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2.
Am J Emerg Med ; 38(1): 163.e1-163.e2, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31477354

RESUMO

Laminaria are cervical dilators inserted for several days preceding second-trimester abortions and other uterine procedures. Our patient was intubated after a life-threatening anaphylactic reaction to laminaria prior to her surgical abortion. Abortions with laminaria dilators are frequently performed outpatient across the United States. Due to stigma, increasing restrictions, and forced closure of family planning clinics, these procedures are often obtained covertly and remotely. Patients may present obtunded, in shock, without records or proxy, and with no external evidence of the allergen's location or continued presence. Emergency and critical care physicians may consider this etiology in obtunded women with anaphylaxis who are responding poorly to standard care.


Assuntos
Aborto Induzido/efeitos adversos , Anafilaxia/etiologia , Anafilaxia/terapia , Cuidados Críticos/métodos , Dilatação/efeitos adversos , Laminaria , Abortivos Esteroides/administração & dosagem , Adulto , Colo do Útero , Dilatação/métodos , Serviço Hospitalar de Emergência , Feminino , Humanos , Intubação Intratraqueal , Mifepristona/administração & dosagem , Gravidez , Segundo Trimestre da Gravidez
3.
Am J Emerg Med ; 38(1): 163.e3-163.e5, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31495520

RESUMO

Impacted esophageal foreign bodies typically first present to the emergency department, with coins being most common in children and food boluses most common in adults. Controversy exists regarding the best treatment options in these cases. We report two cases, one pediatric and one adult, where the use of a novel substitute Hurst dilator constructed of materials regularly found in all EDs was successfully used to treat impacted esophageal foreign bodies.


Assuntos
Dilatação/instrumentação , Dilatação/métodos , Serviço Hospitalar de Emergência , Esôfago/lesões , Corpos Estranhos/terapia , Pré-Escolar , Esôfago/diagnóstico por imagem , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade
4.
Gastroenterology ; 158(4): 840-851, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31836530

RESUMO

Treatment of eosinophilic esophagitis has progressed from elemental formula for children and esophageal dilation for adults to selective exclusion of food triggers and swallowed topical corticosteroids. Management guidelines are available from the American Gastroenterological Association and the Joint Task Force on Allergy Immunology Practice Parameters. We cannot, however, evaluate the efficacy of treatments without a definition of response. We propose a treat-to-target approach, based on symptoms and findings from endoscopy and histology. This approach addresses dissociations between outcomes, such as symptom persistence despite normalization of histologic features and symptom resolution after esophageal dilation despite histologic features of active disease. Eosinophilic esophagitis can now be treated with biologic agents that target specific immune pathways, and findings from prospective trials have indicated that less-restrictive, empiric, elimination diets can be effective and reduce the need for repeated endoscopic assessment of disease activity during food reintroduction. We also discuss eosinophilic esophagitis subtypes, factors associated with disease, and advances in management.


Assuntos
Alérgenos/efeitos adversos , Esofagite Eosinofílica/terapia , Gastroenterologia/métodos , Administração Oral , Adolescente , Adulto , Fatores Etários , Produtos Biológicos/administração & dosagem , Criança , Terapia Combinada/métodos , Deglutição , Exposição Dietética/efeitos adversos , Dilatação/métodos , Dilatação/normas , Exposição Ambiental/efeitos adversos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/etiologia , Esofagite Eosinofílica/patologia , Esofagoscopia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Comportamento Alimentar , Gastroenterologia/normas , Glucocorticoides/administração & dosagem , Humanos , Lactente , Guias de Prática Clínica como Assunto , Inibidores da Bomba de Prótons/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
Klin Padiatr ; 232(1): 13-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31618788

RESUMO

BACKGROUND: There is a lack of experience with fully covered self-expandable metal stents (SEMSs) for the treatment of esophageal leakage particularly in infants and neonates. METHODS: Eight patients (5M, 3F) with a median age of 17 months (range, 1-135 months) who underwent treatment with SEMSs for an anastomotic leakage or perforation of the esophagus were recruited to this retrospective study. Four children were born premature. In six patients the stents were placed primarily as an emergency procedure. RESULTS: Median duration of individual stent placement was 42 days (range, 13-72 days). Six out of eight patients (75%) were treated with one stent only. In three preterm infants who had their stents inserted within the first month relative weight gain was 17% compared with 2% in five patients who were treated later in life (p=0.0986). In four cases (50%) distal migration of the stent was observed. Seven out of eight patients (88%) had their leakage resolved after stent therapy. CONCLUSIONS: Insertion of fully covered SEMSs is an alternative tool for the treatment of esophageal leakage in children and preterm infants, and successful with only one single application in selected cases. It can be used either following previous therapy or as part of an emergency procedure. Because of the absence of manufactured, age-related devices SEMSs that are originally designed for other organs can be applied.


