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Nigerian Journal of Clinical Practice 2014Pancreatic stents are used for a variety of conditions during therapeutic endoscopic retrograde cholangio pancreatography (ERCP). Pancreatic duct stenting reduces the...
Pancreatic stents are used for a variety of conditions during therapeutic endoscopic retrograde cholangio pancreatography (ERCP). Pancreatic duct stenting reduces the incidence of post-ERCP pancreatitis and facilitate bilitary cannulation in difficult cases. Proximal migration of a pancreatic stent during bile duct stone extraction is an infrequent event, but its management can be technically challenging. We present a case that a double flanged pancreatic stent (5 French (Fr), 5 cm) was placed to facilitate the bilitary cannulation during the bile duct stone extraction. The pancreatic duct stent migrated into the proximal pancreas duct at the end of the bile duct stone clearance. After two unsuccessful attempts to remove the impacted stent with a balloon catheter and forceps, wire-guided endoscopic snare retrieval was conducted. Firstly, a guide wire was placed in the pancreatic duct and a soft mini-snare was passed over the guide wire. Then, the mini-snare was advanced into the proximal pancreatic duct over the guide wire and the proximally migrated stent was removed successfully with the mini-snare. Wire-guided endoscopic snare retrieval of proximally migrated pancreatic stents is safe and effective. The successful case of the retrieval with mini-snare provides another option for proximal migration retrieval of pancreatic stent retrieval. Further studies are needed to confirm its effectiveness and elucidate its associated complications.
Topics: Aged, 80 and over; Cholangiopancreatography, Endoscopic Retrograde; Female; Fluoroscopy; Foreign-Body Migration; Gallstones; Humans; Pancreatic Ducts; Stents
PubMed: 24714023
DOI: 10.4103/1119-3077.130253 -
Journal of Youth and Adolescence Oct 2018Adolescent alcohol use is related to disinhibition traits and family environments. However, research is scarce on whether these factors predict alcohol use trajectories...
Adolescent alcohol use is related to disinhibition traits and family environments. However, research is scarce on whether these factors predict alcohol use trajectories distally, from early adolescence into early adulthood. We examined whether sensation seeking and parenting environments in early adolescence predicted adolescents' alcohol use trajectories proximally (middle-adolescence) and distally (early adulthood). Using four waves of data from 345 adolescents (51.3% female; 80% white) and their primary caregivers, we estimated adolescents' alcohol use trajectories and examined variability in these by sensation seeking and parental control. The findings revealed distal, positive associations between sensation seeking and alcohol use; and negative, proximal associations between parental control and alcohol use. Also proximally, there was a significant interaction between sensation seeking and parental control. We discuss implications for theory and practice.
Topics: Adolescent; Adolescent Behavior; Child; Female; Humans; Impulsive Behavior; Male; Parent-Child Relations; Parenting; Risk-Taking; Sensation; Underage Drinking; Young Adult
PubMed: 29905884
DOI: 10.1007/s10964-018-0874-x -
Interactive Cardiovascular and Thoracic... Jul 2021The objective of the study was to evaluate early and midterm outcomes after the frozen elephant trunk (FET) procedure with different proximal landing zones in patients...
OBJECTIVES
The objective of the study was to evaluate early and midterm outcomes after the frozen elephant trunk (FET) procedure with different proximal landing zones in patients with aortic dissection.
METHODS
Forty-four patients with type A and type B aortic dissection that extended down to the abdominal aorta were enrolled in the study. All of the patients had the FET procedure. The patients were divided in 2 groups according to the level of the proximal landing zone: the zone 2 (Z2) group and zone 3 (Z3) group. Early and midterm outcomes including the false lumen (FL) thrombosis rate were monitored in both groups.
RESULTS
The incidence of stroke, delirium and spinal cord ischaemia was 5.9% vs 3.7% (P = 0.533), 5.9% vs 7.4% (P = 0.903) and 5.9% vs 0 (P = 0.533) in the Z2 and Z3 groups, respectively. The 30-day mortality was 9.1% in both groups. The mean distal landing zone was T7.5 (T7; T9) in the Z2 group vs T9 (T8; T10) in the Z3 group (P = 0.668). The 2-year overall survival was 62.2% with no significant difference in the Z2 and Z3 groups (61.6% vs 64.2%; P = 0.940). There were no aortic-related deaths during the follow-up period. Freedom from reintervention at 24 months was 73% and was comparable between Z2 and Z3 (74.1% vs 91.7%; P = 0.123). The rate of early complete FL thrombosis was comparable in the Z2 and Z3 groups. By 24 months of observation in the Z3 group, the rate of complete FL thrombosis was significantly higher (60% vs 77%; P = 0.046).
