 Xchange, Cardica Inc.) next to an ultrathin flexible endoscope through an overtube. The Patients were under conscious sedation with the head reclined in left position, the stapler placed centrally and pushed forward to the bottom of the diverticulum. The septum was divided by the staple rows under flexible endoscopic control.RESULTSIn eleven patients (64.7%) the stapler successfully divided the septum completely. Mean procedure time was 21 min, medium size of the septum was 2.8 cm (range 1.5 cm to 4 cm). In four patients the septum was shorter than 3 cm, in seven longer than 3 cm. To divide the septum, averagely 1.3 stapler cartridges were used. Two minor bleedings occurred. Major adverse events like perforation or secondary haemorrhage did not occur. After an average time of two days patients were discharged from the hospital. In 6 patients (35.3%) the stapler failed due to a thick septum or insufficient reclination of the head. Follow up endoscopy was performed after an average of two months in 9 patients; 4 patients (44.4%) were free of symptoms, 5 patients (55.6%) stated an improvement. A relapse of symptoms did not occur.CONCLUSIONFlexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new, safe and efficient treatment modality. A simultaneously tissue opening and occlusion prevents major complications.

Full-thickness scleral incisions technique for the treatment of a cyclodialysis cleft following ab interno trabeculotomy

Dear Editor, I am Dr.Daniela Alvarez-AscenciofromtheGlaucoma Department at Asociacion Para Evitar la Ceguera (APEC)in Mexico City, Mexico. I write to present a successful case of cyclodyalisis repair in a direct visualization technique that was performed on a patient after a microincisional glaucoma surgery (MIGS) complication.

Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts

AIM To comparatively evaluate Seldinger and Trocar techniques in the percutaneous treatment of hydatid disease. METHODS Trocar and Seldinger techniques were used for 49 and 56 cysts, respectively, among 106 hydatid cysts in 88 patients. The number of males and females were 22 and 66, respectively with a mean age of 44.9 years(range, 15-87). Follow-up studies included cyst diameter, cyst contents, and morphological changes inthe cyst wall, local recurrence, and secondary invasion, using ultrasound, computerized tomography and chest X-rays. RESULTS The positive criteria of healing were a decrease in cyst diameter, progressive solidification of the cyst contents, and disappearance of the cyst. Local recurrence was defined as an increase in the cyst diameter and contents, and appearance of daughter cysts in the primary cavity, while secondary dissemination was defined as the appearance of new cysts outside the treated cyst. Mean duration of follow-up was 19.23 mo(range, 18-26 mo). Follow-up results demonstrated that no significant differences were present between the Trocar and Seldinger techniques in the percentage of decrease in the cyst volume, rate of early complications, local recurrence and secondary dissemination(P = 0.384, 0.069, 0.215 and 0.533, respectively). CONCLUSION There are no differences between the Seldinger and Trocar techniques that gain entry to the cyst cavity in terms of the efficacy of the treatment and the rates of early and late complications.

Surgical treatment of inflammatory bowel disease:From the gastroenterologist’s stand-point

Treatment of ulcerative colitis(UC)and Crohn’s disease(CD)represents,in the majority of cases,a real challenge to the gastroenterologist’s abilities and skills as well as a clinical test concerning his/her levels of medical knowledge and experience.During the last two decades,our pharmaceutical arsenal was significantly strengthened,especially after the introduction of the so-called biological agents,drugs which to a large extent not only improved the results of conservative treatment but also changed the natural history of the disease.However,colectomy is still necessary for some patients with severe UC although smaller compared to the past,precisely because of the improvements achieved in the available conservative treatment.Nevertheless,surgeries to treat colon dysplasia and cancer are increasing to some extent.At the same time,satisfactory improvements in surgical techniques,the pre-and post-operative care of patients,as well as the selection of the appropriate time for performing the surgery have been noticed.Regarding patients with CD,the improvement of conservative treatment did not significantly change the need for surgical treatment since two-thirds of patients need to undergo surgery at some point in the course of their disease.On the other hand,the outcome of the operation has improved through good preoperative care as well as the wide application of more conservative surgical techniques aimed at keeping as much of the bowel in situ as possible.This article discusses the indications for surgical management of UC patients from the gastroenterologist’s point of view,the results of the emerging new techniques such as transanal surgery and robotics,as well as alternative operations to the classic ileo-anal-pouch anastomosis.The author also discusses the basic principles of surgical management of patients with CD based on the results of the relevant literature.The self-evident is emphasized,that is,to achieve an excellent therapeutic result in patients with severe inflammatory bowel disease in today’s era;the close cooperation of gastroenterologists with surgeons,pathologists,imaging,and nutritionists is of paramount importance.

