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1.
Isr Med Assoc J ; 23(5): 297-301, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34024046

RESUMO

BACKGROUND: Management of acquired laryngotracheal stenosis (LTS) is challenging and often requires recurrent procedures. OBJECTIVES: To compare the efficacy and safety of balloon dilatation (BD) versus rigid dilatation (RD) in the treatment of LTS. METHODS: A retrospective study of patients undergoing endoscopic intervention for LTS was performed. RESULTS: The study included 69 balloon (BD) and 48 rigid dilations (RD). Most cases were grade 3 Cotton-Meyer stenosis. Mean time interval to recurrence after BD and RD were 27.9 and 19.6 weeks, respectively. Remission of over 8 weeks was achieved in 71% of BD compared to 31.2% of RD (P < 0.05). In the BD group, dilatation of subglottic stenosis showed higher rates of remission of over 8 weeks compared to upper and mid-tracheal stenosis (92% vs. 62% and 20%, respectively, P < 0.05). Complications were encountered in 4.2% of RD and 2.9% of BD. CONCLUSIONS: BD and RD are effective and safe procedures. Overall, BD achieved slightly better long-term results compared to RD.


Assuntos
Dilatação/métodos , Endoscopia/métodos , Laringoestenose/terapia , Estenose Traqueal/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Dilatação/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
2.
BMC Pulm Med ; 21(1): 73, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648488

RESUMO

BACKGROUND: Scarring central airway stenosis (SCAS) is a potentially life-threatening condition with debilitating symptoms. Interventional bronchoscopy is increasingly used to relieve symptoms in patients with SCAS, but recurrent stenosis is frequently observed. Little data exist on the long-term prognosis of interventional bronchoscopy for SCAS. We aimed to assess the prognostic factors of bronchoscopic interventions in patients with SCAS to optimize treatment. METHODS: This was a retrospective study that enrolled 119 consecutive patients with SCAS from January 2010 to April 2019 at our institution. Long-term clinical success was defined as airway stenosis < 50%, no limitation of physical activity, and a stable condition for > 12 months after the last interventional procedure. We compared patients' demographics, airway stenosis characteristics, and interventional procedures between the successful and unsuccessful groups, and identified significant predictors of long-term outcome with univariate and multivariate logistic regression. RESULTS: A total of 119 patients with 577 therapeutic bronchoscopies were included. Seventy-five (63%) patients were considered to have long-term clinical success. Older age, male gender, smoking, elevated C-reactive protein level, subglottic stenosis, stent or T-tube implantation, previous interventional treatment, and multiple procedures per year were potentially associated with unsuccessful long-term outcomes in the univariate analysis. Current smoker status (odds ratio [OR] 5.70, 95% confidence interval [CI] 1.35-24.17, P = 0.018), subglottic stenosis (OR 4.35, 95% CI 1.31-14.46, P = 0.017), and stent implantation (OR 4.96, 95% CI 1.33-18.48, P = 0.017) were associated with decreased odds of long-term success in the multivariate logistic regression analysis. Of note, there was no significant difference in odds of success between former smokers and nonsmokers. CONCLUSIONS: Current smoker status, subglottic stenosis, and stent implantation are independent factors associated with reduced long-term efficacy of interventional bronchoscopy for SCAS. Smoking cessation should be encouraged to improve the outcome of therapeutic bronchoscopy.


Assuntos
Broncopatias/cirurgia , Broncoscopia/métodos , Cicatriz/cirurgia , Laringoestenose/cirurgia , Stents , Estenose Traqueal/cirurgia , Adulto , Betametasona/análogos & derivados , Betametasona/uso terapêutico , Broncopatias/patologia , Broncopatias/fisiopatologia , Cicatriz/fisiopatologia , Constrição Patológica , Tosse/fisiopatologia , Criocirurgia/métodos , Dilatação/métodos , Combinação de Medicamentos , Dispneia/fisiopatologia , Feminino , Volume Expiratório Forçado , Glucocorticoides/uso terapêutico , Humanos , Injeções Intralesionais , Laringoestenose/fisiopatologia , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Recidiva , Estudos Retrospectivos , Fumar , Estenose Traqueal/fisiopatologia , Capacidade Vital , Adulto Jovem
3.
Medicine (Baltimore) ; 100(11): e24735, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725940

