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Journal of Reconstructive Microsurgery May 1998Under certain circumstances during microsurgical anastomosis, vasospasm may persist, despite the use of multiple topical vasodilators. Mechanical dilatation may be...
Under certain circumstances during microsurgical anastomosis, vasospasm may persist, despite the use of multiple topical vasodilators. Mechanical dilatation may be needed but is difficult to perform in vessels smaller than 1 mm in diameter. Milking dilatation, a simple maneuver similar to a milking patency test, is introduced and tested for vessels of such a size. The femoral arteries of 10 Sprague-Dawley rats were used. Milking dilation was performed on both sides, and a forceful milking dilation method was also used 10 times on one side subsequently. The dilated segments demonstrated a 67.3 percent (29 to 100 percent) increase in their original sizes. The vessels were all patent, with no gross signs of thrombosis or aneurysm formation, when exposed immediately, 1 week, and 4 weeks post procedure. Half of the dilated segments, even those forcefully dilated, returned to their normal size at 4 weeks; the remainder were still dilated. The results of this study demonstrated that milking dilatation is effective and safe for dilating arteries about I mm in diameter or less. However, further study is required before any long-term conclusions can be drawn.
Topics: Anastomosis, Surgical; Animals; Dilatation; Femoral Artery; Intraoperative Care; Pilot Projects; Rats; Rats, Sprague-Dawley; Vascular Patency; Vascular Surgical Procedures
PubMed: 9618089
DOI: 10.1055/s-2007-1000174 -
American Journal of Obstetrics and... Jun 1981
Topics: Abortion, Therapeutic; Catheterization; Cervix Uteri; Dilatation; Female; Humans; Laminaria; Pregnancy; Rubber
PubMed: 7246665
DOI: 10.1016/0002-9378(81)90047-8 -
Annals of Surgery Dec 2013Comparison of short- and long-term effects after laparoscopic Heller myotomy (LHM) and endoscopic balloon dilation (EBD) considering the need for retreatment. (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
Comparison of short- and long-term effects after laparoscopic Heller myotomy (LHM) and endoscopic balloon dilation (EBD) considering the need for retreatment.
BACKGROUND
Previously published studies have indicated that LHM is the most effective treatment for Achalasia. In contrast to that a recent randomized trial found EBD equivalent to LHM 2 years after initial treatment.
METHODS
A search in Medline, PubMed, and Cochrane Central Register of Controlled Trials was conducted for prospective studies on interventional achalasia therapy with predefined exclusion criteria. Data on success rates after the initial and repeated treatment were extracted. An adjusted network meta-analysis and meta-regression analysis was used, combined with a head-to-head comparison, for follow-up at 12, 24, and 60 months.
RESULTS
Sixteen studies including results of 590 LHM and EBD patients were identified. Odds ratio (OR) was 2.20 at 12 months (95% confidence interval: 1.18-4.09; P = 0.01); 5.06 at 24 months (2.61-9.80; P < 0.00001) and 29.83 at 60 months (3.96-224.68; P = 0.001). LHM was also significantly superior for all time points when therapy included re-treatments [OR = 4.83 (1.87-12.50), 19.61 (5.34-71.95), and 17.90 (2.17-147.98); P ≤ 0.01 for all comparisons) Complication rates were not significantly different. Meta-regression analysis showed that amount of dilations had a significant impact on treatment effects (P = 0.009). Every dilation (up to 3) improved treatment effect by 11.9% (2.8%-21.8%).
CONCLUSIONS
In this network meta-analysis, LHM demonstrated superior short- and long-term efficacy and should be considered first-line treatment of esophageal achalasia.
Topics: Dilatation; Esophageal Achalasia; Esophageal Sphincter, Lower; Esophagoscopy; Humans; Laparoscopy; Prospective Studies; Time Factors; Treatment Outcome
PubMed: 24220600
DOI: 10.1097/SLA.0000000000000212 -
Revista Espanola de Enfermedades... Sep 2017Complete gastrointestinal strictures are a technically demanding problem. In this setting, an anterograde technique is associated with a high risk of complications and a...
BACKGROUND AND AIM
Complete gastrointestinal strictures are a technically demanding problem. In this setting, an anterograde technique is associated with a high risk of complications and a combined anterograde-retrograde technique requires a prior ostomy. Our aim was to assess the outcome of a first case series for the management of complete gastrointestinal strictures using endoscopic ultrasound (EUS)-guided puncture as a novel endoscopic approach.
