Background: Double-lumen endotracheal (DLT) is commonly used for one-lung ventilation and lung separation during thoracic surgery. There are case reports of medically induced laryngeal granulomas, mainly in patients a...Background: Double-lumen endotracheal (DLT) is commonly used for one-lung ventilation and lung separation during thoracic surgery. There are case reports of medically induced laryngeal granulomas, mainly in patients after single-lumen endotracheal (SLT) tube intubation and tracheotomy, and giant granulomas of the vocal cords due to double-lumen bronchial tube insertion have rarely been reported. Case presentation: A 49-year-old female patient underwent single-port thoracoscopy after DLT intubation as well as a wedge resection of the lower lobe of the left lung, which caused giant vocal process granulomas (VPGs) postoperatively. Based on a retrospective analysis of the general condition, current medical history, past medical history, and visual laryngoscopic observation of the vocal folds tissue, which ruled out preoperative vocal fold granuloma formation, we hypothesized that double-lumen bronchial catheter intubation may have been the primary cause of her vocal fold granuloma formation. Conclusions: Giant granuloma of the vocal folds after DLT insertion is a rare postoperative complication;therefore, if DLT intubation is to be performed, the anesthesiologist should choose an appropriate intubation plan and deal with it promptly to avoid the risk factors to ensure that the patient’s perioperative period is safe and smooth. In addition, if postoperative complications are encountered, they should be followed up and observed on time.展开更多
Investigating gastrointestinal(GI)motility disorders relies on diagnostic tools to assess muscular contractions,peristalsis propagation and the integrity and coordination of various sphincters.Manometries are the gold...Investigating gastrointestinal(GI)motility disorders relies on diagnostic tools to assess muscular contractions,peristalsis propagation and the integrity and coordination of various sphincters.Manometries are the gold standard to study the GI motor function but it is increasingly acknowledged that manometries do not provide a complete picture in relation to sphincters competencies and muscle fibrosis.Endolumenal functional lumen imaging probe(EndoFLIP)an emerging technology,uses impedance planimetry to measure hollow organs cross sectional area,distensibility and compliance.It has been successfully used as a complementary tool in the assessment of the upper and lower oesophageal sphincters,oesophageal body,the pylorus and the anal canal.In this article,we aim to review the uses of EndoFLIP as a tool to investigate GI motility disorders with a special focus on paediatric practice.The majority of EndoFLIP studies were conducted in adult patients but the uptake of the technology in paediatrics is increasing.EndoFLIP can provide a useful complementary data to the existing GI motility investigation in both children and adults.展开更多
Background: The present study performed a meta-analysis to comprehensively analyze existing randomized controlled trials (RCT) involving the use of double-lumen needle in patients with poor ovarian response to explore...Background: The present study performed a meta-analysis to comprehensively analyze existing randomized controlled trials (RCT) involving the use of double-lumen needle in patients with poor ovarian response to explore whether double-lumen needle was good for specific patients. Methods: The PubMed, EMBASE, Cochrane Library databases and two randomized controlled trials registration centers were thoroughly searched until April 2017. The clinical outcomes of IVF/ICSI cycles were compared between two groups with double-lumen needle and single-lumen needle. Results: Four RCT studies were included in this present meta-analysis. The oocytes yield was similar in two groups (OR 0.88, 95%CI 0.66 - 1.16;I2 = 4%). The procedure time with double-lumen needle was significantly longer than that with single-lumen needle (IV = 1.98, 95%CI 0.95 - 3.00;I2 = 86%). The fertilization rate with double-lumen needle was lower than that with single-lumen needle (OR 0.66, 95%CI 0.44 - 0.97;I2 = 0%). There was no significant difference of live birth rate in two groups (OR 0.76, 95%CI 0.32 - 1.76;I2 = 41%). Conclusion: Double-lumen needle could not benefit patients with a POR in terms of the number of oocytes retrieved, oocyte recovery rate, normal fertilization rate, clinical pregnancy rate, and live birth rate, compared with single-lumen needle.展开更多