RESUMO

BACKGROUND: So far, there was no consensus regarding balloon dilation time in endoscopic papillary balloon dilation (EPBD). Thus, we conducted a systematic review and meta-analysis to compare the stone removal and overall complication rates of dilation of short and long duration with EPBD. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library), Web of Science, EMBASE Databases, and PubMed were searched from their inception to December 1, 2019 for all articles regarding balloon dilation time in EPBD for removal of bile duct stones. The data were extracted and the methodology quality was assessed. Meta-analysis was performed using RevMan5.3 software. RESULTS: Four studies involving a total of 1553 patients were included, 918 in the short dilation group and 635 in the long dilation group. The results of meta-analysis showed that there was no significant difference between the 2 different dilation groups in the complete stone removal in randomized controlled trails (RCTs) group (P = .10) and non-RCTs group (P = 0.45), mechanical lithotripsy requirement (RCTs: P = .92; non-RCTs: P = .47), pancreatitis (RCTs: P = .48; non-RCTs: P = .45), bleeding (RCTs: P = .95; non-RCTs: P = .60), infection of biliary (RCTs: P = .58; non-RCTs: P = .29), perforation (RCTs: P = .32; non-RCTs: P = .37). CONCLUSION: This systematic review suggests that there no significant difference in the efficacy and safety of dilation of short and long duration for removal of bile duct stones with EPBD.


Assuntos
Cateterismo/métodos , Coledocolitíase/cirurgia , Dilatação/métodos , Litotripsia/métodos , Duração da Cirurgia , Idoso , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
4.
Am J Otolaryngol ; 42(1): 102825, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33202329

RESUMO

OBJECTIVES: The aim of this study was to evaluate the 4-year outcomes and effectiveness of balloon sinuplasty in the treatment of chronic rhinosinusitis (CRS). MATERIAL AND METHODS: We evaluated the long-term outcomes in terms of symptoms, nasal endoscopy and computed tomography of 110 patients with CRS submitted to balloon sinuplasty in Centro Hospitalar do Funchal retrospectively. Sinus symptoms were determined by the Sino-Nasal Outcome Test (SNOT-22), endoscopic examination determined by Modified Lund Kennedy score (MLK) and computerized tomography scan of paranasal sinuses (CT-PNS) was evaluated through Lund Mackay scores (LM). Data was collected from 82 patients with chronic rhinosinusitis without nasal polyps (CRSsNP) and from 28 patients with nasal polyps (CRSwNP). RESULTS: Local anesthesia procedures were performed in 45.5% of the patients. First follow up was obtained at 2 years (median 22.45 ± 13.6 months) and at 4 years (median 44.45 ± 14 months) after balloon sinuplasty. The mean baseline SNOT-22 score was of 50.26 ± 15.33 for patients with CRSsNP and 52.25 ± 18.06 in CRSsNP patients. Both scores were reduced to 7.00 ± 13.5 and 10.00 ± 22.50 at 4 years follow-up respectively. Baseline MLK score was 4.90 ± 2.12 for patients in CRSsNP group and 10.00 ± 2.00 in the CRSwNP group Both scores were reduced to 1.65 ± 1.67 and 4.86 ± 2.16. The overall mean average LM CT-PNS score was 8.71 ± 4.728 preoperatively for the CRSsNP and 16.18 ± 3.9 in patients with CRSwNP and were reduced to 1.00 ± 1.75 and 8.69 ± 4.6 after BSP. SNOT 22, MLK and LM scores showed consistent improvement over baseline at all time points until the end of the study (median 44.45 ± 14 months). Significant improvements were recorded at all time points in the patient's symptom score, nasal endoscopy scores and imaging scores (P < 0.0001). CONCLUSION: Balloon sinuplasty appears to be safe and effective for the treatment of CRS with great long-term outcomes.