CONCLUSIONS
No statistically significant differences were observed between landing zones 2 and 3 during the FET procedure with regard to early outcomes. Proximalization of the FET was associated with a shorter FL thrombosis in the midterm follow-up period that affected the distal aortic reintervention rate.
Topics: Aortic Dissection; Aorta, Abdominal; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Humans; Retrospective Studies; Treatment Outcome
PubMed: 33846749
DOI: 10.1093/icvts/ivab086 -
Revista de Gastroenterologia de Mexico 2001Proximal migration of a biliary stent is an uncommon event, but its management can present a technical challenge to the therapeutic endoscopist.
BACKGROUND
Proximal migration of a biliary stent is an uncommon event, but its management can present a technical challenge to the therapeutic endoscopist.
OBJECTIVE
We reviewed the methods that have been used for retrieval of proximally migrated biliary stents in a referral endoscopic center. PATIENTS-METHOD, AND RESULTS: From January 1995 to December 1998, there were 410 procedures for insertion of biliary stents. Eighteen patients had migrated biliary stents; 15 stents (83%) were extracted successfully. One half of the stents were retrieved by grasping the stent directly with a wire basket. Four were recovered using the Soehendra device, and a stone retrieval balloon alongside the stents to provide traction indirectly in two patients. Surgical techniques were necessary in three cases.
CONCLUSIONS
In patients with a dilated duct, indirect traction with a balloon or direct grasping of the stent with a wire basket is usually successful. Cannulating the stent lumen with a wire is often the best approach in patients with biliary stricture or nondilated duct. Using these techniques, most proximally migrated biliary stents can be retrieved endoscopically.
Topics: Bile Ducts; Endoscopy, Digestive System; Foreign-Body Migration; Humans; Prosthesis Failure
PubMed: 11464625
DOI: No ID Found -
International Journal of Colorectal... Feb 2018The purpose of this study is to estimate the detection rates of adenomas and serrated polyps and to identify proximalization and associate risk factors in patients from...
PURPOSE
The purpose of this study is to estimate the detection rates of adenomas and serrated polyps and to identify proximalization and associate risk factors in patients from Southern China.
METHODS
Consecutive patients undergoing colonoscopy from 2004 to 2013 in Guangzhou were included. The proportions of proximal adenomas to advanced adenomas and serrated polyps were compared and potential predictors were evaluated.
RESULTS
Colonoscopies (n = 62,560) were performed, and 11,427 patients were diagnosed with polyps. Detection rates for adenomas, hyperplastic polyps, and serrated adenomas were 12.0, 2.5, and 0.2 patients per 100 colonoscopies. When comparing the 1st (2004-2008) to the 2nd period (2009-2013), adenoma and serrated polyp detection in proximal and distal colon both increased significantly (proximal colon [adenoma 3.9 vs. 6.1 patients/100 colonoscopies, P < 0.001; serrated polyp 0.4 vs. 1.1 patients/100 colonoscopies, P < 0.001]; distal colon [adenoma 6.6 vs. 7.2 patients/100 colonoscopies, P = 0.003; serrated polyp 1.2 vs. 2.4 patients/100 colonoscopies, P < 0.001]). Advanced adenoma detection increased over these two periods only in proximal colon (1st vs. 2nd period: 1.5 vs. 2.4 patients/100 colonoscopies, P < 0.001), not the distal colon (P = 0.114). Multivariate analyses showed that diagnostic period was an independent predictor for adenoma proximalization (OR = 1.36, 95% CI 1.25-1.48, P < 0.001), but not for advanced adenomas (P = 0.117) or serrated polyps (P = 0.928).
CONCLUSIONS
Adenomas and serrated polyps were increasingly detected throughout the colon, whereas advanced adenomas were only in proximal colon. A proximal shift tendency detected by colonoscopy was observed for adenomas, but not advanced adenomas or serrated polyps, in Southern China. The screening for proximal polyps should be emphasized and colonoscopy might be a preferred initial screening tool.
Topics: Adenoma; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Child, Preschool; Colonic Polyps; Colonoscopy; Demography; Female; Humans; Infant; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Young Adult
PubMed: 29282495
DOI: 10.1007/s00384-017-2951-0 -
Annals of Vascular Surgery Jul 2017The patency of long-term hemodialysis access in end-stage renal disease patients remains a significant challenge. Often these patients are affected with limited venous...
