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1.
Medicine (Baltimore) ; 99(11): e19545, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176109

RESUMO

To compare the diagnostic performance of percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography for the pathological assessment of suspected malignant bile duct stricture, using brush cytology and forceps biopsy.The study group comprised 79 consecutive patients who underwent pathological assessment for suspected malignant biliary stricture, 38 of whom underwent percutaneous transhepatic cholangiography (group A) and the other 41 underwent endoscopic retrograde cholangiography (group B). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. A subset analysis was performed to determine the effect of location and pathological type of the stricture on diagnostic performance, and complications were analyzed.The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86.7%, 100%, 100%, 66.7%, and 89.5%, respectively, in group A, and 77.1%, 100%, 100%, 42.9%, and 80.4%, respectively, in group B. For hilar biliary strictures, the sensitivity and accuracy were superior in group A than in group B. Mild complications (transient c and bile leakage) were identified in 7 cases in each group, all resolved spontaneously within 3 to 5 days.Both brush cytology and forceps biopsy performed during percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography provided good diagnostic sensitivity and accuracy. Therefore, both diagnostic approaches can play an important role in planning therapeutic strategy. However, for strictures located at the hilum, pathology sampling via percutaneous transhepatic cholangiography is preferable to endoscopic retrograde cholangiography, as it provides higher sensitivity and accuracy.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/diagnóstico , Colangiografia , Idoso , Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/patologia , Colangiopancreatografia Retrógrada Endoscópica , Constrição Patológica/diagnóstico , Feminino , Humanos , Masculino , Sensibilidade e Especificidade
2.
Artigo em Chinês | MEDLINE | ID: mdl-32086927

RESUMO

Objective:The aim of this study is to o explore the diagnosis, treatment and prognosis of idiopathic subglottic stenosis (ISS) Method:The clinical data of 15 patients with idiopathic subglottic stenosis treated in our department were analyzed retrospectively. The degree of stenosis was classified by the Cotton Airway grading system of Myer, with 8 cases of gradeⅡ, 4 cases of grade Ⅲ and 3 cases of grade Ⅳ. Result:The time of follow-up of HTSS was 0.5-10 years. All 15 patients were successfully extubated without asphyxia, decannulation and wound nonunion. Conclusion:For patients with idiopathic subglottic stenosis in the non-progressive stage, active surgical treatment strategy should be adopted and treated individually. The prognosis is satisfactory.


Assuntos
Laringoestenose/diagnóstico , Laringoestenose/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Constrição Patológica , Humanos , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
4.
Artigo em Chinês | MEDLINE | ID: mdl-32074745

RESUMO

Objective: To assess the outcomes of partial cricotracheal resection (CTR) and extended cricotracheal resection (ECTR) for severe laryngotracheal stenosis. Methods: From November 2009 to September 2017, 18 patients underwent CTR and ECTR at the Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Air Force Medical University for severe laryngotracheal stenosis were reviewed retrospectively. There were 12-male and 6-female patients, with the age ranged from 4 to 56 years (median 25 years). The causes were postintubation in 11 cases, cervical trauma in 4, idiopathic in 3. The stenosis located in subglottic and tracheal (n=12), glottic and subglottic and tracheal (n=3), subglottic (n=2), and glottic and subglottic (n=1). Two patients had concurrent unilateral vocal cord palsy.One patient had undergone previous endoscopic balloon dilation and 8 patients had previous laryngotracheal reconstruction. The stenosis was graded according to modified Myer-Cotton classification as follows: Ⅲb (n=1), Ⅲc(n=1), Ⅳa (n=2), Ⅳb (n=12), Ⅳc (n=2). The surgical outcomes and complications were recorded. Results: Among 18 patients,11 of the 12 patients undergoing CTR were decannulated. Five of the 6 patients undergoing ECTR were decannulated. Resected airway length ranged from 1.5 to 4.0 cm (median 2.8 cm). Surgical complications included infection of incision wound in 2 cases, anastomotic granulation in 2, cervical subcutaneous emphysema in 1, aspiration in 1, and unilateral arytenoid prolapse in 1. No recurrent laryngeal nerve injury or tracheoesophageal fistula occurred. The median follow up was 11 months. Conclusions: CTR is efficient for severe subglottic and upper tracheal stenosis while ECTR is efficient for subglottic stenosis extended to the glottis. Both procedures also provide a salvage therapy for patients with previous failed treatments.