Assuntos
Dilatação/métodos , Pólipos Nasais/complicações , Cirurgia Endoscópica por Orifício Natural/métodos , Seios Paranasais/cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais/diagnóstico por imagem , Qualidade de Vida , Rinite/complicações , Rinite/diagnóstico por imagem , Sinusite/complicações , Sinusite/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Afr J Paediatr Surg ; 17(3 & 4): 74-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33342838

RESUMO

Background: Corrosive ingestion in children occurs usually at home and frequently results in debilitating strictures. Prevention and early intervention programs are very important for good outcomes. Aims and Objectives: This study aims at examining the immediate causative factors and problems of this subset of patients with a special focus on treatment and outcome. This study was to audit the management of patients in the paediatric age group who presented for treatment with history and sequelae of corrosive ingestion seen by the cardiothoracic unit of the University of Benin Teaching Hospital from January 2005 till December 2018. Materials and Methods: This is a 14year retrospective study of patients that presented with oesophageal burn injuries from ingestion of corrosive agents to the Cardiothoracic Unit at the University of Benin Teaching Hospital between January 2005 and December 2018. Essentially the first 5years were retrospectively included but the subsequent years were prospective. All available medical data on these patients were retrieved and studied for epidemiological, clinical and operative procedures and outcome. Results: A total of 49 patients were seen and admitted during the period under review. Male (29) : Female (20) ratio was 1:1.4 Mean age was 4.7±4.8 years with a range of 1-16years, The males presented earlier and had worse strictures as well as more surgical procedures. Caustic soda preparations ingested more (93.9%), all ingestions were within the household setting, and all had first aid given by way of oral palm oil. Only two (4.1%) ingested acids with only one flat battery ingestion. 45.5% of the patients had dilatation only and of these 50% recovered after 3 sessions and required no more sessions. A further 50% were lost to follow up. 38.8% had oesophageal replacement with colon following oesophagectomy. Conclusion: In conclusion, corrosive oesophageal stricture is a debilitating disease in children and affects males more, but it is treatable by multiple dilatations and oesophageal replacement with colon. Prevention should be actively pursued as well as early intervention.


Assuntos
Queimaduras Químicas/terapia , Gerenciamento Clínico , Estenose Esofágica/terapia , Esôfago/lesões , Previsões , Adolescente , Queimaduras Químicas/complicações , Queimaduras Químicas/epidemiologia , Cáusticos/efeitos adversos , Criança , Pré-Escolar , Dilatação/métodos , Estenose Esofágica/epidemiologia , Estenose Esofágica/etiologia , Esôfago/diagnóstico por imagem , Feminino , Seguimentos , Hospitais de Ensino , Humanos , Incidência , Lactente , Masculino , Nigéria/epidemiologia , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 99(44): e22741, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126311

RESUMO

Percutaneous balloon dilatation for benign biliary-enteric anastomosis stricture has been the most widely used alternative to endoscopic treatment. However, patency results from the precedent literature are inconsistent.The objective of this study was to evaluate the safety and feasibility of repeated balloon dilatation with long-term biliary drainage for the treatment of benign biliary-enteric anastomosis strictures.Data from patients with benign biliary-enteric anastomosis strictures who underwent percutaneous transhepatic cholangiography (PTC), repeated balloon dilatation with long-term biliary drainage (repeated-dilatation group; n = 23), or PTC and single balloon dilatation with long-term biliary drainage (single-dilatation group; n = 26) were reviewed. Postoperative complications, jaundice remission, and sustained anastomosis patency were compared between the groups.All procedures were successful. No severe intraoperative complications, such as biliary bleeding and perforation, were observed. The jaundice remission rate in the first week was similar in the 2 groups. During the 26-month follow-up period, 3 patients in the repeated-dilatation group had recurrences (mean time to recurrence: 22.84 ±â€Š0.67 months, range: 18-26 months). In the single-dilatation group, 15 patients had recurrences (mean time to recurrence = 15.28 ±â€Š1.63 months, range: 3-18 months). The duration of patency after dilatation was significantly better in the repeated-dilatation group (P = .01). All patients with recurrence underwent repeat PTC followed by balloon dilatation and biliary drainage.Repeated balloon dilatation and biliary drainage is an effective, minimally invasive, and safe procedure for treating benign biliary-enteric anastomosis strictures, and provides significantly higher patency rates than single dilatation.


