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2.
J Laryngol Otol ; 134(1): 41-45, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31865922

RESUMO

OBJECTIVE: To explore the opinions of the UK consultant body on endoscopic Eustachian tube balloon dilatation in the context of Eustachian tube dysfunction. METHOD: A 10-question online survey was distributed to ENT consultants currently practising in the UK (July-September 2018). RESULTS: A total of 137 ENT consultants responded. Twenty-three per cent reported experience of Eustachian tube balloon dilatation, with a further 10 per cent planning to start performing the procedure. Of those performing the procedure, 16 per cent had more than two years' experience. Thirty-two per cent were performing zero to five procedures a year. Eustachian tube balloon dilatation was primarily conducted to treat Eustachian tube dysfunction symptoms, as well as retraction pockets, baro-challenge-induced Eustachian tube dysfunction and otitis media with effusion. The most common reason for not undertaking Eustachian tube balloon dilatation was insufficient evidence of efficacy (65 per cent). Seventy-two per cent of consultants thought that creating a national database for audit and monitoring purposes would benefit the specialty. CONCLUSION: The majority of UK ENT consultants do not practise Eustachian tube balloon dilatation, citing a lack of high-level evidence to support its use. A national database for auditing and research could facilitate the creation of guidelines.


Assuntos
Dilatação/instrumentação , Otopatias/cirurgia , Tuba Auditiva/cirurgia , Cateterismo/instrumentação , Competência Clínica/estatística & dados numéricos , Consultores , Estudos Transversais , Humanos , Guias de Prática Clínica como Assunto , Inquéritos e Questionários , Resultado do Tratamento , Reino Unido
3.
Medicine (Baltimore) ; 98(44): e17714, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689807

RESUMO

This study aimed to compare clinical results, symptom relief, quality of life and patient satisfaction after the 2 most common procedures for achalasia treatment: laparoscopic Heller myotomy (LHM) and endoscopic balloon dilatation (EBD).Patients treated at University Hospital of Heidelberg with LHM or EBD were included. A retrospective chart review of perioperative data and a prospective follow-up of therapeutic efficiency, Gastrointestinal Quality of Life Index (GIQLI) and patient satisfaction was conducted.Follow-up data (mean follow-up: 75.1 ±â€Š53.9 months for LHM group and 78.9 ±â€Š45.6 months for EBD) were obtained from 36 patients (19 LHM; 17 EBD). Eckardt score (median (q1,q3): 2 (1,4) in both groups, P = .91, GIQLI (LHM: 117 (91.5, 126) vs EBD: 120 (116, 128), P = .495) and patient satisfaction (3 (2,3) vs 3 (2,4), P = .883) did not differ between groups. Fifteen patients (78.9%) in LHM group and 11 (64.7%) in EBD group (P = .562) stated they would undergo the intervention again. All patients with EBD had at least 2 dilatations (100%), whilst only 2 patients (10.5%) had dilatation after LHM (P < .001). There were no complications after EBD, but 2 after LHM (10.5%, P = .517).Both LHM and EBD are able to control symptoms and provide similar quality of life and patient satisfaction. However, reintervention rate was higher following EBD, hence LHM provided a more sustained treatment than EBD.


Assuntos
Dilatação/estatística & dados numéricos , Acalasia Esofágica/cirurgia , Esofagoscopia/estatística & dados numéricos , Miotomia de Heller/estatística & dados numéricos , Dilatação/instrumentação , Dilatação/métodos , Esofagoscopia/métodos , Feminino , Seguimentos , Miotomia de Heller/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Qualidade de Vida , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
4.
Arch Ital Urol Androl ; 91(3)2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577102