Effects of heat treatment on morphological,optical and electrical properties of ITO films by sol-gel technique

Indium-tin-oxide(ITO)films were prepared on the quarts glass by sol-gel technique.Effects of different heat treatment temperatures and cooling methods on the morphological,optical and electrical properties of ITO films were measured by TG/DTA, IR,XRD,SEM,UV-VIS spectrometer and four-probe apparatus.It is found that the crystallized ITO films exhibit a polycrystalline cubic bixbyite structure.The heat treatment process has significant effects on the morphological,optical and electrical properties of ITO films.Elevating the heat treatment temperature can perfect the crystallization process of ITO films,therefore the optical and electrical properties of ITO films are improved.But the further increasing of heat treatment temperature results in the increment of ITO films’resistivity.Compared with ITO films elaborated by furnace cooling,those prepared through air cooling have following characteristics as obviously decreased crystalline size,deeply declined porosity,more compact micro-morphology,improved electrical property and slightly decreased optical transmission.

Monitoring the Treatment of Hepatitis C Viral Infection by Molecular Techniques

The prevalence of Hepatitis C viral infection in Egypt is the highest rate in the world. It is a major public health problem in Egypt. The objective of this study was to detect the clearance of HCV-RNA in Egyptian patients who were recommended for combination therapy of pyglated interferon α 2a and ribavirin (PEG-interferon/Ribavirin). Ninety-five positive HCV-IgG cases were tested for HCV-RNA at baseline and at weeks 4, 12, 24, 48 and 72 of treatment with PEG-interferon α 2a/Ribavirin. The correlations between the viral parameters during and after treatment were evaluated. Patients recommended receiving PEG-interferon 2a/ribavirin combination therapy showed high response rate determined as 71.9% achieved Sustained Virological Response (SVR) from total patients, and 71.4% from patients who received 48 weeks therapy. In general, the employment of TMA provided us the accuracy of results with confidence in our work. There was a significant relation (p < 0.001) between results of Transcription mediated amplification (TMA) and response to therapy that indicate to positive correlation. The development of sensitive accurate assays for HCV-RNA detection and quantification is necessary to improve not only the assessment of the response to antiviral therapy but also our understanding of the mechanism underlying antiviral resistance.

The Potential of Activated Carbon in the Treatment of Water for Human Consumption, a Study of the State of the Art and Its Techniques Used for Its Development

This review article addresses the use of biological activated carbon in water treatment and its techniques for its development, with the premise of analyzing the potential of Activated Carbon (AC) in the treatment of water for human consumption. For this end, it aims to identify the techniques used for the production of AC, use and its benefits, production from vegetable waste for water treatment. Activated carbon has the ability to selectively collect gases, liquids and impurities inside its pores, which is the reason it is widely used in filtration systems and for that the treatment of water, the coal fulfills the function of adsorbent, retaining in its pores certain types of impurities: large particles that cause undesirable color, taste or odor in the water. In the treatment of effluents, coal is used for clarification, deodorization and purification of effluents.

Advances Treatment Technologies in Chemical Industry Wastewater

The main treatment methods of chemical wastewater were reviewed.Physical,chemical,and biochemical treatment technologies effective for removing those pollutants were presented with their applicability,effectiveness and advantages.The problems facing the wastewater treatment in the petroleum chemical industry and coal chemical industry were introduced.In the end,the new progress and trend of the processes were overviewed.

Assisted coiling techniques in treatment of intracranial complex aneurysms

Objective To investigate the application of assisted coiling techniques in the treatment of complex intracranial aneurysms. Methods From Jun. 2007 to Aug. 2010,36 patients with 41 complex intracranial aneurysms were treated by varient endovascular methods,including balloon, stent-assisted coiling and double microcatheter coilingtechniques. Results Among the

The clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment for patients with DeBakey Ⅰ thoracic aortic dissection

Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010,101 cases of DeBakeyⅠaortic dissection were treated by modified total arch replacement and stent elephant trunk technique,in which emergencey surgery were performed on 73 cases. There were 76 male and 25

Endoscopic hemostasis techniques for upper gastrointestinal hemorrhage: A review

Upper gastrointestinal hemorrhage (UGIH) is an urgent disease that is often encountered in daily medical practice. Endoscopic hemostasis is currently indispensable for the treatment of UGIH. Initially, when UGIH is suspected, a cause of UGIH is presumed from the medical interview and physical findings. After ample primary treatment, urgent endoscopy is performed. Many methods of endoscopic hemostasis are in wide use, including hemoclip, injection and thermo-coagulation methods. Although UGIH develops from a wide variety of diseases, such as esophageal varices and gastric and duodenal ulcer, hemostasis is almost always possible. Identification of the causative diseases, primary treatment and characteristic features of endoscopic hemostasis are needed to allow appropriate treatment.

New devices and techniques for endoscopic closure of gastrointestinal perforations

Gastrointestinal perforations,which need to be managed quickly,are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays,with the development of new devices and techniques,endoscopic therapy is becoming more popular. However,there are different indications and clinical efficacies between different methods,because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors,such as the precise location of the perforation,its size and the length of time between the occurrence and diagnosis. In this study,we performed a comprehensive review of various devices and intro-duced the different techniques that are considered effective to treat gastrointestinal perforations. In addition,we focused on the different methods used to achieve successful closure,based on the literature and our clinical experiences.

