BACKGROUND Other than surgery,endoscopic ultrasound-guided fine-needle aspiration(EUSFNA)is the only procedure for histologically diagnosing autoimmune pancreatitis(AIP).However,adequate specimens are difficult to obt...BACKGROUND Other than surgery,endoscopic ultrasound-guided fine-needle aspiration(EUSFNA)is the only procedure for histologically diagnosing autoimmune pancreatitis(AIP).However,adequate specimens are difficult to obtain.Recently,more adequate specimens were reported to be obtained with EUS-FNA with a wet suction technique(WEST)than with conventional EUS-FNA.AIM To histologically diagnose AIP by EUS-FNA with a WEST.METHODS Eleven patients with possible type 1 AIP between February 2016 and August 2018 underwent EUS-FNA with a WEST(WEST group),with four punctures by 19 or 22 G needles.As a historical control,23 type 1 AIP patients who underwent no fewer than four punctures with 19 or 22 G needles were enrolled(DRY group).Patient characteristics and histological findings were compared between the two groups.RESULTS Three histopathological factors according to the International Consensus Diagnostic Criteria were significantly greater in the WEST group than the DRY group[lymphoplasmacytic infiltrate without granulocytic infiltration:9(81.8%)vs 6(26.1%),P=0.003,storiform fibrosis:5(45.5%)vs 1(4.3%),P=0.008,abundant(>10 cells/HPF)IgG4-positive cells:7(63.6%)vs 5(21.7%),P=0.026].Level 1 or level 2 histopathological findings were observed more often in the WEST group than in the DRY group[8(72.7%)vs 3(13.0%),P=0.001].CONCLUSION EUS-FNA with a WEST was more successful than standard EUS-FNA in histologically diagnosing AIP.展开更多
AIM: To evaluate the efficacy of endoscopic ultrasound guided biliary drainage(EUS-BD) in patients with surgically altered anatomies.METHODS: We performed a search of the MEDLINE database for studies published between...AIM: To evaluate the efficacy of endoscopic ultrasound guided biliary drainage(EUS-BD) in patients with surgically altered anatomies.METHODS: We performed a search of the MEDLINE database for studies published between 2001 to July2014 reporting on EUS-BD in patients with surgically altered anatomy using the terms "EUS drainage" and "altered anatomy". All relevant articles were accessed in full text. A manual search of the reference lists of relevant retrieved articles was also performed. Only fulltext English papers were included. Data regarding age, gender, diagnosis, method of EUS-BD and intervention, type of altered anatomy, technical success, clinical success, and complications were extracted and collected. Anatomic alterations were categorized as: group 1, Billroth Ⅰ; group 2, Billroth Ⅱ; group 4, Rouxen-Y with gastric bypass; and group 3, all other types. RESULTS: Twenty three articles identified in the literature search, three reports were from the same group with different numbers of cases. In total, 101 cases of EUS-BD in patients with altered anatomy were identified. Twenty-seven cases had no information and were excluded. Seventy four cases were included for analysis. Data of EUS-BD in patients categorized as group 1, 2 and 4 were limited with 2, 3 and 6 cases with EUS-BD done respectively. Thirty four cases with EUS-BD were reported in group 3. The pooled technical success, clinical success, and complication rates of all reports with available data were 89.18%, 91.07% and 17.5%, respectively. The results are similar to the reported outcomes of EUS-BD in general, however, with limited data of EUS-BD in patients with altered anatomy rendered it difficult to draw a firm conclusion. CONCLUSION: EUS-BD may be an option for patients with altered anatomy after a failed endoscopic-retrogradecholangiography in centers with expertise in EUS-BD procedures in a research setting.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duode...Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duodenal diverticulum,ampullary neoplastic infiltration or surgically altered anatomy.In these cases percutaneous biliary drainage(PTBD)is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life.Endoscopic ultrasound-guided biliary drainage(EUS-BD)is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices.A large amount of data is already collected that proves its efficacy,safety and ability to replace PTBD in cases of ERCP failure.It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future.Several EUS-BD techniques are developed EUS-guided transmural stenting,antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy.EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure.The lack of training,absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure,which is related to life-threatening adverse events.Developing training models,dedicated devices and guidelines hopefully will make EUS-BD easier,safer and well accepted in the future.This paper focuses on the technical aspects of the different EUS-BD procedures,available literature data,advantages,negative aspects and the future perspectives of these modalities.展开更多
Background and Objective: Percutaneous central venous cannulation is a common invasive procedure. In comparison with an external landmark technique, the advantages of ultrasound-guided venous access include direct vis...Background and Objective: Percutaneous central venous cannulation is a common invasive procedure. In comparison with an external landmark technique, the advantages of ultrasound-guided venous access include direct visualization of the anatomy and in vivo visualization of venous cannulation. Methods: We evaluated an ultrasound-guided technique for infraclavicular axillary vein cannulation, focusing on its ease of use, success rate and complications rate. One hundred and twenty patients who submitted to central venous catheter placement were punctured using our technique. The patients were positioned so that their ipsilateral upper limb was abducted at 90° to the longitudinal axis, which makes it possible to visualize the infraclavicular vessels due to the elevation of the clavicle, thereby improving accessibility. Results: Cannulation was successful in all patients. The median time from the start of the first puncture (of the skin) until the aspiration of blood was 15 s (range 7 - 135 s). Both infraclavicular axillary veins were cannulated, and the vein was punctured successfully at the first attempt in 95% of the patients, without complications during the procedure. Conclusion: We propose an ultrasound-guided infraclavicular approach of the axillary vein, with a high success rate and no complications in the present cohort.展开更多
Objective To report a case of ovarian hemorrhage after transvaginal ultrasoundguided oocyte retrieval combined with severe ovarian hyperstimulation syndrome （OHSS）. Methods A 26-year-old woman who was on therapy for...Objective To report a case of ovarian hemorrhage after transvaginal ultrasoundguided oocyte retrieval combined with severe ovarian hyperstimulation syndrome （OHSS）. Methods A 26-year-old woman who was on therapy for infertility presented with abdominal distension and a decrease of urine after transvaginal ultrasound-guided oocyte retrieval for in vitro fertilization-embryo transfer （IVF-ET）. Initial clinical presentation, ultrasound, and lab results were consistent with the diagnosis of severe OHSS. However with 4 d conservative treatments there seemed no recovery and the patient became more serious for her hemoglobin fell from 169.0 g/L to 60.2 g/L along with more abdominal fluid and a decrease of urine. Ultrasound guided paracentesis revealed an ovarian hemorrhage, and the patient underwent emergent surgery. Results The patient underwent emergent laparotomy for oophoroplasty and preservation of ovary. She got twin pregnancy in the second frozen-thawed embryo transfer （FET） cycle and delivered two female babies. Conclusion It is important to distinguish the OHSS from ovarian hemorrhage, because the ovarian hemorrhage with hemoperitoneum requires immediate operative management, whereas OHSS is nearly always managed conservatively. Clinicians must be aware that ovarian hemorrhage may be delayed in women presenting OHSS.展开更多
Cornual heterotopic pregnancy is an extremely rare,life-threatening complication during pregnancy.Here,we report a 33-year-old woman who suffered cornual heterotopic pregnancy after in vitro fertilization embryo trans...Cornual heterotopic pregnancy is an extremely rare,life-threatening complication during pregnancy.Here,we report a 33-year-old woman who suffered cornual heterotopic pregnancy after in vitro fertilization embryo transfer.To prevent rupture during heterotopic pregnancy,she received laparoscopic surgery to remove the ectopic gestational sac at 7^(+2) weeks of gestation.Ultimately,she delivered a healthy boy at 38^(+3) weeks of gestation.Here,we also review the clinical presentations,risk factors,treatment options and outcomes of cornual heterotopic pregnancy.展开更多