Assuntos
Cateterismo/métodos , Dilatação/métodos , Drenagem/métodos , Complicações Pós-Operatórias/cirurgia , Estomas Cirúrgicos/efeitos adversos , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Ductos Biliares/patologia , Ductos Biliares/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estomas Cirúrgicos/patologia , Resultado do Tratamento
8.
Rev Col Bras Cir ; 47: e20202510, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32667580

RESUMO

INTRODUCTION: percutaneous dilatational tracheostomy is currently one of the main procedures performed in an intensive care unit (ICU). However, there are no well-defined indicators of technical difficulty in performing the procedure. OBJECTIVES: to define predictors of difficulty in performing bedside percutaneous dilatational tracheostomy. METHODOLOGY: prospective cohort study encompassing 21 patients who underwent bedside percutaneous dilatational tracheostomy in the ICU at a single center. RESULTS: Sternohyoid (SH) distance shorter than 7 cm is associated with a 50% increase in the risk of technical difficulty (OR 0.44 and p <0.03). CONCLUSION: the reduction in (SH) distance is related to an increased risk of difficulty in performing percutaneous dilatational tracheostomy in the ICU bed.


Assuntos
Insuficiência Respiratória/terapia , Traqueostomia/métodos , Dilatação/efeitos adversos , Dilatação/métodos , Humanos , Unidades de Terapia Intensiva , Projetos Piloto , Estudos Prospectivos , Insuficiência Respiratória/etiologia , Traqueostomia/efeitos adversos
9.
Saudi Med J ; 41(7): 720-725, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32601640

RESUMO

OBJECTIVES: To report the results of endoscopic dilatation of esophageal strictures in children, its complications, and their management. The outcomes of esophageal dilatation differ according to the underlying etiology. METHODS: The study included 46 patients who underwent esophageal dilatation between 2014-2019. All patients underwent a contrast study of the esophagus before endoscopic dilation to determine the location, number, and length of the narrowing. In addition, the type of dilators (balloon versus semi-rigid dilators), the number of dilatation sessions, the interval between them, and the duration of follow-up were also documented. The median age was 2.47 years, and 26 patients were females. Dysphagia was the main presenting symptom, and the leading cause of stricture was esophageal atresia. RESULTS: The main treatment modality was endoscopic balloon dilatation (n=29, 63%). The esophageal diameter was significantly increased after dilation (9 [7-11] versus 12 [10-12.8]) mm; p less than 0.001). Topical mitomycin-C was used as adjuvant therapy in 3 patients (6.5%). Esophageal perforation was reported in 2 cases (4.3%). Patients needed a median of 3 dilatation sessions, 25-75th percentiles: 1-5, and the median duration between the first and last dilatation was 2.18 years 25-75th percentiles: 0.5-4.21. CONCLUSION: Esophageal dilatation is effective for the management of children with esophageal stricture; however, repeated dilatation is frequent, especially in patients with corrosive strictures. Complications are not common, and open surgery is not frequently required.


Assuntos
Transtornos de Deglutição/etiologia , Dilatação/efeitos adversos , Dilatação/métodos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Perfuração Esofágica/etiologia , Estenose Esofágica/terapia , Pré-Escolar , Transtornos de Deglutição/epidemiologia , Dilatação/instrumentação , Atresia Esofágica/complicações , Perfuração Esofágica/epidemiologia , Estenose Esofágica/etiologia , Feminino , Humanos , Lactente , Masculino , Reoperação , Estudos Retrospectivos , Fatores de Tempo
11.
BMC Surg ; 20(1): 163, 2020 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-32698798

RESUMO

BACKGROUND: Delta-shaped anastomosis is a common method of intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy. One common postoperative complication of this procedure is anastomotic stenosis, and endoscopic balloon dilatation is a major remedy for such complications. Other treatment strategies are necessary to manage unsuccessful endoscopic balloon dilatation. CASE PRESENTATION: We present a case where systemic steroid treatment was applied in sustained anastomotic stenosis after endoscopic balloon dilatation. We performed delta-shaped anastomosis in laparoscopic distal gastrectomy to treat early-stage gastric cancer in a patient. The patient experienced abdominal pain post-surgery; subsequent investigation revealed edematous anastomotic stenosis. The stenosis sustained even after endoscopic balloon dilatation and local steroid injection. Consequently, we applied systemic steroid treatment. CONCLUSION: Systemic steroid treatment improved the stenosis and no recurrence was observed. These results suggest that systemic steroid application could be useful to treat anastomotic stenosis.


