Sample records for endoscopic papillary balloon

  1. Is endoscopic papillary large balloon dilation safe for treating large CBD stones?

    PubMed

    Shim, Chan Sup; Kim, Ji Wan; Lee, Tae Yoon; Cheon, Young Koog

    2016-01-01

    In recent years, endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) has been shown to be an effective technique for the removal of large or difficult common bile duct (CBD) stones, as an alternative to EST. Reviewing the literature published since 2003, it is understood that EPLBD has fewer associated overall complications than EST. Bleeding occurred less frequently with EPLBD than with EST. There was no significant difference in postendoscopic retrograde cholangiopancreatography pancreatitis or perforation. Recent accumulated results of EPLBD with or even without EST suggest that it is a safe and effective procedure for the removal of large or difficult bile duct stones without any additional risk of severe adverse events, when performed under appropriate guidelines. Since use of a larger balloon can tear the sphincter as well as the bile duct, possibly resulting in bleeding and perforation, a balloon size that is equal to or smaller in diameter than the diameter of the native distal bile duct is recommended. The maximum transverse diameter of the stone and the balloon-stone diameter ratio have a tendency to affect the success or failure of complete removal of stones by large balloon dilation to prevent adverse effects such as perforation and bleeding. One should take into account the size of the native bile duct, the size and burden of stones, the presence of stricture of distal bile duct, and the presence of the papilla in or adjacent to a diverticulum. Even though the results of EPLBD indicate that it is a relatively safe procedure in patients with common duct stones with a dilated CBD, the recommended guidelines should be followed strictly for the prevention of major adverse events such as bleeding and perforation.

  2. Factors predictive of adverse events following endoscopic papillary large balloon dilation: results from a multicenter series.

    PubMed

    Park, Soo Jung; Kim, Jin Hong; Hwang, Jae Chul; Kim, Ho Gak; Lee, Don Haeng; Jeong, Seok; Cha, Sang-Woo; Cho, Young Deok; Kim, Hong Ja; Kim, Jong Hyeok; Moon, Jong Ho; Park, Sang-Heum; Itoi, Takao; Isayama, Hiroyuki; Kogure, Hirofumi; Lee, Se Joon; Jung, Kyo Tae; Lee, Hye Sun; Baron, Todd H; Lee, Dong Ki

    2013-04-01

    Lack of established guidelines for endoscopic papillary large balloon dilation (EPLBD) may be a reason for aversion of its use in removal of large common bile duct (CBD) stones. We sought to identify factors predictive of adverse events (AEs) following EPLBD. This multicenter retrospective study investigated 946 consecutive patients who underwent attempted removal of CBD stones ≥10 mm in size using EPLBD (balloon size 12-20 mm) with or without endoscopic sphincterotomy (EST) at 12 academic medical centers in Korea and Japan. Ninety-five (10.0 %) patients exhibited AEs including bleeding in 56, pancreatitis in 24, perforation in nine, and cholangitis in six; 90 (94.7 %) of these were classified as mild or moderate in severity. There were four deaths, three as a result of perforation and one due to delayed massive bleeding. Causative factors identified in fatal cases were full-EST and continued balloon inflation despite a persistent waist seen fluoroscopically. Multivariate analyses showed that cirrhosis (OR 8.03, p = 0.003), length of EST (full-EST: OR 6.22, p < 0.001) and stone size (≥16 mm: OR 4.00, p < 0.001) were associated with increased bleeding, and distal CBD stricture (OR 17.08, p < 0.001) was an independent predictor for perforation. On the other hand, balloon size was associated with deceased pancreatitis (≥14 mm: OR 0.27, p = 0.015). EPLBD appears to be a safe and effective therapeutic approach for retrieval of large stones in patients without distal CBD strictures and when performed without full-EST.

  3. Endoscopic papillary large balloon dilation for the removal of bile duct stones.

    PubMed

    Kim, Jin Hong; Yang, Min Jae; Hwang, Jae Chul; Yoo, Byung Moo

    2013-12-14

    Endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) has been widely used as the alternative to EST along with endoscopic mechanical lithotripsy (EML) for the removal of large or difficult bile duct stones. Furthermore, EPLBD without EST was recently introduced as its simplified alternative technique. Thus, we systematically searched PubMed, Medline, the Cochrane Library and EMBASE, and analyzed all gathered data of EPLBD with and without EST, respectively, by using a single standardized definition, reviewing relevant literatures, published between 2003 and June 2013, where it was performed with large-diameter balloons (12-20 mm). The outcomes, including the initial success rate, the rate of needs for EML, and the overall success rate, and adverse events were assessed in each and compared between both of two procedures: "EPLBD with EST" and "EPLBD without EST". A total of 2511 procedures from 30 published articles were included in EPLBD with EST, while a total of 413 procedures from 3 published articles were included in EPLBD without EST. In the results of outcomes, the overall success rate was 96.5% in EPLBD with EST and 97.2% in EPLBD without EST, showing no significant difference between both of them. The initial success rate (84.0% vs 76.2%, P < 0.001) and the success rate of EPLBD without EML (83.2% vs 76.7%, P = 0.001) was significantly higher, while the rate of use of EML was significantly lower (14.1% vs 21.6%, P < 0.001), in EPLBD with EST. The rate of overall adverse events, pancreatitis, bleeding, perforation, other adverse events, surgery for adverse events, and fatal adverse events were 8.3%, 2.4%, 3.6%, 0.6%, 1.7%, 0.2% and 0.2% in EPLBD with EST and 7.0%, 3.9%, 1.9%, 0.5%, 0.7%, 0% and 0% in EPLBD without EST, respectively, showing no significant difference between both of them. In conclusion, recent accumulated results of EPLBD with or even without EST suggest that it is a safe and effective procedure for the

  4. Comparison of endoscopic papillary balloon dilation and sphincterotomy in young patients with CBD stones and gallstones.

    PubMed

    Seo, Yu Ri; Moon, Jong Ho; Choi, Hyun Jong; Kim, Dong Choon; Ha, Ji Su; Lee, Tae Hoon; Cha, Sang-Woo; Cho, Young Deok; Park, Sang-Heum; Kim, Sun-Joo

    2014-05-01

    Endoscopic biliary sphincterotomy (EBS) results in permanent loss of sphincter function and its long-term complications are unknown. Endoscopic papillary balloon dilation (EPBD) is an alternative procedure that preserves sphincter function, although it is associated with a higher risk of pancreatitis than is EBS. The aim of this study was to evaluate the safety and outcomes of EPBD with limited indications for removal of common bile duct (CBD) stones combined with gallstones in patients younger than 40 years. Young (age < 40 years) patients who had CBD stones combined with gallstones on imaging studies were enrolled in this study. A total of 132 patients were randomly divided into the EPBD group (n = 62) or the EBS group (n = 70) for extraction of CBD stones. The ballooning size of EPBD ranged from 6 to 10 mm. Complete bile duct clearance was achieved in 98.4 % (61/62) of the EPBD group and 100 % (70/70) of the EBS group. Mechanical lithotripsy was required in 8.1 % (5/62) of the EPBD group and 8.6 % (6/70) of the EBS group. The early complication rates were 8.1 % (5/62) (five pancreatitis) in the EPBD group and 11.4 % (8/70) (five [7.1 %] pancreatitis, two bleeding and one perforation) in the EBS group. The recurrence rates of CBD stones were 1.6 % (1/62) in the EPBD group and 5.7 % (4/70) in the EBS group. EPBD with limited indications was safe and effective as EBS for removal of CBD stones combined with gallstones in young patients who had a longer life expectancy.

  5. Nasobiliary drainage after endoscopic papillary balloon dilatation may prevent postoperative pancreatitis

    PubMed Central

    Xu, Xiao-Dan; Dai, Jian-Jun; Qian, Jian-Qing; Wang, Wei-Jun

    2015-01-01

    AIM: To evaluate the necessity of endoscopic nasobiliary drainage (ENBD) catheter placement after clearance of common bile duct (CBD) stones. METHODS: Patients enrolled in this study were randomly divided into two groups, according to whether or not they received ENBD after the removal of CBD stones. Group 1 (ENBD group) was then subdivided into three groups: G1a patients received an endoscopic papillary balloon dilatation (EPBD), G1b patients received an endoscopic sphincterotomy (EST), and G1c patients received neither. Group 2 (non-ENBD group) patients were also subdivided into three groups (G2a, G2b, and G2c), similar to Group 1. The maximum CBD diameter, the time for C-reactive protein (CRP) to normalize, levels of serum amylase, total serum bilirubin (TB) and alanine aminotransferase (ALT), and postoperative hospitalization duration (PHD) were measured. RESULTS: A total of 218 patients (139 males, 79 females), with an average age of 60.1 ± 10.8 years, were enrolled in this study. One hundred and thirteen patients who received ENBD were included in Group 1, and 105 patients who did not receive ENBD were included in Group 2. The baseline clinical characteristics were similar in both groups. There were no significant differences in post-endoscopic retrograde cholangiopancreatography (ERCP)-related complications when Groups 1 and 2 were compared. Seventy-seven patients underwent EPBD, and 41 received an ENBD tube (G1a) and 36 did not (G2a). Seventy-three patients underwent EST, and 34 patients received an ENBD tube (G1b) and 39 did not (G2b). The remaining 68 patients underwent neither EPBD nor EST; of these patients, 38 received an ENBD tube (G1c) and 30 did not (G2c). For each of the three pairs of subgroups (G1a vs G2a, G1b vs G2b, G1c vs G2c), there were no significant differences detected in the PHD or the time to normalization of CRP, TB and ALT. In the EPBD group, the incidence of post-ERCP pancreatitis, hyperamylasemia and overall patient complications

  6. Management of late biliary complications in patients with gallbladder stones in situ after endoscopic papillary balloon dilation.

    PubMed

    Tsujino, Takeshi; Kawabe, Takao; Isayama, Hiroyuki; Yashima, Yoko; Yagioka, Hiroshi; Kogure, Hirofumi; Sasaki, Takashi; Arizumi, Toshihiko; Togawa, Osamu; Ito, Yukiko; Matsubara, Saburo; Nakai, Yousuke; Sasashira, Naoki; Hirano, Kenji; Tada, Minoru; Omata, Masao

    2009-04-01

    Patients with untreated gallbladder stones in situ are at high risk for late biliary complications after endoscopic papillary balloon dilation (EPBD) and bile duct stone extraction. Few data exist on the short-term and long-term results in these patients after the recurrence of bile duct stones and acute cholecystitis. The aim of this study was to evaluate the outcome of late biliary complications in patients with gallbladder stones in situ after EPBD. Fifty-six patients who developed late biliary complications, including bile duct stone recurrence (n=43) and acute cholecystitis (n=13), were managed at our institutions. We investigated the short-term and long-term outcomes after the management of late biliary complications. Complete removal of recurrent bile duct stones was achieved in 38 of 43 patients (88%) by repeated EPBD alone. Pancreatitis after repeated EPBD occurred in two patients (5%). After successful bile duct stone extraction by EPBD, none of the 16 patients who underwent cholecystectomy developed late biliary complications (mean follow-up period of 5.2 years), wheras re-recurrent bile duct stones occurred in three of the 21 patients (14%) with gallbladder stones left in situ (mean follow-up period of 4.4 years)(P=0.1148). Re-recurrent bile duct stones were successfully treated endoscopically. One of the eight patients who did not undergo cholecystectomy for acute cholecystitis had a recurrence of cholecystitis, which was managed conservatively. The long-term outcomes of late biliary complications are favorable when patients with concomitant gallbladder stones undergo cholecystectomy. Re-recurrent bile duct stones are considerable when gallbladder stones are left in situ, but should be treated endoscopically.

  7. Management of late biliary complications in patients with gallbladder stones in situ after endoscopic papillary balloon dilation.

    PubMed

    Tsujino, Takeshi; Kawabe, Takao; Isayama, Hiroyuki; Yashima, Yoko; Yagioka, Hiroshi; Kogure, Hirofumi; Sasaki, Takashi; Arizumi, Toshihiko; Togawa, Osamu; Ito, Yukiko; Matsubara, Saburo; Nakai, Yousuke; Sasashira, Naoki; Hirano, Kenji; Tada, Minoru; Omata, Masao

    2009-04-01

    Patients with untreated gallbladder stones in situ are at high risk for late biliary complications after endoscopic papillary balloon dilation (EPBD) and bile duct stone extraction. Few data exist on the short-term and long-term results in these patients after the recurrence of bile duct stones and acute cholecystitis. The aim of this study was to evaluate the outcome of late biliary complications in patients with gallbladder stones in situ after EPBD. Fifty-six patients who developed late biliary complications, including bile duct stone recurrence (n=43) and acute cholecystitis (n=13), were managed at our institutions. We investigated the short-term and long-term outcomes after the management of late biliary complications. Complete removal of recurrent bile duct stones was achieved in 38 of 43 patients (88%) by repeated EPBD alone. Pancreatitis after repeated EPBD occurred in two patients (5%). After successful bile duct stone extraction by EPBD, none of the 16 patients who underwent cholecystectomy developed late biliary complications (mean follow-up period of 5.2 years), whereas re-recurrent bile duct stones occurred in three of the 21 patients (14%) with gallbladder stones left in situ (mean follow-up period of 4.4 years)(P=0.1148). Re-recurrent bile duct stones were successfully treated endoscopically. One of the eight patients who did not undergo cholecystectomy for acute cholecystitis had a recurrence of cholecystitis, which was managed conservatively. The long-term outcomes of late biliary complications are favorable when patients with concomitant gallbladder stones undergo cholecystectomy. Re-recurrent bile duct stones are considerable when gallbladder stones are left in situ, but should be treated endoscopically.

  8. Design of wormlike automated robotic endoscope: dynamic interaction between endoscopic balloon and surrounding tissues.

    PubMed

    Poon, Carmen C Y; Leung, Billy; Chan, Cecilia K W; Lau, James Y W; Chiu, Philip W Y

    2016-02-01

    The current design of capsule endoscope is limited by the inability to control the motion within gastrointestinal tract. The rising incidence of gastrointestinal cancers urged improvement in the method of screening endoscopy. This preclinical study aimed to design and develop a novel locomotive module for capsule endoscope. We investigated the feasibility and physical properties of this newly designed caterpillar-like capsule endoscope with a view to enhancing screening endoscopy. This study consisted of preclinical design and experimental testing on the feasibility of automated locomotion for a prototype caterpillar endoscope. The movement was examined first in the PVC tube and then in porcine intestine. The image captured was transmitted to handheld device to confirm the control of movement. The balloon pressure and volume as well as the contact force between the balloon and surroundings were measured when the balloon was inflated inside (1) a hard PVC tube, (2) a soft PVC tube, (3) muscular sites of porcine colons and (4) less muscular sites of porcine colons. The prototype caterpillar endoscope was able to move inward and backward within the PVC tubing and porcine intestine. Images were able to be captured from the capsule endoscope attached and being observed with a handheld device. Using the onset of a contact force as indication of the buildup of the gripping force between the balloon and the lumen walls, it is concluded from the results of this study that the rate of change in balloon pressure and volume is two good estimators to optimize the inflation of the balloon. The results of this study will facilitate further refinement in the design of caterpillar robotic endoscope to move inside the GI tract.

  9. Comparing the treatment outcomes of endoscopic papillary dilation and endoscopic sphincterotomy for removal of bile duct stones.

    PubMed

    Ochi, Y; Mukawa, K; Kiyosawa, K; Akamatsu, T

    1999-01-01

    To compare the clinical usefulness of endoscopic papillary dilation (EPD) and endoscopic sphincterotomy (EST) for removal of bile duct stones, 110 patients with stones up to 15 mm in diameter and less than 10 in number were randomly treated with either EPD (55 patients) or EST (55 patients). The patients were followed up for a median period of 23 months and endoscopic manometry with the administration of morphine was carried out in 17 patients who were observed more than 12 months after the procedures to evaluate the post-procedure papillary function. Duct clearance was achieved in 51 EPD (92.7%) and 54 EST patients (98.1%, not significantly different). Forty EPD (78.4%) and 51 EST patients (94.4%) achieved duct clearance in the initial procedure (P=0.02). Early complications occurred in one EPD (2.0%) and in three EST patients (5.6%, P=0.62). Complications during the follow-up period occurred in two EPD and eight EST patients. Recurrence of bile duct stones was observed in two EPD and three EST patients (P=0.98). Acute cholecystitis was observed in one EPD and five EST patients (P=0.06) and among patients with gall-bladder stones in situ, the rate of acute cholecystitis after EPD was significantly lower than that after EST (P=0.03). Endoscopic manometry showed the existence of a choledochoduodenal pressure gradient only after EPD, while papillary contractile function was observed after both procedures. In conclusion, both EPD and EST are safe therapeutic modalities, although EPD is more clinically effective in decreasing the risk of acute cholecystitis in patients with gall-bladder stones in situ and in preserving post-procedure papillary function.

