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1.
Mater Sci Eng C Mater Biol Appl ; 127: 112239, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34225879

RESUMO

Biodegradable magnesium (Mg)-based vascular stents can overcome the limitations of conventional permanent metallic stents, such as late in-stent restenosis and thrombosis, but still have difficulty retarding degradation while providing adequate mechanical support to the blood vessel. We incorporated silica nanoparticles surface-functionalized with hexadecyltrimethoxysilane (mSiNP) into a poly (l-lactic acid) (PLLA) coating as a physical barrier to disturb the penetration of the corrosive medium as well as a bioactive source that releases silicon ions capable of stimulating endothelial cells. The corrosion resistance and biocompatibility of this bifunctional PLLA/mSiNP nanocomposite coating were investigated using different weight ratios of mSiNP. The nanocomposite coating containing more than 10 wt% of the mSiNP (PLLA/10mSiNP and PLLA/20mSiNP) significantly delayed the corrosion of the Mg substrate and exhibited favorable endothelial cell responses, compared to the pure PLLA coating. Specifically, the calculated corrosion rates of PLLA/10mSiNP and PLLA/20mSiNP decreased by half, indicating the durability of the coating after immersion in simulated body fluid for 12 days. Based on the in vitro cellular response, the incorporation of the mSiNPs into the PLLA coating significantly improved the endothelial cell responses to the Mg substrate, showing better initial cell surface coverage, migration, and proliferation rate than those of pure PLLA. These results indicate that the PLLA/mSiNP nanocomposite coatings have significant potential to improve the corrosion resistance and vascular compatibility of biodegradable Mg-based vascular stents.


Assuntos
Magnésio , Nanocompostos , Materiais Revestidos Biocompatíveis/farmacologia , Corrosão , Células Endoteliais , Ácido Láctico , Teste de Materiais , Poliésteres , Dióxido de Silício , Stents
2.
Medicina (Kaunas) ; 57(6)2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34198541

RESUMO

The aim of this paper is to share our experience in managing a patient with Klebsiella pneumoniae mycotic abdominal aortic aneurysm who was also infected with COVID-19. A 69-year-old male was transferred to our hospital for the management of an infra-renal mycotic abdominal aortic aneurysm. During his hospital course, the patient contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was intubated due to respiratory distress. Over a short period, his mycotic aneurysm increased in size from 2.5 cm to 3.9 cm. An emergency repair of his expanding aneurysm was achieved using our previously described protocol of coating endovascular stents with rifampin. The patient was managed with a rifampin-coated endovascular stent graft without any major complications. Postoperatively, the patient did not demonstrate any neurological deficits nor any vascular compromise. He remained afebrile during his postoperative course and was extubated sometime thereafter. He was then transferred to the ward for additional monitoring prior to his discharge to a rehab hospital while being on long-term antibiotics. During his hospital stay, he was monitored with serial ultrasounds to ensure the absence of abscess formation, aortic aneurysm growth or graft endoleak. At 6 weeks after stent graft placement, he underwent a CT scan, which showed a patent stent graft, with a residual sac size of 2.5 cm without any evidence of abscess or endoleak. Over a follow-up period of 180 days, the patient remained asymptomatic while remaining on long-term antibiotics. Thus, in patients whose surgical risk is prohibitive, endovascular stent grafts can be used as a bridge to definitive surgical management.


Assuntos
Aneurisma Infectado , Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , COVID-19 , Procedimentos Endovasculares , Idoso , Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Humanos , Masculino , SARS-CoV-2 , Stents , Resultado do Tratamento
3.
J Am Vet Med Assoc ; 259(2): 190-196, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34227860

