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Journal of Pediatric Urology Jun 2022A wide range of surgical interventions have been described for the management of primary obstructive megaureter (POM). Endoscopic balloon dilatation has been developed...
INTRODUCTION
A wide range of surgical interventions have been described for the management of primary obstructive megaureter (POM). Endoscopic balloon dilatation has been developed through last decades as a minimally invasive alternative to classic surgery.
OBJECTIVE
To assess the need for placement of a double J stent after endoscopic balloon dilatation procedure, by comparing the post-operative related outcomes with and without double J placement. Secondary outcome was the success rate, considering the need for further procedure after endoscopic balloon dilatation and the improvement of the ureteral diameter in the two groups.
STUDY DESIGN
Historical retrospective comparison of children treated by endoscopic dilatation for POM, with post-operative JJ stent left in place (2012-2014) or without ureteral JJ stent (since 2015). Post-operative complications were reported following Clavien-Dindo grading system and compared between the two groups. Success rate was defined as absence of need for further surgical reimplantation. Ureteral diameters on preoperative and postoperative renal ultrasounds were compared.
RESULTS
Endoscopic dilatations were performed in 42 patients for 46 renal units during the study period. There was a significantly higher rate of post-operative complications in the group with JJ stenting compared to the group without double J stenting regarding all Clavien-Dindo grades (56% vs 15%, p = 0.014) and Clavien-Dindo grade III only (31% vs 0%, p = 0,0051) (Figure). The success rate was similar in the JJ group (75%, F-up: 70 months [13-101]) and the no JJ group (81%, F-up: 26 months [12-95]). There was a significant improvement of US renal pelvis and ureter dilatation in both groups, with a median follow-up of 35.5 months [12-101].
DISCUSSION
The overall rate of complications was slightly higher than in other reports and higher in the JJ group regarding Clavien-Dindo grade III complications. The success rate was comparable to previous studies reviewing endoscopic dilatations and equivalent in the two groups.
CONCLUSION
In our study, the omission of postoperative ureteral drainage by a JJ stent after endoscopic balloon dilatation of POM did not increase post-operative complications rate without demonstrable impact on the success rate.
Topics: Child; Dilatation; Humans; Retrospective Studies; Stents; Treatment Outcome; Ureter; Ureteral Obstruction
PubMed: 35562267
DOI: 10.1016/j.jpurol.2022.03.028 -
American Journal of Otolaryngology 2021Esophageal dilation (ED) may be performed in the office under local anesthesia or in a procedure/operating room under general anesthesia or intravenous (IV) sedation.... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Esophageal dilation (ED) may be performed in the office under local anesthesia or in a procedure/operating room under general anesthesia or intravenous (IV) sedation. However, indications for type of anesthesia during these procedures have not been established. The purpose of this review is to assess outcomes of esophageal dilation performed using different types of anesthesia to assess the safety of office-based techniques.
METHODS
We conducted a systematic review and meta-analysis comparing the outcomes of anesthesia techniques for ED in adults. Exclusion criteria included reviews, small case series, use of stents, diagnoses with high morbidity, and rare diseases. A comprehensive literature search of the PubMed, CINAHL, and EMBASE databases was performed for articles relating to esophageal dilation.
RESULTS
876 papers were identified of which 164 full text studies were assessed and 25 were included in the analysis using the PRISMA guidelines. Data regarding demographics, dilation technique, and adverse events were extracted. The DerSimonian-Laird random-effect models with inverse-variance weighting were fit to estimate the combined effects. There were no statistically significant differences among mortality, perforation, or bleeding based on anesthetic.
CONCLUSIONS
With office-based procedures gaining popularity in laryngology, there is a need to profile their safety. Office-based ED appears to have equivalent safety to general and IV sedation, although further research is necessary to define indications favoring office-based techniques.
Topics: Ambulatory Surgical Procedures; Anesthesia; Anesthesia, General; Anesthesia, Local; Deep Sedation; Dilatation; Esophagus; Female; Humans; Male; Safety; Treatment Outcome
PubMed: 34216877
DOI: 10.1016/j.amjoto.2021.103128 -
Otolaryngology--head and Neck Surgery :... Nov 2023This study aimed (1) to demonstrate the efficacy of balloon dilation Eustachian tuboplasty (BDET) for dilatory Eustachian tube dysfunction (ETD) and (2) to determine...
OBJECTIVE
This study aimed (1) to demonstrate the efficacy of balloon dilation Eustachian tuboplasty (BDET) for dilatory Eustachian tube dysfunction (ETD) and (2) to determine whether adjunctive ventilation tube insertion (VTI) is superior to myringotomy in relieving symptoms for patients with ETD and concurrent middle ear effusion (MEE) treated with BDET.
STUDY DESIGN
A retrospective cohort study.