Assuntos
Fístula Anastomótica/cirurgia , Doenças do Esôfago/cirurgia , Perfuração Esofágica/cirurgia , Esôfago/lesões , Esôfago/fisiopatologia , Stents , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Criança , Pré-Escolar , Dilatação/métodos , Perfuração Esofágica/complicações , Perfuração Esofágica/diagnóstico , Esôfago/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Metais , Estudos Retrospectivos , Resultado do Tratamento
6.
Artigo em Inglês | MEDLINE | ID: mdl-31281014

RESUMO

Medical and surgical methods can both be recommended for second trimester abortion (after 12-weeks of gestational age). Induced abortion with a mifepristone and misoprostol regimen is the preferred approach; where mifepristone is not available, misoprostol alone for medical abortion is also effective. Dilation and evacuation (D&E) is the procedure of choice for surgical abortions, and adequate cervical preparation contributes significantly to safety. Availability of drugs and instruments, ability to provide pain control, provider skill and comfort, client preference, cultural considerations, and local legislation all influence the method of abortion likely to be performed in a given setting. Both surgical and modern medical methods are safe and effective when provided by a trained, experienced provider.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Induzido/métodos , Mifepristona/uso terapêutico , Misoprostol/uso terapêutico , Abortivos não Esteroides/administração & dosagem , Dilatação/métodos , Feminino , Humanos , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Dor Pós-Operatória , Gravidez , Segundo Trimestre da Gravidez
7.
Braz J Otorhinolaryngol ; 86(1): 56-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30377048

RESUMO

INTRODUCTION: Chronic rhinosinusitis is a broad clinical syndrome characterized by mucosal inflammation of the nose and paranasal sinuses. In order for the paranasal sinuses to maintain their physiological functions; the ostiomeatal complex drainage pathways must be open. Surgical procedures are an important treatment option in patients who do not respond adequately to medical treatment. Although the methods and instruments used in functional endoscopic sinus surgery have continued to improve in recent years, the scar tissue formed during operation disrupts the drainage of the sinuses and reduces postoperative success. The natural ostiodilatation method, which is performed by balloon sinoplasty method, has become more and more popular in recent years. OBJECTIVES: To compare the technique of balloon sinoplasty with the classical functional endoscopic sinus surgery method by considering the severity of chronic sinusitis on the same patient. METHODS: Total of 61 chronic sinusitis patients was included in the study. Paranasal sinus tomography of the patients was taken and according to the Lund-Mackay scoring, chronic sinusitis levels were determined. Cases were divided into two groups: Group 1 (severe chronic sinusitis group) and Group 2 (mild chronic sinusitis). RESULTS: There was no statistically significant difference in the results of comparison of sinuses which underwent balloon sinoplasty and classical functional endoscopic sinus surgery in Group 2 after Lund-Mackay scores. However in Group 1, the results of the comparison of postoperative Lund-Mackay scores of the balloon sinoplasty and the classical endoscopic operation were statistically significantly lower than those of the face half operated with the classical functional endoscopic sinus surgery. CONCLUSION: The success of balloon sinoplasty in patients with mild sinusitis is the same as in classic functional endoscopic sinus surgery. However, as the severity of sinusitis increases, the efficacy of balloon sinoplasty decreases.


Assuntos
Dilatação/métodos , Endoscopia/métodos , Procedimentos Cirúrgicos Nasais/métodos , Rinite/cirurgia , Sinusite/cirurgia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos , Período Pós-Operatório , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Simul Healthc ; 14(6): 415-419, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804426

RESUMO

INTRODUCTION: Bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT) is an invasive procedure regularly performed in the intensive care unit. Risk of serious complications have been estimated in up to 5%, focused during the learning phase. We have not found any published formal training protocols, and commercial simulators are costly and not widely available in some countries. The objective of this study was to present the design and simulator performance of a low-cost BG-PDT simulator. METHODS: A simulator was designed with materials available in a hardware store, synthetic skin pads, ex vivo bovine tracheas, and a pipe inspection camera. The simulator was tested in 8 experts and 9 novices. Sessions were video recorded, and participants were equipped with the Imperial College Surgical Device, a hand motion-tracking device. Performance was evaluated with a multimodal approach, including first attempt success rate, global success rate, total procedural time, Imperial College Surgical Device-derived proficiency parameters, and global rating scale applied blindly by 2 expert observers. A satisfaction survey was applied after the procedure. RESULTS: A simulator was successfully constructed, allowing multiple iterations per assembly, with a fixed cost of US $30 and $4 per use. Experts had greater global and first attempt success rate, performed the procedure faster, and with greater proficiency. It presented high user satisfaction and fidelity. CONCLUSIONS: A low-cost BG-PDT simulator was successfully constructed, with the ability to discriminate between experts and novices, and with high fidelity. Considering its ease of construction and cost, it can be replicated in almost any intensive care unit.


