AIM:To investigate whether percutaneous endoscopic gastrostomy (PEG) tube placement is safe in patients with ventriculoperitoneal (VP) shunts.METHODS: This was a retrospective study of all patients undergoing PEG inse...AIM:To investigate whether percutaneous endoscopic gastrostomy (PEG) tube placement is safe in patients with ventriculoperitoneal (VP) shunts.METHODS: This was a retrospective study of all patients undergoing PEG insertion at our institution between June 1999 and June 2006. Post-PEG complications were compared between two groups according to the presence or absence of VP shunts. VP shunt infection rates, the interval between PEG placement and VP shunt catheter insertion, and long-term follow-up were also investigated.RESULTS: Fifty-five patients qualified for the study. Seven patients (12.7%) had pre-existing VP shunts. All patients received prophylactic antibiotics. The complication rate did not differ between VP shunt patients undergoing PEG (PEG/VP group) and non-VP shunt patients undergoing PEG (control group) [1 (14.3%) vs 6 (12.5%), P=1.000]. All patients in the PEG/VP group had undergone VP shunt insertion prior to PEG placement. The mean interval between VP shunt insertion and PEG placement was 308.7 d (range, 65-831 d). The mean follow-up duration in the PEG/VP group was 6.4 mo (range, 1-15 mo). There were no VP shunt infections, although one patient in the PEG/VP group developed a minor peristomal infection during follow-up.CONCLUSION: Complications following PEG placement in patients with VP shunts were infrequent in this study.展开更多
Objectives:To present a case series of modified transjugular intrahepatic portosystemic shunts(TIPS) and percutaneous transhepatic intrahepatic portosystemic shunts(PTIPS) in cirrhotic patients with variceal bleeding(...Objectives:To present a case series of modified transjugular intrahepatic portosystemic shunts(TIPS) and percutaneous transhepatic intrahepatic portosystemic shunts(PTIPS) in cirrhotic patients with variceal bleeding(VB).In addition,the scientific literature pertaining to PTIPS was reviewed.Methods:This retrospective clinical case series included six cirrhotic patients with VB who were treated with PTIPS after the failure of endoscopic band ligation or endoscopic injection sclerotherapy combined with vasoactive drugs.The treatment was conducted between January 2017 and June 2019 at a single institution.Three patients suffered from severe atrophy of the right or left lobar of the liver as well as the main right or left branch of the portal vein.The remaining three patients showed severe atrophy of the whole liver and portal vein,resulting in widening of the liver fissure.A paired t-test was used to compare the changes in portal pressure gradient between before and after the PTIPS operation.The rebleeding rate,treatment efficacy,complications,and technical success rate were all assessed during follow-up.Results:All six PTIPS procedures were performed successfully,with no severe procedural-related complications observed.None of the patients experienced VB during a mean follow-up of 22.8(range,18.0-28.0) months.The mean portosystemic pressure gradient decreased from 28.3 ± 4.3 mmHg pre-procedure to 12.3 ± 2.6 mmHg immediately post-procedure(P <0.001).At follow-up,one patient was found to have developed grade 2 hepatic encephalopathy thrice during the first year,according to the West Haven criteria.However,this was resolved following medical treatment.Conclusions:When the patient’s portal venous anatomy is unconducive to the performance of TIPS using the transjugular approach,PTIPS can be considered as a safe,effective complementary surgical approach for patients with VB.展开更多