For patients recovering from acute pancreatitis,the development of a pancreatic fluid collection (PFC) predicts a more complex course of recovery,and introduces difficult management decisions with regard to when,wheth...For patients recovering from acute pancreatitis,the development of a pancreatic fluid collection (PFC) predicts a more complex course of recovery,and introduces difficult management decisions with regard to when,whether,and how the collection should be drained.Most PFCs resolve spontaneously and drainage is indicated only in pseudocysts and walled-off pancreatic necrosis when the collections are causing symptoms and/or local complications such as biliary obstruction.Historical approaches to PFC drainage have included surgical (open or laparoscopic cystgastrostomy or pancreatic debridement),and the placement of percutaneous drains.Endoscopic drainage techniques have emerged in the last several years as the preferred approach for most patients,when local expertise is available.Lumen-apposing metal stents(LAMS) have recently been developed as a tool to facilitate potentially safer and easier endoscopic drainage of pancreatic fluid collections,and less commonly,for other indications,such as gallbladder drainage.Physicians considering LAMS placement must be aware of the complications most commonly associated with LAMS including bleeding,migration,buried stent,stent occlusion,and perforation.Because of the patient complexity associated with severe pancreatitis,management of pancreatic fluid collections can be a complex and multidisciplinary endeavor.Successful and safe use of LAMS for patients with pancreatic fluid collections requires that the endoscopist have a full understanding of the potential complications of LAMS techniques,including how to recognize and manage expected complications.展开更多
In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic inter...In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUSguided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and ECLAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients.展开更多
BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft ...BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.展开更多
The advent of lumen apposing metal stents(LAMS)has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological interventions.These procedures have gar...The advent of lumen apposing metal stents(LAMS)has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological interventions.These procedures have garnered popularity due to their minimally invasive nature,higher technical and clinical success rate and lower rate of adverse events.By virtue of their unique design,LAMS provide more efficient drainage,serve as conduit for endoscopic access,are associated with lower rates of leakage and are easy to be removed.Initially used for drainage of pancreatic fluid collections,the use of LAMS has been extended to gallbladder and biliary drainage,treatment of luminal strictures,creation of gastrointestinal fistulae,pancreaticobiliary drainage,improved access for surgically altered anatomy,and drainage of intra-abdominal and pelvic abscesses as well as post-surgical fluid collections.As new indications of endosonographic techniques and LAMS continue to evolve,this review summarizes the current role of LAMS in the management of these various complex conditions and also highlights clinical pearls to guide successful placement of LAMS.展开更多
Objective: To replace the peripheral venous puncture for blood sampling with taking blood samples extracorporally from arterial line before predilution during RCA-CRRT performed. Methods: A new type of double-lumen fe...Objective: To replace the peripheral venous puncture for blood sampling with taking blood samples extracorporally from arterial line before predilution during RCA-CRRT performed. Methods: A new type of double-lumen femoral catheter was used instead of the current tubes. The new type of double-lumen tube had a greater distance from the inner venous ports to the inner arterial ports than current tubes. The minimum distance from the venous port to the arterial port was greatly lengthened. Replacement solution contained citrate, zero Ca<sup>2+</sup>, zero bicarbonate, low Na<sup>+</sup>. Blood samples were synchronously collected from the arterial line before the infusion of citrate replacement fluid and from the peripheral vein. The iCa concentration data of two groups were analyzed to observe the difference between iCa concentration levels in the arterial line and in peripheral vein;the anticoagulant effect of RCA and possible complications were observed, such as bleeding, clottings and hypocalcaemia. Results: 28 times of RCA-CRRT were performed on17 AKI and CRF patients with active bleeding or at the high risk of bleeding;336 blood samples were collected. Statistics showed that the difference of iCa concentration between arterial line group and the peripheral vein group was not significant (P = 0.9), there is a high degree of similarity between the iCa concentration of arterial line blood and the peripheral venous blood. None of the patients developed citrate toxicity or metabolic alkalosis. None induced bleeding, or bleeding aggravated. No obvious clotting occurred. Systemic calcium concentration was achieved in the ideal range. Conclusion: In clinical practice, the data of iCa concentration from arterial line can be used to replace that from peripheral vein when the new type of double-lumen femoral catheter is placed in femoral vein. RCA-CRRT therapy is safe and effective.展开更多
AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challen...AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challenging.We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy.This technique was performed in nine patients between August 2010 and June 2012.Sphincterotomy as described above was performed.Adequate sphincterotomy,successful stone removal,and complications were investigated prospectively.RESULTS:Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients.Sphincterotomy started towards the 4-5 o’clock direction and continued to the upper margin of the papillary roof.Complete stone removal in one session was achieved in all patients.There were no procedure related complications,such as bleeding,pancreatitis,or perforation.CONCLUSION:In patients with B-Ⅱgastrectomy,guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones.展开更多
We are reporting a novel "off-label" use of lumen apposing metal stent(LAMS) for management of refractory gastro-jejunal(GJ) anastomotic stricture after Roux-en-y gastric bypass(RYGB). With increasing preval...We are reporting a novel "off-label" use of lumen apposing metal stent(LAMS) for management of refractory gastro-jejunal(GJ) anastomotic stricture after Roux-en-y gastric bypass(RYGB). With increasing prevalence of obesity, bariatric surgery is performed more frequently than ever. RYGB is one of the most commonly performed bariatric procedures. GJ anastomotic stricture is a late complication of this procedure. Our patient, seven years after RYGB developed GJ anastomotic ulcer and subsequently a stricture not amendable to repeated pneumatic dilations. Instead of using the conventional fully covered self-expanding metal stent(fc SEMS) we deployed the relatively new LAMS keeping in mind its novel dumbbell shaped design. Our patient's symptoms were controlled successfully and she remained asymptomatic on follow-up. Despite initial approval for pancreatic pseudocyst drainage, LAMS has been used with increased frequency at various locations within gastrointestinal tract including GJ anastomotic strictures. Future randomized control trials are warranted to compare the efficacy of fcSEMS to LAMS.展开更多
Objective The benefits and risks of using double lumen tube (DLT) in open thoracotomy are not well studied and the relative contraindication for using it in cases of endobronchial tumours is not proven. In this study,...Objective The benefits and risks of using double lumen tube (DLT) in open thoracotomy are not well studied and the relative contraindication for using it in cases of endobronchial tumours is not proven. In this study, we compared our experience with using DLT versus single lumen tube (SLT) for anesthesia in patients requiring an open thoracotomy for resection of endobronchial tumours. Methods A prospective observational study was performed in a single tertiary care university hospital in patients with endobronchial tumours anesthetized with single and double lumen tubes for open thoracotomy procedures over a period from 2010 till 2018. Results One hundred and six patients with endobronchial tumours were studied. There were 76 males. Median age was 32 years (14 - 62). In 96 cases, endobronchial pathology was a typical carcinoid. 58 patients were anesthetized using a DLT and 48 using a SLT. Four cases of near miss from potentially fatal intraoperative tumour migration occurred in the SLT group (p = 0.025). There was only one case of mild tumour bleeding from the DLT group and time of insertion was longer (16.2 vs. 4.5 min p Conclusions We conclude that it is safe to place a double lumen endo tracheal tube for patients with endobronchial tumours requiring open lobectomies or bronchoplastic procedures. An additional benefit of DLT use is increasing surgical satisfaction by reducing spillage and tidal volume loss during surgical anastomosis of the open airway.展开更多