RESUMO

CASE DESCRIPTION: A 3-year-old 17.5-kg (38.5-lb) mixed-breed dog was referred for evaluation because of nasal discharge, sneezing, and signs of nasal congestion of approximately 9 months' duration. A diagnosis of nasopharyngeal stenosis (NPS) was made prior to referral. CLINICAL FINDINGS: Sneezing, bilateral mucopurulent nasal discharge, reduced nasal airflow, stertor, and increased inspiratory effort were noted on physical examination. Results of serum biochemical analysis were within respective reference ranges. Review of CT images of the skull revealed findings consistent with severe bilateral partial osseous choanal atresia and NPS. Retrograde rhinoscopy confirmed membranous NPS. TREATMENT AND OUTCOME: A ventral rhinotomy was performed; communication between the pharynx and nasal passageway was reestablished by surgical debridement of the caudal border of the palatine bone and vomerine crest and groove, followed by dissection of the membranous NPS and reconstruction of the caudal part of the nasopharynx. A covered nasopharyngeal stent was placed in the newly established nasopharynx. The dog recovered uneventfully but was presented 3 weeks later with recurrent signs; diagnostic findings were consistent with stenosis rostral to the stent. The stenosis was treated with balloon dilation, and a second covered stent was placed rostral to and overlapping the first stent, spanning the stenotic region. Eleven months after this procedure, the dog was doing well. CLINICAL RELEVANCE: Results for this patient suggested that ventral rhinotomy and covered nasopharyngeal stent placement can be used successfully for the management of osseous choanal atresia in dogs; however, careful attention to preoperative planning and potential complications is necessary.


Assuntos
Atresia das Cóanas , Doenças do Cão , Doenças Nasofaríngeas , Animais , Atresia das Cóanas/cirurgia , Atresia das Cóanas/veterinária , Constrição Patológica/cirurgia , Constrição Patológica/veterinária , Doenças do Cão/cirurgia , Cães , Endoscopia/veterinária , Doenças Nasofaríngeas/cirurgia , Doenças Nasofaríngeas/veterinária , Stents
4.
BMJ Case Rep ; 14(7)2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285021

RESUMO

Persistent hiccups has not been reported previously with suprahepatic inferior vena cava (IVC) stenting. Persistent hiccups after palliative oesophageal stenting has been reported. We present a case of a 41-year-old male patient diagnosed with primary Budd-Chiari syndrome who underwent IVC stenting for suprahepatic IVC stenosis. Patient developed transient hiccups post procedure which settled immediately with medications. Patient developed a recurrence of symptoms after a year due to stent migration which led to redo stenting. Post-procedure, the patient developed persistent hiccups which could not be controlled by physiological methods or chlorpromazine and needed baclofen at a dose of 10 mg three times a day. The patient has been symptom-free for the past 2 years. Persistent hiccups may present as a rare complication of suprahepatic IVC stenting due to extrinsic phrenic nerve compression or by direct irritation of the diaphragm. Baclofen has been effective in terminating persistent hiccups in our case.


Assuntos
Síndrome de Budd-Chiari , Soluço , Adulto , Constrição Patológica , Soluço/etiologia , Humanos , Masculino , Stents/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem
5.
Ther Umsch ; 78(6): 277-289, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34291662

RESUMO

Atherosclerosis of the intracranial arteries and of the extracranial carotid artery. Abstract. Intracranial atherosclerotic stenoses are the most common cause of ischemic stroke worldwide. Nowadays, three therapeutic approaches are available for consideration for patients with intracranial atherosclerotic stenoses: A conservative therapy (best medical treatment, management of vascular risk factors and healthy lifestyle), endovascular and surgical therapy. Conservative approach has been recommended for patients with asymptomatic intracranial atherosclerotic stenoses, as well as for those with symptomatic stenoses. Endovascular therapy should be considered as a treatment option for carefully selected patients with recurrent ischemic strokes attributed to the stenotic artery while receiving best medical therapy. Surgical revascularisation is rarely favored in patients with intracranial stenoses. In patients with extracranial atherosclerotic stenoses, carotid endarterectomy (CEA) has been associated with a lower risk of death and recurrent stroke when compared to carotid angioplasty and stenting (CAS). Especially in elderly patients over 70 years of age CEA is preferred over CAS due to the twofold increased 30-day risk of recurrent stroke or death in patients treated with CAS. Results from contemporary studies using modern techniques and devices are expected. It remains unclear whether patients with asymptomatic extracranial atherosclerotic stenoses receiving best medical treatment would benefit of invasive procedures such as CEA or CAS.


