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Journal of Pediatric Surgery Mar 2021There are some studies about the effect of postoperative anal dilatation on anastomotic stenosis and Hirschsprung-associated enterocolitis (HAEC), but we have not seen...
BACKGROUND/PURPOSE
There are some studies about the effect of postoperative anal dilatation on anastomotic stenosis and Hirschsprung-associated enterocolitis (HAEC), but we have not seen any report about preoperative anal dilatation. We hypothesized that preoperative anal dilatation could reduce the incidence of HAEC and facilitate the operation. We aim to compare the HAEC rates and postoperative complications between groups who either had or did not have anal dilatations (AD or NAD) prescribed before laparoscopic-assisted Soave pull-through procedures for Hirschsprung disease (HD); by this means, we will evaluate the benefit of dilatations before the surgery for HD.
METHODS
A retrospective review of children with HD operated in our hospital between 2014 and 2018 was performed. Those with 21 trisomy, total colonic aganglionosis, multiple stage procedures, serious congenital malformations, and lost to follow-up were excluded. Patients were divided into preoperative anal dilatation group (AD group) and no preoperative anal dilatation group (NAD group). Routine anal dilatation was performed in both groups from 2 weeks after laparoscopic-assisted Soave pull-through. The anal dilatation was carried out daily with metal anal dilators with size appropriate to the age of the child. The size of the anal dilators was increased by 1 mm every 2 weeks for at least 3 months. Demographic data, operation time, pre- and postoperative HAEC rates and postoperative obstructive symptoms between groups were compared. Significance was considered at P < 0.05.
RESULTS
There were 95 children (17 female and 78 male) included, 36 AD and 59 NAD. There was no significant difference in demographic data between the two groups. The incidence of HAEC between the groups was not different both preoperatively (14% vs. 24%, P = 0.298) and postoperatively (11% vs. 19%, P = 0.171). The postoperative obstructive symptoms rates were 19% versus 22% for the AD and NAD groups, respectively (P = 0.802). The operation time of group AD was significantly shorter than that of group NAD (P = 0.008). Preoperative anal dilatation could shorten the operation time in short and typical-segment (2.08 ± 0.39 vs. 2.67 ± 0.37, P = 0.009 and 3.05 ± 0.38 vs. 3.29 ± 0.46, P = 0.042), but has no significant effect on long-segment disease (3.85 ± 0.41 vs. 3.89 ± 0.30, P = 0.839).
CONCLUSION
We have not shown a reduced risk of developing HAEC or postoperative obstructive symptoms if anal dilatations are prescribed before surgery. However, it may decrease the difficulties of surgeries, so the operative time is shortened.
LEVEL OF EVIDENCE
Prognosis study.
LEVEL
II.
Topics: Anal Canal; Child; Digestive System Surgical Procedures; Dilatation; Enterocolitis; Female; Hirschsprung Disease; Humans; Infant; Male; Postoperative Complications; Retrospective Studies
PubMed: 32534905
DOI: 10.1016/j.jpedsurg.2020.05.008 -
The Cochrane Database of Systematic... 2014Achalasia is an oesophageal motility disorder, of unknown cause, which results in increased lower oesophageal sphincter (LOS) tone and symptoms of difficulty swallowing.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Achalasia is an oesophageal motility disorder, of unknown cause, which results in increased lower oesophageal sphincter (LOS) tone and symptoms of difficulty swallowing. Treatments are aimed at reducing the LOS tone. Current endoscopic therapeutic options include pneumatic dilation (PD) or botulinum toxin (BTX) injection.
OBJECTIVES
To undertake a systematic review comparing the efficacy and safety of two endoscopic treatments, PD and intrasphincteric BTX injection, in the treatment of oesophageal achalasia.
SEARCH METHODS
Trials were initially identified by searching MEDLINE (1966 to August 2008), EMBASE (1980 to September 2008), ISI Web of Science (1955 to September 2008), The Cochrane Library Issue 3, 2008. Searches in all databases were conducted in October 2005 and updated in September 2008 and April 2014. The Cochrane highly sensitive search strategy for identifying randomised trials in MEDLINE, sensitivity maximising version in the Ovid format, was combined with specific search terms to identify randomised controlled trials in MEDLINE. The MEDLINE search strategy was adapted for use in the other databases that were searched.
