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Urolithiasis Jun 2014Minimizing X-ray exposure during percutaneous nephrolithotomy (PCNL) is challenging. Using the single semirigid dilator, also called "one-shot" or "one-stage" is a good... (Comparative Study)
Comparative Study Randomized Controlled Trial
Minimizing X-ray exposure during percutaneous nephrolithotomy (PCNL) is challenging. Using the single semirigid dilator, also called "one-shot" or "one-stage" is a good alternative to routine telescopic metal dilators to reduce X-ray exposure. Our aim was to compare the single semirigid one-shot dilator with a telescopic metal dilator in PCNL. The intraoperative status was evaluated in 100 consecutive patients randomly assigned to two equal groups undergoing PCNL either with the one-shot (group A) or telescopic technique (group B). No significant difference in stone burden and location existed between the groups (P > 0.05). The mean age of group A and group B was 44.8 ± 15 and 45.6 ± 14 years, respectively (P = 0.78). The mean operation time was 51.14 ± 40.85 min in group A and 57.00 ± 38.85 min in group B (P = 0.46). The mean X-ray exposure time was 41.2 ± 17 and 48.4 ± 15 s in group A and group B, respectively (P = 0.03). The stone-free rate was 94 % (n = 47) in group A and 84 % (n = 42) in group B (P = 0.10). The mean hemoglobin drop was 1.26 ± 0.09 and 1.44 ± 0.11 g/dl in group A and group B, respectively (P = 0.09). The one-shot technique is feasible, safe, and well tolerated in patients undergoing PCNL. In addition to lack of complications, the method also provides less radiation exposure for urologists and nursing teams.
Topics: Adult; Aged; Aged, 80 and over; Dilatation; Female; Fluoroscopy; Humans; Kidney Calculi; Male; Metals; Middle Aged; Nephrostomy, Percutaneous; Radiation Dosage; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 24531816
DOI: 10.1007/s00240-014-0644-5 -
Journal of Endourology Mar 2008Percutaneous nephrolithotomy (PCNL) can be done in patients who have previously had open nephrolithotomy. Currently, dilatation of the nephrostomy tract is achieved... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND AND PURPOSE
Percutaneous nephrolithotomy (PCNL) can be done in patients who have previously had open nephrolithotomy. Currently, dilatation of the nephrostomy tract is achieved using an Amplatz renal dilator or telescopic metal dilators in these patients. The aim of this study was to compare the safety and efficacy of the "one-shot" procedure in patients with previous open nephrolithotomy with those of the current telescopic technique.
PATIENTS AND METHODS
Thirty-one patients with past history of open surgery for kidney stone disease underwent PCNL at our institution from February 2006 to March 2007. Patients were randomly divided into two groups according to dilation technique used: group A (telescopic procedure) and group B (one-shot procedure). X-ray exposure, blood loss, and complications were evaluated.
RESULTS
No significant difference in hemoglobin decrease was seen in the two groups. The stone-free and complication rates were the same in the two groups. Fluoroscopy time during the one-shot procedure was significantly shorter than that of the telescopic procedure (P < 0.000).
CONCLUSION
Our experience indicated that the one-shot procedure is feasible in patients with previous open nephrolithotomy. It is as safe and effective as the telescopic procedure, with significant reduction in x-ray exposure.
Topics: Adult; Aged; Dilatation; Female; Humans; Kidney Calculi; Male; Middle Aged; Nephrostomy, Percutaneous; Radiation Dosage; Reoperation; X-Rays
PubMed: 18271716
DOI: 10.1089/end.2007.0206 -
Rhinology Dec 2006Most studies on nasal dilators have used Breathe Right or Nozovent. Both devices dilate the nasal valves, reduce nasal resistance, and improve nasal airflow. The use of... (Review)
Review
Most studies on nasal dilators have used Breathe Right or Nozovent. Both devices dilate the nasal valves, reduce nasal resistance, and improve nasal airflow. The use of dilators improves airflow most on inspiration, as the valve is stabilised and prevented from collapse. The response varies greatly between individuals, and can be impressive. The effect of nasal dilators may be lower in non-Caucasians. During exercise, nasal dilators delay the onset of oronasal breathing, and can have only small effects on performance thereafter. Nozovent and Breathe Right can reduce snoring, and improve otherwise obstructed breathing during sleep in selected patients. It is a challenge to find those patients, and one way could be to perform polysomnography with and without nasal dilator.
Topics: Airway Resistance; Dilatation; Exercise; Humans; Nasal Cavity; Nasal Obstruction; Snoring
PubMed: 17216739
DOI: No ID Found -
East African Medical Journal Jul 1992Ten patients with pinhole urethral strictures were treated by introducing a flexible guide wire endoscopically through the stricture then passing flexible hollow...
Ten patients with pinhole urethral strictures were treated by introducing a flexible guide wire endoscopically through the stricture then passing flexible hollow dilators over the wire across the stricture. The procedure was successful in 9 out of 10 patients. It inflicts minimal trauma to the urethra and is recommended as a practical substitute for optical urethrotomy where the latter is not available.