BACKGROUND In the context of aortic dissection,increasing pressure within the newly formed false lumen can result in the progressive compression of the true aortic channel.However,true lumen collapse in chronic type B...BACKGROUND In the context of aortic dissection,increasing pressure within the newly formed false lumen can result in the progressive compression of the true aortic channel.However,true lumen collapse in chronic type B aortic dissection(cTBAD)patients is rare,with few clinical or experimental studies to date having explored the causes of such collapse.CASE SUMMARY In the present report,we describe a rare case of true-lumen collapse in an 83-yearold patient diagnosed with cTBAD,and we discuss potential therapeutic interventions for such cases.Following thoracic endovascular aortic repair(TEVAR),computed tomography angiography revealed satisfactory stent-graft positioning,no endoleakage,true lumen enlargement,thrombus formation in the false lumen,and slight enlargement of the true lumen distal to the stent-graft.Computational hemodynamic analyses indicated that the wall shear stress and pressure within the false lumen were significantly reduced following TEVAR.CONCLUSION TEVAR treatment of cTBAD patients suffering from proximal true lumen collapse can facilitate some degree of effective remodeling.展开更多
Pancreatic fluid collections(PFCs)result from injury to the pancreas from acute or chronic pancreatitis,surgery,or trauma.Management of these collections has evolved over the last 2 decades.The choice of interventions...Pancreatic fluid collections(PFCs)result from injury to the pancreas from acute or chronic pancreatitis,surgery,or trauma.Management of these collections has evolved over the last 2 decades.The choice of interventions includes percu-taneous,endoscopic,minimally invasive surgery,or a combined approach.Endoscopic drainage is the drainage of PFCs by creating an artificial communi-cation between the collection and gastrointestinal lumen that is maintained by placing a stent across the fistulous tract.In this editorial,we endeavored to update the current status of endoscopic ultrasound-guided drainage of PFCs.展开更多
BACKGROUND Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has recently emerged as an alternative treatment for gastric outlet obstruction(GOO)in selected patients.AIM To report the initial experience of EUS-GE ...BACKGROUND Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has recently emerged as an alternative treatment for gastric outlet obstruction(GOO)in selected patients.AIM To report the initial experience of EUS-GE in patients with GOO.METHODS This study was a retrospective,observational,multicenter study in which the data from 10 patients who underwent EUS-GE due to GOO between September 2021 and May 2023 were collected.We analyzed technical success,clinical success,adverse events,and survival.Technical success was defined as adequate positioning and deployment of the stent.Clinical success was defined as the patient’s ability to tolerate oral intake without vomiting 7 d after the procedure.Postprocedural adverse events were recorded.RESULTS Eleven procedures in 10 patients with GOO were included.The mean age of the patients was 67.5 years(range:56-77 years).Malignant GOO was present in 9 patients.Technical success was achieved in 9/11 procedures(82%).Among them,clinical success was achieved in 9 patients(100%).Adverse events occurred in 1 patient(9%).The median survival was 3 months(n=7;range:1-8 months).CONCLUSION EUS-GE is a feasible therapeutic option in the treatment of GOO.展开更多
文摘Background: Double-lumen endotracheal (DLT) is commonly used for one-lung ventilation and lung separation during thoracic surgery. There are case reports of medically induced laryngeal granulomas, mainly in patients after single-lumen endotracheal (SLT) tube intubation and tracheotomy, and giant granulomas of the vocal cords due to double-lumen bronchial tube insertion have rarely been reported. Case presentation: A 49-year-old female patient underwent single-port thoracoscopy after DLT intubation as well as a wedge resection of the lower lobe of the left lung, which caused giant vocal process granulomas (VPGs) postoperatively. Based on a retrospective analysis of the general condition, current medical history, past medical history, and visual laryngoscopic observation of the vocal folds tissue, which ruled out preoperative vocal fold granuloma formation, we hypothesized that double-lumen bronchial catheter intubation may have been the primary cause of her vocal fold granuloma formation. Conclusions: Giant granuloma of the vocal folds after DLT insertion is a rare postoperative complication;therefore, if DLT intubation is to be performed, the anesthesiologist should choose an appropriate intubation plan and deal with it promptly to avoid the risk factors to ensure that the patient’s perioperative period is safe and smooth. In addition, if postoperative complications are encountered, they should be followed up and observed on time.