Assuntos
Aterosclerose , Estenose das Carótidas , Endarterectomia das Carótidas , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Angioplastia , Aterosclerose/terapia , Artérias Carótidas , Estenose das Carótidas/terapia , Humanos , Fatores de Risco , Stents , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
6.
Khirurgiia (Mosk) ; (7): 77-83, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34270198

RESUMO

Lung transplantations have been regularly performed in the Russian Federation since 2010. Therefore, the number of lung transplant recipients, as well as the number of patients with airway complications following lung transplantation has been increasing. Treatment of these patients takes place not only in transplantation centers, but also in other hospitals. This review is devoted to risk factors, clinical manifestations, treatment and prevention of airway complications after lung transplantation. We analyzed literature data over the last 15 years. It was confirmed that bronchoscopy is a «gold standard¼ for diagnosis of airway complications while bronchoscopic interventions are preferred for treatment. Balloon and rigid bronchodilation and endoscopic airway stenting are the most effective interventions. Silicone stents are the most optimal. Antimicrobial prophylaxis and timely use of antiproliferative immunosuppressive drugs are important factors in prevention and treatment of airway complications after lung transplantation.


Assuntos
Transplante de Pulmão , Broncoscopia , Constrição Patológica , Humanos , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Federação Russa , Stents
7.
BMJ Case Rep ; 14(7)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253527

RESUMO

A 16-year-old man with horseshoe kidney presented with a right-sided forgotten double J stent (DJS), 1 year after bilateral percutaneous nephrolithotomy. X-ray of the kidney, ureter and bladder showed bilateral residual stones with no encrustations or stone formation on the DJS. Initial attempt of DJS removal using 22 French (Fr) cystoscope and 6/7.5 Fr semirigid ureteroscope failed due to resistance while pulling the DJS and inability to uncoil the upper end of DJS. Finally, percutaneous antegrade scopy was done suggestive of submucosal impaction of the forgotten DJS in upper ureter. The overlying mucosal bridge was cut using holmium: Yttrium Aluminum Garnet (YAG) laser and the DJS was retrieved. The index case highlights an unusual cause of entrapment of the DJS and whenever resistance is encountered, the use of force should be avoided and the cause of resistance should be troubleshooted, thereby preventing serious injuries like ureteral avulsion.


Assuntos
Lasers de Estado Sólido , Nefrolitotomia Percutânea , Ureter , Adolescente , Hólmio , Humanos , Masculino , Stents/efeitos adversos , Ureter/diagnóstico por imagem , Ureter/cirurgia
8.
Zhonghua Nei Ke Za Zhi ; 60(8): 728-733, 2021 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-34304448

RESUMO

Objective: To evaluate the efficacy of endovascular stenting of various types of venous sinus stenosis in idiopathic intracranial hypertension (IIH). Method: Clinical, radiological, and manometric data before and after stenting in venous sinus stenosis were retrospectively analyzed in 99 IIH patients who were refractory to medical therapy or rapidly progressed between July 2004 to July 2019. The follow-up period was between 2.3 months to 11 years. Results: Our study enrolled 21 men (21.2%)and 78 women (78.8%) with average body mass index (BMI) 19.2-40.6(27.0±4.4) kg/m2 and median age 37 years. Before stent placement, the mean transverse sinus stenosis gradient was 1-59(26±8) mmHg. Patients with extrinsic stenosis were younger than those with intrinsic and mixed stenosis. In all cases, stenting was effective for papilledema. Fifty patients complained of headaches. Pulsatile tinnitus in twenty-eight patients completely alleviated after stenting. In one patient, replacement of stent did not improve symptoms, and a subsequent CSF diversion procedure was performed and effective. Conclusion: Irrespective of the type of stenosis, stenting of venous sinus stenosis is an effective treatment for IIH. Patients with persistent papilledema post-stenting and elevated transverse pressure pre-stenting should be followed closely as high risk of stenting failure may occur and further diversion procedure is needed.