Topics: Academic Medical Centers; Adult; Cystoscopy; Dilatation; Humans; Male; Middle Aged; Tanzania; Urethral Stricture; Urography
PubMed: 1396193
DOI: No ID Found -
Gastrointestinal Endoscopy Oct 2017Esophageal dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal dilation... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Esophageal dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal dilation in EoE, especially regarding perforation risk, and to examine perforation risk by dilator type.
METHODS
We conducted a systematic review of the published literature from January 1, 1950 to June 30, 2016 using PubMed, EMBASE, and Web of Science. Studies were included if they described patients with EoE who underwent elective esophageal dilation and also reported the presence or absence of at least 1 adverse event (eg, perforation, bleeding, pain, or hospitalization). We used random-effects meta-analysis to estimate the frequency of each adverse event.
RESULTS
Of 923 identified articles, 37 met inclusion criteria and represented 2034 dilations in 977 patients. On meta-analysis, postprocedure hospitalization occurred in .689% of dilations (95% confidence interval [CI], 0%-1.42%), clinically significant GI hemorrhage in .028% (95% CI, 0%-.217%), and clinically significant chest pain in 3.64% (95% CI, 1.73%-5.55%). Nine perforations were documented, at a rate of .033% (95% CI, 0%-.226%) per procedure after meta-analysis. None of the perforations resulted in surgical intervention or mortality. Most (5/9) were reported before 2009 (rate, .41% [95% CI, 0%-2.75%]); from 2009 forward the rate was .030% (95% CI, 0%-.225%). Dilation method was described in 30 studies (1957 dilations), in which 4 perforations were detected. The estimated perforation rate for bougies was .022% (95% CI, 0%-.347%) and for balloons was .059% (95% CI, 0%-.374%).
CONCLUSIONS
Perforation from esophageal dilation in EoE is rare, and there is no evidence of a significant difference in perforation risk related to dilator type. Esophageal dilation should be considered a safe procedure in EoE.
Topics: Chest Pain; Dilatation; Eosinophilic Esophagitis; Esophageal Perforation; Esophagoscopy; Gastrointestinal Hemorrhage; Hospitalization; Humans; Pain, Postoperative; Postoperative Complications; Postoperative Hemorrhage
PubMed: 28461094
DOI: 10.1016/j.gie.2017.04.028 -
Obstetrics and Gynecology Aug 1983The present study demonstrates that low-power ultrasonic activation of Hegar dilators reduces the mechanical force required for dilatation of the cervix. The acute and...
The present study demonstrates that low-power ultrasonic activation of Hegar dilators reduces the mechanical force required for dilatation of the cervix. The acute and possible late effects of an ultrasonic dilator on the cervical mucosa in the sow were evaluated by histologic study and compared to the effects of similar mechanical dilatation. In both groups early effects were mild to moderate edema and vascular congestion of the cervical mucosa. The immediate changes were comparatively more pronounced after ultrasonic dilatation. No significant pathologic differences were noted five weeks after ultrasonic dilatation of the endocervical canal. Further study may prove the device useful for dilatation of the stenosed cervix and urethra in women.
Topics: Animals; Cervix Mucus; Cervix Uteri; Dilatation; Female; Swine; Ultrasonics; Ultrasonography
PubMed: 6866367
DOI: No ID Found -
Chest Surgery Clinics of North America Aug 1995The widespread use of flexible upper gastrointestinal (GI) endoscopy has renewed interest in management of strictures of the esophagus, including dilation. The rubber...
The widespread use of flexible upper gastrointestinal (GI) endoscopy has renewed interest in management of strictures of the esophagus, including dilation. The rubber Maloney dilator is the most common dilator used, usually for symmetrical strictures 1.2 cm or greater in diameter. The "through the scope" (TTS) balloon dilators usually are used in asymmetrical strictures 1.2 cm or greater in diameter and are especially valuable if fluoroscopy is not available. The new thermoplastic Savary dilators, used with a guidewire and usually with fluoroscopy, have replaced the Eder-Puestow bougies. They are especially useful in difficult strictures that are 1.0 cm or less in diameter and are fibrotic or have transmural fibrosis.
Topics: Catheterization; Dilatation; Esophageal Stenosis; Evaluation Studies as Topic; Humans
PubMed: 7583033
DOI: No ID Found -
Gastrointestinal Endoscopy Dec 1998Antibiotic prophylaxis has been recommended for selected patients undergoing esophageal stricture dilation because of a reported high rate of bacteremia. The aim of this...
BACKGROUND
Antibiotic prophylaxis has been recommended for selected patients undergoing esophageal stricture dilation because of a reported high rate of bacteremia. The aim of this study was to determine the rate of bacteremia after esophageal dilatation in a large series and the source of the organisms recovered.
METHODS
Blood cultures and oral temperatures were obtained before esophageal dilation and at 5 and 30 minutes after dilation. Dilators were cultured immediately before dilation. Procedural data collected included type of dilation, number of passes, and presence of malignancy.