Assuntos
Cartilagem Cricoide/cirurgia , Laringoestenose/cirurgia , Estenose Traqueal/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Constrição Patológica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traqueia/cirurgia , Resultado do Tratamento , Adulto Jovem
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 256-259, 2020 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-32030960

RESUMO

Objective: To review the research progress of total endoscopic minimally invasive technique in treating cervical nerve root canal stenosis (CNRCS). Methods: The related literature at home and abroad was extensively reviewed. The research history, current situation, research progress, advantages and disadvantages of minimally invasive treatment of CNRCS under total endoscope were summarized. Results: In recent years, with the continuous development of minimally invasive technique of total endoscope in spine surgery, the surgical treatment methods are also constantly innovated. Compared with the traditional open surgery, minimally invasive treatment of CNRCS under total endoscope can obtain better effectiveness, keep the stability of the cervical segment to the maximum extent, reduce the impact on the activity of the cervical spine and the occurrence of related surgical complications, which is an effective minimally invasive technology. Conclusion: The minimally invasive treatment of CNRCS under total endoscope has achieved some results, which is expected to be one of the indispensable means to treat CNRCS, but it still needs to be improved.


Assuntos
Cavidade Pulpar , Constrição Patológica , Descompressão Cirúrgica , Endoscópios , Foraminotomia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos
7.
Rev Med Suisse ; 16(680): 272-274, 2020 Feb 05.
Artigo em Francês | MEDLINE | ID: mdl-32022493

RESUMO

Renal artery stenosis can lead to renovascular secondary hypertension. It can also induce an elevation of creatinine, but usually in the case of bilateral stenosis. In addition, it may be associated with the occurrence of heart failure and pulmonary edema. In this context, it may seem intuitive to want to dilate this artery to improve clinical outcome, but the data in current literature speak rather against this intervention. We will see that that there are some specific criteria for revascularization, but the procedure is not without risk. We present here a case of unilateral renal artery stenosis whose indication for invasive treatment was relative, exposing the patients to unnecessary risks.


Assuntos
Obstrução da Artéria Renal/terapia , Constrição Patológica/complicações , Constrição Patológica/terapia , Humanos , Obstrução da Artéria Renal/complicações , Medição de Risco
11.
Zhonghua Yi Xue Za Zhi ; 100(4): 261-264, 2020 Feb 04.
Artigo em Chinês | MEDLINE | ID: mdl-32075352

RESUMO

Objective: To analysis of the efficacy of tubular paraspinal approach and conventional semi-laminar approach in treating lumbar stenosis. Methods: Retrospective research of clinical data of 56 lumbar stenosis cases who were operated in neurosurgery department of first center of PLA general hospital from May 2015 to June 2018. Collecting the information of sex, age, operating time, intraoperative blood loss, postoperative duration in bed, as well as length of hospital stay of those patients. The 2 groups of cases, tubular paraspinal approach group (n=35)and semi-laminal approachgroup (n=21), compared by Japanese orthopedic association (JOA) score and visual analogue scale to assess the functional situation of the patients before operation, 1 week after operation, 1 month after operation, 6 months after operation, and the last follow up. Results: The operating time(83.1±7.3 vs 86.1±9.6 min), intraoperative blood loss(18.2±3.9 vs 40.5±13.3 ml), postoperative duration in bed(37.4±7.8 vs 63.7±15.8 h), as well as length of hospital stay (3.8±1.1 vs 6.5±2.0 d)were all obviously better in tubular paraspinal approach group than in traditional semi-laminar approach group(P<0.05). The postoperative 1 week, 1month, and 6 months JOA score (21.8±3.4, 23.6±2.4, 24.2±2.4 vs 19.9±3.7, 21.6±2.8, 22.4±2.1)and VAS (2.2±1.0, 2.0±1.1, 0.4±0.1 vs 3.1±1.2, 2.6±1.3, 0.5±0.1) were better in tubular paraspinal approach group than semi-laminar approach group (P<0.05). While at the last follow up, the JOA score and VAS were similar in the 2 groups (P>0.05) . Conclusions: In non-fusion techniques for treating lumbar stenosis, tubular paraspinal approach demonstrated less blood loss, shorter stay in bed as well as in hospital, and better symptom relief in early postoperative period than traditional semi-laminal approach. While at long term follow up, both approaches achieved satisfactory outcome.