RESUMO

OBJECTIVES: Introduction of the "access sheet" is one of the most important steps steps of the percutaneous nephrolithotomy (PNL) intervention. In creating the access tract, various dilatators (balloon, metal) are used and different need-based dilatation tools were developed. In this study, we aimed to compare the mechanical Amplatz dilatation (AD), balloon dilatation (BD) and one-shot dilatation (OSD) methods in a retrospective manner. METHODS: A total of 182 patients (127 males and 55 females), who underwent PNL surgery in Urology Department of Fatih Sultan Mehmet Research and Training Hospital between January 2016 and September 2018, were included in this study. RESULTS: The average age was 47.34 ± 12.68 years (age range 15-80) and average BMI was 27.15 ± 5.01 kg/m2 (range between 17.12 and 40.75 kg/m2). There was a prominent difference in terms of operation duration (p = 0.032). Meaningful difference was found among the groups in terms of dilation fluoroscopy time (p = 0.001), with a notable shorter time in OSD group than the others (p < 0.05). Beside this, there was no difference between the AD and BD groups in terms of fluoroscopy times (p > 0.05). Also, there was no difference among the groups by Clavien complication rate (p > 0.05). There was a prominent difference among the groups in terms of hemoglobin decrement (p = 0.012; p < 0.05). The hemoglobin decrease in OSD group was significantly lower than in AD and BD groups (p < 0.05; p < 0.01). On the contrary, there was no meaningful difference between AD and BD groups with this regard (p > 0.05). CONCLUSIONS: As a result, we have concluded that the use of OSD modality in PNL interventions could be superior to other methods with respect to its feasibility, cost-effectiveness, shorter radiation exposure / fluoroscopy time and it could be a preferable way of treatment especially in developing countries.


Assuntos
Dilatação/métodos , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dilatação/efeitos adversos , Dilatação/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Estudos Retrospectivos , Adulto Jovem
5.
Laryngoscope ; 129(11): E412-E414, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31400145

RESUMO

Facial nerve baroparesis is a rare complication of middle ear barotrauma reported almost exclusively in overpressure events related to diving and flying. Until the development of Eustachian tube balloon dilation, no diving compatible options existed to effectively and safely prevent recurrence. We present a case of a U.S. Navy diver with a history of repeated ipsilateral facial nerve paresis that occurred during diving. The patient underwent Eustachian tube balloon dilation of the affected side. Following surgery, the patient completed a recompression chamber simulated dive that allowed the patient to return to diving. The patient has been symptom-free for 12 months following dilation. Laryngoscope, 129:E412-E414, 2019.


Assuntos
Barotrauma/cirurgia , Dilatação/métodos , Mergulho/efeitos adversos , Traumatismos do Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Traumatismos Ocupacionais/cirurgia , Barotrauma/etiologia , Dilatação/instrumentação , Tuba Auditiva/cirurgia , Nervo Facial/cirurgia , Traumatismos do Nervo Facial/etiologia , Paralisia Facial/etiologia , Humanos , Masculino , Militares , Traumatismos Ocupacionais/etiologia , Estados Unidos , Adulto Jovem
6.
Medicine (Baltimore) ; 98(35): e16864, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464914

RESUMO

Intestinal strictures are common complications of Crohn's disease (CD). Endoscopic balloon dilatation (EBD) constitutes an alternative therapy to surgery, but associated factors of procedure success are inconclusive. Therefore, we aimed to evaluate the EBD success rate and its associated factors in CD patients.This is a retrospective cohort study of consecutive EBDs that were conducted between 2006 and 2014 among patients with CD with lower gastrointestinal tract strictures. Patients' and stricture characteristics, short term procedure success and related complications at 1 week follow-up, and long-term clinical endpoints were documented.A total of 138 dilatations were performed on 64 CD patients. The overall dilatation success rate was 84.8%, with no difference between primary or anastomotic strictures, or between first or recurrent dilatation procedures. Long strictures (≥4 cm) were negatively associated with successful EBDs, but not with perforations. A multivariate analysis adjusting for age, sex, smoking, and disease duration revealed that a maximal dilatation diameter of ≥15 mm was positively associated with a successful EBD, while an inflamed stricture was negatively associated with procedure success. Strictures which were both long and inflamed were associated with the lowest EBD success rates compared with other strictures. Only 32.8% of patients required surgery during the follow-up period. Long-term prevention of surgery was negatively associated with stricture length and with a successful EBD.EBD is highly successful in treating intestinal strictures and in prevention of surgery in CD patients. Although EBD of long strictures is safe, it will not prevent surgery in the majority of cases.