RESULTS
Of 100 procedures in 86 patients undergoing esophageal dilation, 22 (22%) were associated with a positive post-dilation blood culture. Bacteremia was more frequent with dilation of malignant strictures compared with benign strictures (9 of 17 [52.9%] vs. 13 of 83 [15.7%], respectively, p = 0.002) and with passage of multiple dilators compared with passage of a single dilator (16 of 46 [34.8%] versus 6 of 54 [11.1%], respectively, p = 0.007). Bacterial isolates from 22 positive blood cultures matched those from a dilator in only one episode (4.5%).
CONCLUSION
The rate of bacteremia after esophageal dilation is 22% and is associated with dilation of malignant strictures or passage of multiple dilators. Organisms cultured from the blood are not transmitted from the dilator.
Topics: Bacteremia; Dilatation; Disinfection; Equipment Contamination; Esophageal Neoplasms; Esophageal Stenosis; Humans; Risk Factors; Time Factors
PubMed: 9852444
DOI: 10.1016/s0016-5107(98)70036-7 -
Alimentary Pharmacology & Therapeutics Jul 2017Oesophageal dilation is frequently used as an adjunct treatment to alleviate symptoms that develop from fibrostenotic remodelling in eosinophilic oesophagitis (EoE).... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Oesophageal dilation is frequently used as an adjunct treatment to alleviate symptoms that develop from fibrostenotic remodelling in eosinophilic oesophagitis (EoE). Earlier reports described an increased risk of complications associated with dilation.
AIM
Perform a systematic review and meta-analysis to assess the efficacy and safety of endoscopic dilation in children and adults with EoE.
METHODS
Professional librarians searched MEDLINE, EMBASE, the Cochrane library, Scopus, and Web of Science for articles in any language describing studies of dilation in EoE through December 2016. Studies were selected and data were abstracted independently and in duplicate. Random effects modelling was used to generate summary estimates for clinical improvement and complications (haemorrhage, perforation, hospitalisation, and death).
RESULTS
The search resulted in 3495 references, of which 27 studies were included in the final analysis. The studies described 845 EoE patients, including 87 paediatric patients, who underwent a total of 1820 oesophageal dilations. The median number of dilations was 3 (range: 1-35). Clinical improvement occurred in 95% of patients (95% CI: 90%-98%, I : 10%, 17 studies). Perforation occurred in 0.38% (95% CI: 0.18%-0.85%, I : 0%, 27 studies), haemorrhage in 0.05% (95% CI: 0%-0.3%, I : 0%, 18 studies), and hospitalisation in 0.67% (95% CI: 0.3%-1.1%, I : 44%, 24 studies). No deaths occurred (95% CI: 0%-0.2% I : 0%, 25 studies).
CONCLUSIONS
Endoscopic dilation is consistently effective in children and adults with EoE, resulting in improvement in 95% of patients with very low rates (<1%) of major complications.
Topics: Adult; Child; Dilatation; Eosinophilic Esophagitis; Esophagoscopy; Humans
PubMed: 28513085
DOI: 10.1111/apt.14123 -
American Journal of Otolaryngology 2024Balloon dilation of the Eustachian tube (BDET) has not been evaluated extensively in children outside of retrospective case series. The purpose of this study is to...
PURPOSE
Balloon dilation of the Eustachian tube (BDET) has not been evaluated extensively in children outside of retrospective case series. The purpose of this study is to report the long-term safety and efficacy of this procedure in children with matched controls.
MATERIALS AND METHODS
This is a two-center retrospective matched cohort study. Children having undergone tympanostomy tube (TT) placement and adenoidectomy with recurrence of symptoms underwent BDET at an academic affiliated multi-specialty practice. Comparison was made with children receiving TT at a tertiary medical center, matching for number of prior TT, prior adenoidectomy, age, and sex. Outcome measures were risk of failure and the need for additional surgery. Kaplan-Meier survival plots were used to compare risk of failure.
RESULTS
Thirty-three Eustachian tubes were dilated in 20 patients, aged 14 months-14 years. All patients had previously undergone TT insertion and adenoidectomy. Patients undergoing BDET had normal post-operative tympanograms in 80 % of cases. Mean follow up was 6.7 years with 2 patients failing in the BDET group and 8 in the TT insertion group. Dilated patients had a significantly lower risk of failure than those who underwent TT insertion (adjusted HR: 0.18; 95 % CI: 0.04, 0.81; p = 0.03). The probability of being failure free at six years was 88 % (95 % CI: 71, 95 %) in the BDET cohort and 53 % (95 % CI: 33, 70 %) in the TT insertion cohort. There were no complications.
CONCLUSIONS
BDET appears to be safe and possibly superior to TT placement in children with refractory Eustachian tube dysfunction.
LEVEL OF EVIDENCE
2b.
Topics: Humans; Eustachian Tube; Male; Female; Child; Retrospective Studies; Dilatation; Child, Preschool; Adolescent; Infant; Adenoidectomy; Middle Ear Ventilation; Treatment Outcome; Time Factors; Follow-Up Studies; Cohort Studies
PubMed: 38154198
DOI: 10.1016/j.amjoto.2023.104208