SELECTION CRITERIA
Randomised controlled trials comparing PD to BTX injection in individuals with primary achalasia.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study quality assessment and data extraction.
MAIN RESULTS
Seven studies involving 178 participants were included. Two studies were excluded from the meta-analysis of remission rates on the basis of clinical heterogeneity of the initial endoscopic protocols. There was no significant difference between PD or BTX treatment in remission within four weeks of the initial intervention; with a risk ratio of remission of 1.11 (95% CI 0.97 to 1.27). There was also no significant difference in the mean oesophageal pressures between the treatment groups; with a weighted mean difference for PD of -0.77 (95% CI -2.44 to 0.91, P = 0.37). Data on remission rates following the initial endoscopic treatment were available for three studies at six months and four studies at 12 months. At six months 46 of 57 PD participants were in remission compared to 29 of 56 in the BTX group, giving a risk ratio of 1.57 (95% CI 1.19 to 2.08, P = 0.0015); whilst at 12 months 55 of 75 PD participants were in remission compared to 27 of 72 BTX participants, with a risk ratio of 1.88 (95% CI 1.35 to 2.61, P = 0.0002). No serious adverse outcomes occurred in participants receiving BTX, whilst PD was complicated by perforation in three cases.
AUTHORS' CONCLUSIONS
The results of this meta-analysis suggest that PD is the more effective endoscopic treatment in the long term (greater than six months) for patients with achalasia.
Topics: Anti-Dyskinesia Agents; Botulinum Toxins; Catheterization; Dilatation; Esophageal Achalasia; Humans; Randomized Controlled Trials as Topic; Remission Induction; Time Factors
PubMed: 25485740
DOI: 10.1002/14651858.CD005046.pub3 -
Annals of Thoracic and Cardiovascular... 2012Radical treatment for achalasia is currently unavailable. At present, most palliative procedures are designed improve the passage of food through the gastroesophageal... (Review)
Review
Radical treatment for achalasia is currently unavailable. At present, most palliative procedures are designed improve the passage of food through the gastroesophageal junction and thereby alleviate symptoms. Drug therapy is of limited, transient effectiveness. Pneumatic dilation (PD) is considered superior to endoscopic botulinum toxin injection (EBTI). The mainstay of surgical treatment for achalasia is laparoscopic Heller myotomy (LHM) with fundoplication, currently considered superior to PD. Per oral endoscopic myotomy (POEM), a "state-of-the-art" procedure for minimally invasive surgery, holds great promise for the future management of achalasia. Definitive conclusions regarding the benefits and risks of currently available treatments for achalasia must await the accumulation of evidence from well-designed clinical trials.
Topics: Dilatation; Esophageal Achalasia; Esophagogastric Junction; Esophagoplasty; Fundoplication; Humans; Laparoscopy; Treatment Outcome
PubMed: 23099422
DOI: 10.5761/atcs.ra.12.01949 -
Current Eye Research Mar 2023Intraocular pressure (IOP) is an important factor in numerous ocular conditions and research areas, including eye growth and myopia. In infant monkeys, IOP is typically...
PURPOSE
Intraocular pressure (IOP) is an important factor in numerous ocular conditions and research areas, including eye growth and myopia. In infant monkeys, IOP is typically measured under anesthesia. This study aimed to establish a method for awake IOP measurement in infant rhesus monkeys, determine diurnal variation, and assess the effects of dilation and sedation.
METHODS
Awake IOP (iCare TonoVet) was measured every 2 h from 7:30 am to 5:30 pm to assess potential diurnal variations in infant rhesus monkeys (age 3 weeks, = 11). The following day, and every 2 weeks to age 15 weeks, IOP was measured under three conditions: (1) awake, (2) awake and dilated (tropicamide 0.5%), and (3) sedated (ketamine and acepromazine) and dilated. Intraclass correlation coefficient (ICC) was used to determine intersession repeatability, and repeated measures. ANOVA was used to determine effects of age and condition.