  10. Endoscopic management of difficult common bile duct stones

    PubMed Central

    Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

    2013-01-01

    Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities. PMID:23345939

  11. Is side-viewing endoscope assisted balloon dilatation better for corrosive gastric outlet obstruction?

    PubMed

    Katiyar, Prashant; Nijhawan, Sandeep; Saradava, Vimal; Nagaich, Neeraj; Gupta, Gaurav; Mathur, Amit; Nepalia, Subhash

    2013-11-01

    Endoscopic balloon dilatation (EBD) is an effective therapy for caustic-induced gastric outlet obstruction (GOO). Gaining access to the stricture site is the most important step. It is sometimes difficult to negotiate a balloon through the stricture with a front-viewing endoscope due to deformed anatomy of stomach. To overcome this technical difficulty, a side-viewing endoscope can be used. There is limited data regarding the use of side-viewing endoscopes in EBD. We here report on the short-term efficacy and safety of EBD in caustic-induced GOO. In technically difficult cases, a side-viewing endoscope was used for EBD and its efficacy and safety were assessed. The study included 25 patients with caustic-induced GOO. Patients underwent EBD using a through-the-scope balloon. Initial balloon dilatation was performed with a front-viewing endoscope. A side-viewing endoscope was used where negotiation across the stricture failed with a front-viewing endoscope. Dilatation was started at 8 mm diameter and was performed at 1-week intervals. The end point of dilatation was 15 mm diameter. In 18 patients successful balloon dilatation was possible with a front-viewing endoscope. A side-viewing endoscope was used in six patients as negotiation across the stricture was not possible with a front-viewing endoscope. In all six patients negotiation across the stricture followed by successful dilatation was successful with a side-viewing endoscope. Of the 25 patients included in this study, 24 (96%) achieved procedural success (18 with a front-viewing endoscope and 6 with a side-viewing endoscope) in 3-9 sessions. Our results show that EBD is a safe and effective option for caustic-induced GOO and in difficult cases a side-viewing endoscope can be used to achieve technical success.

  12. Endoscopic minor papilla balloon dilation for the treatment of symptomatic pancreas divisum.

    PubMed

    Yamamoto, Natsuyo; Isayama, Hiroyuki; Sasahira, Naoki; Tsujino, Takeshi; Nakai, Yousuke; Miyabayashi, Koji; Mizuno, Suguru; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2014-08-01

    A subpopulation of patients with pancreas divisum experience symptomatic events such as recurrent acute pancreatitis and chronic pancreatitis. Minor papilla sphincterotomy has been reported as being an effective treatment. The aim of this study was to evaluate the safety and efficacy of endoscopic balloon dilation for the minor papilla. Between 2000 and 2012, 16 patients were retrospectively included in this study. After endoscopic balloon dilation for the minor papilla was received, a pancreatic stent or a nasal pancreatic drainage catheter was placed for 1 week. If a stricture or obstruction was evident, it was treated with balloon dilation followed by long-term stent placement (1 year). When an outflow of pancreatic juice was disturbed by a pancreatic stone, endoscopic stone extraction was performed. Balloon dilation and stent placement were achieved and were successful in all the cases (16/16; 100%). Clinical improvement was achieved in 7 (84.7%) of the 9 patients with recurrent acute pancreatitis and in 6 (85.7%) of the 7 patients with chronic pancreatitis. Early complications were observed in 1 (6.3%) patient. Pancreatitis or bleeding related to balloon dilation was not observed. Endoscopic balloon dilation for the minor papilla is feasible for the management of symptomatic pancreas divisum.

  13. Utility of the Anterior Oblique-Viewing Endoscope and the Double-Balloon Enteroscope for Endoscopic Retrograde Cholangiopancreatography in Patients with Billroth II Gastrectomy

    PubMed Central

    Sen-yo, Manabu; Kaino, Seiji; Suenaga, Shigeyuki; Uekitani, Toshiyuki; Yoshida, Kanako; Harano, Megumi; Sakaida, Isao

    2012-01-01

    Background/Purpose. The difficulties of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy have been reported. We evaluated the usefulness of an anterior oblique-viewing endoscope and a double-balloon enteroscope for endoscopic retrograde cholangiopancreatography in such patients. Methods. From January 2003 to December 2011, 65 patients with Billroth II gastrectomy were enrolled in this study. An anterior oblique-viewing endoscope was used for all patients. From February 2007, a double-balloon enteroscope was used for the failed cases. The success rate of procedures was compared with those in 20 patients with Billroth II gastrectomy using forward-viewing endoscope or side-viewing endoscope from March 1996 to July 2002 as historical controls. Results. In all patients in whom the papilla was reached (60/65), selective cannulation was achieved. The success rate of selective cannulation and accomplishment of planned procedures in the anterior oblique-viewing endoscope group were both significantly higher than that in the control group (100% versus 70.1%, 100 versus 58.8%, resp.). A double-balloon enteroscope was used in 2 patients, and the papilla could be reached and the planned procedures completed. Conclusions. An anterior oblique-viewing endoscope and double-balloon enteroscope appear to be useful in performing endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy. PMID:23056039

  14. [Use of esophageal small balloon or papillary sphincter knife in the treatment of stent implantation 
for colorectal malignant obstruction].

    PubMed

    Xiao, Dinghua; Liu, Shaojun; Yan, Hanguang; Wang, Xiaoyan

    2018-05-28

    To explore the function of esophageal small balloon or papillary sphincter knife in the treatment of stent implantation for colorectal malignant obstruction, and to improve the success rate of colonic stent placement in such patients.
 Methods: A total of 49 patients with colorectal cancer complicated with almost complete obstruction or colorectal cancer were enrolled for this study. The esophageal small balloon or papillary sphincter knife was used in the guide wires. The guide wires gradually crossed the tumor gap and they were placed in the contralateral intestinal cavity with balloon progression. X-ray was then used to confirm whether the guide wire was inserted in the lesion intestinal cavity, and then the metal bare stent was inserted.
 Results: The guide wires was successfully inserted with conventional methods in these 49 cases, while they were also successfully placed the guide wire and the stent in the new way.
 Conclusion: For the patients with colorectal cancer complicated with complete obstruction or colorectal cancer located in obviously angled location, the use of esophageal small balloon or papillary sphincter knife can help the guide wire insert. They greatly improve the success rate of stent implantation.

  15. Balloon catheter versus basket catheter for endoscopic bile duct stone extraction: a multicenter randomized trial.

    PubMed

    Ishiwatari, Hirotoshi; Kawakami, Hiroshi; Hisai, Hiroyuki; Yane, Kei; Onodera, Manabu; Eto, Kazunori; Haba, Shin; Okuda, Toshinori; Ihara, Hideyuki; Kukitsu, Takehiro; Matsumoto, Ryusuke; Kitaoka, Keisuke; Sonoda, Tomoko; Hayashi, Tsuyoshi

    2016-04-01

    Endoscopic bile duct stone (BDS) removal is a well-established treatment; however, the preference for basket or balloon catheters for extraction is operator-dependent. We therefore conducted a multicenter prospective randomized trial to compare catheter performance. We enrolled patients with a BDS diameter ≤ 10 mm and common bile duct diameter ≤ 15 mm. Participants were randomly assigned to groups that were treated with basket or balloon catheters between October 2013 and September 2014. The primary endpoint was the rate of complete clearance of the duct; the secondary endpoints were the rate and time to complete clearance in one endoscopic session. We initially enrolled 172 consecutive patients; 14 were excluded after randomization. The complete clearance rates were 92.3 % (72/78) in the balloon group and 80.0 % (64 /80) in the basket group. The difference in the rates between the two groups was 12.3 percentage points, indicating non-inferiority of the balloon method (non-inferiority limit -10 %; P < 0.001 for non-inferiority). Moreover, the balloon was superior to the basket (P = 0.037). The rate of complete clearance in one endoscopic session was 97.4 % using the balloon and 97.5 % using the basket (P = 1.00). The median times to complete clearance in one endoscopic session were 6.0 minutes (1 - 30) and 7.8 minutes (1 - 37) in the balloon and basket groups, respectively (P = 0.15). For extraction of BDSs ≤ 10 mm, complete endoscopic treatment with a single catheter is more likely when choosing a balloon catheter over a basket catheter.University Hospital Medical Information Network Trials Registry: UMIN000011887. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Direct peroral cholangioscopy using an ultraslim upper endoscope for biliary lesions.

    PubMed

    Omuta, Shigefumi; Maetani, Iruru; Ukita, Takeo; Nambu, Tomoko; Gon, Katsushige; Shigoka, Hiroaki; Saigusa, Yoshinori; Saito, Michihiro

    2014-02-01

    The development of direct peroral cholangioscopy (DPOC) using an ultraslim endoscope simplifies biliary cannulation. The conventional techniques are cumbersome to perform and require advanced skills. The recent introduction of the guidewires and balloons has improved the therapeutic outcomes. Here we describe an effective and easier method for performing DPOC using an ultraslim upper endoscope. Indications for DPOC were the presence of stones on follow-up of patients who had previously undergone complete sphincteroplasty, including endoscopic sphincterotomy or endoscopic papillary large balloon dilatation. Fifteen patients underwent DPOC. An ultraslim endoscope was inserted perorally and was advanced into the major papilla. The ampulla of Vater was visualized by retroflexing the endoscope in the distal second portion of the duodenum, and then DPOC was performed using a wire-guided cannulation technique with an anchored intraductal balloon catheter. One patient failed in the treatment due to looping of the endoscope in the fornix of the stomach. Fourteen (93.3%) were successfully treated with our modified DPOC technique. Only one patient (6.7%) experienced an adverse event (pancreatitis) who responded well to conservative management. Residual stones of the common bile duct were completely removed in 3 patients. The modified method of DPOC is simple, safe and easy to access the bile duct.

  17. [Efficiency of endoscopic treatment with intra gastric balloon in severe to morbid obesity].

    PubMed

    Houissa, Fatma; Trabelsi, Senda; Hadj Brahim, Kamel; Mouelhi, Leila; Bouzaidi, Slim; Salem, Mohamed; Mekki, Haiffa; El Jery, Kaouther; Said, Yosra; Kheder, Sana; Debbech, Radhouane; Najjar, Taoufik

    2014-12-01

    Obesity raises such a healthcare matter throughout the world. Its management is not only complex but also most often multidisciplinary. The medico-dietary treatment is of inconstant efficiency and the surgical treatment, though more efficient, presents a considerable morbidity-death rate. The endoscopic treatment through intra-gastric balloon avails a seducing alternative namely accounting for surgery preparation. To assess the efficiency of the endoscopic treatment through gastric balloon, both in the short and long term, and this is accounting for weight loss as well as tolerance. We have carried out a retrospective study including the patients suffering from severe to morbid obesity and who had a gastric balloon implemented in our Endoscopy Unit between November 2005 and December 2007. Twenty one patients were included. The average age was 32,19 ± 12,65 years with extremes of 16 and 52 years. Fifteen patients suffered from morbid obesity. The patients' average weight was 134, 52 ± 26,46 kg (extremes 88 and 194 kg). Some co-morbidity was found out with 15 patients. Te balloon implementation (Héliosphère®) was carried out with no incidents in all patients. Six months after the balloon implementation, the average weight loss was 17,5% and the average loss of over weigh was 37%. In biological level, we noted a normalisation of fasting glycaemia in 28,6 % of cases, of the cholesterolemia in 100 %, of the triglyceridemia in 33,33%, of the uraemia in 42,8% and hepatic tests in 50 % of the cases. The metabolic syndrome disappeared in 28,57 % of cases. The assessment after a 5-year-period was marked by the need to surgical treatment in 4 patients and this is due to the loss of efficiency of endoscopic treatment. A bad tolerance of gastric balloon was observed in 34 % of the cases, dominated by sicknesses. Only one patient presented incoercible sicknesses with ionic troubles as well as deshydrating requiring the precocious extraction of the balloon after 48 hours of

  18. Advances in endoscopic balloon therapy for weight loss and its limitations

    PubMed Central

    Vyas, Dinesh; Deshpande, Kaivalya; Pandya, Yagnik

    2017-01-01

    The field of medical and surgical weight loss is undergoing an explosion of new techniques and devices. A lot of these are geared towards endoscopic approaches rather than the conventional and more invasive laparoscopic or open approach. One such recent advance is the introduction of intrgastric balloons. In this article, we discuss the recently Food and Drug Administration approved following balloons for weight loss: the Orbera™ Intragastric Balloon System (Apollo Endosurgery Inc, Austin, TX, United States), the ReShape® Integrated Dual Balloon System (ReShape Medical, Inc., San Clemente, CA, United States), and the Obalon (Obalon® Therapeutics, Inc.). The individual features of each of these balloons, the method of introduction and removal, and the expected weight loss and possible complications are discussed. This review of the various balloons highlights the innovation in the field of weight loss. PMID:29209122

  19. Early endoscopic balloon dilation in caustic-induced gastric injury.

    PubMed

    Kochhar, Rakesh; Poornachandra, Kuchhangi Sureshchandra; Dutta, Usha; Agrawal, Amit; Singh, Kartar

    2010-04-01

    There are no reports on endoscopic balloon dilation (EBD) for caustic-induced gastric outlet obstruction (GOO) in the acute or subacute phase. To study the efficacy of early EBD in patients with caustic-induced gastric injury. Tertiary care center in India. Retrospective analysis of data. Out of 41 patients with caustic-induced GOO who reported to us in the subacute phase between January 2001 and December 2008, 31 were treated by EBD. All 31 had ingested an acid 14.39 +/- 4.65 days earlier. EBD was achieved by using wire-guided balloons under endoscopic guidance. The balloon was negotiated across the narrowed segment and inflated for 60 seconds using a pressure gun. Balloons of incremental diameter, up to a maximum of 3 sizes, were used in each sitting. Procedural success was defined as reaching the end point of dilation (15 mm) and absence of symptoms. All 31 patients (18 male, mean age 32.06 +/- 11.04 years) could be successfully dilated. All but 1 underwent successful dilations to achieve the end point of 15 mm, requiring a median of 9 (range 3-18) dilations over a period of 7 (range 1.5-16) weeks. Complications included self-limiting pain (n = 10), bleeding at the time of the procedure (n = 9), and perforation in 1 patient (3.2%) who required surgery. Thirty patients were followed up for a median of 21 (range 3-72) months with no recurrence. Early EBD by an expert endoscopist is a safe and effective treatment modality in the management of caustic-induced GOO. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  20. Endoscopic endonasal control of the paraclival internal carotid artery by Fogarty balloon catheter inflation: an anatomical study.

    PubMed

    Ruggeri, Andrea; Enseñat, Joaquim; Prats-Galino, Alberto; Lopez-Rueda, Antonio; Berenguer, Joan; Cappelletti, Martina; De Notaris, Matteo; d'Avella, Elena

    2017-03-01

    OBJECTIVE Neurosurgical management of many vascular and neoplastic lesions necessitates control of the internal carotid artery (ICA). The aim of this study was to investigate the feasibility of achieving control of the ICA through the endoscopic endonasal approach by temporary occlusion with a Fogarty balloon catheter. METHODS Ten endoscopic endonasal paraseptal approaches were performed on cadaveric specimens. A Fogarty balloon catheter was inserted through a sellar bony opening and pushed laterally and posteriorly extraarterially along the paraclival carotid artery. The balloon was then inflated, thus achieving temporary occlusion of the vessel. The position of the catheter was confirmed with CT scans, and occlusion of the ICA was demonstrated with angiography. The technique was performed in 2 surgical cases of pituitary macroadenoma with cavernous sinus invasion. RESULTS Positioning the Fogarty balloon catheter at the level of the paraclival ICA was achieved in all cadaveric dissections and surgical cases through a minimally invasive, quick, and safe approach. Inflation of the Fogarty balloon caused interruption of blood flow in 100% of cases. CONCLUSIONS Temporary occlusion of the paraclival ICA performed through the endoscopic endonasal route with the aid of a Fogarty balloon catheter may be another maneuver for dealing with intraoperative ICA control. Further clinical studies are required to prove the efficacy of this method.