目的探讨聚丙烯网片盆腔悬吊术治疗女性盆腔脏器脱垂(pelvic organ prolapse,POP)的疗效。方法回顾性分析2003年12月～2008年12月我院应用国产穿刺锥行网片介入手术治疗79例POP的临床资料,评估该术式的治愈率、并发症、复发率和新盆腔...目的探讨聚丙烯网片盆腔悬吊术治疗女性盆腔脏器脱垂(pelvic organ prolapse,POP)的疗效。方法回顾性分析2003年12月～2008年12月我院应用国产穿刺锥行网片介入手术治疗79例POP的临床资料,评估该术式的治愈率、并发症、复发率和新盆腔症状。POP分级采用盆腔器官脱垂量化系统(POP-Q)评定,泌尿生殖道症状问询采用盆底功能障碍疾病相关问卷(PFDI-20)。结果术后1年POP治愈68例(86.1%),好转8例(10.1%)。术后3个月内POP复发1例(1.3%),再次手术随访2年末复发;术后>1年POP复发3例(3.8%)。排尿障碍术后3个月内发生2例(2.5%),术后>1年发生1例(1.3%)。网片腐蚀术后3个月内发生5例(6.3%),术后>1年发生3例(3.8%)。术后1年出现性生活不适或疼痛4例(5.1%),术后出现膀胱过度活动症(overactive bladder,OAB)5例(6.3%),与网片相关的疼痛1例(1.3%)。结论聚丙烯网片POP腔悬吊术治疗盆疗效满意,复发率低,最多见的并发症是网片腐蚀,新出现的问题是OAB。展开更多
The availability of ultrasound (US) devices has refined techniques for vascular access. The resident trainee’s ability to learn US techniques depends upon device availability, skills, and motivation of instructors. W...The availability of ultrasound (US) devices has refined techniques for vascular access. The resident trainee’s ability to learn US techniques depends upon device availability, skills, and motivation of instructors. We hypothesized that hands-on teaching program of US techniques for vascular access would have a positive impact on the trainee’s perceptions. After IRB approval, PGY3 anesthesiology residents with limited prior experience in US-guided vascular access underwent close supervision by attending staff as they performed US-guided Internal Jugular Vein (IJV) central line placements. A total of 66 land mark (LM) and 75 US-guided IJV cannulation performed by 19 residents were supervised. Residents completing the study were more proactive with 68.4% agreeing to use US based techniques for an anticipated difficulty in accessing central lines. The graduating residents involved in the study all strongly agreed that US imaging for vascular access was within the scope of practice of all anesthesiologists, and that training guidelines be established and incorporated in their practice. Fifty eight percent of residents stated that their confidence and skill levels had significantly improved. Teaching US-guided techniques resulted in an increase employment of such techniques by graduating residents with no impediment attributed to knowledge deficits or inexperience. Residents were more proactive with using US for anticipated difficulty in IJV placement. A short neck, poor landmark, anticoagulation, morbid obesity favored US use by residents. Systematic teaching of US techniques is justified as it significantly improves the resident’s perceptions and confidence.展开更多
文摘BACKGROUND Other than surgery,endoscopic ultrasound-guided fine-needle aspiration(EUSFNA)is the only procedure for histologically diagnosing autoimmune pancreatitis(AIP).However,adequate specimens are difficult to obtain.Recently,more adequate specimens were reported to be obtained with EUS-FNA with a wet suction technique(WEST)than with conventional EUS-FNA.AIM To histologically diagnose AIP by EUS-FNA with a WEST.METHODS Eleven patients with possible type 1 AIP between February 2016 and August 2018 underwent EUS-FNA with a WEST(WEST group),with four punctures by 19 or 22 G needles.As a historical control,23 type 1 AIP patients who underwent no fewer than four punctures with 19 or 22 G needles were enrolled(DRY group).Patient characteristics and histological findings were compared between the two groups.RESULTS Three histopathological factors according to the International Consensus Diagnostic Criteria were significantly greater in the WEST group than the DRY group[lymphoplasmacytic infiltrate without granulocytic infiltration:9(81.8%)vs 6(26.1%),P=0.003,storiform fibrosis:5(45.5%)vs 1(4.3%),P=0.008,abundant(>10 cells/HPF)IgG4-positive cells:7(63.6%)vs 5(21.7%),P=0.026].Level 1 or level 2 histopathological findings were observed more often in the WEST group than in the DRY group[8(72.7%)vs 3(13.0%),P=0.001].CONCLUSION EUS-FNA with a WEST was more successful than standard EUS-FNA in histologically diagnosing AIP.