RESULTS
At age 3 weeks, mean (±SEM) awake IOP was 15.4 ± 0.6 and 15.2 ± 0.7 mmHg for right and left eyes, respectively (=.59). The ICC between sessions was 0.63[-0.5 to 0.9], with a mean difference of 2.2 ± 0.3 mmHg. Diurnal IOP from 7:30 am to 5:30 pm showed no significant variation (=.65). From 3 to 15 weeks of age, there was a significant effect of age (=.01) and condition (<.001). Across ages, IOP was 17.8 ± 0.7 mmHg while awake and undilated, 18.4 ± 0.2 mmHg awake and dilated, and 11.0 ± 0.3 mmHg after sedation and dilation.
CONCLUSIONS
Awake IOP measurement was feasible in young rhesus monkeys. No significant diurnal variations in IOP were observed between 7:30 am and 5:30 pm at age 3 weeks. In awake monkeys, IOP was slightly higher after mydriasis and considerably lower after sedation. Findings show that IOP under ketamine/acepromazine anesthesia is significantly different than awake IOP in young rhesus monkeys.
Topics: Animals; Intraocular Pressure; Macaca mulatta; Ketamine; Acepromazine; Dilatation; Tonometry, Ocular; Glaucoma, Open-Angle; Anesthesia
PubMed: 36357337
DOI: 10.1080/02713683.2022.2141782 -
Best Practice & Research. Clinical... Oct 2015Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease that is increasingly recognized as one of the most common causes of dysphagia and foregut symptoms... (Review)
Review
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease that is increasingly recognized as one of the most common causes of dysphagia and foregut symptoms in adults and children. Topical corticosteroids, elimination diets, and esophageal dilations are effective options for both induction and maintenance therapy in EoE. Current pharmacologic options are being used off-label as no agent has yet been approved by regulatory authorities. Little is known about the natural history of EoE, however, raising controversy regarding the necessity of maintenance and therapy in asymptomatic or treatment-refractory patients. Furthermore, variability in treatment endpoints used in EoE clinical trials makes interpretation and comparability of EoE treatments challenging. Recent validation of a patient-related outcome (PRO) instruments, a histologic scoring tool, and an endoscopic grading system for EoE are significant advances toward establishing consistent treatment endpoints.
Topics: Deglutition Disorders; Diet Therapy; Dilatation; Eosinophilic Esophagitis; Glucocorticoids; Humans
PubMed: 26552781
DOI: 10.1016/j.bpg.2015.09.002 -
Pulmonary Medicine 2016. To systematically review the international literature for studies evaluating internal (NoZovent) and external (Breathe Right Strips) nasal dilators as treatment for... (Meta-Analysis)
Meta-Analysis Review
. To systematically review the international literature for studies evaluating internal (NoZovent) and external (Breathe Right Strips) nasal dilators as treatment for obstructive sleep apnea (OSA). . Systematic review with meta-analysis. . Four databases, including PubMed/MEDLINE, were searched through September 29, 2016. . One-hundred twelve studies were screened, fifty-eight studies were reviewed, and fourteen studies met criteria. In 147 patients, the apnea-hypopnea index (AHI) was reported, and there was an improvement from a mean ± standard deviation (M ± SD) of 28.7 ± 24.0 to 27.4 ± 23.3 events/hr, value 0.64. There was no significant change in AHI, lowest oxygen saturation, or snoring index in OSA patients when using nasal dilators. However, a subanalysis demonstrated a slight reduction in apnea index (AI) with internal nasal dilators (decrease by 4.87 events/hr) versus minimal change for external nasal dilators (increase by 0.64 events/hr). . Although nasal dilators have demonstrated improved nasal breathing, they have not shown improvement in obstructive sleep apnea outcomes, with the exception of mild improvement in apnea index when internal nasal dilators were used.
Topics: Airway Management; Clinical Trials as Topic; Dilatation; Equipment Design; Humans; Severity of Illness Index; Sleep Apnea, Obstructive; Snoring; Treatment Outcome
PubMed: 28070421
DOI: 10.1155/2016/4841310 -
World Journal of Gastroenterology Jan 2010Pneumatic dilation (PD) is considered to be the first line nonsurgical therapy for achalasia. The principle of the procedure is to weaken the lower esophageal sphincter... (Review)
Review
Pneumatic dilation (PD) is considered to be the first line nonsurgical therapy for achalasia. The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial force. The endoscope-guided procedure is done without fluoroscopic control. Clinicians usually use a low-compliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal achalasia. It has the advantage of determining mucosal injury during the dilation process, so that a repeat endoscopy is not needed to assess the mucosal tearing. Previous studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment modalities. Although the results may be promising, long-term follow-up is required in the near future.