SETTING
Tertiary care academic center.
METHODS
Patients with dilatory ETD undergoing BDET with a ≥6-month follow-up period were enrolled and evaluated mainly using Eustachian tube function (ETF) tests and Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). Participants with concurrent MEE were further classified into 2 subgroups, BDET with VTI and BDET with myringotomy. An intergroup comparison and comprehensive outcome evaluation were performed.
RESULTS
In total, 35 patients with 50 symptomatic ears were enrolled. According to ETF test results, the normalized ETF rate was 94% on the last visit. The mean ETDQ-7 scores decreased significantly from 3.7 ± 1.4 to 2.0 ± 0.9 after interventions, with the most improvement in symptoms occurring for "ear fullness" and "muffled hearing." For the final visit, strong correlations among ETF tests, tympanometry, and Valsalva results were noted. The aforementioned assessment results did not significantly differ between (1) the patients with MEE and patients without MEE and (2) "BDET with VTI" subgroup and "BDET with myringotomy" subgroup.
CONCLUSION
BDET was effective for dilatory ETD, even in cases with concurrent MEE. For patients with ETD and MEE, further research is required to evaluate the benefits of adjunctive myringotomy with or without VTI.
Topics: Humans; Eustachian Tube; Dilatation; Retrospective Studies; Endoscopy; Acoustic Impedance Tests; Ear Diseases; Otitis Media with Effusion
PubMed: 37264984
DOI: 10.1002/ohn.383 -
Computerized Medical Imaging and... Sep 2023Deformable medical image registration is an essential preprocess step for several clinical applications. Even though the existing convolutional neural network and...
Deformable medical image registration is an essential preprocess step for several clinical applications. Even though the existing convolutional neural network and transformer based methods achieved the promising results, the limited long-range spatial dependence and non-uniform attention span of these models prohibit further improving the registration performance. To deal with this issue, we proposed a multi-dilation spherical graph transformer (MD-SGT), in which the encoder combined the advantages of convolutional and graph transformer blocks to distinguish effectively the differences between the reference and the template images at various scales. Specifically, the features of each voxel were obtained by aggregating the information from its neighbors sampled from different spherical regions with different dilation rates. The implicit convolution inductive bias and long-range uniform attention span induced by such information aggregation manner made the features more representative for registration. Through the qualitative and quantitative comparisons with state-of-the-art methods on two datasets, we demonstrated that combining long-range uniform attention span and inductive bias are beneficial for promoting the image registration performance, with the Dice score, ASD and HD95 being improved at least by 0.5%, 2.2% and 1.1%, respectively.
Topics: Dilatation; Neural Networks, Computer; Image Processing, Computer-Assisted
PubMed: 37579555
DOI: 10.1016/j.compmedimag.2023.102281 -
Journal of Laparoendoscopic & Advanced... Sep 2020Benign biliary strictures (BBS) befall in ∼7%-23% after hepaticojejunostomy and in 0.3%-0.6% after cholecystectomies. Their treatment options include surgical,...
Benign biliary strictures (BBS) befall in ∼7%-23% after hepaticojejunostomy and in 0.3%-0.6% after cholecystectomies. Their treatment options include surgical, endoscopic, and percutaneous management. The percutaneous approach is an excellent mini-invasive option including balloon dilation, biodegradable stents, and sustained dilation, a procedure born endoscopically. However, when the endoscopic approach fails or it is not available, it is possible to perform it percutaneously. To estimate the technical and clinical success of sustained percutaneous dilation with multiple catheters (SPDMC) in hepaticojejunostomy strictures and the percentage of complications and recurrence. We conducted a retrospective study, from a prospective database from January 2010 to March 2019, of 17 patients with postoperative BBS who failed to percutaneous pneumatic balloon dilation and underwent SPDMC with a mean follow-up of 2 years. Seventeen patients between 28 and 71 years of age underwent SPMDC with technical success of 100%; the average number of catheters used was 5.59 (95% confidence interval [CI] 5.12-6.06) achieving a dilatation diameter of 16.15 mm (95% CI 14.71-17.60), and the therapeutic success rate was 71%, with recurrences of stricture and complications of 29% and 18%, respectively. The mean time with SPMDC was 7.06 months (95% CI 5.56-8.56). The median follow-up after dilation was 16 months, with an average of 27.75 months (95% CI 14.15-41.34). SPMDC is a feasible technique with a high technical success rate, therapeutic success rate, and low morbidity and mortality.
Topics: Adult; Aged; Anastomosis, Surgical; Bile Ducts; Biliary Tract Surgical Procedures; Catheters; Constriction, Pathologic; Dilatation; Female; Follow-Up Studies; Humans; Jejunum; Male; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 32668186
DOI: 10.1089/lap.2020.0418 -
Diseases of the Esophagus : Official... Dec 2022Esophageal strictures in children may cause dysphagia, choking during feeds, and failure to thrive. They can be treated by balloon dilatations, either under endoscopic...