Assuntos
Doença de Crohn/complicações , Dilatação/instrumentação , Obstrução Intestinal/terapia , Adulto , Idoso , Enteroscopia de Balão , Constrição Patológica/etiologia , Constrição Patológica/terapia , Feminino , Humanos , Obstrução Intestinal/etiologia , Israel , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Centros de Atenção Terciária
7.
Khirurgiia (Mosk) ; (8): 85-90, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464281

RESUMO

Secondary pyloric stenosis quickly leads to homeostatic and nutritional disorders that determines the importance of early diagnosis and surgical treatment. In two clinical cases, we have shown that staged endoscopic balloon dilatation of the pylorus is devoid of the most of the known problems and shortcomings of conventional surgery and makes it possible to restore effectively gastrointestinal passage and to improve child's quality of life. This procedure has a high diagnostic and curative value and is followed by positive dynamics of condition of the child with pyloric stenosis.


Assuntos
Cicatriz/cirurgia , Dilatação/instrumentação , Gastroscopia/métodos , Estenose Pilórica/cirurgia , Piloro/cirurgia , Criança , Dilatação/métodos , Humanos , Estenose Pilórica/complicações , Estenose Pilórica/diagnóstico , Estenose Pilórica/etiologia , Piloro/patologia
8.
Khirurgiia (Mosk) ; (6): 60-64, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317942

RESUMO

AIM: To evaluate the efficacy of the most common endoscopic transpapillary interventions for choledocholithiasis in randomized controlled trial. MATERIAL AND METHODS: There were 90 patients with choledocholithiasis who were randomized into 3 groups: main, clinical comparison 1, clinical comparison 2. In the main group A (n=30), patients underwent endoscopic partial papillosphincterotomy combined with balloon dilatation, in the group of clinical comparison 1 (n=30) - endoscopic papillosphincterotomy, in the group of clinical comparison 2 (n=30) - endoscopic papillosphincterotomy with mechanical lithotripsy. RESULTS: The greatest number of complications (38%) was observed in the group of clinical comparison 2. Less morbidity was noted in the group of clinical comparison 1 (19%). Minimum number of complications was observed in the main group (6%). Acute pancreatitis was diagnosed in groups of clinical comparison 1 and 2 as a rule, whereas only 3% of patients had this complication in the main group. Cholangitis was predominantly observed in the group of clinical comparison 2, in other groups this complication occurred in 3% of patients. Bleeding was observed only in the groups of clinical comparison 1 and 2 (10 and 13%, respectively). Loss of the lithotripter rope (3%) was detected only in the group of clinical comparison 2. CONCLUSION: Endoscopic partial papillosphincterotomy with balloon dilatation is advisable for choledocholithiasis due to minimal risk of intra- and postoperative complications.


Assuntos
Coledocolitíase/cirurgia , Esfinterotomia Endoscópica/métodos , Coledocolitíase/terapia , Dilatação/efeitos adversos , Dilatação/instrumentação , Humanos , Litotripsia/métodos , Esfinterotomia Endoscópica/efeitos adversos , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(26): e16292, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261603

RESUMO

RATIONALE: The management of complete obstruction of anastomosis following colorectal surgery is challenging. Some modified minimally invasive methods have been reported to be successfully implemented in some cases. In this case report, we present a case to share our experience. PATIENT CONCERNS: A 64-year-old man underwent low anterior resection and single barrel ileostomy for rectal cancer 5 months ago. Completely obstructed anastomotic stenosis was found during colonoscopy. DIAGNOSIS: Colonoscopy showed the anastomosis at 8 cm from the anal verge was completely obstructed. INTERVENTIONS: A small incision was made by a needle knife, and then the stenosis was sequentially dilated by using a wire-guided balloon dilator. OUTCOMES: The luminal continuity was reestablished. The patient underwent successful ileostomy closure 2 months later. At 18-months follow-up, no restenosis of the anastomosis was observed during colonoscopy. LESSONS: Endoscopic small incision with a needle knife along with balloon dilation could be an alternative method for patients with complete obstruction of anastomosis after colorectal resection. But this procedure should be performed with great caution in selected patients and performed only by highly experienced endoscopists.