Assuntos
Fusão Vertebral , Constrição Patológica , Humanos , Vértebras Lombares , Região Lombossacral , Estudos Retrospectivos , Resultado do Tratamento
12.
Anticancer Res ; 40(2): 1071-1077, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014956

RESUMO

BACKGROUND/AIM: Severe benign cicatricial stricture (SBCS) is a major complication after definitive chemoradiation therapy (dCRT) for esophageal squamous cell carcinoma (ESCC). This study was conducted to investigate risk factors of SBCS in patients with localized ESCC. PATIENTS AND METHODS: This study included 197 patients with clinical stage (cSt) II/III ESCC with T3 primary tumor, treated with dCRT between 2000 and 2011. SBCS was defined as the inability to pass a 9-mm diameter endoscope or the presence of symptoms requiring treatment. RESULTS: Complete response was obtained in 87 patients (44%). Multivariate analysis revealed that hypoalbuminemia (hazard ratio=5.65; 95% confidence interval=1.50-21.28; p=0.010) and the inability to pass an endoscope (hazard ratio=5.90; 95% confidence interval=1.52-22.85; p=0.010) were risk factors of SBCS. CONCLUSION: The inability to pass an endoscope and hypoalbuminemia were identified as risk factors of SBCS in patients with cSt II/III ESCC with T3 primary tumor.


Assuntos
Quimiorradioterapia/efeitos adversos , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Neoplasias Esofágicas/complicações , Esôfago/patologia , Adulto , Idoso , Biomarcadores , Quimiorradioterapia/métodos , Constrição Patológica/epidemiologia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida
13.
Curr Urol Rep ; 21(1): 3, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31960193

RESUMO

PURPOSE OF REVIEW: In the setting of kidney transplantation, the ureter is a common source for complications. As a result, prevention of ureteral complications and their management is of crucial importance. In this context, the purpose of this review is to summarize recent literature on the ureter in the kidney transplant setting with a special focus on new findings. We conducted a PubMed and Medline search over the last 10 years to identify all new publications related to ureteroneoimplantations, stents and management of complications in the kidney transplant setting. RECENT FINDINGS: Performance of the "Lich-Gregoir" technique for ureteroneocystostomy seems to be favourable in regard to postoperative complications when compared with other methods described in the literature. Moreover, major urologic complications can be further reduced by ureteral stenting. A new approach for management of ureteral strictures in renal transplants is presented. We discussed the usage of a ureteral stent covered with a biostable polymer aiming to prevent tissue ingrowth into the lumen as a new option for management of ureteral stricture in the kidney transplant setting.


Assuntos
Transplante de Rim/métodos , Ureter/cirurgia , Obstrução Ureteral/terapia , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos , Anastomose Cirúrgica/efeitos adversos , Constrição Patológica , Humanos , Stents , Obstrução Ureteral/etiologia
14.
Urology ; 137: 183-189, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31926195

RESUMO

OBJECTIVE: To characterize the bulbospongiosus muscle (BSM) in patients with bulbar urethral strictures. MATERIALS AND METHODS: We studied 21 patients divided into 2 groups: Stricture Group (n = 14; mean age = 62.00 years) with bulbar stricture submitted to open urethroplasty; and Control Group (n = 7; mean age = 60.14 years) with penile strictures (hypospadias cripples, penile cancer and/or penile infection) who were submitted to perineal urethrostomy. Samples of the BSM were dissected and histologic sections were stained by histochemical and immunohistochemical techniques. Histomorphometric analyzes were performed on photomicrographs. Means were statistically compared using the unpaired Student t test and the Mann-Whitney test (P <.05). RESULTS: The etiology of bulbar urethral stricture was idiopathic in 2 cases (14.29%), post-TURP in 6 (42.86%), post open radical prostatectomy in 5 (35.71%) and post open prostatectomy in 1 case (7.14%). The average length of the stricture was 2.08 cm. The only parameter analyzed with significant difference between the groups was the vessels (significant difference between the control group: 5.11 ± 1.98% and stricture group: 3.57 ± 1.32%, P = .0460). The quantitative analysis of collagen (Control Group: 10.63 ± 5.37% and Stricture Group: 10.83 ± 4.55%, P = .9296); diameter of BSM muscle fibers (Control Group: 41.71 ± 14.63 µm and Stricture Group: 40.11 ± 8.59 µm, P = .76 and elastic system fibers (Control Group; 3.83 ± 1.54% and Stricture Group: 5.43 ± 2.90%, P = .2601) showed no significant difference. CONCLUSIONS: Histologic analysis showed a significant decrease of the BSM vessels in urethral stricture, without changes in elastic fibers, collagen, nerves, and muscle fiber diameter. These findings show that the bulbar urethral stricture causes minimal alterations in the structure of the BSM.