Assuntos
Pseudotumor Cerebral , Seios Transversos , Adulto , Constrição Patológica/cirurgia , Feminino , Humanos , Masculino , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/cirurgia , Estudos Retrospectivos , Stents , Seios Transversos/cirurgia
9.
Artigo em Chinês | MEDLINE | ID: mdl-34304494

RESUMO

Objective:To evaluate the clinical effect of endoscopic repair for the treatment of children with bilateral congenital choanal atresia. Methods:A retrospective analysis was conducted in our department that six children who were diagnosed as bilateral congenital choanal atresia by nasopharyngeal endoscopy and nasal CT scanning. All cases underwent endoscopic repair and placed the silicone stent to support the enlarged nostrils for six months, and these patients were followed up to observe re-atresia rate after taking out of the supporting tube. Results:Six cases' nasal ventilation were effectively improved after operation without serious complications, 5 cases showed a satisfactory curative effect after taking out of the supporting tube, only 1 case with bony atresia found choanal re-atresia during follow-up. Conclusion:The clinical effect of using endoscopic repair for children with bilateral congenital choanal atresia showed remarkable efficacy with a low re-atresia.


Assuntos
Atresia das Cóanas , Criança , Atresia das Cóanas/cirurgia , Endoscopia , Humanos , Nariz , Estudos Retrospectivos , Stents , Resultado do Tratamento
10.
J Clin Neurosci ; 90: 199-205, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275549

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of the low-profile Acandis Acclino microstent for embolization of recurrent and residual intracranial aneurysms. METHODS: Consecutive patients treated with the Acclino for aneurysm remnants at three German neurovascular centers were enrolled. The technical success, complications, angiographic and clinical outcome were investigated. RESULTS: Nineteen patients (median age: 53 years) with 19 aneurysm remnants (median size: 5 mm, anterior circulation: 14) were included. Initial aneurysm treatment consisted of stand-alone coiling in 14 cases, stent-assisted coiling in 4 and clipping in 1. Acclino stent-assisted coil embolization was performed technically successfully in all patients. Morbidity occurred in one patient (5.3%) due to aneurysm perforation. At the angiographic follow-up with a median follow-up duration of 21 months (range: 5-37 months), complete occlusion was obtained in 76.9%. The retreatment rate was 7.7%. CONCLUSIONS: Retreatment of aneurysm remnants with the Acclino microstent was associated with high aneurysm occlusion rates and acceptable morbidity. Further studies will be necessary to draw a definite conclusion.


Assuntos
Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Stents , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
11.
J Clin Neurosci ; 90: 8-13, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275585

RESUMO

OBJECTIVE: To report the stent-assisted coil embolization and flow diversion treatments of blood-blister-like aneurysms based on the theory of acute dissection of the internal carotid artery. PATIENTS AND METHODS: From July 2016 through July 2020, 27 patients presenting with subarachnoid hemorrhage (SAH) due to rupture of internal carotid artery blood blister-like aneurysms were subjected to endovascular treatment with stent-assisted coiling or Pipeline flow diversion. Clinical outcomes were evaluated using modified Rankin Scale score (mRS). RESULTS: A proximal stenosis caused by angiopathology adjacent to aneurysms were found on internal carotid artery angiograms in all 27 cases. The angiopathology combining with the aneurysms implement that acute dissection of the supraclinoid segment of the internal carotid artery indicated the pathogenesis of blood blister-like aneurysm formation. All aneurysms were treated successfully with alleviation of the adjacent angiopathology after stenting on angiograms. During 1-12 months, mean 3.5 months, complete aneurysm obliteration without adjacent stenosis were found in 25(92.6%) patients. Two (7.4%) cases of recanalization were retreated with complete obliteration at 1 week and 3 months after initial treatment. Clinical mRS 0 and 1 outcomes were observed in 23(85.2%) patients, mRS 2 in 3(11.1%) patients and mRS 6 in 1(3.7%) not related to aneurysm treatment during follow-up. CONCLUSIONS: Acute focal dissection of supraclinoid segment of internal carotid artery underlies the development of blood blister-like aneurysm. Stent-assisted coiling and flow diversion treatments constitute appropriate treatment based on the arterial dissection pathology.