Assuntos
Colonoscopia , Neoplasias Colorretais/cirurgia , Obstrução Intestinal/terapia , Complicações Pós-Operatórias/terapia , Anastomose Cirúrgica , Terapia Combinada , Constrição Patológica , Dilatação/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade
10.
Zhonghua Shao Shang Za Zhi ; 35(5): 388-391, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31154739

RESUMO

Objective: To explore the application value of color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns complicated with upper respiratory tract obstruction. Methods: From July 2013 to June 2018, 17 patients with head and neck burns complicated with upper respiratory tract obstruction, including 15 males and 2 females, aged 19-63 years, were hospitalized in our unit and treated with color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps. Before operation, the trachea was examined by color Doppler ultrasonography to specify condition of trachea and peribronchial tissues and organs for comprehensive assessment, so as to confirm optimal incision site of puncture and pathways as well as specify distance from anterior cervical skin to intima of anterior tracheal wall. Then, under real-time guidance of color Doppler ultrasound, percutaneous dilational tracheostomy with dilatation forceps was performed. The position, shape, inner diameter, and intraluminal abnormalities of trachea of patients before operation, abnormal location of peribronchial vessels and thyroid, distance from anterior cervical skin to intima of anterior tracheal wall, success rate of puncture, surgical time (from skin disinfection to successful catheterization), success rate of catheterization, intraoperative blood loss, heart rate, blood pressure, respiration, percutaneous oxygen saturation, and presence or absence of complications such as vascular/thyroid injury, emphysema, pneumothorax, suffocation, postoperative hemorrhea, wound infection after operation were observed and detected. Results: (1)Preoperative color Doppler ultrasonography showed that the trachea of one patient deviated from the anterior median line of neck 13 mm to the right; 17 patients had edema of different degrees in the cervical soft tissue and more secretions in the trachea; 3 patients had the trachea changed from round to oval with reduced anteroposterior diameter; 1 patient had a small artery obstruction at the conventional puncture point; 2 patients had the trachea covered by the congestive and swollen isthmus of the thyroid between the first and the third tracheal cartilage rings; 16 patients had a distance from anterior cervical skin to anterior tracheal wall intima of 17-33 mm, and 1 patient had a distance from anterior cervical skin to anterior tracheal wall intima of 47 mm. (2) Puncture for 17 patients was successful at one time, and success rate of puncture was 100%. The operation time was 5-11 min, with an average of 7 min, and the success rate of catheterization was 100%. (3) Intraoperative blood loss of patients was less, all not exceeding 8 mL. Intraoperative percutaneous oxygen saturation was maintained between 0.90 and 0.99. The heart rate, blood pressure, and respiration were stable. (4) No complications such as vascular/thyroid injury, emphysema, pneumothorax, suffocation, postoperative massive hemorrhage, or wound infection occurred in any patient. Conclusions: Applying color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns combined with upper respiratory tract obstruction can not only open up the airway quickly and effectively, but also reduce the complications related to the operation. It is expected to improve the success rate of rescue and improve the prognosis, making it of good application value.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Queimaduras/complicações , Dilatação/instrumentação , Traqueostomia/métodos , Ultrassonografia Doppler em Cores/métodos , Adulto , Cuidados Críticos , Feminino , Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço , Estudos Prospectivos , Instrumentos Cirúrgicos , Traqueostomia/efeitos adversos , Adulto Jovem
11.
BMC Gastroenterol ; 19(1): 93, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215401