Assuntos
Doenças do Pênis , Pênis , Complicações Pós-Operatórias , Uretra , Estreitamento Uretral , Procedimentos Cirúrgicos Urológicos , Pesos e Medidas Corporais/métodos , Brasil , Constrição Patológica , Correlação de Dados , Técnicas de Imagem por Elasticidade/métodos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/patologia , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/irrigação sanguínea , Uretra/inervação , Uretra/patologia , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
16.
Gene ; 736: 144386, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31978512

RESUMO

Neuropathic pain, caused by damage to the nerve system, is one of the most challenging diseases in the world. Moreover, the etiology remains unclear. Circular RNAs (circRNAs) have been revealed to participate in various biological progress, including neuropathic pain. However, the way circRNAs participate in the progress of neuropathic pain still needs further study. In this research, we established CCI rat models and measured the expression level of ciRS-7 in the spinal dorsal horn in the postoperative rats. The level of ciRS-7 was positively associated with the progress of neuropathic pain. Next, we test the expression of autophagy and inflammation in the CCI rats, and the results indicate that ciRS-7 associates with the progress of neuropathic pain partly by upregulated the expression level of autophagy and inflammation in the CCI rats. Furthermore, we found ciRS-7 regulates neuropathic pain progress by sponging to miR-135a-5p. In CCI rats, inhibiting miR-135a-5p decreases the level of autophagy and inflammation and alleviates neuropathic pain. We present this research that might provide a new insight for neuropathic pain study.


Assuntos
Autofagia/genética , Constrição Patológica/genética , Inflamação/genética , MicroRNAs/genética , Neuralgia/genética , RNA Longo não Codificante/genética , Animais , Linhagem Celular , Células HEK293 , Humanos , Masculino , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/genética , Regulação para Cima/genética
17.
Br J Radiol ; 93(1108): 20191046, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31971831

RESUMO

OBJECTIVE: To study the outcome of salvage percutaneous transhepatic biliary drainage (PTBD) in complex and technically challenging post-liver transplant (LT) biliary complications and analyse the reason for failure of endoscopic retrograde cholangiopancreatography (ERCP). METHODS AND MATERIALS: Hospital data were searched for all LT patients with biliary complications requiring salvage PTBD (upon failure of ERCP) from January 2010 to May 2017. Patients who underwent primary PTBD were excluded. Patients clinical and biochemical parameters were analysed for clinical, biochemical and imaging response, stent-free survival and the reason for ERCP failure. RESULTS: Salvage PTBD was performed in 32 patients with post-LT biliary stricture/bile leak presenting with deranged liver function in 12 (37.5%), cholangitis in 12 (37.5%) and cholangitis with cholangitic abscess in remaining 8 (25%) patients. Of 32 patients, 20 (62.5%) already had plastic biliary stent placed by ERCP, while in remaining (n = 12, 37.5%) a wire could not be negotiated across stricture by ERCP. These patients were found to have long/tortuous stricture (n = 18, 56.3%) and multiple duct disconnection at anastomosis (n = 14, 43.7%). Immediate as well as sustained (persisting for a year or more) clinical and biochemical improvement was seen in 26 (81.3%) patients, while failure of resolution of sepsis and death occurred in remaining 6 (18.8%). CONCLUSION: Salvage PTBD is an effective treatment in difficult-to-treat post-LT biliary strictures with deranged liver functions with or without cholangitis/cholangitic abscess. It can reduce graft loss with improved clinical outcome. Post-LT ductal anatomy at anastomosis is important to decide the appropriate approach (ERCP/PTBD). ADVANCES IN KNOWLEDGE: (1). PTBD as a salvage procedure in difficult anatomy or upon failure of ERCP-based intervention is effective and a good alternative strategy. (2). Postoperative surgical anatomy (type & length of stricture, number of ductanastomosis, location and graft-recipient duct alignment) is the key factor indeciding the appropriate therapeutic procedure.