  1. Factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery.

    PubMed

    de Moura, Eduardo G H; Orso, Ivan R B; Aurélio, Eduardo F; de Moura, Eduardo T H; de Moura, Diogo T H; Santo, Marco A

    2016-01-01

    Roux-en-Y gastric bypass is a commonly used technique of bariatric surgery. One of the most important complications is gastrojejunal anastomotic stricture. Endoscopic balloon dilation appears to be well tolerated and effective, but well-designed randomized, controlled trials have not yet been conducted. Identify factors associated with complications or failure of endoscopic balloon dilation of anastomotic stricture secondary to Roux-en-Y gastric bypass surgery. Gastrointestinal endoscopy service, university hospital, Brazil. The records of 64 patients with anastomotic stricture submitted to endoscopic dilation with hydrostatic balloon dilation were reviewed. Information was collected on gastric pouch length, anastomosis diameter before dilation, number of dilation sessions, balloon diameter at each session, anastomosis diameter after the last dilation session, presence of postsurgical complications, endoscopic complications, and outcome of dilation. Comparisons were made among postsurgical and endoscopic complications; number of dilations, balloon diameter; anastomosis diameter before dilation; and dilation outcome. Success of dilation treatment was 95%. Perforation was positively and significantly associated with the number of dilation sessions (P = .03). Highly significant associations were found between ischemic segment and perforation (P<.001) and between ischemic segment and bleeding (P = .047). Ischemic segment (P = .02) and fistula (P = .032) were also associated with dilation failure. Ischemic segment and fistula were found to be important risk factors for balloon dilation failure. The greater the number of dilation sessions, the greater the number of endoscopic complications. Copyright © 2016 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  2. Benign Post-Radiation Rectal Stricture Treated with Endoscopic Balloon Dilation and Intralesional Triamcinolone Injection

    PubMed Central

    Karanikas, Michael; Touzopoulos, Panagiotis; Mitrakas, Alexandros; Zezos, Petros; Zarogoulidis, Paul; Machairiotis, Nikolaos; Efremidou, Eleni; Liratzopoulos, Nikolaos; Polychronidis, Alexandros; Kouklakis, George

    2012-01-01

    Post-radiation stricture is a rare complication after pelvis irradiation, but must be in the mind of the clinician evaluating a lower gastrointestinal obstruction. Endoscopy has gained an important role in chronic radiation proctitis with several therapeutic options for management of intestinal strictures. The treatment of rectal strictures has been limited to surgery with high morbidity and mortality. Therefore, a less invasive therapeutic approach for benign rectal strictures, endoscopic balloon dilation with or without intralesional steroid injection, has become a common treatment modality. We present a case of benign post-radiation rectal stricture treated successfully with balloon dilation and adjuvant intralesional triamcinolone injection. A 70-year-old woman presented to the emergency room complaining for 2 weeks of diarrhea and meteorism, 11 years after radiation of the pelvis due to adenocarcinoma of the uterus. Colonoscopy revealed a stricture at the rectum and multiple endoscopic biopsies were obtained from the stricture. The stricture was treated with endoscopic balloon dilation and intralesional triamcinolone injection. The procedure appears to have a high success rate and a very low complication rate. Histologic examination of the biopsies revealed non-specific inflammatory changes of the rectal mucosa and no specific changes of the mucosa due to radiation. All biopsies were negative for malignancy. The patient is stricture-free 12 months post-treatment. PMID:23271987

  3. Prior minimal endoscopic sphincterotomy to prevent pancreatitis related to endoscopic balloon sphincteroplasty

    PubMed Central

    Kanazawa, Ryo; Sai, Jin Kan; Ito, Tomoyasu; Miura, Hiroko; Ishii, Shigeto; Saito, Hiroaki; Tomishima, Ko; Shimizu, Ryo; Sato, Koki; Hayashi, Manabu; Watanabe, Sumio; Shiina, Shuichiro

    2016-01-01

    AIM To investigate the efficacy of prior minimal endoscopic sphincterotomy (EST) to prevent pancreatitis related to endoscopic balloon sphincteroplasty (EBS). METHODS After bile duct access was gained and cholangiogram confirmed the presence of stones < 8 mm in the common bile duct at endoscopic retrograde cholangiography, patients were subjected to minimal EST (up to one-third of the size the papilla) plus 8 mm EBS (EST-EBS group). The incidence of pancreatitis and the difference in serum amylase level after the procedure were examined and compared with those associated with 8-mm EBS alone in 32 patients of historical control (control group). RESULTS One hundred and five patients were included in the EST-EBS group, and complete stone removal was accomplished in all of them. The difference in serum amylase level after the procedure was - 25.0 (217.9) IU/L in the EST-EBS group and this value was significantly lower than the 365.5 (576.3) IU/L observed in the control group (P < 0.001). The incidence of post-procedure pancreatitis was 0% (0/105) in the EST-EBS group and 15.6% (5/32) in the control group (P < 0.001). CONCLUSION Prior minimal EST might be useful to prevent the elevation of serum amylase level and the occurrence of pancreatitis related to EBS. PMID:27803773

  4. Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Roux-en-Y small bowel surgery.

    PubMed

    De Koning, Michael; Moreels, Tom G

    2016-08-22

    Roux-en-Y reconstructive surgery excludes the biliopancreatic system from conventional endoscopic access. Balloon-assisted enteroscopy allows therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in these patients, avoiding rescue surgery. The objective of the current study is to compare success and complication rate of double-balloon (DBE) and single-balloon enteroscope (SBE) to perform ERCP in Roux-en-Y patients. Seventy three Roux-en-Y patients with suspected biliary tract pathology underwent balloon-assisted enteroscopy in a tertiary-care center. Retrospective analysis of 95 consecutive therapeutic ERCP procedures was performed to define and compare success and complication rate of DBE and SBE. Male-female ratio was 28/45 with a mean age of 58 ± 2 years. 30 (32 %) procedures were performed with DBE and 65 (68 %) with SBE. Overall ERCP success rate was 73 % for DBE and 75 % for SBE (P = 0.831). Failure was due to inability to reach or cannulate the intact papilla or bilioenteric anastomosis. Success rate was significantly higher when performed at the bilioenteric anastomosis (80 % success in 56 procedures) or at the intact papilla in short-limb Roux-en-Y (80 % in 15 procedures) as compared to the intact papilla in long-limb (58 % in 24 procedures; P = 0.040). Adverse event rates were 10 % (DBE) and 8 % (SBE) (P = 0.707) and mostly dealt with conservatively. ERCP after Roux-en-Y altered small bowel anatomy is feasible and safe using both DBE and SBE. Both techniques are equally competent with high success rates and acceptable adverse events rates. ERCP at the level of the intact papilla in long limb Roux-en-Y is less successful as compared to short-limb or bilioenteric anastomosis.

  5. Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration

    PubMed Central

    Kumar, Nitin

    2015-01-01

    A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, space-occupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo OverStitch, TransOral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoBarrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons (Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and SatiSphere. The AspireAssist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo OverStitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery. PMID:26240686

  6. Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration.

    PubMed

    Kumar, Nitin

    2015-07-25

    A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, space-occupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo OverStitch, TransOral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoBarrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons (Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and SatiSphere. The AspireAssist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo OverStitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.

  7. Endoscopic management of bile duct stones: residual bile duct stones after surgery, cholangitis, and "difficult stones".

    PubMed

    Karsenti, D

    2013-06-01

    Endoscopic treatment has become, according to the latest recommendations, the standard treatment for common bile duct stones (CBDS), although in certain situations, surgical clearance of the common duct at the time of laparoscopic cholecystectomy is still considered a possible alternative. The purpose of this article is not to compare endoscopic with surgical treatment of CBDS, but to describe the various techniques of endoscopic treatment, detailing their preferential indications and the various treatment options that must sometimes be considered when faced with "difficult calculi" of the CBD. The different techniques of lithotripsy and the role of biliary drainage with plastic or metallic stents will be detailed as well as papillary balloon dilatation and particularly the technique of sphincterotomy with macrodilatation of the sphincter of Oddi (SMSO), a recently described approach that has changed the strategy for endoscopic management of CBDS. Finally, the overall strategy for endoscopic management of CBDS, with description of different techniques, will be exposed. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  8. Endoscopic balloon dilatation as an effective treatment for lower and upper benign gastrointestinal system anastomotic stenosis.

    PubMed

    Akarsu, Cevher; Unsal, Mustafa Gokhan; Dural, Ahmet Cem; Kones, Osman; Kocatas, Ali; Karabulut, Mehmet; Kankaya, Burak; Ates, Mustafa; Alis, Halil

    2015-04-01

    Endoscopic balloon dilatation (EBD) is currently accepted as an effective, safe, and first-line treatment of postoperative benign gastrointestinal anastomosis stenosis (BGAS); however, a limited number of publications on the subject exist in the literature. The aim of the study was to retrospectively evaluate the efficiency of endoscopic dilatation in patients with postoperative intestinal anastomotic stenoses at a single surgical center. Patients with postoperative BGAS treated by EBD at our institution from February 2008 to 2012 were included. The dilatations were all performed using through-the-scope balloons. The balloon was introduced into the stricture using a guidewire under radiologic guidance. Each dilatation session consisted of 2 to 3 two-minute multistep inflations of the balloon until adequate dilatation was achieved. Of the 48 patients included in the study, 44 patients (91.7%) fully recovered and 4 (8.3%) did not respond to treatment. The mean follow-up period was 24 months (range, 3 to 57 mo). Four patients who did not respond to the procedure were treated surgically. Two patients (4.1%) with intestinal perforation during EBD were treated conservatively with a stent. EBD has a low rate of complications and a high success rate, is well tolerated, and avoids further surgical procedures for BGAS. Therefore, EBD should be the first choice of treatment for postoperative anastomotic stenoses.

  9. Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography

    PubMed Central

    Osoegawa, Takashi; Motomura, Yasuaki; Akahoshi, Kazuya; Higuchi, Naomi; Tanaka, Yoshimasa; Hisano, Terumasa; Itaba, Souichi; Gibo, Junya; Yamada, Mariko; Kubokawa, Masaru; Sumida, Yorinobu; Akiho, Hirotada; Ihara, Eikichi; Nakamura, Kazuhiko

    2012-01-01

    AIM: To investigate the clinical outcome of double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) in patients with altered gastrointestinal anatomy. METHODS: Between September 2006 and April 2011, 47 procedures of DB-ERCP were performed in 28 patients with a Roux-en-Y total gastrectomy (n = 11), Billroth II gastrectomy (n = 15), or Roux-en-Y anastomosis with hepaticojejunostomy (n = 2). DB-ERCP was performed using a short-type DBE combined with several technical innovations such as using an endoscope attachment, marking by submucosal tattooing, selectively applying contrast medium, and CO2 insufflations. RESULTS: The papilla of Vater or hepaticojejunostomy site was reached in its entirety with a 96% success rate (45/47 procedures). There were no significant differences in the success rate of reaching the blind end with a DBE among Roux-en-Y total gastrectomy (96%), Billroth II reconstruction (94%), or pancreatoduodenectomy (100%), respectively (P = 0.91). The total successful rate of cannulation and contrast enhancement of the target bile duct in patients whom the blind end was reached with a DBE was 40/45 procedures (89%). Again, there were no significant differences in the success rate of cannulation and contrast enhancement of the target bile duct with a DBE among Roux-en-Y total gastrectomy (88 %), Billroth II reconstruction (89%), or pancreatoduodenectomy (100%), respectively (P = 0.67). Treatment was achieved in all 40 procedures (100%) in patients whom the contrast enhancement of the bile duct was successful. Common endoscopic treatments were endoscopic biliary drainage (24 procedures) and extraction of stones (14 procedures). Biliary drainage was done by placement of plastic stents. Stones extraction was done by lithotomy with the mechanical lithotripter followed by extraction with a basket or by the balloon pull-through method. Endoscopic sphincterotomy was performed in 14 procedures with a needle precutting

  10. Innovations and techniques for balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy

    PubMed Central

    Yamauchi, Hiroshi; Kida, Mitsuhiro; Imaizumi, Hiroshi; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Koizumi, Wasaburo

    2015-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine. Recently, many studies have reported that balloon-enteroscope-assisted ERCP (BEA-ERCP) is a safe and effective procedure. However, further improvements in outcomes and the development of simplified procedures are required. Percutaneous treatment, Laparoscopy-assisted ERCP, endoscopic ultrasound-guided anterograde intervention, and open surgery are effective treatments. However, treatment should be noninvasive, effective, and safe. We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications. BEA-ERCP still requires high expertise-level techniques and is far from a routinely performed procedure. Various techniques have been proposed to facilitate scope insertion (insertion with percutaneous transhepatic biliary drainage (PTBD) rendezvous technique, Short type single-balloon enteroscopes with passive bending section, Intraluminal injection of indigo carmine, CO2 inflation guidance), cannulation (PTBD or percutaneous transgallbladder drainage rendezvous technique, Dilation using screw drill, Rendezvous technique combining DBE with a cholangioscope, endoscopic ultrasound-guided rendezvous technique), and treatment (overtube-assisted technique, Short type balloon enteroscopes) during BEA-ERCP. The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients. A standard procedure for ERCP yet to be established for patients with a reconstructed intestine. At present, BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as first-line treatment. In this article, we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy. PMID:26074685

  11. Balloon-type versus non-balloon-type replacement percutaneous endoscopic gastrostomy: which is better?

    PubMed

    Heiser, M; Malaty, H

    2001-01-01

    Percutaneous endoscopic gastrostomy (PEG) has been an established procedure for nearly 20 years. Caring for patients with a PEG has been incorporated into the practice of nurses in most gastroenterology settings. Several practice-related questions have arisen, particularly in relation to replacement PEGs. In an attempt to obtain relevant information for decisions relating to cost-effectiveness and providing optimum care for PEG replacement, two clinical research questions were studied: (1) is there a difference in patient (stomal) response related to two different replacement PEG tubes, and (2) is there a difference in the duration (life-span) between the two types of replacement tubes? A non-experimental, two-group descriptive study was conducted to answer the two clinical research questions. Two types of replacement PEG tubes were evaluated: a balloon type and a non-balloon type. Stoma response (recording skin and insertion site characteristics) and PEG life span were the measures of interest. Differences in the occurrence of skin and insertion site problems between the two groups were not statistically significant. Differences between the life spans of the two tubes were found to be statistically significant at three time intervals. Findings give information to the practitioner involved in making independent and interdependent practice decisions when planning care for patients with a PEG. Suggestions for additional research and replication are included.

  12. Immediate detection of endoscopic retrograde cholangiopancreatography-related periampullary perforation: Fluoroscopy or endoscopy?