Assuntos
Broncoscopia/instrumentação , Dilatação/métodos , Desenho de Equipamento , Treinamento por Simulação/métodos , Traqueostomia/economia , Traqueostomia/educação , Competência Clínica , Controle de Custos , Humanos , Unidades de Terapia Intensiva , Estudantes de Medicina
9.
Pediatr Med Chir ; 41(2)2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31867939

RESUMO

The management of congenital primary obstructive megaureter (POM) is usually conservative, especially during the first year of life. Endoscopic high-pressure balloon dilatation (EHPBD) is indicated when symptoms, increasing dilatation and progressive renal damage are recorded, particularly in children younger than one year of age. We identified and described endoscopic prognostic factors predicting the success or failure of endoscopic dilatation. Thirty-eight patients (33 M;5 F) with POM from 2005-2018 were included. Diagnosis was based on US distal ureter dilatation (>7 mm), obstructive MAG-3 diuretic renogram and absence of vesicoureteral reflux (cystography). 24 patients were under 1 year of age. All patients underwent cystoscopy and high-pressure balloon dilatation with 3,5 Fr dilating balloon, after ascending pyelography. Median follow-up was of 6.5 years. We identified characteristics with poor prognosis: stenotic punctiform ureteral ostium and/or ostium located in a bladder diverticulum (9 pts) and stenotic tract longer than 1 cm (5 pts). The patients with a stenotic tract shorter than 1 cm (18 pts) were divided into two groups: <5 mm (5 pts) and between 5 and 10 mm (13 pts) showed a good response to dilatation. Endoscopic evaluation of ureteral ostium with pneumatic dilatation when possible is a useful diagnostic and therapeutic solution for POM treatment, especially under one year of age. EHPBD is effective in short stenotic tracts (<5 mm). It may also be repeated with good results in intermediate stenotic sections (5 mm-1 cm). According to our preliminary results, the procedure is more effective if performed earlier (3-7 months of life). Greater cohort and longer follow-up are needed to verify the stability of these results.


Assuntos
Cistoscopia/métodos , Dilatação/métodos , Endoscopia/métodos , Obstrução Ureteral/cirurgia , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Obstrução Ureteral/diagnóstico , Urografia
10.
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
11.
BMC Gastroenterol ; 19(1): 181, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711439

RESUMO

BACKGROUND: Pneumatic dilation (PD) is often billed as a "short term" treatment for achalasia but anecdotally can last years. This study sought to explore how long a single pneumatic dilation may induce symptom remission in a treatment-naïve achalasia patient. METHODS: A single center, retrospective chart review of patients with an ICD-9 or - 10 code of achalasia between 2005 and 2017 was performed. Treatment naïve patients with manometric diagnosis of primary achalasia were included. Outcomes (success or failure); single vs multiple PD; age; and estimated duration of effect were evaluated. Each patient underwent a single PD unless re-intervention was required for relapse. RESULTS: 83 patients (52% female, median 51.6 ± 3.6 years) were included. 43% underwent 2 PD and 13% underwent 3 PD. There was no significant relation between age, gender, and number of PDs. After 1 PD, 87.5% of patients reported > 1 year of symptom remission. 80.5% of relapsed patients reported success after a 2nd dilation. 1 PD was more likely to result in success than multiple PDs (p < 0.001). The measured median duration of remission after 1 PD was 4.23 years, and for 2 PDs, 3.71 years. The median estimated remission time after 1 PD was 8.5 years (CI 7.3-9.7, p = 0.03). CONCLUSIONS: PD is a safe, durable treatment for achalasia. A single PD is likely to last years. A second PD, if required, also has a high likelihood of success.