Esophageal strictures in children may cause dysphagia, choking during feeds, and failure to thrive. They can be treated by balloon dilatations, either under endoscopic or fluoroscopic guidance; there is no literature comparing the methods. Retrospective review of the medical records of children (0-18 years) who were treated with balloon dilatations between 2010 and 2020. The primary outcome was the number of dilatation sessions required until clinical success after 3 months. Secondary outcomes were long-term success at 12 months, and complications of bleeding and perforation. Forty-six patients underwent 174 dilatation sessions. Success rates in the endoscopy and fluoroscopy groups were similar: 62% versus 67% (p = 0.454) at 3 months and 57% versus 67% (p = 0.721) at 12 months. Complication rate was lower in the endoscopy group (0% vs. 15%, p < 0.001). Both endoscopic and radiologic-guided balloon dilatations were shown to be equally effective, but endoscopic guidance had fewer complications.
Topics: Humans; Child; Esophageal Stenosis; Dilatation; Treatment Outcome; Endoscopy; Fluoroscopy; Retrospective Studies
PubMed: 35796004
DOI: 10.1093/dote/doac048 -
Annals of the New York Academy of... Nov 2021The maximum diameter of the balloon used for balloon dilatation(BD) of esophagogastric anastomotic stricture (EAS) is generally 20 millimeters. This study aimed to...
The maximum diameter of the balloon used for balloon dilatation(BD) of esophagogastric anastomotic stricture (EAS) is generally 20 millimeters. This study aimed to evaluate the safety and efficacy of BD under fluoroscopy, using balloons with a diameter of 25-30 millimeters. We retrospectively analyzed the data of patients with benign EAS treated by large BD (balloon diameter, 25-30 mm) under fluoroscopy. The Cox proportional hazards model (PHM) was used to identify the factors associated with stricture-free survival. The results show that a total of 127 patients were included in this study, and 204 BDs were performed. The technical success rate was 96.6%, and the clinical success rate was 99.2%. The incidence of serious adverse events was 3.4% (7/204). One patient died of massive hemorrhage during BD, and nine patients were lost to follow-up. For the remaining 117 patients, the median stricture-free survival period was 14.9 months. In multivariable analysis using the Cox PHM, only balloon diameter was significantly associated with stricture-free survival. The stricture-free survival period tended to increase as balloon diameter increased. Large BD under fluoroscopy appears to be safe and effective for the treatment of benign EAS after esophagectomy.
Topics: Dilatation; Disease Management; Esophageal Stenosis; Fluoroscopy; Gastric Balloon; Humans; Prognosis; Proportional Hazards Models; Treatment Outcome
PubMed: 34533853
DOI: 10.1111/nyas.14682 -
Lower Urinary Tract Symptoms May 2022To evaluate the relation between clinically relevant stricture recurrence after first urethroplasty and prior endoscopic treatments (dilatation and/or direct visual...
OBJECTIVE
To evaluate the relation between clinically relevant stricture recurrence after first urethroplasty and prior endoscopic treatments (dilatation and/or direct visual internal urethrotomy) or intermittent self-dilatation (ISD).
METHODS
Patients with bulbar urethral strictures treated with first urethroplasty between 2011 and April 2019 were included in a prospectively gathered database with standardized follow-up. Stricture recurrence was defined as any need for reintervention. Primary outcome was the analysis of recurrence risk after first urethroplasty in relation with the number of prior endoscopic treatments or performance of ISD. Univariate and multivariate statistical analyses were performed.
RESULTS
Overall, 106 patients were included with a median follow-up of 12 months (interquartile range 8-13]. Reintervention was necessary in 16 patients (15%). Recurrence was more prevalent in patients with ≥3 prior endoscopic treatments (28%, P = .009). No increased risk of recurrence was found in patients with 1 or 2 prior endoscopic treatments. The prevalence of prior ISD was twice as high in the stricture recurrence group (56% vs 26%, P = .014), and ISD was performed in 61% of the patients with ≥3 prior endoscopic treatments (P < .001). The number of prior endoscopic interventions and performance of ISD were no independent predictors for recurrence in the multivariable analysis.
CONCLUSIONS
This study shows that the risk of recurrence after first urethroplasty is increased in patients with ≥3 prior endoscopic treatments and in those who performed ISD. Patients performing ISD more often had ≥3 prior endoscopic treatments. Prior endoscopic treatment and performance of ISD were not independent predictors of stricture recurrence.