Assuntos
Constrição Patológica/etiologia , Gastrectomia/efeitos adversos , Gastroenterostomia/efeitos adversos , Glucocorticoides/administração & dosagem , Prednisolona/administração & dosagem , Neoplasias Gástricas , Administração Intravenosa , Idoso , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Constrição Patológica/tratamento farmacológico , Dilatação/métodos , Edema/tratamento farmacológico , Edema/etiologia , Gastrectomia/métodos , Gastroenterostomia/métodos , Humanos , Laparoscopia , Masculino , Recidiva Local de Neoplasia , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia
13.
J Urol ; 204(5): 1012-1018, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32396409

RESUMO

PURPOSE: We determined if the "bag squeeze" technique decreases pain during flexible cystoscopy in men. MATERIALS AND METHODS: This single center, prospective, double-blind, randomized controlled trial recruited 200 consenting participants who were ambulatory, outpatient males who had undergone prior cystoscopy and were not expected to require any secondary procedures. Men with prior urethral stricture or bladder neck contracture were excluded from study. Once eligibility was assessed and consent obtained, participants were randomized to undergo cystoscopy with the bag squeeze (group A) or the sham bag squeeze procedure (group B). Following cystoscopy, participants completed a pain questionnaire (visual analogue scale). Differences in mean pain score between groups were evaluated using Students' t-test with a 2-sided alpha of 0.05. RESULTS: A total of 200 patients were randomized and underwent flexible cystoscopy. Ten participants were ineligible because they required secondary procedures. Among the 190 eligible patients 97 were randomized to bag squeeze (group A) and 93 to sham bag squeeze (group B) with mean pain scores of 1.91 and 3.39, respectively (p <0.005). CONCLUSIONS: This study demonstrated a clinically meaningful decrease in pain for men undergoing flexible cystoscopy when the irrigation bag squeeze technique was used vs placebo bag squeeze. Accordingly, this useful, simple and free method to improve patient comfort during flexible cystoscopy should be adopted by clinicians.


Assuntos
Cistoscopia/efeitos adversos , Dilatação/métodos , Manejo da Dor/métodos , Dor Processual/prevenção & controle , Solução Salina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Dilatação/instrumentação , Método Duplo-Cego , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/instrumentação , Medição da Dor , Dor Processual/diagnóstico , Dor Processual/etiologia , Estudos Prospectivos , Resultado do Tratamento
14.
Aliment Pharmacol Ther ; 51(12): 1233-1246, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32406116

RESUMO

BACKGROUND: Medical therapy and/or endoscopic balloon dilation with intralesional therapies are options for the treatment of small bowel fibrostenotic Crohn's disease (CD). AIM: To perform a systematic review summarising evidence for efficacy of systemic and endoscopic intralesional medical therapy in established small bowel strictures in adult CD patients. METHODS: A systematic search of MEDLINE, EMBASE, CENTRAL and Scopus was conducted. Primary outcomes were rates of surgical resection and repeat endoscopic dilation. Pooled event rates from random effects models across studies with 95% confidence intervals were reported. RESULTS: Ten studies describing systemic medical therapy and eight studies of intralesional injection were included. One randomised controlled trial each for systemic therapy and intrastricture injection were identified. Only observational studies were found for systemic biologic therapies, which exclusively included tumour necrosis factor (TNF) antagonists, while intralesional therapies all involved corticosteroids except for one study that evaluated infliximab. Pooled event rates for surgical resection after systemic and intralesional therapy were 28.3% (95% CI: 18.2%-41.3%) and 18.5% (95% CI: 8.3%-36.2%), respectively over a median follow-up of 23 months (range 5.5-105.8), and 21.8 months (range 5-47). Risk of repeat endoscopic balloon dilation in those with intralesional therapy was 58.3% (95% CI: 36.6%-77.3%) over a median follow-up of 21.8 months (range 5-47). CONCLUSIONS: There are no favoured therapies for patients with stricturing small bowel CD. Data are lacking for ustekinumab and vedolizumab. No endoscopic intralesional medications provided a clear benefit for prevention of repeat EBD or surgery.