RESUMO

BACKGROUND: The removal of large bile duct stones (> 15 mm) by conventional endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) can be challenging, requiring mechanical lithotripsy (ML) in addition to EST or EPBD. The primary complication of ML is basket and stone impaction, which can lead to complications such as pancreatitis and cholangitis. The present study aims to investigate the efficacy of limited EST plus endoscopic papillary large balloon dilation (EST-EPLBD) for large bile duct stone extraction with an extent of cutting < 1/2 the length of the papillary mound. METHODS: We enrolled 185 patients with ≥15 mm bile duct stones who received EST, EPLBD and limited EST-EPLBD treatment from January 1, 2010 to February 28, 2018, at Kaohsiung Chang Gung Memorial Hospital (Kaohsiung, Taiwan). All patients were categorized into three groups: EST group (n = 31), EPLBD group (n = 96), and limited EST-EPLBD group (n = 58). The primary outcome variables were the success rate of complete stone removal and complications. RESULTS: The limited EST-EPLBD group exhibited a higher success rate of the first-session treatment compared with the EST and EPLBD groups (98.3% vs. 83.9% vs. 86.5%; P = 0.032) but required a longer procedure time (32 (12-61) min vs. 23.5 (17-68) min vs. 25.0 (14-60) min; P = 0.001). The need for ML during the procedure was 4 (12.9%) in the EST group, 10 (10.4%) in the EPLBD group and 2 (3.4%) in the limited EST-EPLBD group. Post-procedure bleeding in the EST group was more common than that in the limited EST-EPLBD group (9.7% vs. 0%; P = 0.038). Furthermore, dilated bile duct was the only risk factor for bile duct stone recurrence in the limited EST-EPLBD group. CONCLUSIONS: Limited EST-EPLBD exhibits a higher success rate but requires marginally longer procedure time for the first-session treatment. Furthermore, dilated bile duct is the only risk factor for bile duct stone recurrence in patients undergoing limited EST-EPLBD.


Assuntos
Ampola Hepatopancreática/cirurgia , Coledocolitíase/cirurgia , Dilatação/métodos , Enteroscopia de Balão Único/métodos , Esfinterotomia Endoscópica/métodos , Adulto , Cateterismo , Coledocolitíase/patologia , Dilatação/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Enteroscopia de Balão Único/instrumentação , Resultado do Tratamento
12.
Arq Gastroenterol ; 56(1): 95-98, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31141071

RESUMO

BACKGROUND: Bougies dilation is considered an effective technique for the treatment of simple benign esophageal strictures. The "rule of three" has been advocated to prevent reported adverse events such as bleeding and perforation. However, adherence to this rule has increased the cost and duration of treatment. OBJECTIVE: To demonstrate the safety and long-term benefits of progressive bougie dilations until reaching 15 mm (45Fr) in one single session endoscopy with non-adherence to the rule of three. METHODS: A retrospective analysis of a prospectively collected data of patients with simple benign esophageal strictures treated with multiple progressive bougie dilators until reaching 15 mm (45Fr) in one single session. RESULTS: The median age was 58 years (range 28-89), and 83.3% of patients were female. The main presenting symptom was dysphagia for solids in 11/12 cases (91.6%). The cause of their simple benign esophageal stricture was distributed as follows: 7/12 esophageal webs, 2/12 peptic stenosis, 2/12 Schatzki rings and one caustic injury. 75% required only one session for clinical success. No serious adverse events were described. No recurrence of symptoms was noted in a median follow-up of 20 months. CONCLUSION: The rule of three in patients with simple benign esophageal strictures secondary to esophageal webs, Schatzki rings and peptic strictures treated with Savary-Gilliard dilators is not necessary, showing good clinical results. Prospective studies with more patients are necessary.


Assuntos
Dilatação/instrumentação , Estenose Esofágica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dilatação/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
13.
J Pediatr Adolesc Gynecol ; 32(4): 354-358, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31091469

RESUMO

Vaginal dilator therapy is used to increase vaginal length for vaginal agenesis, to increase vaginal width for vaginal narrowing, and to prevent or treat stenosis after vaginal surgery. Although it is an effective therapy, many reproductive health providers have had little training on how to guide patients through this therapy. The purpose of this review is to educate providers on how to assess patient readiness and how to support patients through the process of vaginal dilation.


Assuntos
Anormalidades Congênitas/terapia , Dilatação/instrumentação , Vagina/anormalidades , Feminino , Ginecologia/educação , Humanos , Resultado do Tratamento
14.
Dig Endosc ; 31(4): 448-452, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30965388

RESUMO

Endoscopic dilation for severe benign biliary stricture using mechanical dilation devices is occasionally ineffective. Hence, diathermic dilation has recently been gaining attention as a salvage procedure. We evaluated the short- and long-term outcomes of diathermic dilation for severe benign biliary stricture that could not be dilated using conventional mechanical dilation. Thirteen consecutive cases with severe benign biliary stricture that underwent diathermic dilation using 6-Fr electrocautery dilator were enrolled. Short- and long-term outcomes were analyzed. Diathermic dilation was successful in 13 cases (100%), whereas stent was successfully placed in 12 cases (92.3%). Adverse events occurred in two cases (15.4%): mild hemobilia and cholangitis. Recurrence of bile duct stricture was observed in five out of 12 cases (41. 7%) in the 1115-day median follow-up period. Finally, eight cases achieved stent-free state (61.5%) and have remained stent-free without any episode of cholangitis and abnormal liver function test. Diathermic dilation using 6-Fr electrocautery dilator is a promising salvage procedure for severe benign biliary stricture when the conventional dilation technique has been ineffective.