    PubMed Central

    Motomura, Yasuaki; Akahoshi, Kazuya; Gibo, Junya; Kanayama, Kenji; Fukuda, Shinichiro; Hamada, Shouhei; Otsuka, Yoshihiro; Kubokawa, Masaru; Kajiyama, Kiyoshi; Nakamura, Kazuhiko

    2014-01-01

    AIM: To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations to support immediate or early diagnosis. METHODS: Consecutive patients who underwent ERCP procedures at our hospital between January 2008 and June 2013 were retrospectively enrolled in the study (n = 2674). All procedures had been carried out using digital fluoroscopic assistance with the patient under conscious sedation. For patients showing alterations in the gastrointestinal anatomy, a short-type double balloon enteroscope had been applied. Cases of perforation had been identified by the presence of air in or leakage of contrast medium into the retroperitoneal space, or upon endoscopic detection of an abdominal cavity related to the perforated lumen. For patients with ERCP-related perforations, the data on medical history, endoscopic findings, radiologic findings, diagnostic methods, management, and clinical outcomes were used for descriptive analysis. RESULTS: Of the 2674 ERCP procedures performed during the 71-mo study period, only six (0.22%) resulted in perforations (male/female, 2/4; median age: 84 years; age range: 57-97 years). The cases included an endoscope-related duodenal perforation, two periampullary perforations related to endoscopic sphincterotomy, two periampullary perforations related to endoscopic papillary balloon dilation, and a periampullary or bile duct perforation secondary to endoscopic instrument trauma. No cases of guidewire-related perforation occurred. The video endoscope system employed in all procedures was only able to immediately detect the endoscope-related perforation; the other five perforation cases were all detected by subsequent digital fluoroscope applied intraoperatively (at a median post-ERCP intervention time of 15 min). Three out of the six total perforation cases, including the single case of endoscope-related duodenal injury, were surgically treated; the remaining three cases were

  13. Short-type single balloon enteroscope for endoscopic retrograde cholangiopancreatography with altered gastrointestinal anatomy

    PubMed Central

    Yamauchi, Hiroshi; Kida, Mitsuhiro; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Takezawa, Miyoko; Kikuchi, Hidehiko; Watanabe, Maya; Imaizumi, Hiroshi; Koizumi, Wasaburo

    2013-01-01

    AIM: To evaluate the effectiveness of a short-type single-balloon-enteroscope (SBE) for endoscopic retrograde cholangiopancreatography (ERCP) in patients with a reconstructed intestine. METHODS: Short-type SBE was developed to perform ERCP in postoperative patients with a reconstructed intestine. Short-type SBE is a direct-viewing endoscope with the following specifications: working length, 1520 mm; total length, 1840 mm; channel diameter, 3.2 mm. In addition, short-type SBE has a water-jet channel. The study group comprised 22 patients who underwent 31 sessions of short-type SBE-assisted ERCP from June 2011 through May 2012. Reconstruction was performed by Billroth-II (B-II) gastrectomy in 6 patients (8 sessions), Roux-en-Y (R-Y) gastrectomy in 14 patients (21 sessions), and R-Y hepaticojejunostomy in 2 patients (2 sessions). We retrospectively studied the rate of reaching the blind end (papilla of Vater or choledochojejunal anastomosis), mean time required to reach the blind end, diagnostic success rate (defined as the rate of successfully imaging the bile and pancreatic ducts), therapeutic success rate (defined as the rate of successfully completing endoscopic treatment), mean procedure time, and complications. RESULTS: Among the 31 sessions of ERCP, the rate of reaching the blind end was 88% in B-II gastrectomy, 91% in R-Y gastrectomy, and 100% in R-Y hepaticojejunostomy. The mean time required to reach the papilla was 18.3 min in B-II gastrectomy, 21.1 min in R-Y gastrectomy, and 32.5 min in R-Y hepaticojejunostomy. The diagnostic success rates in all patients and those with an intact papilla were respectively 86% and 86% in B-II gastrectomy, 90% and 87% in R-Y gastrectomy, and 100% in R-Y hepaticojejunostomy. The therapeutic success rates in all patients and those with an intact papilla were respectively 100% and 100% in B-II gastrectomy, 94% and 92% in R-Y gastrectomy, and 100% in R-Y hepaticojejunostomy. Because the channel diameter was 3.2 mm, stone

  14. Congenital duodenal web: successful management with endoscopic dilatation

    PubMed Central

    Poddar, Ujjal; Jain, Vikas; Yachha, Surender Kumar; Srivastava, Anshu

    2016-01-01

    Background and study aims: Congenital duodenal web (CDW) is an uncommon cause of duodenal obstruction and endoscopic balloon dilatation has been reported in just eight pediatric cases to date. Here we are reporting three cases of CDW managed successfully with balloon dilatation. Cases and methods: In 2014 we diagnosed three cases of CDW on the basis of typical radiological and endoscopic findings. Endoscopic balloon dilatation was done under conscious sedation with a through-the-scope controlled radial expansion (CRE) balloon. Results: All three children presented late (median age 8 [range 2 – 9] years) with bilious vomiting, upper abdominal distension, and failure to thrive. One of them had associated Down syndrome and another had horseshoe kidney. In all cases, CDW was observed in the second part of the duodenum beyond the ampulla, causing partial duodenal obstruction. After repeated endoscopic dilatation (2 – 4 sessions), all three patients became asymptomatic. None of the patients experienced complications after balloon dilatation. Conclusions: Duodenal diaphragm should be suspected in patients with abdominal distension with bilious vomiting, even in relatively older children. Endoscopic balloon dilatation is a simple and effective method of treating this condition. PMID:27004237

  15. Single Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients Who Underwent a Gastrectomy with Roux-en-Y Anastomosis: Six Cases from a Single Center.

    PubMed

    Soh, Jae Seung; Yang, Dong-Hoon; Lee, Sang Soo; Lee, Seohyun; Bae, Jungho; Byeon, Jeong-Sik; Myung, Seung-Jae; Yang, Suk-Kyun

    2015-09-01

    Patients with altered anatomy such as a Roux-en-Y anastomosis often present with various pancreaticobiliary problems requiring therapeutic intervention. However, a conventional endoscopic approach to the papilla is very difficult owing to the long afferent limb and acute angle of a Roux-en-Y anastomosis. Balloon-assisted enteroscopy can be used for endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered anatomy. We experienced six cases of Roux-en-Y anastomosis with biliary problems, and attempted ERCP using single balloon enteroscopy (SBE). SBE insertion followed by replacement with a conventional endoscope was attempted in five of six patients. The papilla was successfully approached using SBE in all cases. However, therapeutic intervention was completed in only three cases because of poor maneuverability caused by postoperative adhesion. We conclude that in patients with Roux-en-Y anastomosis, the ampulla can be readily accessed with SBE, but longer dedicated accessories are necessary to improve this therapeutic intervention.

  16. Comparative study of balloon and metal olive dilators for endoscopic management of benign anastomotic rectal strictures: clinical and cost-effectiveness outcomes.

    PubMed

    Xinopoulos, Dimitrios; Kypreos, Dimitrios; Bassioukas, Stefanos P; Korkolis, Dimitrios; Mavridis, Konstantinos; Scorilas, Andreas; Dimitroulopoulos, Dimitrios; Loukou, Argyro; Paraskevas, Emmanouel

    2011-03-01

    Postoperative anastomotic strictures frequently complicate colorectal resection. Currently, various endoscopic techniques are being employed in their management, but the establishment of an optimal therapeutic strategy is still pending. The purpose of our study is to compare through-the-scope (TTS) balloon dilators versus Eder-Puestow metal olive dilators in the treatment of postoperative benign rectal strictures, considering the clinical outcome and cost-effectiveness of each method. A total of 39 patients with benign anastomotic rectal stenosis were retrospectively studied. In group A, 15 patients underwent dilation with Eder-Puestow metal olives, while in group B 19 patients were treated by means of TTS balloon dilators. The technical and clinical success of dilation, complications, number of repeated sessions required, disease-free time intervals, and the overall cost of each procedure were evaluated. Dilations were technically successful in all patients. No major complications occurred in either group. The number of dilations needed, rate of stricture recurrence, and duration of stenosis-free time intervals were not statistically significantly different between the two groups. Both methods proved more effective in older patients, given the greater number of dilations required in younger patients of both groups and higher frequency of stricture relapse in younger balloon-dilated patients (median 64.00 years) compared with older ones (median 75.00 years) (p = 0.001). An indisputable advantage of the Eder-Puestow technique, compared with TTS balloon dilators, is the low cost of equipment (median 22.30 compared with 680 , respectively; p < 0.001). Endoscopic dilation of postoperative benign rectal strictures is equally effective and safe, especially in older patients, when performed by Eder-Puestow bougies or TTS balloon dilators. However, metal olivary tips seem to surpass balloon dilators when considering the obvious economical benefits of the

  17. Oncocytic Type Intraductal Papillary Mucinous Neoplasm of the Pancreas with Unusually Low Mucin Production Mimicking Intraductal Tubulopapillary Neoplasm: A Report of a Case Diagnosed by a Preoperative Endoscopic Biopsy

    PubMed Central

    Yoshida, Yukinari; Endo, Takao; Tanaka, Eiichi; Kikuchi, Takefumi; Akino, Kimishige; Mita, Hiroaki; Adachi, Yasuyo; Nakamura, Masahiro; Adachi, Yasushi; Ishii, Yoshifumi; Matsumoto, Joe; Hirano, Satoshi; Nitta, Takeo; Mitsuhashi, Tomoko; Kato, Yasuo

    2017-01-01

    We herein report the case of a 78-year-old woman with an intraductal tumor with scant mucin production in a moderately dilated main pancreatic duct that resembled an intraductal tubulopapillary neoplasm (ITPN) on imaging. An endoscopic transpapillary forceps biopsy enabled an accurate preoperative diagnosis of the tumor as an oncocytic type intraductal papillary mucinous neoplasm (IPMN) of the pancreas microscopically showing papillary growth consisting of oncocytic cells with a typical mucin expression profile, although with few intraepithelial lumina containing mucin. This is the first case of an oncocytic type IPMN mimicking an ITPN that was able to be diagnosed preoperatively. PMID:29021473

  18. Single- and double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y plus hepaticojejunostomy anastomosis and Whipple resection.

    PubMed

    Itokawa, Fumihide; Itoi, Takao; Ishii, Kentaro; Sofuni, Atsushi; Moriyasu, Fuminori

    2014-04-01

    In patients with Roux-en-Y hepaticojejunostomy (HJ with R-Y) and Whipple resection, endoscopic retrograde cholangiopancreatography (ERCP) can be challenging. We report our experience with ERCP using balloon-assisted enteroscopy (BAE) (BAE-ERCP) in patients with HJ with R-Y, and Whipple resection. BAE-ERCP procedures were carried out in 62 patients (HJ with R-Y:Whipple resection=34:28). Overall, the rates of reaching the anastomosis were 85.3% (29/34) in HJ with R-Y and 96.4% (27/28) in Whipple resection. In terms of HJ with R-Y, insertion success rate by standard single-balloon enteroscopy (SBE) was 89.3% (25/28). Insertion success rate by short BAE, including SBE and double-balloon enteroscopy (DBE), was 50% (3/6). There was a statistically significant difference of insertion success rate between standard long BE and short BE (P=0.021). However, in the Whipple patients, insertion success rate by standard and short SBE was 93.8% (15/16) and 91.7% (11/12), respectively. Initial insertion success rate by short BAE in Whipple patients was significantly higher than in HJ with R-Y (91.7% vs 50%, P=0.045). Therapeutic interventions included dilation of anastomosis stricture, stone extraction, endoscopic mechanical lithotripsy, biliary stent placement, stent extraction, endoscopic nasobiliary drainage, direct cholangioscopy, and electrohydraulic lithotripsy. Our HJ with R-Y series and Whipple series treatment success rate was 90% (18/20) and 95.0% (19/20), respectively. BAE-ERCP enabled ERCP to be carried out in patients with HJ. It is considered safe and feasible. Further experience and device improvement are needed. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

  19. [Two cases of afferent loop syndrome caused by obstruction at the jejuno-jejunostomy site in the Roux-en-Y loop that were successfully treated by endoscopic balloon dilatation].

    PubMed

    Yasuda, Atsushi; Imamoto, Haruhiko; Furukawa, Hiroshi; Imano, Motohiro; Yasuda, Takushi; Okuno, Kiyokata

    2014-11-01

    We report 2 rare cases of afferent loop syndrome caused by obstruction at the jejuno-jejunostomy site in the Roux-en-Y loop after total gastrectomy, which was successfully treated by endoscopic balloon dilatation of the anastomotic stenosis. Case 1: A 62-year-old woman presented with malaise and lower abdominal distension 6 months after laparoscopy-assisted total gastrectomy with Roux-en-Y reconstruction. She was diagnosed with afferent loop syndrome; CT imaging indicated marked dilatation of the afferent loop, with membranous obstruction at the jejuno-jejunostomy site in the Roux-en-Y loop. Although almost complete occlusion was noted at the jejuno-jejunostomy site, the obstruction was successfully relieved by endoscopic balloon dilation using TandemTM XL Triple Lumen ERCP Cannula (Boston Scientific)®. Case 2: A 70-year-old man presented with malaise and lower abdominal distension 3 years after laparoscopy-assisted total gastrectomy with Roux-en-Y reconstruction. He was diagnosed with afferent loop syndrome; CT imaging indicated complete obstruction at the jejuno-jejunostomy site in the Roux-en-Y loop. As in case 1, the obstruction was successfully treated by endoscopic balloon dilatation of the occluded anastomosis.

  20. Effectiveness of a reusable low-cost balloon trocar dissection device in the creation of preperitoneal space during endoscopic surgery. An experimental study in swine.

    PubMed

    Nácul, Miguel Prestes; Cavazzola, Leandro Totti; Loureiro, Marcelo de Paula; Bonin, Eduardo Aimoré; Ferreira, Paulo Roberto Walter

    2015-09-01

    To evaluate a new, low-cost, reusable balloon trocar device for dissection of the preperitoneal space during endoscopic surgery. Twenty swine (weight: 15-37 kg) were randomized to two groups, according to whether the preperitoneal space was created with a new balloon device manufactured by Bhio-Supply (group B) or with the commercially available OMSPDB 1000® balloon device manufactured by Covidien (group C). Quality and size of the created preperitoneal space, identification of anatomic structures, balloon dissection time, total procedure time, balloon resistance and internal pressure after insufflation with 300 mL of ambient air, balloon-related complications, and procedure cost were assessed. No significant differences in dissection time, total procedure time, or size of the created preperitoneal space were found between the groups. Balloons in group B had a significantly higher internal pressure compared to balloons in group C. None of the balloons ruptured during the experiment. Three animals in group C had balloon-related peritoneal lacerations. Despite a higher individual device cost, group B had a lower procedure cost over the entire experiment. The new balloon device is not inferior to the commercially available device in terms of the safety and effectiveness for creating a preperitoneal space in swine.

  1. Diagnostic and therapeutic direct peroral cholangioscopy using an intraductal anchoring balloon.

    PubMed

    Parsi, Mansour A; Stevens, Tyler; Vargo, John J

    2012-08-14

    To report our experience using a recently introduced anchoring balloon for diagnostic and therapeutic direct peroral cholangioscopy (DPOC). Consecutive patients referred for diagnostic or therapeutic peroral cholangioscopy were evaluated in a prospective cohort study. The patients underwent DPOC using an intraductal anchoring balloon, which was recently introduced to allow consistent access to the biliary tree with an ultraslim upper endoscope. The device was later voluntarily withdrawn from the market by the manufacturer. Fourteen patients underwent DPOC using the anchoring balloon. Biliary access with an ultraslim upper endoscope was accomplished in all 14 patients. In 12 (86%) patients, ductal access required sphincteroplasty with a 10-mm dilating balloon. Intraductal placement of the ultraslim upper endoscope allowed satisfactory visualization of the biliary mucosa to the level of the confluence of the right and left hepatic ducts in 13 of 14 patients (93%). Therapeutic interventions by DPOC were successfully completed in all five attempted cases (intraductal biopsy in one and DPOC guided laser lithotripsy in four). Adverse events occurred in a patient on immunosuppressive therapy who developed an intrahepatic biloma at the site of the anchoring balloon. This required hospitalization and antibiotics. Repeat endoscopic retrograde cholangiopancreatography 8 wk after the index procedure showed resolution of the biloma. Use of this anchoring balloon allowed consistent access to the biliary tree for performance of diagnostic and therapeutic DPOC distal to the biliary bifurcation.

  2. Endoscopic papillectomy: indications, techniques, and results.

    PubMed

    De Palma, Giovanni D

    2014-02-14

    Endoscopic papillectomy (EP) is currently accepted as a viable alternative therapy to surgery in sporadic ampullary adenoma and has been reported to have high success and low recurrence rates. At present, the indications for EP are not yet fully established. The accepted criteria for EP include size (up to 5 cm), no evidence of intraductal growth, and no evidence of malignancy on endoscopic findings (ulceration, friability, and spontaneous bleeding). Endoscopic ultrasound (EUS) is the imaging modality of choice for local T staging in ampullary neoplasms. Data reported in the literature have revealed that linear EUS is superior to helical computed tomography in the preoperative assessment of tumor size, detection of regional nodal metastases and detection of major vascular invasion. Endoscopic ampullectomy is performed using a standard duodenoscope in a similar manner to snare polypectomy of a mucosal lesion. There is no standardization of the equipment or technique and broad EP methods are described. Endoscopic ampullectomy is considered a ''high-risk'' procedure due to complications. Complications of endoscopic papillectomy can be classified as early (pancreatitis, bleeding, perforation, and cholangitis) and late (papillary stenosis) complications. The appropriate use of stenting after ampullectomy may prevent post-procedural pancreatitis and papillary stenosis. Tumor recurrence of benign lesions occurs in up to 20% of patients and depends on tumor size, final histology, presence of intraductal tumor, coexisting familial adenomatous polyposis (FAP), and the expertise of the endoscopist. Recurrent lesions are usually benign and most can be retreated endoscopically.

  3. Endoscopic approaches to treatment of achalasia

    PubMed Central

    Friedel, David; Modayil, Rani; Iqbal, Shahzad; Grendell, James H.

    2013-01-01

    Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy. PMID:23503707

  4. [Clinical application of self-made drainage tube with balloon for iatrogenic colonic perforation].

    PubMed

    Liu, Bing-rong; Li, Hui; Zhao, Li-xia; Song, Ji-tao; Wang, Yan-jun; Chen, Jing; Liu, Wei

    2012-07-01

    To investigate the clinical efficacy of colonic bypass drainage by self-made drainage tube with balloon for iatrogenic colonic perforation. A retrospective analysis of 8 patients with iatrogenic colonic perforations from January 2009 to March 2011 was performed. Self-made drainage tubes with balloon were placed in the bowel lumen endoscopically after perforations were closed with endoclips or endoloops under endoscope. The inflatable balloon at the front-end of the tube was fixed at the mouth side of colonic perforation to achieve continuous drainage of stool and intestinal juice. Endoscopic bypass continuous drainage by using self-made drainage tube with balloon was successfully carried out in all the 8 patients. All the perforations healed and no surgical intervention required. Bypass drainage continued for 3-10 days(mean 7.6 days). One patient received colonoscopy 3 days after the procedure, and displacement of the drainage tube was noticed requiring endoscopic adjustment. All the drainage tubes were removed uneventfully, and no ulceration or perforation occurred at balloon fixed site after removal. After follow up ranging from 12 to 36 months, no chronic fistula, adhesive obstruction, or abdominal infection occurred. Colonic bypass drainage by self-made drainage tube with balloon for iatrogenic colonic perforation is simple, feasible, safe and reliable.