Topics: Constriction, Pathologic; Dilatation; Female; Humans; Male; Recurrence; Retrospective Studies; Treatment Outcome; Urethra; Urethral Stricture
PubMed: 34794210
DOI: 10.1111/luts.12419 -
Scientific Reports Aug 2022Retinal microvascular calibre has been proposed as a predictor of cardiac events. Surgery is a major stimulus for inflammation which potentially affects small vessel...
Retinal microvascular calibre has been proposed as a predictor of cardiac events. Surgery is a major stimulus for inflammation which potentially affects small vessel calibre. This study examined the effects of surgery on retinal, and thus systemic, small vessel size, and the potentially confounding effect of surgery when retinal vessel calibre is used to predict cardiac risk in hospital patients. Consecutive participants were recruited from a preoperative assessment clinic at a teaching hospital. They provided demographic and clinical details, and underwent retinal imaging before and again, within 3 days after surgery, with a non-mydriatic retinal camera. Images were graded for vessel calibre using semi-automated software based on the Parr-Hubbard formula with Knudtson's modification (IVAN, U Wisconsin). Differences were examined using Fisher's exact test or a paired t-test, and calibre determinants identified from univariate and multiple linear regression analysis (STATA version 11.2). Sixty-eight participants (23 men, 34%) with a mean age of 55 ± 14.5 years, were recruited. Fourteen (21%) underwent a laparotomy which was considered major surgery and 54 (79%) had Other surgery. Mean C-reactive protein (CRP) levels increased post-operatively from 7.8 ± 20.2 mg/L to 43.9 ± 55.1 mg/L (p < 0.01), and mean serum albumin decreased from 38.9 ± 4.4 g/L to 33.9 ± 5.5 g/L (p < 0.01). Mean central retinal arteriole and venular equivalent calibre (CRAE, CRVE) increased post-operatively (142.4 ± 13.3 µm to 146.4 ± 13.0 µm, p < 0.01 and 213.1 ± 16.8 µm to 217.9 ± 18.3 µm, p < 0.01, respectively). The systemic microvasculature dilates post-operatively possibly secondary to inflammation and endothelial dysfunction. These changes were present within 3 days of surgery and may confound the use of small vessel calibre to predict cardiac risk in surgical inpatients. Microvascular dilatation in response to other inflammatory stimuli such as pneumonia is a known potential confounder in hospital patients.
Topics: Adult; Aged; Dilatation; Dilatation, Pathologic; Humans; Inflammation; Male; Middle Aged; Retina; Retinal Vessels; Systemic Inflammatory Response Syndrome
PubMed: 35918491
DOI: 10.1038/s41598-022-17467-7 -
Experimental Physiology Oct 2023Handgrip exercise (HG), a small muscle exercise, improves cognitive function and is expected to provide a useful exercise mode to maintain cerebral health. However, the...
Handgrip exercise (HG), a small muscle exercise, improves cognitive function and is expected to provide a useful exercise mode to maintain cerebral health. However, the effect of HG on cerebral blood flow regulation is not fully understood. The present study aimed to examine the effect of acute HG on cerebral endothelial function as one of the essential cerebral blood flow regulatory functions. Thirteen healthy young participants performed interval HG, consisting of 4 sets of 2 min HG at 25% of maximum voluntary contraction with 3 min recovery between each set. Cognitive performance was evaluated before and at 5 and 60 min after interval HG using the Go/No-Go task (reaction time and accuracy). The diameter and blood velocity of the internal carotid artery (ICA) were measured using a duplex Doppler ultrasound system. To assess cerebral endothelial function, hypercapnia (30 s of hypercapnia stimulation, end-tidal partial pressure of CO : +9 mmHg)-induced cerebrovascular flow-mediated dilatation (cFMD) was induced, calculated as relative peak dilatation from baseline diameter. The shear rate (SR) was calculated using the diameter and blood velocity of the ICA. As a result, cognitive performance improved only at 5 min after interval HG (reaction time, P = 0.008; accuracy, P = 0.186), whereas ICA SR during interval HG and cFMD after interval HG were unchanged (P = 0.313 and P = 0.440, respectively). These results suggest that enhancement in cerebral endothelial function is not an essential mechanism responsible for acute HG-induced cognitive improvement. NEW FINDINGS: What is the central question of this study? Does handgrip exercise, a small muscle exercise, improve cerebral endothelial function? What is the main finding and its importance? Acute interval isometric handgrip exercise (2 min of exercise at 25% maximum voluntary contraction, followed by 3 min of recovery, repeated for a total of 4 sets) did not improve cerebral endothelial function. Since the cerebrovascular shear rate did not change during exercise, it is possible that acute handgrip exercise is not sufficient stimulation to improve cerebral endothelial function.
Topics: Humans; Carotid Artery, Internal; Carbon Dioxide; Hypercapnia; Dilatation; Hand Strength; Blood Flow Velocity; Cerebrovascular Circulation
PubMed: 37626473
DOI: 10.1113/EP091125