Assuntos
Doença de Crohn/tratamento farmacológico , Obstrução Intestinal/tratamento farmacológico , Corticosteroides/administração & dosagem , Terapia Combinada/estatística & dados numéricos , Constrição Patológica/complicações , Constrição Patológica/tratamento farmacológico , Constrição Patológica/epidemiologia , Constrição Patológica/cirurgia , Doença de Crohn/complicações , Doença de Crohn/epidemiologia , Doença de Crohn/cirurgia , Dilatação/métodos , Dilatação/estatística & dados numéricos , Endoscopia Gastrointestinal/métodos , Endoscopia Gastrointestinal/estatística & dados numéricos , Fibrose/complicações , Fibrose/tratamento farmacológico , Fibrose/epidemiologia , Fibrose/cirurgia , Humanos , Infusões Intralesionais , Obstrução Intestinal/complicações , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/cirurgia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/imunologia
15.
Phys Ther ; 100(8): 1357-1371, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32367126

RESUMO

OBJECTIVE: The aim of this systematic review was to identify, evaluate, and synthesize the evidence from studies that have investigated the effect of nonsurgical, nonpharmacological, pelvic floor muscle interventions on any type of pelvic floor dysfunction or health-related quality of life in patients after any type of treatment for gynecological cancer. METHODS: Six electronic databases (Cochrane Library 2018, CINAHL 1982-2018, MEDLINE 1950-2018, EMBASE 1980-2018, PsycINFO 1806-2018, and EMCARE 1995-2018) were systematically searched in June 2018. Reference lists of identified articles were hand searched. Randomized controlled trials (RCTs), cohort studies, and case series were included if they investigated the effects of conservative treatments, including pelvic floor muscle training or dilator training, on bladder, bowel, or sexual function in patients who had received treatment for gynecological cancer. Risk of bias was assessed using the Physiotherapy Evidence Database scale for RCTs and the Newcastle-Ottawa scale for cohort studies. RESULTS: Five RCTs and 2 retrospective cohort studies were included (n = 886). The results provided moderate-level evidence that pelvic floor muscle training with counseling and yoga or core exercises were beneficial for sexual function (standardized mean difference = -0.96, 95% CI = -1.22 to -0.70, I2 = 0%) and health-related quality of life (standardized mean difference = 0.63, 95% CI = 0.38 to 0.88, I2 = 0%) in survivors of cervical cancer and very low-level evidence that dilator therapy reduced vaginal complications in survivors of cervical and uterine cancer (odds ratio = 0.37, 95% CI = 0.17 to 0.80, I2 = 54%). There were insufficient data for meta-analysis of bladder or bowel function. CONCLUSION: Conservative pelvic floor muscle interventions may be beneficial for improving sexual function and health-related quality of life in survivors of gynecological cancer. Given the levels of evidence reported in this review, further high-quality studies are needed, especially to investigate effects on bladder and bowel function. IMPACT: This review provides moderate-level evidence for the role of pelvic floor rehabilitation to improve health outcomes in the gynecological cancer survivorship journey. Clinicians and health service providers should consider how to provide cancer survivors the opportunity to participate in supervised pelvic floor rehabilitation programs.


Assuntos
Tratamento Conservador/métodos , Neoplasias dos Genitais Femininos/terapia , Distúrbios do Assoalho Pélvico/terapia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Aconselhamento , Dilatação/instrumentação , Dilatação/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Força Muscular , Avaliação de Resultados em Cuidados de Saúde , Distúrbios do Assoalho Pélvico/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Comportamento Sexual , Bexiga Urinária/fisiologia , Ioga
16.
Pediatr. aten. prim ; 22(85): 63-66, ene.-mar. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193447

RESUMO

La estenosis esofágica congénita es una malformación rara que ocurre debido a la separación incompleta del esófago y del sistema respiratorio. Generalmente cursa con vómitos persistentes que suelen debutar o exacerbarse con la introducción de la alimentación complementaria y con ello de los alimentos sólidos. Dados los síntomas de presentación, la sospecha diagnóstica se puede realizar desde las consultas de Pediatría de Atención Primaria. El diagnóstico se realiza mediante una endoscopia digestiva alta que mostrará normalidad de la mucosa y un tránsito digestivo. Existe controversia en cuanto al tratamiento de elección, prefiriéndose el tratamiento conservador mediante dilataciones endoscópicas de inicio


Esophageal congenital stenosis is an unusual type of malformation that occurs due to incomplete division of the esophagus and respiratory system. Generally, it shows up with persistent vomiting that tends to debut or exacerbate with the introduction of complementary feeding and solid foods. A high degree of suspicion is necessary for diagnosis from Primary Care pediatricians. A high digestive endoscopy with normal mucosa and a digestive transit confirm the diagnosis. There is controversy regarding the treatment of choice, conservative treatment is preferred by initial endoscopic dilations