Assuntos
Acalasia Esofágica , Efeitos Adversos de Longa Duração , Dilatação/efeitos adversos , Dilatação/métodos , Dilatação/estatística & dados numéricos , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/epidemiologia , Acalasia Esofágica/terapia , Esfíncter Esofágico Inferior/fisiopatologia , Feminino , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/epidemiologia , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos/epidemiologia
12.
Eur J Obstet Gynecol Reprod Biol ; 243: 111-119, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689673

RESUMO

BACKGROUND: There is great controversy regarding the most effective route for cervical priming before diagnostic or operative hysteroscopy. OBJECTIVE: To evaluate the evidence from published randomized clinical trials (RCTs) about the efficacy and safety of oral vs vaginal misoprostol for cervical priming before hysteroscopy. SEARCH STRATEGY: Electronic databases including PubMed, Cochrane Library, Scopus and Web of Science were searched using the relevant keywords. SELECTION CRITERIA: All RCTs assessing the effect of oral vs vaginal misoprostol before hysteroscopy for cervical priming were considered. One hundred and ten studies were identified, of which eight studies were deemed eligible for this review. DATA COLLECTION AND ANALYSIS: The extracted outcomes were: cervical canal width, ease of dilatation, time for cervical dilatation and adverse effects (nausea, vomiting, diarrhoea, bleeding, fever, abdominal pain/uterine cramping and any complications during the procedure). All statistical analyses were completed using RevMan. MAIN RESULTS: Eight RCTs with 768 patients were included in this meta-analysis. Cervical canal width did not differ significantly between the two routes of misoprostol administration [mean difference -0.25 mm, 95% confidence interval (CI) -0.92-0.42; p = 0.47]. However, the vaginal route was significantly superior to the oral route for reducing the time for cervical dilatation (standardized mean difference 0.17, 95% CI 0.02-0.32; p = 0.03). No significant differences in adverse effects were found between the routes, except for diarrhoea which was significantly less prevalent with vaginal administration of misoprostol (risk ratio 2.48, 95% CI 1.17-5.26; p = 0.02). CONCLUSIONS: Oral and vaginal administration of misoprostol before hysteroscopy were similar in terms of cervical canal width, ease of dilatation and various adverse effects, except that the vaginal route was associated with faster cervical dilatation and lower prevalence of diarrhoea.


Assuntos
Colo do Útero , Histeroscopia/métodos , Misoprostol/administração & dosagem , Ocitócicos/uso terapêutico , Pré-Medicação/métodos , Dor Abdominal/induzido quimicamente , Administração Intravaginal , Administração Oral , Diarreia/induzido quimicamente , Dilatação/métodos , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Monaldi Arch Chest Dis ; 89(3)2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31663300

RESUMO

Tracheal stenosis represents a possible complication in intubated or tracheotomised patients. Tracheal resection is currently the gold standard for the treatment of complex stenosis while granulomas and simple stenosis (e.g., web-like) are often treated by endoscopic procedures, which do not consistently give satisfactory long-term results, due to frequent relapses. Administering continuous positive airway pressure (CPAP) after endoscopic procedures might represent a new add-on option for the treatment of this complication. In this case series are presented two patients with tracheal stenosis showed after the removal of tracheostomy tube, both treated with CPAP. The results were straightforward: CPAP treatment helped to keep stable the tracheal lumen, without adverse effects. No further endoscopic dilations were necessary thereafter, with a likely positive impact on patients' quality of life and on health expenditure.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Dilatação/métodos , Endoscopia , Estenose Traqueal/terapia , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Insuficiência Respiratória/terapia , Estenose Traqueal/etiologia , Traqueostomia/efeitos adversos , Resultado do Tratamento
15.
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
16.
Physiol Int ; 106(3): 207-212, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31564118

RESUMO

PURPOSE: Consumption of alternative flours, such as sprouted chickpea flour, has shown increased popularity in recent years. Foods rich in antioxidants have been shown to influence brachial artery flow-mediated dilation (FMD), a non-invasive test of a crucial layer of the artery called the endothelium. Partially replacing the semolina flour in pasta with sprouted chickpea flour (SCF) may acutely affect endothelial function post-digestion. We sought to determine if FMD was higher, lower, or the same post-digestion of pasta made with 60% semolina flour and 40% SCF (SCF40) vs. post-digestion of pasta made with 100% semolina flour (SEM100, i.e., control). METHODS: Trolox equivalent antioxidant capacity (TEAC) analysis was performed on the same flour samples. Healthy participants underwent a screening visit and two randomized controlled meal data collection visits (SCF40 and SEM100). At each data collection visit, participants consumed 255 g of pasta with butter. FMD was assessed 2-3 h after pasta consumption. RESULTS: TEAC results showed that SCF40 (2.031 ± 0.096 mmol trolox/100 g sample) had significantly greater antioxidant capacity than SEM100 (1.736 ± 0.046 mmol trolox/100 g sample; p = 0.02). Twenty-two healthy participants (5 men and 17 women; 26 ± 2 years, 66.6 ± 2.3 kg, BMI = 24 ± 1 kg/m2, SBP = 114 ± 3 mmHg, DBP = 75 ± 2 mmHg, HR = 74 ± 3 BPM) were studied. FMD in the SCF40 condition (10.3% ± 1.2%) was greater than the SEM100 condition (7.9% ± 0.8%, p = 0.02). CONCLUSION: These data suggest that partial substitution with sprouted chickpea flour in place of semolina flour in pasta acutely improves post-digestion FMD, which may be beneficial for cardiovascular health (ClinicalTrials.gov Identifier: NCT03801486).