BACKGROUND
The patency of long-term hemodialysis access in end-stage renal disease patients remains a significant challenge. Often these patients are affected with limited venous outflow options, requiring limb abandonment, and creation of new access in the contralateral arm. Vascular surgeons are familiar with the exposure of the proximal axillary artery via an infraclavicular incision. The axillary vein is easily exposed through this technique. The use of the hybrid Gore graft can make the venous anastomosis easier. A hybrid graft with its venous outflow placed in the proximal axillary vein can extend the options of upper extremity access procedures. We reviewed our early experience with this technique.
METHODS
A review of dialysis procedures at the Loma Linda VA was performed. All patients undergoing placement of arteriovenous grafts utilizing the Gore hybrid placed into the proximal axillary vein for outflow were identified. Outcomes in terms of primary and secondary patency rates were determined.
RESULTS
Eight patients had placement of an arteriovenous hybrid graft in the proximal axillary vein via an infraclavicular incision. All patients had exhausted other options for hemodialysis access in the ipsilateral upper extremity. All grafts were used successfully for dialysis. The mean primary and secondary patency rates at 6 months were 37.5% and 62.5%, respectively. One patient developed steal syndrome, requiring proximalization of the graft. Seven out of the 8 patients required secondary procedures including thrombectomy (n = 16) and angioplasty (n = 17).
CONCLUSIONS
Placement of a hybrid graft in the proximal axillary vein is an effective and suitable option for patients who have exhausted arteriovenous access sites in the arm. This procedure can easily be performed in an outpatient setting with a low complication rate and allowing for preservation of the contralateral upper extremity for future use.
Topics: Aged; Aged, 80 and over; Arteriovenous Shunt, Surgical; Axillary Vein; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; California; Female; Graft Occlusion, Vascular; Humans; Kidney Failure, Chronic; Male; Middle Aged; Phlebography; Prosthesis Design; Regional Blood Flow; Renal Dialysis; Retrospective Studies; Risk Factors; Sutureless Surgical Procedures; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 28344184
DOI: 10.1016/j.avsg.2017.02.002 -
Fertility and Sterility May 2005To describe proximal occlusion of a hydrosalpinx by hysteroscopic placement of a microinsert before IVF-ET.
OBJECTIVE
To describe proximal occlusion of a hydrosalpinx by hysteroscopic placement of a microinsert before IVF-ET.
DESIGN
Case report.
SETTING
Health maintenance organization and tertiary-care assisted reproductive technology unit.
PATIENT(S)
Obese, infertile woman with pelvic adhesive disease and unilateral hydrosalpinx.
INTERVENTION(S)
Hysteroscopic placement of a microinsert into the proximal segment of a fallopian tube that was distally obstructed by hydrosalpinx. No intraoperative or postoperative complications occurred with hysteroscopic placement of microinsert.
MAIN OUTCOME MEASURE(S)
Nonincisional proximal tubal occlusion under local anesthesia and intravenous sedation. Pregnancy by IVF-ET.
RESULT(S)
No intraoperative or postoperative complications with hysteroscopic placement of microinsert were seen. After uterine transfer of three embryos, dichorionic-diamniotic twins were delivered by cesarean section at 34 weeks of gestation.
CONCLUSIONS(S)
Hysteroscopic placement of a microinsert to proximally occlude a hydrosalpinx might be an alternative to laparoscopic proximal tubal occlusion or salpingectomy in patients with tubal disease planning IVF-ET.
Topics: Adult; Embryo Transfer; Fallopian Tubes; Female; Fertilization in Vitro; Humans; Hysteroscopy; Laparoscopy; Live Birth
PubMed: 15866598
DOI: 10.1016/j.fertnstert.2004.10.056 -
Journal of Orthopaedic Trauma Jul 2003To determine the specific frame construction strategies that can increase the stability of hybrid (ring with tensioned wires proximally connected by bars to half-pins...
OBJECTIVE
To determine the specific frame construction strategies that can increase the stability of hybrid (ring with tensioned wires proximally connected by bars to half-pins distally) external fixation of proximal tibia fractures. DESIGN Repeated measures biomechanical testing.
SETTING
Laboratory.
SPECIMENS
Composite fiberglass tibias.