AIM: To investigate long-term efficacy of two different devices more than five years after percutaneous atrial septal defect(ASD) closure in adults.METHODS: All patients who underwent percutaneous closure of an ASD in...AIM: To investigate long-term efficacy of two different devices more than five years after percutaneous atrial septal defect(ASD) closure in adults.METHODS: All patients who underwent percutaneous closure of an ASD in the St. Antonius Hospital, Nieuwegein, The Netherlands, between February 1998 and December 2006 were included. Percutaneous closure took place under general anaesthesia and transesophageal echocardiographic moni toring. Transthoracic echocardiography(TTE) was performed 24 h post-procedure to visualize the device position and to look for residual shunting using color Doppler. All complications were registered. All patients were invited for an outpatient visit and contrast TTE more than 5-years after closure. Efficacy was based on the presence of a residual right-to-left shunt(RLS), graded as minimal, moderate or severe. The presence of a residual left-to-right shunt(LRS) was diagnosed using color Doppler, and was not graded. Descriptive statistics were used for patients' characteristics. Univariate analysis was used to identify predictors for residual shunting.RESULTS: In total, 104 patients(mean age 45.5 ± 17.1 years) underwent percutaneous ASD closure using an Amplatzer device(ASO) in 76 patients and a Cardioseal/Starflex device(CS/SF) in 28 patients. The mean follow-up was 6.4 ± 3.4 years. Device migration occurred in 4 patients of whom two cases occurred during the index hospitalization(1 ASO, 1 CS/SF). The other 2 cases of device migration occurred during the first 6 mo of follow-up(2 CS/SF). The recurrent thrombo-embolic event rate was similar in both groups: 0.4% per follow-up year. More than 12 mo post-ASD closure and latest follow-up, new-onset supraventricular tachyarrhythmia's occurred in 3.9% and 0% for the ASO and CS/SF group, respectively. The RLS rate at latest follow-up was 17.4%(minimal 10.9%, moderate 2.2%, severe 4.3%) and 45.5%(minimal 27.3%, moderate 18.2%, severe 0%) for the ASO- and CS/SF groups, respectively. There was no residual LRS in both groups.CONCLUSION: Percutaneous ASD closure has good long-term safety and efficacy profiles. The residual RLS rate seems to be high more than 5 years after closure, especially in the CS/SF. Residual LRS was not observed.展开更多
Childhood priapism is a rare entity and there is currently no consensus regarding its contemporary management.The use of perioperative anticoagulation and open distal corporaglandular shunt procedure in the management...Childhood priapism is a rare entity and there is currently no consensus regarding its contemporary management.The use of perioperative anticoagulation and open distal corporaglandular shunt procedure in the management of childhood priapism has not been reported in the literature.We present a stuttering case of a 13-year-old boy who presented with idiopathic ischaemic priapism lasting 13 h in duration,which recurred despite corporal aspiration and alpha-adrenergic agonist injections,percutaneous distal shunt surgery,and revision of percutaneous distal shunt surgery.He was eventually successfully managed with perioperative subcutaneous enoxaparin,oral aspirin and clopidogrel in conjunction with an Al-Ghorab shunt,which led to sustained detumescence but with spontaneous morning erections.In paediatric patients with sustained childhood priaprism failing stepwise treatments,an Al-Ghorab shunt with perioperative anticoagulation is a viable option.展开更多
Objective:To investigate the clinical value of a minimally-invasive treatment of communicating hydrocephalus using a percutaneous lumboperitoneal (LP) shunt.Method:The clinical and long-term follow-up data of 256 pati...Objective:To investigate the clinical value of a minimally-invasive treatment of communicating hydrocephalus using a percutaneous lumboperitoneal (LP) shunt.Method:The clinical and long-term follow-up data of 256 patients suffering from communicating hydrocephalus and undergoing percutaneous LP shunt during 1998 to 2008 were retrospectively analyzed.Results:After the follow-up,which lasted 6 months to 10 years,219 cases of communicating hydrocephalus recovered well (ventricular size returned to normal and symptoms completely disappeared),25 cases were brought under control (ventricle size reduced by 50% and symptoms partially abated),and 12 cases showed no obvious changes.Fifteen obese subjects needed modifications of the shunt due to the obstruction of the abdominal end following wrapping,and one subject underwent extubation as the subject was unable to tolerate stimulation of the cauda equina.The effectiveness of shunting was 91.40% and the probability of shunt-tube obstruction,which occurs predominantly in the abdominal end,was only 5.85%,far lower than that of ventriculoperitoneal (VP) shunt.Three subjects had a history of infection following VP shunting.Conclusion:LP shunting is minimally invasive and effective in treating communicating hydrocephalus,with fewer complications.展开更多
