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Dysphagia Aug 2020Endoscopic dilatation is the recommended primary therapy for chronic corrosive esophageal strictures (ES), and surgery is reserved for failed dilatation. Through this...
Endoscopic dilatation is the recommended primary therapy for chronic corrosive esophageal strictures (ES), and surgery is reserved for failed dilatation. Through this study, we intend to analyze the efficacy and long-term outcomes of both endoscopic and surgical interventions in corrosive ES. A retrospective cohort analysis of patients with chronic corrosive ES, managed with endoscopic or surgical procedures at a tertiary teaching institute in North India from December 2009 to December 2016, was performed from a prospectively maintained database. The primary outcome measure was the absence of dysphagia following dilatation or surgery. During the study period, 64 patients with ES underwent surgical or endoscopic treatment. Associated gastric strictures and pharyngeal strictures were present in 39 (60%) and 22 patients (28.9%), respectively. The mean age was 28.8 years and mean BMI was 14.2 kg/m. Acid was the most common corrosive substance. Endoscopic dilatation using Savary-Gilliard (SG) dilators was successful in achieving persistent symptom relief in 46 patients (71.8%) after a total of 358 sessions (mean number of dilatations were 5.2 ± 1.2) of dilatations over 2 years. The dilatation therapy failed in 18 patients (28.1%) including technical failures (15.6%), perforations (3.1%), refractory stricture (1.5%) and recurrent strictures (7.8%). Increasing stricture length (more than 6 cm) was associated with poor outcome of endoscopic dilatation (p < 0.001). Only eleven patients (17%) required esophageal replacement (resection: 0, bypass: 11) for failed dilatations including seven gastric pull-ups and four pharyngo-coloplasty. The stricture rate after surgery was 36.3% (4/11). The median follows up was 32 months. Endoscopic dilatation of corrosive ES is safe and effective therapy and should be the first-line therapy for these patients and surgery should be considered only in patients who have unsuccessful outcome following dilatation therapy.
Topics: Adult; Burns, Chemical; Dilatation; Esophageal Stenosis; Esophagectomy; Esophagoscopy; Female; Humans; Male; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome
PubMed: 31485830
DOI: 10.1007/s00455-019-10058-1 -
Arquivos Brasileiros de Cardiologia Nov 2019
Topics: Dilatation; Echocardiography; Echocardiography, Transesophageal; Humans; Schistosomiasis; Splenic Diseases
PubMed: 31800717
DOI: 10.5935/abc.20190234 -
Journal of Pediatric Surgery Oct 2019Anal dilatation is performed after repair of anorectal malformations(ARMs) and is vital in prevention of anal stricture formation. The ideal protocol utilizes Hegar...
BACKGROUND
Anal dilatation is performed after repair of anorectal malformations(ARMs) and is vital in prevention of anal stricture formation. The ideal protocol utilizes Hegar dilators. In our setup, few parents will acquire Hegar dilators for home based anal dilatation but majority will use fingers as an alternative. The basis of this study was to determine the effectiveness of digital anal dilatations in preventing anal strictures.
MATERIALS AND METHODS
This was a descriptive cross-sectional study carried out at Kenyatta National Hospital (KNH) which recruited children post ARM repair undergoing digital anal dilatation. The diameters of the digits used for anal dilatation were assessed for adequacy using the desired anal size as a reference point. The main outcome variable was the presence of anal strictures. Data were entered in a data collection sheet and analyzed by use of SPSS (V.21.0 Chicago, Illinois). Chi-square test and Fisher's exact test were used to ascertain association among variables. A P-value of less than 0.05 was considered statistically significant.
RESULTS
50 patients with ARM post repair were recruited in the study. The rate of occurrence of anal stricture was 22%. Among the participants with anal strictures, only 27% were compliant to the dilatation regimen while 73% reported noncompliance. The mean diameter(mm) of the dilating digits at the level of the middle phalanx was Index finger (15.4 ± 0.58), middle finger (15.2 ± 0.61), ring finger (14.2 ± 0.71), small finger (12.5 ± 0.91) and thumb (17.6 ± 0.78). 46% of the participants were dilated with appropriately sized digits. The remainder had dilatations done with larger (22%) or smaller digits (32%). Notably, anal strictures occurred in participants who were dilated with inappropriately sized digits (P = 0.001).
CONCLUSION
Digital anal dilatation is safe and effective as a mode of anal dilation in the setting of compliance to a strict dilatation protocol, daily frequency of dilations and use of appropriately sized digits. Owing to the variability in the finger size, we recommend that digits be calibrated and education given to the caregivers on the use of the appropriately sized digit.
LEVEL OF EVIDENCE
Treatment study. Level III.