文摘Investigating gastrointestinal(GI)motility disorders relies on diagnostic tools to assess muscular contractions,peristalsis propagation and the integrity and coordination of various sphincters.Manometries are the gold standard to study the GI motor function but it is increasingly acknowledged that manometries do not provide a complete picture in relation to sphincters competencies and muscle fibrosis.Endolumenal functional lumen imaging probe(EndoFLIP)an emerging technology,uses impedance planimetry to measure hollow organs cross sectional area,distensibility and compliance.It has been successfully used as a complementary tool in the assessment of the upper and lower oesophageal sphincters,oesophageal body,the pylorus and the anal canal.In this article,we aim to review the uses of EndoFLIP as a tool to investigate GI motility disorders with a special focus on paediatric practice.The majority of EndoFLIP studies were conducted in adult patients but the uptake of the technology in paediatrics is increasing.EndoFLIP can provide a useful complementary data to the existing GI motility investigation in both children and adults.
文摘Background: The present study performed a meta-analysis to comprehensively analyze existing randomized controlled trials (RCT) involving the use of double-lumen needle in patients with poor ovarian response to explore whether double-lumen needle was good for specific patients. Methods: The PubMed, EMBASE, Cochrane Library databases and two randomized controlled trials registration centers were thoroughly searched until April 2017. The clinical outcomes of IVF/ICSI cycles were compared between two groups with double-lumen needle and single-lumen needle. Results: Four RCT studies were included in this present meta-analysis. The oocytes yield was similar in two groups (OR 0.88, 95%CI 0.66 - 1.16;I2 = 4%). The procedure time with double-lumen needle was significantly longer than that with single-lumen needle (IV = 1.98, 95%CI 0.95 - 3.00;I2 = 86%). The fertilization rate with double-lumen needle was lower than that with single-lumen needle (OR 0.66, 95%CI 0.44 - 0.97;I2 = 0%). There was no significant difference of live birth rate in two groups (OR 0.76, 95%CI 0.32 - 1.76;I2 = 41%). Conclusion: Double-lumen needle could not benefit patients with a POR in terms of the number of oocytes retrieved, oocyte recovery rate, normal fertilization rate, clinical pregnancy rate, and live birth rate, compared with single-lumen needle.
文摘For patients recovering from acute pancreatitis,the development of a pancreatic fluid collection (PFC) predicts a more complex course of recovery,and introduces difficult management decisions with regard to when,whether,and how the collection should be drained.Most PFCs resolve spontaneously and drainage is indicated only in pseudocysts and walled-off pancreatic necrosis when the collections are causing symptoms and/or local complications such as biliary obstruction.Historical approaches to PFC drainage have included surgical (open or laparoscopic cystgastrostomy or pancreatic debridement),and the placement of percutaneous drains.Endoscopic drainage techniques have emerged in the last several years as the preferred approach for most patients,when local expertise is available.Lumen-apposing metal stents(LAMS) have recently been developed as a tool to facilitate potentially safer and easier endoscopic drainage of pancreatic fluid collections,and less commonly,for other indications,such as gallbladder drainage.Physicians considering LAMS placement must be aware of the complications most commonly associated with LAMS including bleeding,migration,buried stent,stent occlusion,and perforation.Because of the patient complexity associated with severe pancreatitis,management of pancreatic fluid collections can be a complex and multidisciplinary endeavor.Successful and safe use of LAMS for patients with pancreatic fluid collections requires that the endoscopist have a full understanding of the potential complications of LAMS techniques,including how to recognize and manage expected complications.
文摘In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUSguided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and ECLAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients.
基金Supported by National Natural Science Foundation of China,No.81600375
文摘BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.