Assuntos
Colestase/cirurgia , Diatermia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Colestase/diagnóstico por imagem , Constrição Patológica , Dilatação/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva
15.
Strahlenther Onkol ; 195(10): 902-912, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30997541

RESUMO

BACKGROUND: Despite a lack of evidence and low compliance, current guidelines recommend the use of a vaginal dilator (VD) after pelvic radiotherapy (RT). We analyzed the effect of VD on vaginal stenosis (VS) and its influence on sexual quality of life (QoL) in women treated with adjuvant RT for endometrial cancer (EC). METHODS: Between 2014 and 2015, 56 consecutive patients were instructed to use a VD after completion of treatment. The maximum diameter of the comfortably introducible VD was measured before and at 1 year after treatment. The degree of VS was evaluated clinically, and sexual QoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) sexual functioning items before RT, during RT, at 6 weeks, and at 1 year after RT. RESULTS: One year after RT, mean VD diameter had decreased by 2.7 ± 3.2 mm (p < 0.001) and 36 patients (64.3%) had clinical VS (grade I-III). A larger decrease in VD diameter correlated with a higher degree of clinical VS (p < 0.001). VD use (p = 0.81), RT modality (p = 0.68), and adjuvant ChT (p = 0.87) had no influence on VD diameter. Sexual activity decreased during RT and increased beyond pre-RT values 1 year after RT (p < 0.001). Sexual enjoyment decreased continuously during and after completion of RT (p = 0.013) and was influenced negatively by a higher degree of clinical VS (p = 0.01). CONCLUSION: Almost two thirds of patients developed clinical VS 1 year after adjuvant RT for EC, and sexual enjoyment was substantially reduced by VS. The use of a VD after RT may not serve to prevent sexual impairments and VS.


Assuntos
Adenocarcinoma/terapia , Dilatação/instrumentação , Neoplasias do Endométrio/radioterapia , Orgasmo/efeitos da radiação , Lesões por Radiação/terapia , Vagina/efeitos da radiação , Doenças Vaginais/terapia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica/etiologia , Constrição Patológica/terapia , Relação Dose-Resposta à Radiação , Neoplasias do Endométrio/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cooperação do Paciente , Qualidade de Vida , Lesões por Radiação/etiologia , Doenças Vaginais/etiologia
16.
Dtsch Med Wochenschr ; 144(8): 547-552, 2019 04.
Artigo em Alemão | MEDLINE | ID: mdl-30986863

RESUMO

Bedside percutaneous dilatational tracheostomy has become one of the most commonly used interventions in ICU medicine. Different techniques have been developed, but guidance of percutaneous dilatational tracheostomy by video bronchoscope has been suggested to be clinically reasonable for direct visualization. The current Step-by-Step tutorial gives a detailed instruction of the procedure with visualization of every single step offering tips and pitfalls of the procedure.


Assuntos
Traqueostomia/métodos , Broncoscopia , Contraindicações de Procedimentos , Dilatação/efeitos adversos , Dilatação/instrumentação , Dilatação/métodos , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Traqueostomia/efeitos adversos , Traqueostomia/instrumentação
17.
BMJ Case Rep ; 12(4)2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-31005874

RESUMO

Vaginal agenesis is one of the major congenital anomalies affecting women. Postoperative prosthetic vaginal dilators are indicated in patients treated surgically for vaginal agenesis. Although different dental materials such as acrylics and silicone-coated materials are used, addition silicones alone have never been used for the fabrication of prosthetic vaginal dilators. Addition silicone materials have advantages, such as high elastic recovery, high tear and tensile strengths, which aid in the definitive use of vaginal dilators. Vaginal dilators fabricated using addition silicone materials act as an efficient prosthesis in terms of function and ease of use in surgically treated vaginal agenesis patients.