Assuntos
Aneurisma Dissecante/terapia , Doenças das Artérias Carótidas/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Adulto , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/patologia , Prótese Vascular , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/patologia , Artéria Carótida Interna/patologia , Procedimentos Endovasculares/instrumentação , Humanos , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Retratamento , Estudos Retrospectivos , Stents , Hemorragia Subaracnóidea/etiologia , Resultado do Tratamento
12.
BMC Surg ; 21(1): 314, 2021 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-34273941

RESUMO

BACKGROUND: Chronic strictures following Roux-en-Y Gastric Bypass (RYGB) are a troublesome complication that can lead to significant morbidity. The use of stents has been described but the need for X-ray and risk of migration have meant limited use in the management of these strictures. Lumen apposing metal stents (LAMS) have traditionally been used for management of pancreatic pseudocysts. They don't require X-ray and are easy to deploy with a short learning curve. This paper explores the use of LAMS to treat post RYGB strictures and explores their safety and efficacy. METHODS: A prospective study over a 4-year period looking at 14 patients with post RYGB strictures. These patients were privately insured patients operated within a tertiary Private facility. The patients were followed up for between 1 and 3 years. We have prospectively collected data on the efficacy and safety of LAMS in these patients. Patients were followed up until stent removal or definitive surgery to correct a stricture. RESULTS: 421 patients underwent RYGB in the study period. 14 (3.3%) of these patients developed a stricture that resulted in insertion of LAMS. There was no immediate complications and 12 patients had complete resolution of their stricture. There were no reoperations due to migration related issues although a migration rate of 19% was noted. 2 patients required surgery to correct refractory strictures not relieved by a LAMS stent, both of these were strictures associated with marginal ulceration of the gastro jejunostomy. CONCLUSION: LAMS are a safe and effective method to manage post RYGB strictures. They have a high rate of resolution of strictures and can be safely deployed across strictures with no immediate complication. Migration does still appear to be a problem, however, does not appear to affect patient outcome or increase morbidity. Insertion is straightforward and doesn't appear to be associated with a long learning curve.


Assuntos
Derivação Gástrica , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Derivação Gástrica/efeitos adversos , Humanos , Jejunostomia , Obesidade , Estudos Prospectivos , Stents
13.
Medicine (Baltimore) ; 100(27): e26612, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232217

RESUMO

RATIONALE: Endovascular treatment (EVT) is considered a preferred procedure of superficial femoral artery (SFA) pseudoaneurysm in recent years. However, heterotopic ossification (HO) after SFA pseudoaneurysm is a rare occurrence, that may cause late stent-graft fracture. PATIENT CONCERNS: A 58-year-old male who underwent EVT for SFA pseudoaneurysm 8 years ago presented with a progressive mass at the right thigh and claudication. Computed tomography angiography (CTA) showed fracture and occlusion of stent-graft, which was compressed by the deep femoral artery (DFA) pseudoaneurysm and a bone-like body. DIAGNOSIS: According to the CTA images, the stent-graft was fractured and occluded, accompanied by DFA pseudoaneurysm. INTERVENTIONS AND OUTCOMES: Debridement and arterial reconstruction were performed. Pathological analysis showed that the bone-like body was derived from HO. CTA at one-year follow-up showed that the prosthetic vessel was patent and previous hematoma disappeared. CONCLUSIONS: This report demonstrates that residual hematoma can induce HO, which may result in late stent fracture, and it should thus be removed timely. Patients with SFA pseudoaneurysm who have undergone EVT should be followed up regularly.


Assuntos
Falso Aneurisma/cirurgia , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Artéria Femoral , Hematoma/etiologia , Ossificação Heterotópica/complicações , Stents/efeitos adversos , Falso Aneurisma/diagnóstico , Angiografia por Tomografia Computadorizada , Hematoma/diagnóstico , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico
14.
Medicine (Baltimore) ; 100(28): e26598, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34260542