目的 探讨经皮门静脉穿刺改良经颈内静脉肝内门体分流术（TIPS）较常规TIPS方法的优越性及临床疗效.方法 回顾性分析空军总医院2009年3月～2011年9月采用TIPS技术治疗门脉高压急性上消化道出血患者36例,其中15例采用常规TIPS技术,21例...目的 探讨经皮门静脉穿刺改良经颈内静脉肝内门体分流术（TIPS）较常规TIPS方法的优越性及临床疗效.方法 回顾性分析空军总医院2009年3月～2011年9月采用TIPS技术治疗门脉高压急性上消化道出血患者36例,其中15例采用常规TIPS技术,21例采用经皮肝穿刺门静脉造影改良TIPS技术.结果 改良TIPS组与常规TIPS组相比,手术时间显著缩短（183.69±56.77 vs 140.32±43.56）、手术开始至胃冠状静脉封堵时间显著缩短（130.81±66.39 vs 12.53±13.18）、穿刺针数显著减少（7.57±3.14 vs 4.16±2.73）、改良TIPS组手术成功率100％,常规TIPS组手术成功率80％,两组治疗均可显著降低门静脉压力.结论 超声引导下经皮门静脉穿刺造影,可标识定位指导TIPS操作,并可在第一时间封堵胃冠状静脉出血,提高了TIPS穿刺的准确性和安全性,可行性优于常规TIPS操作方法.展开更多
文摘AIM:To investigate whether percutaneous endoscopic gastrostomy (PEG) tube placement is safe in patients with ventriculoperitoneal (VP) shunts.METHODS: This was a retrospective study of all patients undergoing PEG insertion at our institution between June 1999 and June 2006. Post-PEG complications were compared between two groups according to the presence or absence of VP shunts. VP shunt infection rates, the interval between PEG placement and VP shunt catheter insertion, and long-term follow-up were also investigated.RESULTS: Fifty-five patients qualified for the study. Seven patients (12.7%) had pre-existing VP shunts. All patients received prophylactic antibiotics. The complication rate did not differ between VP shunt patients undergoing PEG (PEG/VP group) and non-VP shunt patients undergoing PEG (control group) [1 (14.3%) vs 6 (12.5%), P=1.000]. All patients in the PEG/VP group had undergone VP shunt insertion prior to PEG placement. The mean interval between VP shunt insertion and PEG placement was 308.7 d (range, 65-831 d). The mean follow-up duration in the PEG/VP group was 6.4 mo (range, 1-15 mo). There were no VP shunt infections, although one patient in the PEG/VP group developed a minor peristomal infection during follow-up.CONCLUSION: Complications following PEG placement in patients with VP shunts were infrequent in this study.
基金supported by the Jiangsu Provincial Medical Talent Funding (ZDRCA2016038)the Suzhou Special Diagnosis and Treatment Technology of Clinical Key Diseases (LCZX201704)+2 种基金the National Natural Science Foundation of China (81771945, 81901847)the Natural Science Foundation of Jiangsu Province (BK20190177)the Suzhou Science and Technology Youth Plan (KJXW2018003)。
文摘Objectives:To present a case series of modified transjugular intrahepatic portosystemic shunts(TIPS) and percutaneous transhepatic intrahepatic portosystemic shunts(PTIPS) in cirrhotic patients with variceal bleeding(VB).In addition,the scientific literature pertaining to PTIPS was reviewed.Methods:This retrospective clinical case series included six cirrhotic patients with VB who were treated with PTIPS after the failure of endoscopic band ligation or endoscopic injection sclerotherapy combined with vasoactive drugs.The treatment was conducted between January 2017 and June 2019 at a single institution.Three patients suffered from severe atrophy of the right or left lobar of the liver as well as the main right or left branch of the portal vein.The remaining three patients showed severe atrophy of the whole liver and portal vein,resulting in widening of the liver fissure.A paired t-test was used to compare the changes in portal pressure gradient between before and after the PTIPS operation.The rebleeding rate,treatment efficacy,complications,and technical success rate were all assessed during follow-up.Results:All six PTIPS procedures were performed successfully,with no severe procedural-related complications observed.None of the patients experienced VB during a mean follow-up of 22.8(range,18.0-28.0) months.The mean portosystemic pressure gradient decreased from 28.3 ± 4.3 mmHg pre-procedure to 12.3 ± 2.6 mmHg immediately post-procedure(P <0.001).At follow-up,one patient was found to have developed grade 2 hepatic encephalopathy thrice during the first year,according to the West Haven criteria.However,this was resolved following medical treatment.Conclusions:When the patient’s portal venous anatomy is unconducive to the performance of TIPS using the transjugular approach,PTIPS can be considered as a safe,effective complementary surgical approach for patients with VB.