Assuntos
Anormalidades Congênitas/cirurgia , Dilatação/instrumentação , Próteses e Implantes , Vagina/anormalidades , Feminino , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Silicones , Vagina/cirurgia
18.
Ear Nose Throat J ; 98(5): 291-294, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31012349

RESUMO

Sialendoscopy has emerged as a safe, effective and minimally invasive technique for management of obstructive and inflammatory salivary gland disease. The aim of our study was to analyze outcomes of sialendoscopy and steroid irrigation in patients with sialadenitis without sialoliths. We performed a retrospective analysis of patients who underwent interventional sialendoscopy with steroid irrigation from 2013 to 2016, for the treatment of sialadenitis without sialolithiasis. Twenty-two patients underwent interventional sialendoscopy with ductal dilation and steroid irrigation for the treatment of sialadenitis without any evidence of sialolithiasis. Conservative measures had failed in all. Eleven patients had symptoms arising from the parotid gland, 4 patients had symptoms arising from the submandibular gland, while 6 patients had symptoms in both parotid and submandibular glands. One patient complained of only xerostomia without glandular symptoms. The mean age of the study group which included 1 male and 21 females was 44.6 years (range: 3-86 years). Four patients had autoimmune disease, while 7 patients had a history of radioactive iodine therapy. No identifiable cause for sialadenitis was found in the remaining 11 patients. The mean follow-up period was 378.9 days (range: 16-1143 days). All patients underwent sialendoscopy with ductal dilation and steroid irrigation. Twelve patients showed a complete response and 9 patients had a partial response, while 1 patient reported no response. Only 3 patients required repeat sialendoscopy. The combination of sialendoscopy with ductal dilation and steroid irrigation is a safe and effective treatment option for patients with sialadenitis without sialoliths refractory to conservative measures. Prospective studies with a larger case series are needed to establish its role as a definitive treatment option.


Assuntos
Endoscopia/métodos , Glucocorticoides/uso terapêutico , Ductos Salivares , Sialadenite , Adulto , Dilatação/instrumentação , Dilatação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ductos Salivares/efeitos dos fármacos , Ductos Salivares/patologia , Ductos Salivares/cirurgia , Sialadenite/diagnóstico , Sialadenite/tratamento farmacológico , Sialadenite/etiologia , Sialadenite/cirurgia , Irrigação Terapêutica/métodos , Resultado do Tratamento , Estados Unidos
19.
Surg Laparosc Endosc Percutan Tech ; 29(4): 280-284, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30870313

RESUMO

It is currently unclear whether endoscopic papillary balloon dilation (EPBD) is associated with increased severe postendoscopic retrograde cholangiopancreatography pancreatitis (PEP)-related morbidity owing to conflicting reports. This study aimed to investigate whether EPBD increases the risk of PEP and hyperamylasemia. Clinical data of patients with choledocholithiasis, treated at the Second Affiliated Hospital of Harbin Medical University from January 2015 to December 2016 were analyzed. Patients were divided into the EPBD group and endoscopic sphincterotomy (EST)+EPBD group, and their characteristics and PEP and hyperamylasemia incidences were compared. Incidences related to dilated balloon diameter were also analyzed. There were no significant differences in patient characteristics and the incidences of PEP (2.6% vs. 0%; P=0.257) and hyperamylasemia (4.4% vs. 5.6%; P=0.954) between the 2 groups. Results were similar even with different balloon dilatations. EPBD without endoscopic sphincterotomy did not increase the risk of PEP and hyperamylasemia. It is a safe option for choledocholithiasis patients.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Coledocolitíase/cirurgia , Hiperamilassemia/etiologia , Pancreatite/etiologia , Esfinterotomia Endoscópica/efeitos adversos , Adulto , Fatores Etários , Idoso , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocolitíase/diagnóstico por imagem , Estudos de Coortes , Dilatação/instrumentação , Dilatação/métodos , Feminino , Hospitais Universitários , Humanos , Hiperamilassemia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Pancreatite/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Esfinterotomia Endoscópica/métodos , Resultado do Tratamento
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