RESUMO

BACKGROUND: Previous studies have shown conflicting results on the benefits of deferred stenting (DS) in infarct size and the incidence of microvascular obstruction in patients with ST elevation myocardial infarction (STEMI). However, effect of DS on left ventricular (LV) function was not known. We aimed to evaluate whether DS improve LV function and relevant clinical outcomes after STEMI, using follow-up data from the INNOVATION study (NCT02324348). METHODS: In total, 114 patients were randomly assigned to DS group or immediate stenting (IS) group at a 1:1 ratio. LV functional remodeling indices and MACE (major adverse cardiac events: a composite of death, non-fatal MI, unplanned target vessel revascularization, or hospitalization due to heart failure) were compared between DS and IS groups. RESULTS: Serial echocardiographic analyses were completed in 89 subjects (78%). There were no significant changes in LV volume in either group. While LV ejection fraction and wall motion score index (WMSI) improved in both groups during follow-up, the increments were not statistically different between the 2 groups (4.3 ±â€Š8.2 vs 3.2 ±â€Š7.1, P = .504 for ΔLV ejection fraction; -0.16 ±â€Š0.25 vs -0.16 ±â€Š0.25, P = .99 for ΔWMSI). However, E/e'' was decreased and e' was increased only in the DS group (-3.31 ±â€Š5.60 vs -0.46 ±â€Š3.10, P = .005 for ΔE/e'; 0.77 ±â€Š1.71 vs -0.22 ±â€Š1.64, P = .009 for Δe'). The incidence of major adverse cardiac events was numerically lower in the DS group than in the IS group without a statistical significance at 1-year follow-up. CONCLUSIONS: Routine DS improved LV diastolic function but not systolic function compared with IS in patients with STEMI.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Stents/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Função Ventricular Esquerda/fisiologia , Idoso , Ecocardiografia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Volume Sistólico , Fatores de Tempo , Remodelação Ventricular/fisiologia
15.
BMC Womens Health ; 21(1): 270, 2021 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-34246259

RESUMO

BACKGROUND: Malignant obstruction and associated hydronephrosis is a common complication of advanced cervical cancer. Percutaneous nephrostomy (PCN) followed by antegrade stenting is often required to relieve obstruction as retrograde access fails in considerable proportion of such patients. Reno-pleural fistula is a rare complication of PCN which creates a patent connection between the renal collecting system and the thoracic cavity, and urine accumulation in the pleural space can cause pleural effusion (i.e., urinothorax). Upward or downward migration is a complication of indwelling ureteric stents. Further migration with extrusion outside of the urinary tract is uncommon. Herein we present an unprecedented case in adult of ureteric stent upward migration through a reno-pleural fistula into the thoracic cavity managed by thoracoscopy. CASE PRESENTATION: A 66-year-old female was diagnosed of advanced stage cervical cancer with suspicious bladder invasion. Given her bilateral hydronephrosis with impaired renal function, she underwent bilateral PCN and subsequent antegrade ureteric stenting. However, she presented with dyspnea, right back pain, and oliguria four days after bilateral PCN catheter removal. Computed tomography reported massive right pleural effusion and an intrathoracic ureteric stent within reno-pleural fistula. Thoracoscopy with thoracostomy was performed to remove the ureteric stent and urine in right pleural space. A week later, urinothorax had resolved and right PCN was performed again. She was discharged after regaining normal renal function with right PCN and a left ureteric stent in place. CONCLUSIONS: A reno-pleural fistula can serve as a route for ureteric stent migration and that continuous drainage of urine can cause urinothorax once the stent reaches the thoracic cavity. Anytime a supracostal approach is used for PCN, even when using small caliber catheters, clinicians should pay special attention given the risk of pleural injury and subsequent complications.


Assuntos
Fístula , Nefrostomia Percutânea , Adulto , Idoso , Drenagem , Feminino , Fístula/etiologia , Fístula/cirurgia , Humanos , Rim/fisiologia , Stents/efeitos adversos
16.
Rev Med Inst Mex Seguro Soc ; 59(2): 163-169, 2021 Jun 14.
Artigo em Espanhol | MEDLINE | ID: mdl-34232410

RESUMO

Background: The May-Thurner syndrome consists of an anatomical anomaly of the iliac veins that predisposes the person presenting it to the appearance of venous insufficiency and recurrent thrombotic episodes of the lower limbs. The aim of this article was to present a case of this pathology, highlighting a rare symptom that led to its diagnosis. Case report: 46-year-old woman with severe abdominal pain in the right iliac fossa not associated with other gastrointestinal symptoms or fever. Contrast tomography of the abdomen and pelvis reported bilateral common iliac vein thrombosis. After ruling out acute surgical abdomen or immunological pathologies, an abdominal-pelvic angiography was performed, which led to the diagnosis of May-Thurner syndrome. It was performed endovascularly, pharmaco-mechanical thrombolysis, balloon plasty, and stent installation. Conclusions: This type of abdominal vascular compression syndromes are rare and require a high index of suspicion to be diagnosed, which is why publications of this type of pathology take on relevance since they teach readers about the pathology.