  5. Diagnostic and therapeutic direct peroral cholangioscopy using an intraductal anchoring balloon

    PubMed Central

    Parsi, Mansour A; Stevens, Tyler; Vargo, John J

    2012-01-01

    AIM: To report our experience using a recently introduced anchoring balloon for diagnostic and therapeutic direct peroral cholangioscopy (DPOC). METHODS: Consecutive patients referred for diagnostic or therapeutic peroral cholangioscopy were evaluated in a prospective cohort study. The patients underwent DPOC using an intraductal anchoring balloon, which was recently introduced to allow consistent access to the biliary tree with an ultraslim upper endoscope. The device was later voluntarily withdrawn from the market by the manufacturer. RESULTS: Fourteen patients underwent DPOC using the anchoring balloon. Biliary access with an ultraslim upper endoscope was accomplished in all 14 patients. In 12 (86%) patients, ductal access required sphincteroplasty with a 10-mm dilating balloon. Intraductal placement of the ultraslim upper endoscope allowed satisfactory visualization of the biliary mucosa to the level of the confluence of the right and left hepatic ducts in 13 of 14 patients (93%). Therapeutic interventions by DPOC were successfully completed in all five attempted cases (intraductal biopsy in one and DPOC guided laser lithotripsy in four). Adverse events occurred in a patient on immunosuppressive therapy who developed an intrahepatic biloma at the site of the anchoring balloon. This required hospitalization and antibiotics. Repeat endoscopic retrograde cholangiopancreatography 8 wk after the index procedure showed resolution of the biloma. CONCLUSION: Use of this anchoring balloon allowed consistent access to the biliary tree for performance of diagnostic and therapeutic DPOC distal to the biliary bifurcation. PMID:22912549

  6. The role of endoscopic therapy in obesity management: intragastric balloons and aspiration therapy

    PubMed Central

    Kumar, Nitin; Sullivan, Shelby; Thompson, Christopher C

    2017-01-01

    Weight management is increasingly incorporating endoscopic bariatric therapy (EBT). As the global burden of obesity and its comorbidities has increased, it is evident that novel therapeutic approaches will be necessary to address the obesity epidemic. EBTs offer greater efficacy than diet and lifestyle modification and lower invasiveness than bariatric surgery. The US Food and Drug Administration has approved two intragastric balloons and aspiration therapy for the treatment of obesity: Apollo Orbera is indicated for the treatment of Class I and Class II obesity, Re Shape Integrated Dual Balloon system is indicated for the same range with a comorbidity, and Aspire Bariatrics AspireAssist is approved for patients with a body mass index of 35–55 kg/m2. These devices have proven safe and effective in clinical trials and are gaining commercial acceptance in the USA; the Orbera has been used extensively outside the USA for over 20 years. These devices will need to be delivered in the context of a multidisciplinary weight loss program, integrating comprehensive care of obesity. Patient selection is important, and ensuring appropriate patient expectations and understanding of alternatives such as pharmacologic therapy and surgery is essential. With several EBTs on the horizon, patients with obesity will have an even broader array of safe and effective options for weight management in the future. PMID:28740414

  7. The role of endoscopic therapy in obesity management: intragastric balloons and aspiration therapy.

    PubMed

    Kumar, Nitin; Sullivan, Shelby; Thompson, Christopher C

    2017-01-01

    Weight management is increasingly incorporating endoscopic bariatric therapy (EBT). As the global burden of obesity and its comorbidities has increased, it is evident that novel therapeutic approaches will be necessary to address the obesity epidemic. EBTs offer greater efficacy than diet and lifestyle modification and lower invasiveness than bariatric surgery. The US Food and Drug Administration has approved two intragastric balloons and aspiration therapy for the treatment of obesity: Apollo Orbera is indicated for the treatment of Class I and Class II obesity, Re Shape Integrated Dual Balloon system is indicated for the same range with a comorbidity, and Aspire Bariatrics AspireAssist is approved for patients with a body mass index of 35-55 kg/m 2 . These devices have proven safe and effective in clinical trials and are gaining commercial acceptance in the USA; the Orbera has been used extensively outside the USA for over 20 years. These devices will need to be delivered in the context of a multidisciplinary weight loss program, integrating comprehensive care of obesity. Patient selection is important, and ensuring appropriate patient expectations and understanding of alternatives such as pharmacologic therapy and surgery is essential. With several EBTs on the horizon, patients with obesity will have an even broader array of safe and effective options for weight management in the future.

  8. Endoscopic treatment of bile duct complications after orthotopic liver transplantation.

    PubMed

    Polese, L; Cillo, U; Brolese, A; Boccagni, P; Neri, D; Bassi, D; Erroi, F; Zanus, G; D'Amico, D F; Norberto, L

    2007-01-01

    To assess the indications and results of endoscopic retrograde cholangio-pancreatography (ERCP) in patients who have undergone ortotopic liver transplantation (OLT). We reviewed data from 42 consecutive patients who underwent ERCP for biliary complications after OLT over an 8-year period, in particular recording indications and success of the treatment after a mean of 17 months follow-up. Cholangiograms performed in 33/42 patients (79%) displayed anastomotic strictures in 17 patients (52%), bile duct stones in 8 (24%), both bile duct stones and an anastomotic stricture in 2 (6%), papillary stenosis in 1 (3%), and anastomotic biliary leakage in 1 (3%). In contrast, the contrastogram was normal in four patients (12%). Stone extraction was completed in 9/10 patients (90%) with a mean of 1.2 sessions, while stricture dilation was achieved in 12/19 patients (63%) after a mean of 1.7 sessions, by stent positioning (n = 7), balloon dilation (n = 4), or Soehendra dilator (n = 1). Both biliary leakage and papillary stenosis were cured by ERCP. Only one procedure-related complication -- severe pancreatitis (2.4%) -- was observed and no mortality. ERCP is a safe and effective mode of management of bile duct complications after OLT. It should be attempted before a surgical approach. Better results are obtained for treatment of biliary stones than of anastomotic strictures.

  9. Quality of life and cosmetic result of single-port access endoscopic thyroidectomy via axillary approach in patients with papillary thyroid carcinoma.

    PubMed

    Huang, Jian-Kang; Ma, Ling; Song, Wen-Hua; Lu, Bang-Yu; Huang, Yu-Bin; Dong, Hui-Ming

    2016-01-01

    Endoscopic thyroidectomy for minimally invasive thyroid surgery has been widely applied in the past decade. The present study aimed to evaluate the effects of single-port access transaxillary totally endoscopic thyroidectomy on the postoperative outcomes and functional parameters, including quality of life and cosmetic result in patients with papillary thyroid carcinoma (PTC). Seventy-five patients with PTC who underwent endoscopic thyroidectomy via a single-port access transaxillary approach were included (experimental group). A total of 123 patients with PTC who were subjected to conventional open total thyroidectomy served as the control group. The health-related quality of life and cosmetic and satisfaction outcomes were assessed postoperatively. The mean operation time was significantly increased in the experimental group. The physiological functions and social functions in the two groups were remarkably augmented after 6 months of surgery. However, there was no significant difference in the scores of speech and taste between the two groups at the indicated time of 1 month and 6 months. In addition, the scores for appearance, satisfaction with appearance, role-physical, bodily pain, and general health in the experimental group were better than those in the control group at 1 month and 6 months after surgery. The single-port access transaxillary totally endoscopic thyroidectomy is safe and feasible for the treatment of patients with PTC. The subjects who underwent this technique have a good perception of their general state of health and are likely to participate in social activities. It is worthy of being clinically used for patients with PTC.

  10. Development of optical laser balloon and drainage from radiation vulcanized natural rubber latex

    NASA Astrophysics Data System (ADS)

    Shimamura, Yoshiyuki

    Rubber film made of radiation vulcanized natural rubber latex (RVNRL) has better transparency and lower toxicity compared with sulfur-vulcanized latex film. Optical laser balloon (optical endoscopical balloon) and drainage were developed by using RVNRL. An endoscope was equipped with a saline-filled latex rubber balloon at its tip to displace contaminating blood, bile, or gastric contents during operative portoscopy, biliary endoscopy, or upper gastrointestinal endoscopy. The transmission of Nd-Yag laser through the balloon is 98%, higher than the sulfur-vulcanized latex rubber (75%). High transparency of the drainage bag facilitated easy observation of discharged fluids without detaching the bag from the tube.

  11. Balloon dilatation of benign and malignant esophageal strictures. Blind retrograde balloon dilatation.

    PubMed

    Graham, D Y; Smith, J L

    1985-06-01

    Balloon esophageal dilatation offers many theoretical advantages (safety, speed, and patient comfort) over dilatation with mercury-filled bougies or with the Eder-Puestow system. The authors used balloon dilators in 22 patients with dysphagia secondary to benign or malignant strictures. Dilatation was performed with fluoroscopic guidance, blindly, or by a combination of these techniques. For "blind" stricture dilatation, an Eder-Puestow spring-tipped guide wire is placed into the stomach using a fiberoptic endoscope. The distance from the incisor teeth to the stricture is measured, and the balloon shaft is marked to indicate when the middle of the balloon is within the stricture. Dilatation is then performed using the antegrade or, the preferred, retrograde technique. Finally, the dilated stricture is calibrated by pulling an inflated balloon through the previously strictured area without difficulty. An attempt was made to achieve an esophageal diameter of 15 mm at the initial dilatation episode, and patient discomfort was used as a guide as to the final diameter. The balloon dilatation technique was highly successful, and a stricture diameter of 15 mm (45-47 French) was achieved at the initial dilatation in most instances. Malignant strictures were easily dilated. Balloon dilatation is convenient, effective, quick, and potentially safer than the previous Eder-Puestow or mercury-filled bougie techniques.

  12. Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis.

    PubMed

    Al Sabah, Salman; Al Haddad, Eliana; Siddique, Iqbal

    2017-09-01

    Laparoscopic sleeve gastrectomy (LSG) is becoming an increasingly popular form of bariatric surgery, accounting for more than 50% of these procedures performed in the USA. Given this popularity, more is being understood about the complications associated with LSG, which, though uncommon, include the formation of strictures and stenosis. The purpose of this study is to establish a safe and effective protocol for the treatment of stenosis post-LSG using endoscopic balloon dilatation. This is a prospective review of 26 patients who had undergone LSG in Kuwait, followed by sleeve gastrectomy stenosis (SGS) and were then referred to Amiri Hospital for endoscopic balloon dilatation from October 2008 up to June 2016. A total of 26 patients (four males; 22 females) presented with symptoms of stenosis post-LSG during the study period. The mean age of the patients was 34.6 ± 10.8 years. The mean body mass index at the time of surgery was 43 ± 1.6 kg/m 2 . The median interval from the initial LSG surgery was 95 days. Nine patients had an early presentation (≤3 months from surgery), while 17 presented late (>3 months). The patients were followed for a mean duration of 156 ± 20 days from the last endoscopic balloon dilatation. A total of 23 (88.5%) patients had complete resolution of their symptoms. Adverse events were observed in one patients, who was removed from the study. Gastric stenosis is a rare but potentially serious complication of LSG. Serial dilatation of SGS employing endoscopic balloons is a safe method of treatment, with high efficacy rates. This new method may offer a less invasive alternative to surgical revision. However, if endoscopic treatment fails, surgery is necessary.

  13. Dislodgement of variceal bands after esophageal balloon tamponade for variceal bleeding.

    PubMed

    Mogrovejo, Estela; Manickam, Palaniappan; Polidori, Gregg; Cappell, Mitchell S

    2014-01-01

    A 43-year-old male with alcoholic cirrhosis underwent EGD for hematemesis which revealed bleeding, grade II, lower esophageal varices that were endoscopically ligated with 6 bands. All the bands remained attached to varices at the completion of EGD. Despite apparent initial hemostasis, balloon tamponade was performed one hour later for suspected continued bleeding. Due to suspected continuing bleeding, EGD was repeated 4 h after initial EGD, and 3 h after balloon tamponade. This EGD revealed the esophageal varices; none of the bands remaining on esophageal mucosa; multiple mucosal stigmata likely from trauma at initial site of variceal bands before dislodgement; and 3 dislodged bands in gastric body, duodenal bulb, or descending duodenum. The patient expired 17 h thereafter from hypovolemic shock. This single report may suggest an apparently novel, balloon tamponade complication: dislodgement of previously placed, endoscopic bands. The proposed pathophysiology is release of bands by stretching entrapped, esophageal mucosa during esophageal balloon tamponade. This complication, if confirmed, might render balloon tamponade a less desirable option very soon after band ligation.

  14. Endoscopic electrosurgical papillotomy and manometry in biliary tract disease.

    PubMed

    Geenen, J E; Hogan, W J; Shaffer, R D; Stewart, E T; Dodds, W J; Arndorfer, R C

    1977-05-09

    Endoscopic papillotomy was performed in 13 patients after cholecystectomy for retained or recurrent common bile duct calculi (11 patients) and a clinical picture suggesting papillary stenosis (two patients). Following endoscopic papillotomy, ten of the 11 patients spontaneously passed common bile duct (CBD) stones verified on repeated endoscopic retrograde cholangiopancreatography (ERCP) study. One patient failed to pass a large CBD calculus; one patient experienced cholangitis three months after in inadequate papillotomy and required operative intervention. Endoscopic papillotomy substantially decreased the pressure gradient existing between the CBD and the duodenum in all five patients studied with ERCP manometry. Endoscopic papillotomy is a relatively safe and effective procedure for postcholecystectomy patients with retained or recurrent CBD stones. The majority of CBD stones will pass spontaneously if the papillotomy is adequate.

  15. Plastic Biliary Stent Migration During Multiple Stents Placement and Successful Endoscopic Removal Using Intra-Stent Balloon Inflation Technique: A Case Report and Literature Review.

    PubMed

    Calcara, Calcedonio; Broglia, Laura; Comi, Giovanni; Balzarini, Marco

    2016-02-05

    Late migration of a plastic biliary stent after endoscopic placement is a well known complication, but there is little information regarding migration of a plastic stent during multiple stents placement. A white man was hospitalized for severe jaundice due to neoplastic hilar stenosis. Surgical eligibility appeared unclear on admission and endoscopy was carried out, but the first stent migrated proximally at the time of second stent insertion. After failed attempts with various devices, the migrated stent was removed successfully through cannulation with a dilation balloon. The migration of a plastic biliary stent during multiple stents placement is a possible complication. In this context, extraction can be very complicated. In our patient, cannulation of a stent with a dilation balloon was the only effective method.

  16. [The Management of Common Bile Duct Stones].

    PubMed

    Park, Chang Hwan

    2018-05-25

    Common bile duct (CBD) stone is a relatively frequent disorder with a prevalence of 10-20% in patients with gallstones. This is also associated with serious complications, including obstructive jaundice, acute suppurative cholangitis, and acute pancreatitis. Early diagnosis and prompt treatment is the most important for managing CBD stones. According to a recent meta-analysis, endoscopic ultrasonography and magnetic resonance cholangiopancreatography have high sensitivity, specificity, and accuracy for the diagnosis of CBD stones. Endoscopic ultrasonography, in particular, has been reported to have higher sensitivity between them. A suggested management algorithm for patients with symptomatic gallstones is based on whether they are at low, intermediate, or high probability of CBD stones. Single-stage laparoscopic CBD exploration and cholecystectomy is superior to endoscopic retrograde cholangiopancreatography (ERCP) plus laparoscopic cholecystectomy with respect to technical success and shorter hospital stay in high risk patients with gallstones and CBD stones, where expertise, operative time, and instruments are available. ERCP plus laparoscopic cholecystectomy is usually performed to treat patients with CBD stones and gallstones in many institutions. Patients at intermediate probability of CBD stones after initial evaluation benefit from additional biliary imaging. Patients with a low probability of CBD stones should undergo cholecystectomy without further evaluation. Endoscopic sphincterotomy and endoscopic papillary balloon dilation in ERCP are the primary methods for dilating the papilla of Vater for endoscopic removal of CBD stones. Endoscopic papillary large balloon dilation is now increasingly performed due to the usefulness in the management of giant or difficult CBD stones. Scheduled repeated ERCP may be considered in patients with high risk of recurrent CBD stones.