METHODS
Using the Heidelberg and Ilizarov systems, external fixators were tested on composite fiberglass tibias with a 1-cm proximal osteotomy (OTA fracture classification 41-A3.3) in seven frame configurations: unilateral frames with 5-mm diameter half-pins and 6-mm diameter half-pins; hybrid (as described above), with and without a 6-mm anterior proximal half-pin; a "box" hybrid (additional ring group distal to the fracture connected by symmetrically spaced bars to the proximal rings) with and without an anterior, proximal half-pin; and a full, four-ring configuration. Each configuration was loaded in four positions (central, medial, posterior, and posteromedial).
MAIN OUTCOME MEASUREMENTS
Displacement at point of loading of proximal fragment.
RESULTS
The "box" hybrid was stiffer than the standard hybrid for all loading positions. The addition of an anterior half-pin stiffened the standard hybrid and the "box" hybrid.
CONCLUSIONS
The most dramatic improvements in the stability of hybrid frames used for proximal tibial fractures result from addition of an anterior, proximal half-pin.
Topics: Biomechanical Phenomena; Equipment Design; External Fixators; Tibial Fractures
PubMed: 12843726
DOI: 10.1097/00005131-200307000-00005 -
Case Reports in Radiology 2012Popliteal cysts are swellings in the popliteal fossa due to enlargement of the gastrocnemius semimembranous bursa. These cysts might burst, and they usually rupture...
Popliteal cysts are swellings in the popliteal fossa due to enlargement of the gastrocnemius semimembranous bursa. These cysts might burst, and they usually rupture posteriorly and inferiorly with severe pain in the calf. We describe a patient with popliteal cyst that dissected proximally and ruptured in the soft tissue of the thigh.
PubMed: 23094179
DOI: 10.1155/2012/292414 -
The Journal of Physiology Mar 2021The post-exercise recovery of phosphocreatine, a measure of the oxidative capacity of muscles, as assessed by P MR spectroscopy, shows a striking increase from distal...
KEY POINTS
The post-exercise recovery of phosphocreatine, a measure of the oxidative capacity of muscles, as assessed by P MR spectroscopy, shows a striking increase from distal to proximal along the human tibialis anterior muscle. To investigate why this muscle exhibits a greater oxidative capacity proximally, we tested whether the spatial variation in phosphocreatine recovery rate is related to oxygen supply, muscle fibre type or type of exercise. We revealed that oxygen supply also increases from distal to proximal along the tibialis anterior, and that it strongly correlated with phosphocreatine recovery. Carnosine level, a surrogate measure for muscle fibre type was not different between proximal and distal, and type of exercise did not affect the gradient in phosphocreatine recovery rate. Taken together, the findings of this study suggest that the post-exercise spatial gradients in oxygen supply and phosphocreatine recovery are driven by a higher intrinsic mitochondrial oxidative capacity proximally.
ABSTRACT
Phosphorus magnetic resonance spectroscopy ( P MRS) of human tibialis anterior (TA) revealed a strong proximo-distal gradient in the post-exercise phosphocreatine (PCr) recovery rate constant (k ), a measure of muscle oxidative capacity. The aim of this study was to investigate whether this k gradient is related to O supply, resting phosphorylation potential, muscle fibre type, or type of exercise. Fifteen male volunteers performed continuous isometric ankle dorsiflexion at 30% maximum force until exhaustion. At multiple locations along the TA, we measured the oxidative PCr resynthesis rate (V = k × PCr depletion) by P MRS, the oxyhaemoglobin recovery rate constant (k ) by near infrared spectroscopy, and muscle perfusion with MR intravoxel incoherent motion imaging. The k , k , V and muscle perfusion depended on measurement location (P < 0.001, P < 0.001, P = 0.032 and P = 0.003, respectively), all being greater proximally. The k and muscle perfusion correlated with k (r = 0.956 and r = 0.852, respectively) and V (r = 0.932 and r = 0.985, respectively), the latter reflecting metabolic O consumption. Resting phosphorylation potential (PCr/inorganic phosphate) was also higher proximally (P < 0.001). The surrogate for fibre type, carnosine content measured by H MRS, did not differ between distal and proximal TA (P = 0.884). Performing intermittent exercise to avoid exercise ischaemia, still led to larger k proximally than distally (P = 0.013). In conclusion, the spatial k gradient is strongly associated with the spatial variation in O supply. It cannot be explained by exercise-induced ischaemia nor by fibre type. Our findings suggest it is driven by a higher proximal intrinsic mitochondrial oxidative capacity, apparently to support contractile performance of the TA.
Topics: Adenosine Triphosphate; Exercise; Humans; Male; Muscle Contraction; Muscle, Skeletal; Phosphocreatine
PubMed: 33369737
DOI: 10.1113/JP280771