Assuntos
Síndrome de May-Thurner , Trombose Venosa , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Síndrome de May-Thurner/diagnóstico , Síndrome de May-Thurner/diagnóstico por imagem , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
17.
World J Surg Oncol ; 19(1): 194, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215276

RESUMO

BACKGROUND: Placement of a self-expanding metal stent (SEMS) in patients presenting with an acute colorectal obstruction (ACO) may obviate emergency surgery (ES), potentially effectively palliating incurable tumors, acting as a bridge to surgery (BTS) in patients with operable or potentially operable tumors and achieving effective decompression of other ACO. We present our experience with SEMS insertion by colorectal surgeons without fluoroscopic monitoring for ACO especially for acute malignant colorectal obstruction (AMCO) for nearly a 14-year period (2007-2020). AIM: To explore the safety and effectiveness of SEMS insertion in the management of ACO by colorectal surgeons using a two-person approach colonoscopy without fluoroscopic monitoring. METHODS: We reviewed the medical records of patients retrospectively to identify all patients presenting to our unit with ACO especially with AMCO who had stenting carried out to achieve colonic decompression. All 434 procedures were performed by colorectal surgeons using a two-person approach colonoscopy without fluoroscopic monitoring. RESULTS: The overall technique success rate and clinic success rate by SEMS insertion were 428/434 (98.6%) and 412/434 (94.9%). The overall incidence of complications by SEMS insertion was 19/434 (4.4%). The complications included clinical perforation (6/434, 1.4%); stent migration (2/434, 0.5%), 1 of which re-stent; stent detachment (fell off) (3/434, 0.7%), none of them with re-stent; stool impaction (6/434, 1.4%), 1 of which re-stent; and abdominal or anal pain (2/434, 0.5%). There was no hemorrhage in any of the 434 patients. CONCLUSIONS: SEMS insertion is a relatively safe and effective technique for colonic decompression in dealing with ACO as either a BTS or as a palliative measure. It is also a solution to other causes of ACO such as recurrent tumor, benign diseases, or extra-luminal compression. Therefore, ES was largely avoided.


Assuntos
Neoplasias Colorretais , Obstrução Intestinal , Cirurgiões , Colonoscopia , Humanos , Recidiva Local de Neoplasia , Cuidados Paliativos , Prognóstico , Estudos Retrospectivos , Stents , Resultado do Tratamento
18.
J Cardiothorac Surg ; 16(1): 190, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233714

RESUMO

OBJECTIVE: Acute aortic dissection is a life-threatening condition. Thoracic endovascular aortic repair (TEVAR), together with optimized medical treatment, is currently the first line treatment for acute Stanford type B aortic dissection. TEVAR can close the entry tear and reduce mortality. Aortic remodeling after TEVAR can directly affect the patient's long-term prognosis. The factors that influence aortic remodeling have, however, received insufficient clinical attention and remain unclear. It is very important to identify these factors. METHODS: A total of 100 patients were continuously enrolled from 2011 to 2018 in 2 centers. Relevant data, including time from hospital admission to surgery, medicine use and aortic computed tomography angiography images obtained before and 6 months after surgery were collected. Patients were divided into favorable and adverse aortic remodeling groups, according to the degree of aortic remodeling. Analysis of variance and the chi-square test were performed using SPSS software to compare differences between groups and to determine the factors that influence postoperative aortic remodeling. RESULTS: The proportion of single-stent implantations was higher in the favorable remodeling group than in the adverse remodeling group (79.5% vs. 53.8% in distal end of stent-graft level and 81.3% vs. 56.4% in diaphragm level, respectively, p < 0.05). The earlier the TEVAR procedure was performed, the better the aortic remodeling (3.4 days vs. 4.8 days in distal stent graft levels, and 3.6 days vs. 4.9 days in diaphragm level, respectively, p < 0.05), the presence of residual distal entry tears in the abdominal aorta also improved aortic remodeling after TEVAR (85.7% vs. 55.1% in the celiac trunk level, and 92.0% vs. 48.9% in the right renal artery level, respectively, p < 0.05). CONCLUSION: Single stent-graft implantation and early surgery were associated with favorable aortic remodeling. Distal entry tears were also conducive to aortic remodeling after surgery for aortic dissection.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Remodelação Vascular/fisiologia , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
J Clin Neurosci ; 90: 256-261, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275559