The Application and Operation-Effect Analysis for Complex Tibial Plateau Fractures with 3D Printing Technique

Objective: To investigate the value of 3D printing techniques in the treatment of complex tibial plateau fractures. Methods: From September 2016 to September 2018, 28 patients with complex tibial plateau fractures were treated in our hospital. According to the odevity of hospitalized order, the patients were divided into two groups. Group A used 3D reconstruction, virtually reduction, 3D printing and demonstration of individual fracture model before operation while group B only received conventional process by use X-rays or CT image. Comparison between the two groups was made in operation time, operative blood loss, radiation frequency, surgery instrument cost and knee function score. Results: The follow-up was 14.4 months on average (ranged 6 to 22 months). There was no statistical difference of the surgery instrument cost between the 2 groups (P > 0.05). The operation time of group A was significantly shorter than that of group B (P χ2 = 0.373, P = 0.54). Conclusion: 3D printing techniques can improve surgery effect in complex tibial plateau fractures.

Techniques for Treating Sulphuric Acid Pickling Waste Liquid of Steel Industry

Pickling waste liquid of the steel industry is included in National Hazardous Wastes Catalogue because of its high corrosion and large discharge. The techniques for treating pickling waste liquid （ H2SO4 ） in steel industry is summarized. The advantages, disadvantages and applied ranges of all kinds of control technologies are comparatively analysed. The research trends of techniques for treating pickling waste liquid （ H2SO4 ） are the resource reclamation technologies in future which is pointed out in the paper.

Grain refinement technique of refractory low alloy steel

Grain refinement by cyclic heat treatment and deformation induced transformation technique of the refractory low-alloy steel and 12Cr1MoV was studied. Three cyclic heat treatments and a single-pass hot rolling process by a Gleeble-1500 system were performed. The results show that the austenite grain sizes are affected by the cyclic quenching number, quencher, heating temperature before rolling, deforming tem- perature, strain and strain rate. The ferrite grain sizes are affected by the austenite grain refinement, deforming temperature, strain and the quenching cooling rate. The ferrite with grain size of around 3μm may be produced by the technique.

Effects of Gas Metal Arc Welding Techniques on the Mechanical Properties of Duplex Stainless Steel

The study has compared the effect of gas metal arc welding techniques on some mechanical properties of duplex stainless steel. The samples after welded were given post weld heat treatment (quenching in engine and neem oil). After the analyses, it was established that duplex stainless steel can be weld successfully using gas metal arc welding process (GMAW). Both Lubricating oil and neem oil can serve as quenching medium for post welding heat treatment of duplex stainless steel. The results of the studies also show that welding and heat treatment really affect the mechanical properties of the alloy;the control strength was 811.47 MN/m2 while that of the welded samples ranged from 177.07 to 257.32 MN/m2. The control impact energy was 162.70 J, while that of the welded samples ranged from 38.64 J to 56.20 J. The research also shows that the stress relief heat treatment gives better strength (A3 = 331 MN/m2) compared to those that were quenched in lubricating oil (A2 = 329 MN/m2) and neem oil (A1 = 222 MN/m2), but the reverse is the case in terms of toughness.

Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome:Two case reports

BACKGROUND A swallowing disorder may occur following a brainstem stroke,especially one that occurs in the swallowing centers.Lateral medullary syndrome(referred to as LMS),a rare condition in which a vascular event occurs in the territory of the posterior inferior cerebellar artery or the vertebral artery,has been reported to lead to more severe and longer lasting dysphagia.CASE SUMMARY We report two patients with dysphagia due to LMS and propose a novel technique named hyoid-complex elevation and stimulation technique(known as HEST).The two patients had no other functional incapacity back into life,but nasogastric feeding was the only possible way for nutrition because of severe aspirations.Swallowing function was evaluated by functional oral intake scale,modified water swallow test,surface electromyographic signal associated with video fluorography swallowing study to assess the situation of aspiration,pharyngeal residue,pharyngeal peristalsis,upper esophageal opening and the ability of deglutition.Both patients were treated with the HEST method for dysphagia and recovered quickly.CONCLUSION HEST is effective for shortening the in-hospital time and improving the quality of life for patients with dysphagia who suffer from LMS and likely other strokes.

Treatment of talipes equinovarus after triceps surae intramuscular hemangioma surgery by Ilizarov technology in adults:A case report

BACKGROUND Postoperative complications of triceps surae intramuscular hemangioma surgery with talipes equinovarus have rarely been described,and the evidence for treatment is limited.The purpose of this case study was to report the new application of the Ilizarov technique,which successfully treated talipes equinovarus in adults after triceps surae intramuscular hemangioma.CASE SUMMARY A 29-year-old woman treated with the Ilizarov technique for talipes equinovarus in the right leg after triceps surae intramuscular hemangioma surgery.The equinus deformity was roughly corrected after 2 years of follow-up,without significant secondary sequelae.CONCLUSION Talipes equinovarus caused by postoperative sequelae of intramuscular hemangioma was successfully corrected by the Ilizarov technique.The Ilizarov technique may be used for treating talipes equinovarus caused by various causes.