PATIENTS AND METHODS
This retrospective case-series describes four cases that were referred for treatment of complete benign gastrointestinal strictures, three upper and one lower. Recanalization was attempted with EUS-guided puncture using a 22G or 19G needle and contrast filling was visualized by fluoroscopy. Afterwards, a cystotome and/or a dilator balloon were used under endoscopic and fluoroscopic guidance. A fully covered metal stent was placed in two cases, keeping the strictures open in order to prevent another stricture. Feasibility, adverse events, efficacy and the number of dilations required after recanalization were evaluated.
RESULTS
Technical and clinical success was achieved in three of the four cases (75%). A first dilation was performed using a dilator balloon in all successful cases and fully covered metal stents were used in two cases. These patients underwent a consecutive number of balloon dilatations (range 1-4) and all three were able to eat a soft diet. No adverse events were related to the EUS-guided approach. In the failed case with a long stricture (> 3 cm), an endoscopic rendezvous technique was attempted which caused a pneumothorax requiring a chest tube placement.
CONCLUSION
EUS-guided recanalization, as a first approach in the treatment of complete digestive stricture, is a feasible and promising procedure that can help to avoid major surgery.
Topics: Constriction, Pathologic; Digestive System Surgical Procedures; Dilatation; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Retrospective Studies; Stents; Surgery, Computer-Assisted; Treatment Failure; Ultrasonography, Interventional
PubMed: 28724308
DOI: 10.17235/reed.2017.4972/2017 -
Revista de Gastroenterologia Del Peru :... Jan 2015The endoscopic dilation of the gastrointestinal tract is carried out to relieve either functional or organic disorders, secondary to a variety of both benign and... (Review)
Review
The endoscopic dilation of the gastrointestinal tract is carried out to relieve either functional or organic disorders, secondary to a variety of both benign and malignant diseases. With the advent of new technologies, virtually all digestive stenosis can be managed in a minimally invasive way. Despite its wide dissemination in actual practice, there are few controlled studies comparing the different forms of endoscopic dilation. In this article, we review this technique and the evidence available for application in different segments of the gastrointestinal tract. The future of the dilations includes the development of dilators to assess dilation during the procedure. These advents and the implementation indications, benefits and risks for each of the existing systems of dilations.
Topics: Constriction, Pathologic; Contraindications; Digestive System Diseases; Dilatation; Endoscopy, Digestive System; Humans; Treatment Outcome
PubMed: 25875518
DOI: No ID Found -
Gastroenterology Clinics of North... Dec 1991Esophageal cancer is incurable in most patients. Tumor anatomy must be carefully defined using radiographic and endoscopic techniques. These techniques can also provide... (Review)
Review
Esophageal cancer is incurable in most patients. Tumor anatomy must be carefully defined using radiographic and endoscopic techniques. These techniques can also provide useful information to plan palliative treatment. The goals of palliation must be explicitly discussed and defined with the patient and family. Palliative manipulation is best done by a physician with experience in the procedures, after consideration of all available options to ensure effective palliation with minimal risk of complications. Esophageal dilation is an integral part of most palliative treatment programs, either as sole or adjunctive therapy. Dilation can maintain luminal patency in most patients and can be performed easily, effectively, and safely in an outpatient setting. An esophageal prosthesis can further alleviate symptoms in patients in whom more conventional palliative techniques are unsuccessful. Because prosthesis placement is associated with a relatively high rate of complications, it should be reserved for patients with advanced refractory disease or tracheo-esophageal fistula, for whom no other palliative alternatives exist.
Topics: Combined Modality Therapy; Dilatation; Esophageal Neoplasms; Humans; Palliative Care; Prostheses and Implants
PubMed: 1723968
DOI: No ID Found -
Radiology Oct 1983Six strictures of the ureter were dilated with balloon angioplasty catheters. Two obstructed ureterovesical junctions in transplant patients were successfully treated....
Six strictures of the ureter were dilated with balloon angioplasty catheters. Two obstructed ureterovesical junctions in transplant patients were successfully treated. One obstructed ureteropelvic junction in a transplant kidney with a redundant ureter failed to respond. One of 2 uretero-ileostomy junction strictures was successfully treated, though one mid-ureteral stricture remained unchanged. Multiple dilatations were necessary in several patients. No significant complications were noted. Pre- and post-dilatation assessment of obstruction using the Whitaker test was helpful in transplant patients.