文摘AIM: To evaluate the efficacy of endoscopic ultrasound guided biliary drainage(EUS-BD) in patients with surgically altered anatomies.METHODS: We performed a search of the MEDLINE database for studies published between 2001 to July2014 reporting on EUS-BD in patients with surgically altered anatomy using the terms "EUS drainage" and "altered anatomy". All relevant articles were accessed in full text. A manual search of the reference lists of relevant retrieved articles was also performed. Only fulltext English papers were included. Data regarding age, gender, diagnosis, method of EUS-BD and intervention, type of altered anatomy, technical success, clinical success, and complications were extracted and collected. Anatomic alterations were categorized as: group 1, Billroth Ⅰ; group 2, Billroth Ⅱ; group 4, Rouxen-Y with gastric bypass; and group 3, all other types. RESULTS: Twenty three articles identified in the literature search, three reports were from the same group with different numbers of cases. In total, 101 cases of EUS-BD in patients with altered anatomy were identified. Twenty-seven cases had no information and were excluded. Seventy four cases were included for analysis. Data of EUS-BD in patients categorized as group 1, 2 and 4 were limited with 2, 3 and 6 cases with EUS-BD done respectively. Thirty four cases with EUS-BD were reported in group 3. The pooled technical success, clinical success, and complication rates of all reports with available data were 89.18%, 91.07% and 17.5%, respectively. The results are similar to the reported outcomes of EUS-BD in general, however, with limited data of EUS-BD in patients with altered anatomy rendered it difficult to draw a firm conclusion. CONCLUSION: EUS-BD may be an option for patients with altered anatomy after a failed endoscopic-retrogradecholangiography in centers with expertise in EUS-BD procedures in a research setting.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duodenal diverticulum,ampullary neoplastic infiltration or surgically altered anatomy.In these cases percutaneous biliary drainage(PTBD)is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life.Endoscopic ultrasound-guided biliary drainage(EUS-BD)is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices.A large amount of data is already collected that proves its efficacy,safety and ability to replace PTBD in cases of ERCP failure.It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future.Several EUS-BD techniques are developed EUS-guided transmural stenting,antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy.EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure.The lack of training,absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure,which is related to life-threatening adverse events.Developing training models,dedicated devices and guidelines hopefully will make EUS-BD easier,safer and well accepted in the future.This paper focuses on the technical aspects of the different EUS-BD procedures,available literature data,advantages,negative aspects and the future perspectives of these modalities.
文摘Background and Objective: Percutaneous central venous cannulation is a common invasive procedure. In comparison with an external landmark technique, the advantages of ultrasound-guided venous access include direct visualization of the anatomy and in vivo visualization of venous cannulation. Methods: We evaluated an ultrasound-guided technique for infraclavicular axillary vein cannulation, focusing on its ease of use, success rate and complications rate. One hundred and twenty patients who submitted to central venous catheter placement were punctured using our technique. The patients were positioned so that their ipsilateral upper limb was abducted at 90° to the longitudinal axis, which makes it possible to visualize the infraclavicular vessels due to the elevation of the clavicle, thereby improving accessibility. Results: Cannulation was successful in all patients. The median time from the start of the first puncture (of the skin) until the aspiration of blood was 15 s (range 7 - 135 s). Both infraclavicular axillary veins were cannulated, and the vein was punctured successfully at the first attempt in 95% of the patients, without complications during the procedure. Conclusion: We propose an ultrasound-guided infraclavicular approach of the axillary vein, with a high success rate and no complications in the present cohort.