Assuntos
Colangite/terapia , Colestase/terapia , Drenagem/métodos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/terapia , Terapia de Salvação/métodos , Abscesso/terapia , Adulto , Fístula Anastomótica/terapia , Colangiopancreatografia Retrógrada Endoscópica , Constrição Patológica/terapia , Drenagem/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Terapia de Salvação/estatística & dados numéricos , Stents/estatística & dados numéricos
18.
Urology ; 135: 64-65, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31895682
19.
Medicine (Baltimore) ; 99(2): e18752, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914096

RESUMO

The high prevalence of hepatitis B virus (HBV) infection and intracranial atherosclerotic stenosis (ICAS) in Asia raises the question as to whether HBV infection is associated with ICAS. To answer this question, we tested the association between HBV infection and ICAS. Totally, 3072 in-hospital subjects were retrospectively enrolled. All subjects underwent computed tomography angiography (CTA) and serological testing for HBV infection. Based on the results of CTA, all subjects were categorized into 4 groups including ICAS, extracranial atherosclerotic stenosis (ECAS), ICAS/ECAS (both ICAS and ECAS), and normal. HBV infection was divided into 4 patterns including hepatitis B core antibody (anti-HBc) positive/hepatitis B surface antigen (HBsAg) positive, anti-HBc-positive/HBsAg-negative, anti-HBc-negative/HBsAg-positive, and anti-HBc-negative/HBsAg-negative. Risk factors for atherosclerosis were collected based on medical records. Multiple logistic regression models were used to determine the association between infection patterns and ICAS. We found that the anti-HBc-positive / HBsAg-negative pattern was associated with the increased risk of ICAS (OR = 1.462) and not associated with ECAS or ICAS / ECAS. The HBc-positive/HBsAg-positive pattern was not associated with ICAS, ECAS or ICAS/ECAS. In conclusions, the anti-HBc-positive/HBsAg-negative pattern was associated with the increased risk of ICAS. Anti-HBc should be employed to investigate the association between HBV infection and cerebrovascular diseases.


Assuntos
Aterosclerose/epidemiologia , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Hepatite B/epidemiologia , Arteriosclerose Intracraniana/epidemiologia , Idoso , Aterosclerose/diagnóstico por imagem , China/epidemiologia , Angiografia por Tomografia Computadorizada , Constrição Patológica , Feminino , Hepatite B/sangue , Hepatite B/imunologia , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
20.
Medicine (Baltimore) ; 99(4): e18890, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977898

RESUMO

RATIONALE: Takayasu arteritis (TA) is a systemic large-vessel vasculitis which can be accompanied by the symptoms associated with vascular stenosis. PATIENT CONCERNS: We describe 2 female juveniles with TA who presented with progressive intermittent claudication. DIAGNOSIS: Contrast-enhanced computed tomography (CT) revealed the stenosis of femoral arteries and increased levels of C-reactive protein (CRP), and serum amyloid A (SAA) were noted in both patients. According to European league against rheumatism consensus criteria for the diagnosis of TA was confirmed in both patients. INTERVENTIONS: Both patients had shown resistance to glucocorticoids and treated with tocilizumab (TCZ) (subcutaneous injections, 162 mg/week). OUTCOMES: These treatments improved claudication symptoms. Follow-up imaging by enhanced CT revealed restoration of advanced stenosis of the femoral arteries in both patients. They achieved normalization of levels of the acute-phase reactants CRP and SAA. Serum levels of interleukin-6 were increased transiently after TCZ injection, but declined to within normal ranges at 12 weeks. LESSONS: Juvenile patients with TA presenting with advanced stenosis of the femoral arteries are not rare. The clinical courses of our patients suggested the beneficial effects of TCZ against the progressive vascular stenosis observed in refractory TA.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Arterite de Takayasu/tratamento farmacológico , Adolescente , Constrição Patológica/etiologia , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Interleucina-6/sangue , Claudicação Intermitente/etiologia , Perna (Membro) , Arterite de Takayasu/complicações , Arterite de Takayasu/etiologia , Arterite de Takayasu/fisiopatologia , Resultado do Tratamento
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