文摘The advent of lumen apposing metal stents(LAMS)has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological interventions.These procedures have garnered popularity due to their minimally invasive nature,higher technical and clinical success rate and lower rate of adverse events.By virtue of their unique design,LAMS provide more efficient drainage,serve as conduit for endoscopic access,are associated with lower rates of leakage and are easy to be removed.Initially used for drainage of pancreatic fluid collections,the use of LAMS has been extended to gallbladder and biliary drainage,treatment of luminal strictures,creation of gastrointestinal fistulae,pancreaticobiliary drainage,improved access for surgically altered anatomy,and drainage of intra-abdominal and pelvic abscesses as well as post-surgical fluid collections.As new indications of endosonographic techniques and LAMS continue to evolve,this review summarizes the current role of LAMS in the management of these various complex conditions and also highlights clinical pearls to guide successful placement of LAMS.
文摘Objective: To replace the peripheral venous puncture for blood sampling with taking blood samples extracorporally from arterial line before predilution during RCA-CRRT performed. Methods: A new type of double-lumen femoral catheter was used instead of the current tubes. The new type of double-lumen tube had a greater distance from the inner venous ports to the inner arterial ports than current tubes. The minimum distance from the venous port to the arterial port was greatly lengthened. Replacement solution contained citrate, zero Ca<sup>2+</sup>, zero bicarbonate, low Na<sup>+</sup>. Blood samples were synchronously collected from the arterial line before the infusion of citrate replacement fluid and from the peripheral vein. The iCa concentration data of two groups were analyzed to observe the difference between iCa concentration levels in the arterial line and in peripheral vein;the anticoagulant effect of RCA and possible complications were observed, such as bleeding, clottings and hypocalcaemia. Results: 28 times of RCA-CRRT were performed on17 AKI and CRF patients with active bleeding or at the high risk of bleeding;336 blood samples were collected. Statistics showed that the difference of iCa concentration between arterial line group and the peripheral vein group was not significant (P = 0.9), there is a high degree of similarity between the iCa concentration of arterial line blood and the peripheral venous blood. None of the patients developed citrate toxicity or metabolic alkalosis. None induced bleeding, or bleeding aggravated. No obvious clotting occurred. Systemic calcium concentration was achieved in the ideal range. Conclusion: In clinical practice, the data of iCa concentration from arterial line can be used to replace that from peripheral vein when the new type of double-lumen femoral catheter is placed in femoral vein. RCA-CRRT therapy is safe and effective.
文摘AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challenging.We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy.This technique was performed in nine patients between August 2010 and June 2012.Sphincterotomy as described above was performed.Adequate sphincterotomy,successful stone removal,and complications were investigated prospectively.RESULTS:Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients.Sphincterotomy started towards the 4-5 o’clock direction and continued to the upper margin of the papillary roof.Complete stone removal in one session was achieved in all patients.There were no procedure related complications,such as bleeding,pancreatitis,or perforation.CONCLUSION:In patients with B-Ⅱgastrectomy,guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones.
文摘We are reporting a novel "off-label" use of lumen apposing metal stent(LAMS) for management of refractory gastro-jejunal(GJ) anastomotic stricture after Roux-en-y gastric bypass(RYGB). With increasing prevalence of obesity, bariatric surgery is performed more frequently than ever. RYGB is one of the most commonly performed bariatric procedures. GJ anastomotic stricture is a late complication of this procedure. Our patient, seven years after RYGB developed GJ anastomotic ulcer and subsequently a stricture not amendable to repeated pneumatic dilations. Instead of using the conventional fully covered self-expanding metal stent(fc SEMS) we deployed the relatively new LAMS keeping in mind its novel dumbbell shaped design. Our patient's symptoms were controlled successfully and she remained asymptomatic on follow-up. Despite initial approval for pancreatic pseudocyst drainage, LAMS has been used with increased frequency at various locations within gastrointestinal tract including GJ anastomotic strictures. Future randomized control trials are warranted to compare the efficacy of fcSEMS to LAMS.