  17. Intraductal papillary neoplasm originating from an anomalous bile duct.

    PubMed

    Maki, Harufumi; Aoki, Taku; Ishizawa, Takeaki; Tanaka, Mariko; Sakatani, Takashi; Beck, Yoshifumi; Hasegawa, Kiyoshi; Sakamoto, Yoshihiro; Kokudo, Norihiro

    2017-04-01

    An 82-year-old woman who had been suffering from repeated obstructive jaundice for 7 years was referred to our hospital. Although endoscopic aspiration of the mucin in the common bile duct had been temporally effective, origin of the mucin production had not been detectable. The patient thus had been forced to be on long-term follow-up without curative resection. Endoscopic retrograde cholangioscopy on admission revealed massive mucin in the common bile duct. In addition, an anomalous bile duct located proximal to the gallbladder was identified. Since the lumen of the anomalous duct was irregular and the rest of biliary tree was completely free of suspicious lesions, the anomalous duct was judged to be the primary site. Surgical resection of the segment 4 and 5 of the liver combined with the extrahepatic biliary tract was performed. Pathological diagnosis was compatible to intraductal papillary neoplasm with high-grade intraepithelial dysplasia of the anomalous bile duct. The patient has been free from the disease for 6.5 years after resection. This is the first case of intraductal papillary neoplasm derived from an anomalous bile duct, which was resected after long-term conservative treatment. The present case suggested the slow growing character of natural history of the neoplasm.

  18. Antigravity ESD - double-balloon-assisted underwater with traction hybrid technique.

    PubMed

    Sharma, Sam K; Hiratsuka, Takahiro; Hara, Hisashi; Milsom, Jeffrey W

    2018-06-01

     Complex colorectal polyps or those positioned in difficult anatomic locations are an endoscopic therapeutic challenge. Underwater endoscopic submucosal dissection (UESD) is a potential technical solution to facilitate efficient polyp removal. In addition, endoscopic tissue retraction has been confined to limited methods of varying efficacy and complexity. The aim of this study was to evaluate the efficiency of a unique UESD technique for removing complex polyps using double-balloon-assisted retraction (R).  Using fresh ex-vivo porcine rectum, 4-cm polyps were created using electrosurgery and positioned at "6 o'clock" within an established ESD model. Six resections were performed in each group. Underwater techniques were facilitated using a novel double-balloon platform (Dilumen, Lumendi, Westport, Connecticut, United States).  UESD-R had a significantly shorter total procedural time than cap-assisted ESD and UESD alone (24 vs. 58 vs. 56 mins). UESD-R produced a dissection time on average of 5 minutes, attributed to the retraction provided. There was also a subjective significant reduction in electrosurgical smoke with the underwater techniques contributing to improved visualization.  Here we report the first ex-vivo experience of a unique double-balloon endoscopic platform optimized for UESD with tissue traction capability. UESD-R removed complex lesions in significantly shorter time than conventional means. The combined benefits of UESD and retraction appeared to be additive when tackling complex polyps and should be studied further.

  19. Percutaneous Transhepatic Cutting Balloon Papillotomy for Removal of Common Bile Duct Stones

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Ozkan, Ugur; Gumus, Burcak

    2009-09-15

    We report the case of a 66-year-old female who presented with jaundice secondary to recurrent adenocarcinoma of the gallbladder and several common bile duct stones. Percutaneous papillary dilatation was planned to remove the common bile duct stones. Papilla was dilated through the percutaneous approach with an 8-mm peripheral cutting balloon instead of a standard balloon. All the stones were pushed successfully into the duodenum with a saline flush. No complications were encountered. Use of a peripheral cutting balloon for dilatation of the papilla seems to be safe and effective because it has the advantage of controlled incision and dilatation ofmore » the target at low pressures.« less

  20. A comparison of two methods of endoscopic dilation of acute subglottic stenosis using a ferret model.

    PubMed

    Tubbs, Kyle J; Silva, Rodrigo C; Ramirez, Harvey E; Castleman, William L; Collins, William O

    2013-01-01

    Balloon dilation is accepted as a first line treatment of acute subglottic stenosis, but its effects on the subglottic tissue remain largely unknown. We aimed to develop an animal model of acute subglottic stenosis using endoscopic techniques. Once developed, this model was used to compare the immediate effects of balloon dilation and endotracheal tube dilation on subglottic tissue. Prospective randomized animal study. Acute subglottic injury was induced in 10 ferrets by endoscopic cauterization with silver nitrate. After 48-72 hours of observation, eight animals were randomized to undergo subglottic dilation with either a 5-mm balloon or endotracheal tubes of increasing diameter. These eight ferrets were euthanized within 10 minutes after dilation. The other two ferrets served as controls and were euthanized following observation only. The larynx from each ferret was harvested, and the subglottis was examined histologically by a pathologist blinded to the treatment arms. Acute subglottic stenosis was induced in all 10 ferrets using the endoscopic technique. Both balloon and endotracheal tube dilation resulted in comparable improvement in the subglottic airway diameter. A decreased thickness of submucosa/lamina propria was seen in the balloon dilation group. Acute subglottic stenosis can be reliably induced in ferrets using endoscopic techniques. Multiple dilation methods can be used to relieve acute obstruction. Balloon dilators seem to improve airway patency, in part, by decreasing the thickness of the submucosa and lamina propria. Further research is needed to determine how this impacts later stages of wound healing and final outcomes. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  1. Direct peroral cholangioscopy using an ultrathin endoscope: making technique easier.

    PubMed

    Sola-Vera, Javier; Uceda, Francisco; Cuesta, Rubén; Vázquez, Narcís

    2014-01-01

    Cholangioscopy is a useful tool for the study and treatment of biliary pathology. Ultrathin upper endoscopes allow direct peroral cholangioscopy (DPC) but have some drawbacks. The aim of the study was to evaluate the success rate of DPC with an ultrathin endoscope using a balloon catheter to reach the biliary confluence. Prospective observational study. An ultrathin endoscope (Olympus XP180N, outer diameter 5.5 mm, working channel 2 mm) was used. To access the biliary tree, free-hand technique was used. To reach the biliary confluence an intraductal balloon catheter (Olympus B5-2Q diameter 1.9 mm) and a 0.025 inch guide wire was used. In all cases sphincterotomy and/or sphincteroplasty was performed. The success rate was defined as the percentage of cases in which the biliary confluence could be reached with the ultrathin endoscope. Fifteen patients (8 men/7 women) were included. Mean age was 77.7 + or - 10.8 years (range 45-91). The indications for cholangioscopy were suspected bile duct stones (n = 9), electrohydraulic lithotripsy for the treatment of difficult choledocholithiasis (n = 5) and evaluation of biliary stricture (n = 1). Access to the bile duct was achieved in 14/15 cases (93.3%). Biliary confluence was reached in 13/15 cases (86.7%). One complication was observed in one patient (oxigen desaturation). DPC with an ultrathin endoscope can be done with the free-hand technique. Intraductal balloon-guided DPC allows full examination of the common bile duct in most cases.

  2. Endoscopic balloon dilatation of Crohn's disease strictures: results from a large United kingdom series.

    PubMed

    Bhalme, Mahesh; Sarkar, Sanchoy; Lal, Simon; Bodger, Keith; Baker, Rose; Willert, Robert P

    2014-02-01

    Stricturing is a common complication of Crohn's disease. Endoscopic balloon dilatation (EBD) offers a valuable alternative to surgical intervention, but there are limited data on factors influencing its safety and efficacy. A multicenter retrospective audit across 4 U.K. teaching hospitals was performed on the use of EBD for Crohn's strictures between 1998 and 2011. Demographics, smoking status, medications, C-reactive protein, endoscopic findings, and subsequent surgery at follow-up were recorded. Success of EBD was defined as symptomatic improvement without the need for surgery at follow-up. Seventy-nine patients (47 women; median age, 48 yr) were identified for this study. Forty-eight (61%) patients had ileocolonic anastomotic strictures, whereas the rest had de novo strictures. In total, 191 EBDs (range, 1-11; median 2) were carried out on 93 strictures (range, 1-5; median 1) over a median duration of 12 months (range, 1-84). There were no serious adverse events. Success at index EBD was 34%, with a further 43% achieving long-term benefit from additional EBDs. Eighteen (23%) patients required surgery. Time to surgery after the first EDB was 2.6 to 71.1 months (median, 12.8 mo). Longer Crohn's disease duration (P = 0.03) and high C-reactive protein (P = 0.008) were associated with an increased need for subsequent surgery. EBD was safe and effective in achieving long-term symptom improvement and avoidance of surgery in most patients. Prospective controlled trials are needed to evaluate the effect of other factors, including Crohn's disease phenotype, and the role of concomitant medication to identify those best suited to EBD.

  3. Advanced endoscopic imaging to improve adenoma detection

    PubMed Central

    Neumann, Helmut; Nägel, Andreas; Buda, Andrea

    2015-01-01

    Advanced endoscopic imaging is revolutionizing our way on how to diagnose and treat colorectal lesions. Within recent years a variety of modern endoscopic imaging techniques was introduced to improve adenoma detection rates. Those include high-definition imaging, dye-less chromoendoscopy techniques and novel, highly flexible endoscopes, some of them equipped with balloons or multiple lenses in order to improve adenoma detection rates. In this review we will focus on the newest developments in the field of colonoscopic imaging to improve adenoma detection rates. Described techniques include high-definition imaging, optical chromoendoscopy techniques, virtual chromoendoscopy techniques, the Third Eye Retroscope and other retroviewing devices, the G-EYE endoscope and the Full Spectrum Endoscopy-system. PMID:25789092

  4. Influence of periampullary diverticulum on the occurrence of pancreaticobiliary diseases and outcomes of endoscopic retrograde cholangiopancreatography.

    PubMed

    Chen, Lu; Xia, Lu; Lu, Yi; Bie, Like; Gong, Biao

    2017-01-01

    Periampullary diverticulum (PAD) is frequently encountered in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to investigate the association of PAD with pancreaticobiliary diseases as well as the impact of PAD on the technical success of ERCP and different methods of bile duct stone extraction. A total of 1489 cases of patients with PAD were identified from 6390 patients who underwent ERCP. These patients were compared with 1500 controls without PAD in terms of biliary stone formation, technical success, and complications of ERCP. Patients with PAD had increased prevalence of bile duct stones, gallstones, and cholangitis (P<0.01). Successful cannulation rates were similar in the PAD and the control group (98.59 vs. 99.07%, P=0.225). The incidence of complications did not differ between the PAD and the control group. Successful stone removal rate of endoscopic sphincterotomy (EST) was lower in the PAD group than in the control group (83.53 vs. 94.31%, P=0.005). In patients with PAD, the rate of successful stone removal was lower in the EST group than in the endoscopic papillary balloon dilation (EPBD) and EPBD combined with limited EST (ESBD) group. The rates of complications were similar among different treatments (EST, EPBD, or ESBD) in patients with PAD. PAD is associated with bile duct stones, gallstones, and cholangitis. In addition, PAD should not be considered a barrier to a successful cannulation. Moreover, EST is less effective than EPBD and ESBD in patients with PAD, whereas EST, EPBD, and ESBD are equally safe in patients with PAD.

  5. Endoscopic approach for management of biliary strictures in liver transplant recipients: A systematic review and meta-analysis

    PubMed Central

    Aparício, Dayse Pereira da Silva; Otoch, José Pinhata; Montero, Edna Frasson de Souza; Artifon, Everson Luiz de Almeida

    2016-01-01

    The most common biliary complication after liver transplantation is anastomotic stricture (AS) and it can occur isolated or in combination with other complications. Liver graft from a cadaveric donor or a living donor has an influence on the incidence of biliary strictures as well as on the response to endoscopic treatment. Endoscopic treatment using balloon dilation and insertion of biliary stents by endoscopic retrograde cholangiopancreatography (ERCP) is the initial approach to these complications. Aim The aim of this article is to compare different endoscopic techniques to treat post-liver transplantation biliary strictures. Methods The search was carried out on MEDLINE, EMBASE, Scielo-LILACS and Cochrane Library databases through June 2015. A total of 1100 articles were retrieved. Ten clinical trials were analyzed, and seven were included in the meta-analysis. Conclusions The endoscopic treatment of AS was equally effective when compared the use of fully covered self-expandable metal stents (FCSEMS) vs. plastic stents, but the use of FCSEMS was associated with a lower complication risk. The treatment of AS with balloon dilation or balloon dilation associated with plastic stents presented similar results. Deceased donor liver transplantation reduced the risk of biliary stenosis and the endoscopic treatment in these patients was more effective when compared with Living donor liver transplantation. PMID:29026597

  6. [Characteristics of Crohn's disease under 
double balloon enteroscopy].

    PubMed

    Jia, Jia; Liu, Rui; Liu, Xiangjie; Shen, Shourong; Guo, Qin

    2018-05-28

    To observe ulcer characteristics of Crohn's disease under double balloon enteroscopy, and to evaluate the correlation between endoscopic severity and clinical manifestations.
 Methods: A prospective, observational study from July 2015 to December 2016 in the Third Xiangya Hospital, Central South University, we selected 45 patients with positive double-balloon enteroscopy (DBE) and confirmed Crohn's disease. Two digestive internal physician observed the ulcer characteristics of Crohn's disease under double balloon enteroscopy, and gave a simple endoscopic score for CD (SES-CD). We analyzed the correlation between SES-CD and Crohn's disease activity index (CDAI).
 Results: DBE indicated 24 patient ulcers (53.33%) locating at the end of the ileum, 5 (11.11%) locating at ileocolon, 16 (35.56%) locating at upper gatrointestinal tract and they did not affect the end of the ileum. Among them, 8 cases (17.78%) affected only jejunum. Thirty-two patients with longitudinal ulcers in Crohn's disease, accounting for 71.11%. There was no correlation between SES-CD score and CDAI score (r=0.237, P=0.136).
 Conclusion: The ulcerative appearance in Crohn's disease were diverse under double balloon enteroscopy. Crohn's disease could only affect the upper gastrointestinal tract or jejunum. The unwounded ileum and ileocecal valve couldn't be a sign to exclude Crohn's disease. CDAI score couldn't fully assess the prognosis of Crohn's disease.

  7. Endoscopy-guided balloon dilation of benign anastomotic strictures after radical gastrectomy for gastric cancer.

    PubMed

    Lee, Hyun Jik; Park, Wan; Lee, Hyuk; Lee, Keun Ho; Park, Jun Chul; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan; Noh, Sung Hoon

    2014-07-01

    The aim of this study was to evaluate the outcome of endoscopic dilation for benign anastomotic stricture after radical gastrectomy in gastric cancer patients. Gastric cancer patients who underwent endoscopic balloon dilation for benign anastomosis stricture after radical gastrectomy during a 6-year period were reviewed retrospectively. Twenty-one patients developed benign strictures at the site of anastomosis. The majority of strictures occurred within 1 year after surgery (95.2%). The median duration to stenosis after surgery was 1.70 months (range, 0.17 to 23.97 months). The success rate of the first endoscopic dilation was 61.9%. Between the restenosis group (n=8) and the no restenosis group (n=13), there were no significant differences in the body mass index (22.82 kg/m(2) vs 22.46 kg/m(2)), interval to symptom onset (73.9 days vs 109.3 days), interval to treatment (84.6 days vs 115.6 days), maximal balloon diameter (14.12 mm vs 15.62 mm), number of balloon dilation sessions (1.75 vs 1.31), location of gastric cancer or type of surgery. One patient required surgery because of stricture refractory to repeated dilation. Endoscopic dilation is a highly effective treatment for benign anastomotic strictures after radical gastrectomy for gastric cancer and should be considered a primary intervention prior to proceeding with surgical revision.

  8. Long-term outcome of peroral endoscopic myotomy for achalasia treatment in a 9-year-old female patient.

    PubMed

    Yamashita, Kanefumi; Shiwaku, Hironari; Hirose, Ryuichiro; Kai, Hiroki; Nakashima, Ryo; Kato, Daisuke; Beppu, Richiko; Takeno, Shinsuke; Sasaki, Takamitsu; Nimura, Satoshi; Iwasaki, Akinori; Inoue, Haruhiro; Yamashita, Yuichi

    2016-11-01

    Achalasia is a primary motility disorder with incomplete lower esophageal sphincter relaxation; it has an annual incidence of 0.11 cases per 100 000 children. Peroral endoscopic myotomy (POEM) is a new endoscopic treatment method for achalasia. Reports about POEM in pediatric patients are rare. We herein report the case of a 9-year-old female patient with achalasia who underwent POEM. The patient underwent endoscopic balloon dilatation because medication was not effective at a previous hospital; however, endoscopic balloon dilatation was not effective either. She then underwent successful POEM upon admission at our hospital. The patient was symptom-free at 2 years postoperatively with no signs of esophagitis in the absence of proton-pump inhibitor therapy. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  9. Complications of retrograde balloon cautery endopyelotomy.