Topics: Adult; Aged; Angioplasty, Balloon; Catheterization; Dilatation; Female; Humans; Kidney Transplantation; Male; Middle Aged; Ureteral Obstruction
PubMed: 6225143
DOI: 10.1148/radiology.149.1.6225143 -
Anesthesia and Analgesia Dec 2002Percutaneous tracheostomy with single-step dilation technique using Griggs' guidewire dilating forceps (GWDF) is a well-recognized procedure. Recently, Ciaglia has... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
UNLABELLED
Percutaneous tracheostomy with single-step dilation technique using Griggs' guidewire dilating forceps (GWDF) is a well-recognized procedure. Recently, Ciaglia has introduced a one-step dilation technique using a curved, gradually tapered dilator, the Ciaglia Blue Rhino (CBR). In a prospective, randomized study, we performed percutaneous tracheostomy in 60 consecutive patients, using either the CBR or the GWDF technique. Postoperatively, all patients had bronchoscopy by a blinded consultant, and stoma characteristics and injuries to the trachea were studied. Mean tracheostomy time (skin incision to insertion of tracheostomy tube) in the two procedures (CBR 7.5 min versus GWDF 6.5 min) was not different (P > 0.05). The GWDF technique was associated with under-dilation and over-dilation of the tracheal stoma, each in almost one-third of patients. In the CBR group, the procedure was associated with a significant increase in peak airway pressure (P < 0.05) in all patients. There were nine cases of tracheal cartilage rupture, three cases of longitudinal tracheal abrasion, and one pneumothorax. Three patients had tracheal in-drawing at the scar site with huskiness of voice at 8 wk after decannulation; however, none had any breathing difficulty. We conclude that the techniques are equally effective in the formation of percutaneous tracheostomy. However, tracheal stoma over-dilation with GWDF and increase in peak airway pressure and rupture of tracheal rings with CBR remain major concerns.
IMPLICATIONS
The tracheas of 60 patients were cannulated through an artificial opening by using a single-step dilation technique with Ciaglia Blue Rhino or Griggs' dilation forceps. The techniques were equally effective for cannulation of the trachea. However, Ciaglia Blue Rhino was associated with rupture of tracheal rings in one-third of patients and increased airway pressure in all, whereas the Griggs' technique was associated with under- or over-formation of the tracheal opening, each in one-third of patients.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Dilatation; Female; Humans; Male; Middle Aged; Prospective Studies; Surgical Instruments; Tracheostomy
PubMed: 12456450
DOI: 10.1097/00000539-200212000-00050 -
Canadian Journal of Surgery. Journal... Nov 1980The authors review their experience over a 2-year period with transluminal arterial dilatation using the Grüntzig catheter. In 96 patients 136 aortoiliac or...
The authors review their experience over a 2-year period with transluminal arterial dilatation using the Grüntzig catheter. In 96 patients 136 aortoiliac or femoropopliteal arterial segments were dilated. The success rates at 1 year were 76% and 70%, respectively, for aortoiliac and femoropopliteal dilatations. The early and late results indicate that this procedure is useful in managing peripheral arterial occlusive disease in certain patients and that there are few complications when the procedure is carried out by a skilled angiographer.
Topics: Aortic Diseases; Arterial Occlusive Diseases; Dilatation; Femoral Artery; Humans; Iliac Artery; Popliteal Artery
PubMed: 7448658
DOI: No ID Found -
The American Journal of Gastroenterology Apr 1987Pneumatic dilation of the lower esophageal sphincter was accomplished by endoscopic visualization and positioning of a modified polyurethane dilator (90 F diameter)...
Pneumatic dilation of the lower esophageal sphincter was accomplished by endoscopic visualization and positioning of a modified polyurethane dilator (90 F diameter) without fluoroscopy in 17 consecutive patients with advanced symptomatic achalasia. All patients were monitored for completeness of dilation by pre- and postdilation radionuclide scintiscan. Despite advanced megaesophagus, prior dilatations, or complicating disease, all patients showed prompt relief of symptoms.
Topics: Adult; Aged; Dilatation; Esophageal Achalasia; Esophagoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Radionuclide Imaging
PubMed: 3565334
DOI: No ID Found