Assuntos
Artéria Braquial/efeitos dos fármacos , Cicer/química , Preparações de Plantas/farmacologia , Adulto , Antioxidantes/farmacologia , Fibras na Dieta , Dilatação/métodos , Feminino , Farinha , Humanos , Masculino , Amido/química
17.
Am Heart J ; 216: 82-90, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31415994

RESUMO

Coronary stenting without angioplasty pretreatment (direct stenting) may simplify procedures in appropriate lesions. Direct stenting is facilitated by smaller profile coronary stent platforms. The present study was designed for regulatory approval of a novel drug-eluting coronary stent and incorporates both randomized comparison for non-inferiority to an approved predicate device as well as a nested evaluation of subjects eligible for direct stenting. STUDY DESIGN AND OBJECTIVES: Prospective, single-blind, randomized, active-control, multi-center study designed to assess the safety and efficacy of the novel Svelte sirolimus-eluting stent (SES) systems. A total of 1630 subjects with up to 3 target lesions will be randomized 1:1 to the Svelte SES versus either the Xience or Promus everolimus-eluting stents (control). Randomization will be stratified by whether or not a direct stenting strategy is planned by the investigator. The primary endpoint is target lesion failure (TLF) at 12 months post index procedure, defined as cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization, and the primary analysis is a non-inferiority test with a non-inferiority margin of 3.58%. Secondary clinical endpoints include individual components of TLF, stent thrombosis and measures of procedural resource utilization including contrast administration, fluoroscopy exposure and procedural resource utilization as well as costs. CONCLUSION: The OPTMIZE Trial will evaluate the safety, efficacy and clinical value of the novel Svelte SES in subjects with up to 3 lesions, and will provide a comparison of direct stenting between randomized devices.


Assuntos
Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Everolimo/administração & dosagem , Imunossupressores/administração & dosagem , Intervenção Coronária Percutânea/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sirolimo/administração & dosagem , Doença da Artéria Coronariana/patologia , Dilatação/métodos , Stents Farmacológicos/efeitos adversos , Estudos de Equivalência como Asunto , Humanos , Estudos Multicêntricos como Assunto , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Prospectivos , Desenho de Prótese , Método Simples-Cego , Resultado do Tratamento
18.
Turk J Gastroenterol ; 30(8): 673-679, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31418410

RESUMO

BACKGROUND/AIMS: The anastomotic strictures are one of the most common colorectal surgery complications, and various endoscopic techniques have been defined. Balloon dilation is the most well-known and the simplest procedure. In this article, we aimed to present our series of endoscopic interventions and electroincision management for anastomotic strictures. MATERIALS AND METHODS: The files of 59 patients, who underwent colorectal surgery between January 2010 and September 2017 in our hospital and were diagnosed during the follow-up with anastomotic stricture, were analyzed. The outcomes of endoscopic interventions such as balloon dilation and electroincision were compared and reported. RESULTS: The mean age of the 59 patients included in the study was 59.5±16.26 years. The primary operative indications were colorectal cancer in 46, inflammatory bowel disease in 7, diverticulum in 5, and penetrating trauma in one patient. Single- or multiple-balloon dilations were successful in 48 patients. Electroincision was performed in 11 patients because of the balloon dilation failure. None of the patients needed a secondary surgery. During the mean 33.75 months of the follow-up, the stricture recurred in seven patients who had undergone balloon dilation. Repeated balloon dilation was successful in these patients without any need for an additional surgical intervention. CONCLUSION: Balloon dilation can be performed safely as the primary treatment option, because of its easy access and noninvasive application. Electroincision is also a safe and effective endoscopic technique that can be preferred especially when the balloon dilation fails.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Eletrocirurgia/métodos , Endoscopia Gastrointestinal/métodos , Enteropatias/cirurgia , Complicações Pós-Operatórias/cirurgia , Ferida Cirúrgica , Adulto , Idoso , Constrição Patológica , Dilatação/efeitos adversos , Dilatação/instrumentação , Dilatação/métodos , Feminino , Humanos , Enteropatias/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
19.
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
20.
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
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