    PubMed

    Schwartz, B F; Stoller, M L

    1999-11-01

    Adult ureteropelvic junction obstruction is increasingly managed with endoscopic techniques. Retrograde balloon cautery endopyelotomy is quick, requires minimal hospital stay and allows most patients a rapid return to work. The complication rate of retrograde balloon cautery endopyelotomy ranges from 13 to 34%, with vascular injury in 0 to 16% of patients. We report 5 uncommon complications, including 4 vascular injuries, that clinicians should be familiar with when using this technique. We reviewed 52 retrograde endoscopic endopyelotomy procedures performed during a 5-year period. There were 5 uncommon complications. Accessory lower pole renal artery injuries occurred in 3 patients, 1 of whom presented 12 days after endopyelotomy. Embolization was successfully performed in all 3 cases and none had subsequent hypertension. In 1 case a right ovarian vein laceration was not evident on preoperative or postoperative angiography. Emergency post-embolization abdominal exploration revealed a 2 mm. injury to the right ovarian vein before entering the right renal vein close to the ureteropelvic junction incision. Nephrectomy and ovarian vein ligature were curative. In 1 case the electrocautery wire broke intracorporeally after firing, resulting in a bobby pin-like configuration. Successful removal was accomplished by twisting the catheter and wrapping the wire around the tip, enabling atraumatic removal. Retrograde balloon cautery endopyelotomy is an emerging technology with potential adverse outcomes. The complications we noted are complex and potentially life threatening. Awareness of these complications may help avoid poor outcomes and expedite appropriate treatment.

  10. Review of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography using several endoscopic methods in patients with surgically altered gastrointestinal anatomy

    PubMed Central

    Shimatani, Masaaki; Takaoka, Makoto; Tokuhara, Mitsuo; Miyoshi, Hideaki; Ikeura, Tsukasa; Okazaki, Kazuichi

    2015-01-01

    The endoscopic approach for biliary diseases in patients with surgically altered gastrointestinal anatomy (SAGA) had been generally deemed impractical. However, it was radically made feasible by the introduction of double balloon endoscopy (DBE) that was originally developed for diagnosis and treatments for small-bowel diseases. Followed by the subsequent development of single-balloon endoscopy (SBE) and spiral endoscopy (SE), interventions using several endoscopes for biliary disease in patients with SAGA widely gained an acceptance as a new modality. Many studies have been made on this new technique. Yet, some problems are to be solved. For instance, the mutual unavailability among devices due to different working lengths and channels, and unestablished standardization of procedural techniques can be raised. Additionally, in an attempt to standardize endoscopic procedures, it is important to evaluate biliary cannulating methods by case with existence of papilla or not. A full comprehension of the features of respective scope types is also required. However there are not many papers written as a review. In our manuscript, we would like to evaluate and make a review of the present status of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography applying DBE, SBE and SE for biliary diseases in patients with SAGA for establishment of these modalities as a new technology and further improvement of the scopes and devices. PMID:26078830

  11. Endoscopic management of Crohn’s strictures

    PubMed Central

    Bessissow, Talat; Reinglas, Jason; Aruljothy, Achuthan; Lakatos, Peter L; Van Assche, Gert

    2018-01-01

    Symptomatic intestinal strictures develop in more than one third of patients with Crohn’s disease (CD) within 10 years of disease onset. Strictures can be inflammatory, fibrotic or mixed and result in a significant decline in quality of life, frequently requiring surgery for palliation of symptoms. Patients under the age of 40 with perianal disease are more likely to suffer from disabling ileocolonic disease thus may have a greater risk for fibrostenotic strictures. Treatment options for fibrostenotic strictures are limited to endoscopic and surgical therapy. Endoscopic balloon dilatation (EBD) appears to be a safe, less invasive and effective alternative modality to replace or defer surgery. Serious complications are rare and occur in less than 3% of procedures. For non-complex strictures without adjacent fistulizaation or perforation that are less than 5 cm in length, EBD should be considered as first-line therapy. The aim of this review is to present the current literature on the endoscopic management of small bowel and colonic strictures in CD, which includes balloon dilatation, adjuvant techniques of intralesional injection of steroids and anti-tumor necrosis factor, and metal stent insertion. Short and long-term outcomes, complications and safety of EBD will be discussed. PMID:29740201

  12. Current Status of Peroral Endoscopic Myotomy

    PubMed Central

    Cho, Young Kwan; Kim, Seong Hwan

    2018-01-01

    Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders. PMID:29397656

  13. Current Status of Peroral Endoscopic Myotomy.

    PubMed

    Cho, Young Kwan; Kim, Seong Hwan

    2018-01-01

    Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.

  14. Safety and effectiveness of gastric balloons associated with hypocaloric diet for the treatment of obesity.

    PubMed

    de Castro, Maria Luisa; Morales, Maria Jose; Martínez-Olmos, Miguel A; Pineda, Juan R; Cid, Lucia; Estévez, Pamela; del-Campo, Victor; Rodríguez-Prada, J Ignacio

    2013-10-01

    intragastric balloons provide early satiety and thereby induce short-term weight loss. The aim of this study was to evaluate safety and short and medium-term effectiveness of gastric balloons associated to hypocaloric diet in obesity. from May 2004 to June 2011 91 obese patients, body mass index (BMI) 45.2 +/- 7.2 kg/m2 were prospectively followed after endoscopic implantation of a gastric balloon associated to restricted diet. Successful therapy was defined as percent loss of total weight (%LTW) > or = 5 % at six months after balloon placement and 6 and 12 months after their withdrawal. All analyses followed intention-to treat principles considering significant p-values < 0.05. we placed 73 fluid-filled balloons (80.2 %) and 18 air-filled ones (19.8 %). Compared to baseline values, at 6-month 73.7 % subjects succeeded, showing significant reductions in weight (13.3 +/- 8.8 kg), BMI (5 +/- 3.4 kg/m2) (p < 0.0001), with % LTW 11 +/- 7 %. Six and twelve months after retrieval 45.1 % and 28.6 % patients reached % LTW > or = 5 %. Short-term and medium-term effectiveness was negatively associated to obesity in first-grade relatives (p = 0.003 and p = 0.04). Higher weight loss 6 months after balloon placement independently predicted medium-term effectiveness (p = 0.0001). Mortality was absent but there were two spontaneous deflations of air-filled balloons and severe withdrawal difficulties in 8 patients, leading to surgery in one case. Retrieval complications associated to air-filled balloons (p = 0.0005). in obesity, effectiveness of gastric balloons associated to hypocaloric diet decreases over time.Complications occurred mainly in the retrieval endoscopic procedure and related to air-filled balloons.

  15. [Endoscopic sinus surgery in flowing water].

    PubMed

    Noda, K; Doi, K; Noiri, T; Koizuka, I; Kubo, T

    2000-05-01

    A balloon has been developed that completely fills the choana, preventing water from leaking into the pharynx even when the water is entering into the nasal cavity at a rate of 1000 ml per minute. The balloon enables endoscopic sinus surgery (ESS) to be safely performed in "flowing water". This surgical technique is similar to that used in transurethral resections of the prostate because the tip of the endoscope is kept clean, and blood, debris and resected tissues are continuously removed by the water flow. In addition, the water pressure helps to suppress bleeding. This technique enables ESS to be performed with greater ease and efficiency. We have performed ESS in flowing water on 38 patients with chronic sinusitis under local anaesthesia. No complications, such as water leakage into the pharynx, were encountered, and only a few patients felt discomfort from the insertion of the balloon. Even if the balloon had burst, an emergency could have been easily prevented by withdrawing the endoscope from the nasal cavity and stopping the flow of water. Ultrasonography (USG) was used to examine the water-filled nasal cavity during surgery (SSD-2000 and Micro Tip Radial (ASU-101); Aloka, Ltd., Japan). Using USG, the middle turbinate, the inferior turbinate and the nasal septum could be visualized in a single coronal image. When the sensor was in the posterior ethmoid sinus, the orbit and its optic nerve could also be visualized. Since this surgery is performed under local anesthesia, eye movements can rapidly alter the position of the optic nerve. Thus, visualization of the optic nerve's exact position is extremely important. Unfortunately, USG is not very useful for localizing structures and guiding the surgeon to distant tumors or cysts located behind thick bones, since ultrasound can not penetrate hard masses or bones. In this situation, navigation systems are more reliable than USG. Nevertheless, USG is often useful for depicting surgical sites, especially during a

  16. Solo-Surgeon Retroauricular Approach Endoscopic Thyroidectomy.

    PubMed

    Lee, Doh Young; Baek, Seung-Kuk; Jung, Kwang-Yoon

    2017-01-01

    This study aimed to evaluate the feasibility and efficacy of solo-surgeon retroauricular thyroidectomy. For solo-surgery, we used an Endoeye Flex Laparo-Thoraco Videoscope (Olympus America, Inc.). A Vitom Karl Storz holding system (Karl Storz GmbH & Co.) composed of several bars connected by a ball-joint system was used for fixation of endoscope. A snake retractor and a brain-spoon retractor were used on the sternocleidomastoid. Endoscopic thyroidectomy using the solo-surgeon technique was performed in 10 patients having papillary thyroid carcinoma. The mean patient age was 36.0 ± 11.1 years, and all patients were female. There were no postoperative complications such as vocal cord paralysis and hematoma. When compared with the operating times and volume of drainage of a control group of 100 patients who underwent surgery through the conventional retroauricular approach between May 2013 and December 2015, the operating times and volume of drainage were not significantly different (P = .781 and .541, respectively). Solo-surgeon retroauricular thyroidectomy is safe and feasible when performed by a surgeon competent in endoscopic thyroidectomy.

  17. Balloon dilation and intralesional steroid for benign rectal stricture management in a cat.

    PubMed

    Chavkin, Jessica A; Spector, Donna J; Stanley, Skye W

    2010-08-01

    A 4-year-old castrated male domestic shorthair presented for 1 week of constipation and tenesmus. A rectal stricture had been diagnosed 8 months prior at the time of adoption and the cat had been successfully managed with stool softeners until presentation. A complete diagnostic work-up failed to reveal an underlying etiology for the stricture and colonoscopy was performed. Endoscopic biopsies of the stricture revealed benign non-specific inflammatory changes. Balloon dilation of the rectal stricture was performed during the initial colonoscopy and 3 and 9 days later. Triamcinolone acetonide was injected into the stricture site with endoscopic guidance during the third dilation procedure. The patient has been monitored for over 27 months; follow-up indicates no signs of tenesmus and repeated rectal examinations reveal no stricture recurrence. This case report demonstrates that endoscopic balloon dilation with intralesional steroid injection represented a minimally invasive and effective option for the treatment of a benign rectal stricture in this cat, and deserves further prospective investigation. Copyright 2010 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

  18. Endoscopic Therapy in Crohn's Disease: Principle, Preparation, and Technique.

    PubMed

    Chen, Min; Shen, Bo

    2015-09-01

    Stricture and fistula are common complications of Crohn's disease. Endoscopic balloon dilation and needle-knife stricturotomy has become a valid treatment option for Crohn's disease-associated strictures. Endoscopic therapy is also increasingly used in Crohn's disease-associated fistula. Preprocedural preparations, including routine laboratory testing, imaging examination, anticoagulant management, bowel cleansing and proper sedation, are essential to ensure a successful and safe endoscopic therapy. Adverse events, such as perforation and excessive bleeding, may occur during endoscopic intervention. The endoscopist should be well trained, always be cautious, anticipate for possible procedure-associated complications, be prepared for damage control during endoscopy, and have surgical backup ready. In this review, we discuss the principle, preparation, techniques of endoscopic therapy, as well as the prevention and management of endoscopic procedure-associated complications. We propose that inflammatory bowel disease endoscopy may be a part of training for "super" gastroenterology fellows, i.e., those seeking a career in advanced endoscopy or in inflammatory bowel disease.

  19. Long-term outcome of 154 patients receiving balloon-occluded retrograde transvenous obliteration for gastric fundal varices.

    PubMed

    Imai, Yukinori; Nakazawa, Manabu; Ando, Satsuki; Sugawara, Kayoko; Mochida, Satoshi

    2016-11-01

    This study aims to clarify the long-term outcome of therapeutic strategies including balloon-occluded retrograde transvenous obliteration (B-RTO) for patients with gastric fundal varices. The subjects were 154 patients with gastric fundal varices fulfilling the criteria for receiving B-RTO. In patients showing variceal bleeding, endoscopic therapies and/or balloon tamponade was performed to achieve hemostasis. B-RTO was accomplished with injection of 5% ethanolamine oleate through a standard balloon catheter except for patients with atypical varices, in whom a microballoon catheter was used to occlude drainage vessels other than a gastrorenal shunt. In patients complicated with esophageal varices at baseline, endoscopic therapies were performed following B-RTO. Balloon-occluded retrograde transvenous obliteration was performed successfully in 147 patients (95%), including 15 patients using a microballoon catheter. Complete variceal obliteration was achieved in all patients. Additional endoscopic therapies for esophageal varices were performed in 31 patients. Gastric varices did not recur in any of these patients. The cumulative survival rates at 1, 3, and 5 years after B-RTO were 91%, 76%, and 72%, respectively. Child-Pugh scores and hepatocellular carcinoma complication were identified as prognostic factors associated with survival rates. The cumulative exacerbation rates of esophageal varices at 1, 3, and 5 years were 13%, 20%, and 27%, respectively, and rupture developed in six patients, which were successfully treated with endoscopic therapies. Therapeutic strategies including B-RTO with a microballoon catheter were useful to achieve a favorable outcome in patients with gastric fundal varices especially in those manifesting Child-Pugh class-A liver damage and/or those without hepatocellular carcinoma complication. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  20. Endoscopic subcutaneous mastectomy: A novel and effective treatment for gynecomastia

    PubMed Central

    CAO, HUA; YANG, ZHI-XUE; SUN, YI-HUI; WU, HAO-RONG; JIANG, GUO-QIN

    2013-01-01

    The aim of this study was to evaluate the procedure for and efficacy of endoscopic subcutaneous mastectomy for gynecomastia. Endoscopic subcutaneous mastectomy was performed on 100 benign, palpable breast enlargements in 58 male patients who were followed-up for 15–63 months. The surgery was conducted with the insufflation of CO2 subdermally. No cases were converted to open surgery. The unilateral surgery time was 70–90 min. The mean volume of the resected tissue was 200 ml. All procedures were completed successfully, with satisfactory clinical effects and ideal esthetic results postoperatively. There were three cases (3%) of papillary epidermal partial necrosis; following removal of the dressing during the hospital stay, normal nipple sensation returned. Endoscopic subcutaneous mastectomy had good clinical effects and ideal cosmetic results and is an appropriate approach for gynecomastia. PMID:23837054

  1. Endoscopic Treatment of Biliary Stenosis in Patients with Alveolar Echinococcosis--Report of 7 Consecutive Patients with Serial ERC Approach.

    PubMed

    Stojkovic, Marija; Junghanss, Thomas; Veeser, Mira; Weber, Tim F; Sauer, Peter

    2016-02-01

    Biliary vessel pathology due to alveolar echicococcosis (AE) results in variable combinations of stenosis, necrosis and inflammation. Modern management strategies for patients with cholestasis are desperately needed. The aim is proof of principle of serial ERC (endoscopic retrograde cholangiography) balloon dilation for AE biliary pathology. Retrospective case series of seven consecutive patients with AE-associated biliary pathology and ERC treatment in an interdisciplinary endoscopy unit at a University Hospital which hosts a national echinococcosis treatment center. The AE patient cohort consists of 106 patients with AE of the liver of which 13 presented with cholestasis. 6/13 received bilio-digestive anastomosis and 7/13 patients were treated by ERC and are reported here. Biliary stricture balloon dilation was performed with 18-Fr balloons at the initial and with 24-Fr balloons at subsequent interventions. If indicated 10 Fr plastic stents were placed. Six patients were treated by repeated balloon dilation and stenting, one by stenting only. After an acute phase of 6 months with repeated balloon dilation, three patients showed "sustained clinical success" and four patients "assisted therapeutic success," of which one has not yet reached the six month endpoint. In one patient, sustained success could not be achieved despite repeated insertion of plastic stents and balloon dilation, but with temporary insertion of a fully covered self-expanding metal stent (FCSEMS). There was no loss to follow up. No major complications were observed. Serial endoscopic dilation is a standard tool in the treatment of benign biliary strictures. Serial endoscopic intervention with balloon dilation combined with benzimidazole treatment can re-establish and maintain biliary duct patency in AE associated pathology and probably contributes to avoid or postpone bilio-digestive anastomosis. This approach is in accordance with current ERC guidelines and is minimally disruptive for patients.