Assuntos
Humanos , Masculino , Lactente , Estenose Esofágica/diagnóstico por imagem , Ultrassonografia/métodos , Dilatação/métodos , Estenose Esofágica/congênito , Atenção Primária à Saúde/métodos , Vômito/etiologia
17.
Gen Thorac Cardiovasc Surg ; 68(6): 655-658, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32048145

RESUMO

We reported a new minimally invasive procedure to treat tracheal stenosis below tracheostomy tube using standard Ciaglia Blue Dolphin kit for percutaneous tracheostomy. Under endoscopic view, the Dolphin kit was inserted through the stoma into the stenosis; the balloon was inflated until a sufficient tracheal diameter was obtained; then, a longer tracheostomy tube was inserted through the stenosis and the distal tip placed near the carina. This procedure was succesfully applied in seven patients.


Assuntos
Dilatação/métodos , Estenose Traqueal/terapia , Adulto , Idoso , Dilatação/instrumentação , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traqueostomia
19.
Dig Dis Sci ; 65(4): 957-960, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32026277

RESUMO

We report a 39-year-old Native American female with an almost 20-year history of dysphagia that had increased in the 6 months prior to the initial evaluation. Investigation revealed a number of distinct esophageal disorders including Plummer-Vinson syndrome, gastroesophageal reflux disease with esophagitis, distal esophageal stricture, esophageal intramural pseudo-diverticulosis, and recurrent esophageal Candida infections. Although prolonged therapy with proton pump inhibitors, fluconazole, nystatin, and repeated esophageal balloon dilations relieved her symptoms, her prognosis remains uncertain.


Assuntos
Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Saúde Holística , Síndrome de Plummer-Vinson/complicações , Síndrome de Plummer-Vinson/terapia , Adulto , Anemia Ferropriva/complicações , Anemia Ferropriva/diagnóstico por imagem , Anemia Ferropriva/terapia , Transtornos de Deglutição/diagnóstico por imagem , Dilatação/métodos , Endoscopia do Sistema Digestório/métodos , Feminino , Humanos , Síndrome de Plummer-Vinson/diagnóstico por imagem , Inibidores da Bomba de Prótons/uso terapêutico , Resultado do Tratamento
20.
Am J Phys Med Rehabil ; 99(8): 719-724, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32032093

RESUMO

OBJECTIVE: Glenohumeral joint hydrodilatation with corticosteroids has been proposed as an effective secondary therapeutic procedure for primary adhesive capsulitis. However, little is known about which subgroup of patients would benefit from this procedure. This study aimed to identify covariates associated with improved prognosis in patients receiving ultrasound-guided hydrodilatation with corticosteroid injection. DESIGN: This was a cohort study. Data on baseline demographic characteristics, disease status, past medical conditions, and initial ultrasonographic findings were collected. Linear and logistic regression analyses were performed to determine the prognostic factors associated with better clinical outcomes. RESULTS: Fifty-three patients (54 shoulders) were included. Linear regression analysis showed that coracohumeral ligament thickness of less than 3 mm, use of analgesics before hydrodilatation, and female sex were associated with good improvement in the Shoulder Pain and Disability Index score. Multivariate logistic regression analysis showed that coracohumeral ligament thickness of less than 3 mm on ultrasound was associated with a strong tendency (P = 0.054) of reaching the minimal detectable change. In addition, capsule rupture did not play a role in determining the clinical efficacy of hydrodilatation. CONCLUSIONS: In patients with primary adhesive capsulitis, coracohumeral ligament thickness of less than 3 mm is correlated with greater short-term improvement in the Shoulder Pain and Disability Index score after ultrasound-guided hydrodilatation with steroid injection is performed.


Assuntos
Bursite/terapia , Dilatação/métodos , Glucocorticoides/administração & dosagem , Articulação do Ombro/diagnóstico por imagem , Triancinolona Acetonida/administração & dosagem , Analgésicos/uso terapêutico , Bursite/diagnóstico por imagem , Estudos de Coortes , Avaliação da Deficiência , Feminino , Humanos , Injeções Intra-Articulares , Ligamentos Articulares/diagnóstico por imagem , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Ultrassonografia de Intervenção , Escala Visual Analógica
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