文摘Objective To report a case of ovarian hemorrhage after transvaginal ultrasoundguided oocyte retrieval combined with severe ovarian hyperstimulation syndrome （OHSS）. Methods A 26-year-old woman who was on therapy for infertility presented with abdominal distension and a decrease of urine after transvaginal ultrasound-guided oocyte retrieval for in vitro fertilization-embryo transfer （IVF-ET）. Initial clinical presentation, ultrasound, and lab results were consistent with the diagnosis of severe OHSS. However with 4 d conservative treatments there seemed no recovery and the patient became more serious for her hemoglobin fell from 169.0 g/L to 60.2 g/L along with more abdominal fluid and a decrease of urine. Ultrasound guided paracentesis revealed an ovarian hemorrhage, and the patient underwent emergent surgery. Results The patient underwent emergent laparotomy for oophoroplasty and preservation of ovary. She got twin pregnancy in the second frozen-thawed embryo transfer （FET） cycle and delivered two female babies. Conclusion It is important to distinguish the OHSS from ovarian hemorrhage, because the ovarian hemorrhage with hemoperitoneum requires immediate operative management, whereas OHSS is nearly always managed conservatively. Clinicians must be aware that ovarian hemorrhage may be delayed in women presenting OHSS.
文摘Cornual heterotopic pregnancy is an extremely rare,life-threatening complication during pregnancy.Here,we report a 33-year-old woman who suffered cornual heterotopic pregnancy after in vitro fertilization embryo transfer.To prevent rupture during heterotopic pregnancy,she received laparoscopic surgery to remove the ectopic gestational sac at 7^(+2) weeks of gestation.Ultimately,she delivered a healthy boy at 38^(+3) weeks of gestation.Here,we also review the clinical presentations,risk factors,treatment options and outcomes of cornual heterotopic pregnancy.
文摘目的探讨聚丙烯网片盆腔悬吊术治疗女性盆腔脏器脱垂(pelvic organ prolapse,POP)的疗效。方法回顾性分析2003年12月～2008年12月我院应用国产穿刺锥行网片介入手术治疗79例POP的临床资料,评估该术式的治愈率、并发症、复发率和新盆腔症状。POP分级采用盆腔器官脱垂量化系统(POP-Q)评定,泌尿生殖道症状问询采用盆底功能障碍疾病相关问卷(PFDI-20)。结果术后1年POP治愈68例(86.1%),好转8例(10.1%)。术后3个月内POP复发1例(1.3%),再次手术随访2年末复发;术后>1年POP复发3例(3.8%)。排尿障碍术后3个月内发生2例(2.5%),术后>1年发生1例(1.3%)。网片腐蚀术后3个月内发生5例(6.3%),术后>1年发生3例(3.8%)。术后1年出现性生活不适或疼痛4例(5.1%),术后出现膀胱过度活动症(overactive bladder,OAB)5例(6.3%),与网片相关的疼痛1例(1.3%)。结论聚丙烯网片POP腔悬吊术治疗盆疗效满意,复发率低,最多见的并发症是网片腐蚀,新出现的问题是OAB。
文摘The availability of ultrasound (US) devices has refined techniques for vascular access. The resident trainee’s ability to learn US techniques depends upon device availability, skills, and motivation of instructors. We hypothesized that hands-on teaching program of US techniques for vascular access would have a positive impact on the trainee’s perceptions. After IRB approval, PGY3 anesthesiology residents with limited prior experience in US-guided vascular access underwent close supervision by attending staff as they performed US-guided Internal Jugular Vein (IJV) central line placements. A total of 66 land mark (LM) and 75 US-guided IJV cannulation performed by 19 residents were supervised. Residents completing the study were more proactive with 68.4% agreeing to use US based techniques for an anticipated difficulty in accessing central lines. The graduating residents involved in the study all strongly agreed that US imaging for vascular access was within the scope of practice of all anesthesiologists, and that training guidelines be established and incorporated in their practice. Fifty eight percent of residents stated that their confidence and skill levels had significantly improved. Teaching US-guided techniques resulted in an increase employment of such techniques by graduating residents with no impediment attributed to knowledge deficits or inexperience. Residents were more proactive with using US for anticipated difficulty in IJV placement. A short neck, poor landmark, anticoagulation, morbid obesity favored US use by residents. Systematic teaching of US techniques is justified as it significantly improves the resident’s perceptions and confidence.