文摘AIM: To investigate long-term efficacy of two different devices more than five years after percutaneous atrial septal defect(ASD) closure in adults.METHODS: All patients who underwent percutaneous closure of an ASD in the St. Antonius Hospital, Nieuwegein, The Netherlands, between February 1998 and December 2006 were included. Percutaneous closure took place under general anaesthesia and transesophageal echocardiographic moni toring. Transthoracic echocardiography(TTE) was performed 24 h post-procedure to visualize the device position and to look for residual shunting using color Doppler. All complications were registered. All patients were invited for an outpatient visit and contrast TTE more than 5-years after closure. Efficacy was based on the presence of a residual right-to-left shunt(RLS), graded as minimal, moderate or severe. The presence of a residual left-to-right shunt(LRS) was diagnosed using color Doppler, and was not graded. Descriptive statistics were used for patients' characteristics. Univariate analysis was used to identify predictors for residual shunting.RESULTS: In total, 104 patients(mean age 45.5 ± 17.1 years) underwent percutaneous ASD closure using an Amplatzer device(ASO) in 76 patients and a Cardioseal/Starflex device(CS/SF) in 28 patients. The mean follow-up was 6.4 ± 3.4 years. Device migration occurred in 4 patients of whom two cases occurred during the index hospitalization(1 ASO, 1 CS/SF). The other 2 cases of device migration occurred during the first 6 mo of follow-up(2 CS/SF). The recurrent thrombo-embolic event rate was similar in both groups: 0.4% per follow-up year. More than 12 mo post-ASD closure and latest follow-up, new-onset supraventricular tachyarrhythmia's occurred in 3.9% and 0% for the ASO and CS/SF group, respectively. The RLS rate at latest follow-up was 17.4%(minimal 10.9%, moderate 2.2%, severe 4.3%) and 45.5%(minimal 27.3%, moderate 18.2%, severe 0%) for the ASO- and CS/SF groups, respectively. There was no residual LRS in both groups.CONCLUSION: Percutaneous ASD closure has good long-term safety and efficacy profiles. The residual RLS rate seems to be high more than 5 years after closure, especially in the CS/SF. Residual LRS was not observed.
文摘Childhood priapism is a rare entity and there is currently no consensus regarding its contemporary management.The use of perioperative anticoagulation and open distal corporaglandular shunt procedure in the management of childhood priapism has not been reported in the literature.We present a stuttering case of a 13-year-old boy who presented with idiopathic ischaemic priapism lasting 13 h in duration,which recurred despite corporal aspiration and alpha-adrenergic agonist injections,percutaneous distal shunt surgery,and revision of percutaneous distal shunt surgery.He was eventually successfully managed with perioperative subcutaneous enoxaparin,oral aspirin and clopidogrel in conjunction with an Al-Ghorab shunt,which led to sustained detumescence but with spontaneous morning erections.In paediatric patients with sustained childhood priaprism failing stepwise treatments,an Al-Ghorab shunt with perioperative anticoagulation is a viable option.
基金Project (Nos. 308372673 and 30801185) supported by the National Natural Science Foundation of China
文摘Objective:To investigate the clinical value of a minimally-invasive treatment of communicating hydrocephalus using a percutaneous lumboperitoneal (LP) shunt.Method:The clinical and long-term follow-up data of 256 patients suffering from communicating hydrocephalus and undergoing percutaneous LP shunt during 1998 to 2008 were retrospectively analyzed.Results:After the follow-up,which lasted 6 months to 10 years,219 cases of communicating hydrocephalus recovered well (ventricular size returned to normal and symptoms completely disappeared),25 cases were brought under control (ventricle size reduced by 50% and symptoms partially abated),and 12 cases showed no obvious changes.Fifteen obese subjects needed modifications of the shunt due to the obstruction of the abdominal end following wrapping,and one subject underwent extubation as the subject was unable to tolerate stimulation of the cauda equina.The effectiveness of shunting was 91.40% and the probability of shunt-tube obstruction,which occurs predominantly in the abdominal end,was only 5.85%,far lower than that of ventriculoperitoneal (VP) shunt.Three subjects had a history of infection following VP shunting.Conclusion:LP shunting is minimally invasive and effective in treating communicating hydrocephalus,with fewer complications.
文摘目的 探讨经皮门静脉穿刺改良经颈内静脉肝内门体分流术（TIPS）较常规TIPS方法的优越性及临床疗效.方法 回顾性分析空军总医院2009年3月～2011年9月采用TIPS技术治疗门脉高压急性上消化道出血患者36例,其中15例采用常规TIPS技术,21例采用经皮肝穿刺门静脉造影改良TIPS技术.结果 改良TIPS组与常规TIPS组相比,手术时间显著缩短（183.69±56.77 vs 140.32±43.56）、手术开始至胃冠状静脉封堵时间显著缩短（130.81±66.39 vs 12.53±13.18）、穿刺针数显著减少（7.57±3.14 vs 4.16±2.73）、改良TIPS组手术成功率100％,常规TIPS组手术成功率80％,两组治疗均可显著降低门静脉压力.结论 超声引导下经皮门静脉穿刺造影,可标识定位指导TIPS操作,并可在第一时间封堵胃冠状静脉出血,提高了TIPS穿刺的准确性和安全性,可行性优于常规TIPS操作方法.