Topics: Adolescent; Anal Canal; Anorectal Malformations; Anus Diseases; Child; Child, Preschool; Constriction, Pathologic; Cross-Sectional Studies; Digestive System Surgical Procedures; Dilatation; Female; Fingers; Humans; Infant; Male; Patient Compliance; Postoperative Care; Postoperative Complications; Treatment Outcome
PubMed: 31053362
DOI: 10.1016/j.jpedsurg.2019.04.004 -
Ophthalmology Jan 2021To evaluate the safety of pupillary dilation in primary angle-closure suspects (PACS) with concurrent visually significant cataract (VSC), to identify risk factors... (Observational Study)
Observational Study
PURPOSE
To evaluate the safety of pupillary dilation in primary angle-closure suspects (PACS) with concurrent visually significant cataract (VSC), to identify risk factors associated with elevated intraocular pressure (IOP), and to describe changes in anterior segment anatomy after pupillary dilation.
DESIGN
Prospective study.
PARTICIPANTS
Patients with PACS and VSC and no prior laser or intraocular surgery were recruited. Visually significant cataract was defined as best-corrected visual acuity ≤ 20/40 due to cataract.
METHODS
Subjects' eyes were dilated with 0.5% tropicamide and 0.5% phenylephrine hydrochloride. A standardized eye examination, biometry, and swept-source OCT (SS-OCT) were performed before dilation. Intraocular pressure and SS-OCT were repeated 1, 4, and 6 hours postdilation (PDH1, PDH4, and PDH6, respectively). All parameters were compared between time points before and after dilation using paired t test. Linear regression models were used to determine the risk factors associated with postdilation IOP changes.
MAIN OUTCOME MEASURES
Change in IOP and SS-OCT parameters from baseline.
RESULTS
Seventy-eight eyes from 78 patients were included, with 78, 66, and 12 patients completing the study at PDH1, PDH4, and PDH6, respectively. Mean IOP increased from 14.8 ± 2.6 mmHg at baseline to 15.5 ± 3.5 mmHg at PDH1 (P = 0.03) and decreased to 14.9 ± 3.1 mmHg at PDH4 (P = 0.09). Four patients (5.13%) and 3 patients (3.85%) had an increase in IOP ≥ 5 mmHg at PDH1 and PDH4, respectively. Two patients (2.56%) and 1 patient (1.28%) had an increase in IOP ≥ 8 mmHg at PDH1 and PDH4, respectively. None developed acute primary angle-closure during the observation period. Almost all anterior chamber parameters showed a significant increase after dilation at PDH1 and PDH4, except lens vault and iris volume, which decreased at PDH1 and PDH4 from baseline. Increase in anterior chamber depth was negatively associated with the level of IOP elevation after dilation (P < 0.01).
CONCLUSIONS
Dilation of patients' eyes with PACS and VSC in this cohort appears to have a low risk for IOP spike. This may be associated with relaxation of the ciliary muscle leading to posterior displacement of the lens-iris diaphragm and deepening of the anterior chamber.
Topics: Aged; Aged, 80 and over; Anterior Chamber; Biometry; Dilatation; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Male; Middle Aged; Prospective Studies; Tomography, Optical Coherence
PubMed: 32652206
DOI: 10.1016/j.ophtha.2020.07.009 -
BMJ Case Reports Dec 2023A woman in her 30s at 29 weeks of gestation was diagnosed with a fetal abdominal cyst and polyhydramnios. As the cyst gradually increased in size, an elective caesarean...
A woman in her 30s at 29 weeks of gestation was diagnosed with a fetal abdominal cyst and polyhydramnios. As the cyst gradually increased in size, an elective caesarean section was performed at 38 weeks of gestation. The neonate experienced respiratory distress due to tense abdominal distension shortly after birth. An emergency laparotomy was performed. The intestinal tract was markedly dilated and contiguous with the cyst. The small bowel distal to the dilated intestine had herniated through the defect. The dilated segment was resected, and an ileostomy was created. The operative and histopathological findings suggested segmental dilatation of the intestine (SDI). SDI is a rare gastrointestinal disorder presenting during the neonatal period. It can cause respiratory failure in newborns by compression owing to its large size. SDI should be considered in the differential diagnosis of relatively large abdominal cysts, and collaboration with paediatric surgeons and neonatologists is necessary for successful outcomes.
Topics: Child; Infant, Newborn; Humans; Pregnancy; Female; Cesarean Section; Dilatation; Intestinal Diseases; Intestines; Cysts
PubMed: 38154863
DOI: 10.1136/bcr-2023-256842 -
JACC. Cardiovascular Interventions Dec 2019
Topics: Dilatation; Echocardiography, Transesophageal; Humans; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 31857017
DOI: 10.1016/j.jcin.2019.10.016 -
Gastrointestinal Endoscopy Dec 2020
Topics: Dilatation; Esophageal Motility Disorders; Esophageal Stenosis; Feedback; Humans; Retrospective Studies
PubMed: 33236997
DOI: 10.1016/j.gie.2020.06.045 -
Catheterization and Cardiovascular... Feb 2021To determine over-dilation potential of commercially available covered stents.
OBJECTIVES
To determine over-dilation potential of commercially available covered stents.