文摘Objective The benefits and risks of using double lumen tube (DLT) in open thoracotomy are not well studied and the relative contraindication for using it in cases of endobronchial tumours is not proven. In this study, we compared our experience with using DLT versus single lumen tube (SLT) for anesthesia in patients requiring an open thoracotomy for resection of endobronchial tumours. Methods A prospective observational study was performed in a single tertiary care university hospital in patients with endobronchial tumours anesthetized with single and double lumen tubes for open thoracotomy procedures over a period from 2010 till 2018. Results One hundred and six patients with endobronchial tumours were studied. There were 76 males. Median age was 32 years (14 - 62). In 96 cases, endobronchial pathology was a typical carcinoid. 58 patients were anesthetized using a DLT and 48 using a SLT. Four cases of near miss from potentially fatal intraoperative tumour migration occurred in the SLT group (p = 0.025). There was only one case of mild tumour bleeding from the DLT group and time of insertion was longer (16.2 vs. 4.5 min p Conclusions We conclude that it is safe to place a double lumen endo tracheal tube for patients with endobronchial tumours requiring open lobectomies or bronchoplastic procedures. An additional benefit of DLT use is increasing surgical satisfaction by reducing spillage and tidal volume loss during surgical anastomosis of the open airway.
文摘BACKGROUND In the context of aortic dissection,increasing pressure within the newly formed false lumen can result in the progressive compression of the true aortic channel.However,true lumen collapse in chronic type B aortic dissection(cTBAD)patients is rare,with few clinical or experimental studies to date having explored the causes of such collapse.CASE SUMMARY In the present report,we describe a rare case of true-lumen collapse in an 83-yearold patient diagnosed with cTBAD,and we discuss potential therapeutic interventions for such cases.Following thoracic endovascular aortic repair(TEVAR),computed tomography angiography revealed satisfactory stent-graft positioning,no endoleakage,true lumen enlargement,thrombus formation in the false lumen,and slight enlargement of the true lumen distal to the stent-graft.Computational hemodynamic analyses indicated that the wall shear stress and pressure within the false lumen were significantly reduced following TEVAR.CONCLUSION TEVAR treatment of cTBAD patients suffering from proximal true lumen collapse can facilitate some degree of effective remodeling.
文摘Pancreatic fluid collections(PFCs)result from injury to the pancreas from acute or chronic pancreatitis,surgery,or trauma.Management of these collections has evolved over the last 2 decades.The choice of interventions includes percu-taneous,endoscopic,minimally invasive surgery,or a combined approach.Endoscopic drainage is the drainage of PFCs by creating an artificial communi-cation between the collection and gastrointestinal lumen that is maintained by placing a stent across the fistulous tract.In this editorial,we endeavored to update the current status of endoscopic ultrasound-guided drainage of PFCs.
文摘BACKGROUND Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has recently emerged as an alternative treatment for gastric outlet obstruction(GOO)in selected patients.AIM To report the initial experience of EUS-GE in patients with GOO.METHODS This study was a retrospective,observational,multicenter study in which the data from 10 patients who underwent EUS-GE due to GOO between September 2021 and May 2023 were collected.We analyzed technical success,clinical success,adverse events,and survival.Technical success was defined as adequate positioning and deployment of the stent.Clinical success was defined as the patient’s ability to tolerate oral intake without vomiting 7 d after the procedure.Postprocedural adverse events were recorded.RESULTS Eleven procedures in 10 patients with GOO were included.The mean age of the patients was 67.5 years(range:56-77 years).Malignant GOO was present in 9 patients.Technical success was achieved in 9/11 procedures(82%).Among them,clinical success was achieved in 9 patients(100%).Adverse events occurred in 1 patient(9%).The median survival was 3 months(n=7;range:1-8 months).CONCLUSION EUS-GE is a feasible therapeutic option in the treatment of GOO.