Topics: Botulinum Toxins; Dilatation; Esophageal Achalasia; Esophagoscopy; Humans; Injections; Laparoscopy; Treatment Outcome
PubMed: 20101764
DOI: 10.3748/wjg.v16.i4.411 -
American Journal of Obstetrics and... May 2023The assessment of labor progress is germane to every woman in labor. Two labor disorders-arrest of dilation and arrest of descent-are the primary indications for surgery... (Review)
Review
The assessment of labor progress is germane to every woman in labor. Two labor disorders-arrest of dilation and arrest of descent-are the primary indications for surgery in close to 50% of all intrapartum cesarean deliveries and are often contributing indications for cesarean deliveries for fetal heart rate abnormalities. Beginning in 1954, the assessment of labor progress was transformed by Friedman. He published a series of seminal works describing the relationship between cervical dilation, station of the presenting part, and time. He proposed nomenclature for the classification of labor disorders. Generations of obstetricians used this terminology and normal labor curves to determine expected rates of dilation and fetal descent and to decide when intervention was required. The analysis of labor progress presents many mathematical challenges. Clinical measurements of dilation and station are imprecise and prone to variation, especially for inexperienced observers. Many interrelated factors influence how the cervix dilates and how the fetus descends. There is substantial variability in when data collection begins and in the frequency of examinations. Statistical methods to account for these issues have advanced considerably in recent decades. In parallel, there is growing recognition among clinicians of the limitations of using time alone to assess progress in cervical dilation in labor. There is wide variation in the patterns of dilation over time and most labors do not follow an average dilation curve. Reliable assessment of labor progression is important because uncertainty leads to both over-use and under-use of cesarean delivery and neither of these extremes are desirable. This review traces the evolution of labor curves, describes how limitations are being addressed to reduce uncertainty and to improve the assessment of labor progression using modern statistical techniques and multi-dimensional data, and discusses the implications for obstetrical practice.
Topics: Pregnancy; Female; Humans; Dilatation; Labor, Obstetric; Cesarean Section; Fetus; Time Factors; Labor Stage, First
PubMed: 37164488
DOI: 10.1016/j.ajog.2022.12.005 -
Pediatric Surgery International Mar 2024Congenital esophageal stenosis (CES) associated with esophageal atresia (EA) is rare, and no standard treatment has been established. We reviewed cases of EA-associated... (Review)
Review
PURPOSE
Congenital esophageal stenosis (CES) associated with esophageal atresia (EA) is rare, and no standard treatment has been established. We reviewed cases of EA-associated CES to assess the clinical characteristics and treatment outcomes, especially the feasibility of endoscopic dilatation.
METHODS
We retrospectively examined patients with EA-associated CES. We also compared treatment outcomes of EA-associated CES with those of EA patients without CES who developed postoperative anastomotic stricture.
RESULTS
Among 44 patients with EA, ten had CES (23%). Postoperative complications were not significantly different between EA patients with CES and those without CES but with anastomotic stricture. All CES patients underwent balloon dilatation as initial treatment. Eight of nine patients (89%) were successfully treated by dilatation only, and one patient underwent surgical resection. The median number of balloon dilatations for CES was five (2-17), which was higher than that for anastomotic stricture in patients without CES (p = 0.012). Esophageal perforation occurred in five patients with CES (5/9, 56%) after dilatation, but all perforations were successfully managed conservatively with an uneventful post-dilatation course.
CONCLUSIONS
Twenty-three percent of patients with EA had CES. Although balloon dilatation for EA-associated CES required multiple treatments and carried a risk of perforation, balloon dilatation showed an 89% success rate and all perforations could be managed conservatively.
Topics: Humans; Esophageal Atresia; Esophageal Stenosis; Dilatation; Retrospective Studies; Constriction, Pathologic; Treatment Outcome; Postoperative Complications; Anastomosis, Surgical
PubMed: 38517524
DOI: 10.1007/s00383-024-05652-w -
CMAJ : Canadian Medical Association... Sep 2022
Topics: Humans; Dilatation
PubMed: 36265063
DOI: 10.1503/cmaj.147016-l