BACKGROUND
Covered stents including the Atrium iCast, Gore VBX, and Lifestream stents (LS) can treat ruptures, dissections, and aneurysms in small vessels. Especially in growing patients, stents often require serial dilations beyond their implant or nominal diameters. Tolerance of serial dilations is clinically important information for interventionalists.
METHODS
Serial dilations of 5-12 mm iCast, VBX, and LS covered stents were performed in 1-2 mm increments (up to 20 mm). With each dilation, foreshortening and recoil were measured, and stent strut and covering integrity were assessed. High-pressure balloons were used to expand the stents until they fractured or could not be further expanded.
RESULTS
The 5-8 mm LS tolerated dilation to 14.5-16 mm. The 10-12 mm LS stents tolerated dilation to 18 mm and fractured on the 20 mm balloon. LS stents foreshortened 35%-45% on average after 8 mm of over-dilation and had 5%-10% recoil on <6 mm over-dilation. All iCast stents tolerated dilation to 12-13 mm and required fracture for dilation to >14 mm. ICast stents foreshortened 19%-29% at maximum dilation, with 3-6% recoil on <2 mm over-dilation, and < 3% thereafter. VBX stents over-dilated to 2.9-4.7 mm above nominal, foreshortening 40%-50% after 4-6 mm of over-dilation before collapsing into a ring. VBX stent recoil was <2.5% on all dilations.
CONCLUSIONS
LS stents had the greatest over-dilation potential. VBX stents had the least recoil but tended to foreshorten significantly 3-4 mm above nominal. Regardless of nominal size, all iCast stents (including the 5 mm) tolerated dilation to a maximum of 12-13 mm.
Topics: Dilatation; Humans; Prosthesis Design; Stents; Treatment Outcome
PubMed: 33283447
DOI: 10.1002/ccd.29421 -
Surgical Endoscopy Jul 2021The magnetic sphincter augmentation device (MSA) provides effective relief of gastroesophageal reflux symptoms. Dysphagia after MSA implantation sometimes prompts...
BACKGROUND
The magnetic sphincter augmentation device (MSA) provides effective relief of gastroesophageal reflux symptoms. Dysphagia after MSA implantation sometimes prompts endoscopic dilation. The manufacturer's instructions are that it be performed 6 or more weeks after implantation under fluoroscopic guidance to not more than 15 mm keeping 3 or more beads closed. The purpose of this study was to assess adherence to these recommendations and explore the techniques used and outcomes after MSA dilation.
METHODS AND PROCEDURES
We conducted a multicenter retrospective review of patients undergoing dilation for dysphagia after MSA placement from 2012 to 2018.
RESULTS
A total of 144 patients underwent 245 dilations. The median size of MSA placed was 14 beads (range 12-17) and the median time to dilation was 175 days. A second dilation was performed in 67 patients, 22 patients had a third dilation and 7 patients underwent 4 or more dilations. In total, 17 devices (11.8%) were eventually explanted. The majority of dilations were performed with a balloon dilator (81%). The median dilator size was 18 mm and 73.4% were done with a dilator larger than 15 mm. There was no association between dilator size and need for subsequent dilation. Fluoroscopy was used in 28% of cases. There were no perforations or device erosions related to dilation.
DISCUSSION
There is no clinical credence to the manufacturer's recommendation for the use of fluoroscopy and limitation to 15 mm when dilating a patient for dysphagia after MSA implantation. Use of a larger size dilator was not associated with perforation or device erosion, but also did not reduce the need for repeat dilation. Given this, we would recommend that the initial dilation for any size MSA device be done using a 15 mm through-the-scope balloon dilator. Dysphagia prompting dilation after MSA implantation is associated with nearly a 12% risk of device explantation.
Topics: Dilatation; Esophageal Sphincter, Lower; Gastroesophageal Reflux; Humans; Magnetic Phenomena; Retrospective Studies; Treatment Outcome
PubMed: 32671521
DOI: 10.1007/s00464-020-07799-8 -
Experimental Brain Research Feb 2021We investigated whether Early Posterior Negativity (EPN) indicated the subjective dilation of time when judging the duration of arousing stimuli. Participants performed...
We investigated whether Early Posterior Negativity (EPN) indicated the subjective dilation of time when judging the duration of arousing stimuli. Participants performed a visual temporal bisection task along with high-level and low-level arousing auditory stimuli, while we simultaneously recorded EEG. In accordance with previous studies, arousing stimuli were temporally overestimated and led to higher EPN amplitude. Yet, we observed that time dilation and EPN amplitude were significantly correlated and this effect cannot be explained by confounds from stimulus valence. We interpret our findings in terms of the pacemaker-accumulator model of human timing, and suggest that EPN indicates an arousal-based increasing of the speed of our mental clock.
Topics: Arousal; Dilatation; Emotions; Humans; Time Perception
PubMed: 33277996
DOI: 10.1007/s00221-020-05991-9