RESUMO

OBJECTIVE: Severe intracranial atherosclerotic stenosis has become one of the main causes resulting transient ischemic attack and stroke. This study aimed to evaluate the efficacy and safety of low profile visualized intraluminal support (LVIS) stent in treating symptomatic intracranial atherosclerotic stenosis. METHODS: Data of 31 patients with at least 70% stenosis treated with LVIS stent in our center were retrospectively collected between July 2017 and November 2020. Further evaluation of lesion characteristics, technical success rate, preoperative complication, clinical and angiographic follow-up outcome, delayed in-stent stenosis were conducted. RESULTS: Stent delivery and deployment were successfully achieved in all 31 patients (100%). 22 cases (71%) were located in anterior circulation and 9 cases (29%) were located in posterior circulation. The mean degree of stenosis lesion before stent deployment was 85.6 ±â€¯9.4%, while after stenting was 11.2 ±â€¯11.8%. One patient suffered from ischemic complication in stenting procedure, and timely delivery of rt-PA successfully recanalized the artery. Clinical follow-up was available in all 31patients (100%) with mean follow-up time 15.0 ±â€¯12.1(3-45) months. No patients experienced the recurrence of stroke or TIA or death after discharge. Angiographic follow-up was available in 21patients (67.7%) with mean follow-up time 11.43 ±â€¯6.8 (6-36) months. 19 patients (90.5%) were stable while 2 patients (9.5%) developed ISR in their last angiographic follow-up. The 2 patients received balloon angioplasty and reached satisfactory results after retreatment. CONCLUSION: This preliminary study suggests that LVIS stent deployment was a feasible approach in treating intracranial atherosclerotic stenosis with satisfactory procedure success rate, low complication rate and favorable long-term outcome.


Assuntos
Procedimentos Endovasculares/métodos , Arteriosclerose Intracraniana/cirurgia , Stents , Adulto , Idoso , Angioplastia com Balão , Isquemia Encefálica/etiologia , Isquemia Encefálica/terapia , Angiografia Cerebral , Circulação Cerebrovascular , Constrição Patológica , Feminino , Seguimentos , Oclusão de Enxerto Vascular , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Resultado do Tratamento
20.
BMJ Case Rep ; 14(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34257131

RESUMO

Boerhaave's syndrome or spontaneous perforation of the oesophagus is a life-threatening condition that carries high mortality. Delayed diagnosis has a mortality rate of 20%-50%. While surgical intervention has been the mainstay of treatment, advancements in endoscopy and oesophageal stenting have allowed for alternative management. Our case involves a 33-year-old man with self-induced emesis and DKA. After 10 days in the ICU, he developed a large right pleural effusion, which was treated with chest tube placement. Upper GI study confirmed delayed Boerhaave's syndrome. A self-expanding stent was inserted followed by percutaneous endoscopic gastrostomy (PEG) for decompression and jejunal extension for nutrition. He developed empyema and underwent right thoracotomy for washout and lung decortication. Stent was exchanged once due to recurrent leak following migration and removed after 40 days. Endoscopic stent placement with PEG with jejunal extension followed by thoracotomy is a viable alternative to primary repair of delayed oesophageal perforation.


Assuntos
Perfuração Esofágica , Doenças do Mediastino , Adulto , Endoscopia , Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Humanos , Masculino , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/cirurgia , Ruptura Espontânea , Stents
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