  2. Endoscopic Treatment of Biliary Stenosis in Patients with Alveolar Echinococcosis – Report of 7 Consecutive Patients with Serial ERC Approach

    PubMed Central

    Stojkovic, Marija; Junghanss, Thomas; Veeser, Mira; Weber, Tim F.; Sauer, Peter

    2016-01-01

    Background and Aims Biliary vessel pathology due to alveolar echicococcosis (AE) results in variable combinations of stenosis, necrosis and inflammation. Modern management strategies for patients with cholestasis are desperately needed. The aim is proof of principle of serial ERC (endoscopic retrograde cholangiography) balloon dilation for AE biliary pathology. Methods Retrospective case series of seven consecutive patients with AE-associated biliary pathology and ERC treatment in an interdisciplinary endoscopy unit at a University Hospital which hosts a national echinococcosis treatment center. The AE patient cohort consists of 106 patients with AE of the liver of which 13 presented with cholestasis. 6/13 received bilio-digestive anastomosis and 7/13 patients were treated by ERC and are reported here. Biliary stricture balloon dilation was performed with 18-Fr balloons at the initial and with 24-Fr balloons at subsequent interventions. If indicated 10 Fr plastic stents were placed. Results Six patients were treated by repeated balloon dilation and stenting, one by stenting only. After an acute phase of 6 months with repeated balloon dilation, three patients showed “sustained clinical success” and four patients “assisted therapeutic success,” of which one has not yet reached the six month endpoint. In one patient, sustained success could not be achieved despite repeated insertion of plastic stents and balloon dilation, but with temporary insertion of a fully covered self-expanding metal stent (FCSEMS). There was no loss to follow up. No major complications were observed. Conclusions Serial endoscopic dilation is a standard tool in the treatment of benign biliary strictures. Serial endoscopic intervention with balloon dilation combined with benzimidazole treatment can re-establish and maintain biliary duct patency in AE associated pathology and probably contributes to avoid or postpone bilio-digestive anastomosis. This approach is in accordance with current

  3. p27kip1 expression distinguishes papillary hyperplasia in Graves' disease from papillary thyroid carcinoma.

    PubMed

    Erickson, L A; Yousef, O M; Jin, L; Lohse, C M; Pankratz, V S; Lloyd, R V

    2000-09-01

    In most cases, the histopathologic and cytologic distinction between Graves' disease and papillary thyroid carcinoma is relatively easy, but on occasion Graves' disease may simulate a thyroid papillary carcinoma. For example, papillary fronds with fibrovascular cores may be present in both Graves' disease and papillary carcinoma. p27kip1 (p27) is a cyclin-dependent kinase inhibitory protein that has been shown to be an independent prognostic factor in a variety of human tumors. Our previous studies of p27 expression in hyperplastic and neoplastic endocrine lesions showed that the level of p27 was quite different in these two conditions. To determine if this distinction could also be made between Graves' disease and papillary carcinoma, we analyzed expression of p27 and other cell cycle proteins in a series of cases of Graves' disease with papillary hyperplasia and a series of papillary thyroid carcinomas. Formalin-fixed paraffin-embedded tissues from 61 randomly selected patients with thyroid disease, including 29 cases of Graves' disease with papillary architectural features and 32 cases of papillary carcinoma, were analyzed for expression of p27, Ki-67, and DNA topoisomerase II alpha (topo II alpha) by immunostaining. The distribution of immunoreactivity was analyzed by quantifying the percentage of positive nuclei that was expressed as the labeling index (LI) plus or minus the standard error of the mean. The papillary hyperplasia of Graves' disease had a p27 LI of 68.2 +/- 3.1 (range, 24 to 88), whereas papillary carcinomas had a LI of 25.6 +/- 2.5 (range, 12 to 70) (P < .0001). No significant differences in Ki-67 or topo II alpha expression were identified between papillary hyperplasia in Graves' disease and papillary carcinoma. These results indicate that p27 protein expression is significantly higher in papillary hyperplasia of Graves' disease compared to papillary carcinoma, which may be diagnostically useful in difficult cases.

  4. Fine-needle aspiration cytology of intraductal papillary-mucinous tumors: a retrospective analysis.

    PubMed

    Layfield, Lester J; Cramer, Harvey

    2005-01-01

    Intraductal papillary-mucinous tumor (IPMT) of the pancreas has become the accepted terminology for a group of mucin-producing epithelial proliferations lying within ectatic segments of the main pancreatic duct or its large branches. These neoplasms generally are associated with an indolent course, characteristic endoscopic ultrasonographic (EUS) findings, and a variable histo- and cytomorphology ranging from hyperplasia to carcinoma. Cytological specimens obtained by endoscopic ultrasound-guided or percutaneous fine-needle aspiration (FNA) are characterized by a background containing abundant mucin in which are entrapped single or loosely cohesive clusters of neoplastic cells characteristically showing a goblet-cell morphology. The degree of nuclear atypia, cell crowding, and cell shape varies between smears within a single case and between cases. Cytomorphological examination, when coupled with EUS features, is accurate for the diagnosis of these lesions but often it underdiagnoses the grade of the neoplasm. (c) 2005 Wiley-Liss, Inc.

  5. [Endoscopic manometry in the common bile duct].

    PubMed

    Brandstätter, G; Kratochvil, P; Stupnicki, T; Zenker, G; Justich, E; Resch, M

    1982-09-17

    Reproducible results were obtained by endoscopic transpapillary pressure measurements with the help of a constantly perfused catheter. Manometric measurements were performed in 51 patients without any premedication. 14 patients with a normal biliary system were compared with 17 patients after cholecystectomy, 14 patients with stones in the common bile duct and 6 patients after papillotomy. Although there were significant differences in the diameter of the common bile duct in the four groups, only the papillotomized patients demonstrated a distinct change of the pressure in the bile duct. In these patients almost no pressure gradient existed between the biliary ducts and the duodenum. On the other hand, there was an increase in intraluminal pressure in the 2 patients with papillary stenosis. Endoscopic manometric measurements in the common bile duct are indicated to obtain reliable data on stenosis of the papilla duodeni, insufficient papillotomy or recurrent stenosis.

  6. Endoscope-guided pneumatic dilation for treatment of esophageal achalasia

    PubMed Central

    Chuah, Seng-Kee; Wu, Keng-Liang; Hu, Tsung-Hui; Tai, Wei-Chen; Changchien, Chi-Sin

    2010-01-01

    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. PMID:20101764

  7. Prognostic significance of atypical papillary urothelial hyperplasia.

    PubMed

    Swierczynski, Sharon L; Epstein, Jonathan I

    2002-05-01

    Typical papillary hyperplasia, a recently recognized precursor lesion to low-grade papillary urothelial neoplasms, consists of undulating folds of cytologically benign urothelium. Well-developed, branching fibrovascular cores of a papillary neoplasm are not evident. We have noted lesions with the architectural pattern of papillary hyperplasia; however, the overlying urothelium demonstrated varying degrees of cytologic atypia. We identified 15 cases of atypical papillary hyperplasia (13 males, 2 females, age 55 to 92) with overlying urothelium showing cytologic atypia. Of these cases, 8 (53%) were received in consultation. Of the 15 cases, 8 exhibited overlying flat carcinoma in situ (CIS), 4 had overlying dysplasia, and 3 were transitional between papillary hyperplasia with atypia and the earliest lesions of papillary neoplasia. Of these cases, 5 patients had multiple specimens with atypical papillary hyperplasia (range, 2 to 8) over time. Concurrent to the diagnosis of atypical papillary hyperplasia, there were 25 different urothelial lesions: CIS (n = 11), papilloma (n = 1), papillary neoplasm of low malignant potential with CIS (n = 1), high-grade papillary urothelial carcinoma (n = 10; 3 with CIS), small-cell carcinoma (n = 1), and infiltrating urothelial carcinoma (n = 1). Of 11 patients with known prior history, 2 had 12 prior urothelial neoplasms (9 low-grade papillary neoplasms, 2 papillary urothelial neoplasms of low malignant potential, and 1 high-grade papillary cancer). Of 10 patients with atypical papillary hyperplasia and a minimum of 1 year of follow-up, 9 had 19 recurrences: CIS (n = 4), papilloma (n = 1), papillary neoplasm of low malignant potential (n = 1), infiltrating urothelial carcinoma (n = 3; 1 with CIS), and high-grade papillary urothelial carcinoma (n = 10; 5 with invasion and 2 with CIS). Whether the papillary hyperplasia had overlying CIS or dysplasia did not affect the correlation with urothelial neoplasms. Immunohistochemical analysis

  8. Hereditary Papillary Renal Cell Carcinoma

    MedlinePlus

    ... of papillary cancer called type 1 papillary renal cell cancer. Individuals with HPRC have an increased risk of ... that the risk for type 1 papillary renal cell cancer can be passed from generation to generation in ...

  9. Gastric emptying and intragastric balloon in obese patients.

    PubMed

    Bonazzi, P; Petrelli, M D; Lorenzini, I; Peruzzi, E; Nicolai, A; Galeazzi, R

    2005-01-01

    Intragastric balloons have been proposed to induce weight loss in obese subjects. The consequences of the balloon on gastric physiology remain poorly studied. We studied the influence of an intragastric balloon on gastric emptying in obese patients. 12 patients were included in the study, with BMI (mean +/- SD) of 38.51 +/- 4.32 kg/m2. The balloon was inserted under light anaesthesia and endoscopic control, inflated with 700 ml saline, and removed 6 months later. Body weight and gastric emptying (T1/2 and T lag) using 13C-octanoic acid breath test were monitored before balloon placement, during its permanence and 2 months after removal. Mean weight loss was: 6.2 +/- 2.3 kg after one month; 12.4 +/- 5.8 kg after 3 months; 14.4 +/- 6.6 kg after 6 months and 10.1 +/- 4.3 kg two months after BIB removal. Gastric emptying rates were significantly decreased in the first periods with balloon in place, and returned to pre-implantation values after balloon removal. T1/2 was: 87 +/- 32 min before BIB positioning, 181 +/- 91 min after 1 month, 145 +/- 99 min after 3 months, 104 +/- 50 min after 6 months and 90 +/- 43 min 2 months after removal. T lag was 36 +/- 18 min before BIB positioning, 102 +/- 82 min after 1 month, 77 +/- 53 min after 3 months, 59 +/- 28 min after 6 months and 40 +/- 21 min. 2 months after removal. BIB in obese patients seems to be a good help in following the hypo caloric diet, especially during the first three months when the gastric emptying is slower and the sense of repletion is higher. After this period gastric emptying starts to return to normal and the stomach adapts to BIB loosing efficacy in weight loss.

  10. [Endoscopic operation in the treatment of congenital duodenal membranous stenosis].

    PubMed

    Kong, Chihuan; Li, Long; Dong, Ning; Li, Xu; Zhang, Yanling

    2015-08-01

    To investigate the safety and efficacy of endoscopic duodenal valvectomy in the treatment of congenital duodenal membranous stenosis. Clinical data of two children with congenital duodenal membranous stenosis undergoing endoscopic duodenal valvectomy in our institute within October 2014 were analyzed retrospectively. This procedure was performed with Microknife XL and CRE balloon catheter through porous channel in the 9 mm flexible endoscope. The first case was a 2-year-old boy who received two endoscopic operations including duodenal diaphragm resection and duodenal dilatation because of incision retraction. The second case was a 19-month-old gril who received once endoscopic duodenal valvectomy. Duodenal obstruction of these two children was relieved after operation. Postoperative x-rays showed no perforation. They could play in the floor 6 hours after operation without any complains, drink water 12 hours, take liquid diets 2 days and half solid food 3 days after operation. During follow-up a month after operation, the body weight gained was 1.5 and 1.0 kg respectively, and the dietary components was significantly improved. Endoscopic duodenal valvectomy is feasible and effective in the treatment of congenital duodenal membranous stenosis.

  11. Endoscopic management of bile leakage after liver transplantation.

    PubMed

    Oh, Dong-Wook; Lee, Sung Koo; Song, Tae Jun; Park, Do Hyun; Lee, Sang Soo; Seo, Dong-Wan; Kim, Myung-Hwan

    2015-05-23

    Endoscopic retrograde cholangiopancreatography (ERCP) can be an effective treatment for bile leakage after liver transplantation. We evaluated the efficacy of endoscopic treatment in liver transplantation in patients who developed bile leaks. Forty-two patients who developed bile leaks after liver transplantation were included in the study. If a bile leak was observed on ERCP, a sphincterotomy was performed, and a nasobiliary catheter was then inserted. If a bile leak was accompanied by a bile duct stricture, either the stricture was dilated with balloons, followed by nasobiliary catheter insertion across the bile duct stricture, or endoscopic retrograde biliary drainage was performed. In the bile leakage alone group (22 patients), endoscopic treatment was technically successful in 19 (86.4%) and clinically successful in 17 (77.3%) cases. Among the 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 (65.0%) and clinically successful in 10 (50.0%) cases. Among the 42 patients who underwent ERCP, technical success was achieved in 32 (76.2%) cases and clinical success was achieved in 27 (64.3%) cases. ERCP is an effective and safe therapeutic modality for bile leaks after liver transplantation. ERCP should be considered as an initial therapeutic modality in post-liver transplantation patients.

  12. Endoscopic Management of Bile Leakage after Liver Transplantation

    PubMed Central

    Oh, Dongwook; Lee, Sung Koo; Song, Tae Jun; Park, Do Hyun; Lee, Sang Soo; Seo, Dong-Wan; Kim, Myung-Hwan

    2015-01-01

    Background/Aims Endoscopic retrograde cholangiopancreatography (ERCP) can be an effective treatment for bile leakage after liver transplantation. We evaluated the efficacy of endoscopic treatment in liver transplantation in patients who developed bile leaks. Methods Forty-two patients who developed bile leaks after liver transplantation were included in the study. If a bile leak was observed on ERCP, a sphincterotomy was performed, and a nasobiliary catheter was then inserted. If a bile leak was accompanied by a bile duct stricture, either the stricture was dilated with balloons, followed by nasobiliary catheter insertion across the bile duct stricture, or endoscopic retrograde biliary drainage was performed. Results In the bile leakage alone group (22 patients), endoscopic treatment was technically successful in 19 (86.4%) and clinically successful in 17 (77.3%) cases. Among the 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 (65.0%) and clinically successful in 10 (50.0%) cases. Among the 42 patients who underwent ERCP, technical success was achieved in 32 (76.2%) cases and clinical success was achieved in 27 (64.3%) cases. Conclusions ERCP is an effective and safe therapeutic modality for bile leaks after liver transplantation. ERCP should be considered as an initial therapeutic modality in post-liver transplantation patients. PMID:25717048

  13. Locoregional mitomycin C injection for esophageal stricture after endoscopic submucosal dissection.

    PubMed

    Machida, H; Tominaga, K; Minamino, H; Sugimori, S; Okazaki, H; Yamagami, H; Tanigawa, T; Watanabe, K; Watanabe, T; Fujiwara, Y; Arakawa, T

    2012-06-01

    This prospective study aimed to evaluate the feasibility and safety of locoregional mitomycin C (MMC) injection to treat refractory esophageal strictures after endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. Patients with dysphagia and strictures that were refractory to repeated endoscopic balloon dilation (EBD) were eligible. After EBD, MMC was injected into the dilated site. Between June 2009 and August 2010, five patients were recruited. The treatment was performed once in two patients and twice in three patients with recurrent dysphagia or restenosis. In all patients, passing a standard endoscope through the site was easy and the dysphagia grade improved (grade 3→1 in 3 patients, grade 4→2 in 2 patients). No serious complications were noted. During the observation period of 4.8 months, neither recurrent dysphagia nor re-stricture appeared in any of the patients. The combination of locoregional MMC injections and EBD is feasible and safe for the treatment of esophageal strictures after ESD.Recently, endoscopic submucosal dissection (ESD) has been developed and accepted as a new endoscopic treatment for gastrointestinal tumors. ESD is a promising treatment for superficial esophageal carcinoma (SEC), and it has a reliable en bloc resection rate. However, the application of ESD for widespread lesions is challenging because of the high risk of the development of severe strictures, which lead to a low quality of life after ESD. Although endoscopic balloon dilation (EBD) is effective for benign strictures, it needs to be performed frequently until the dysphagia disappears 1. Mitomycin C (MMC), which is a chemotherapeutic agent derived from some Streptomyces species 2, reduces scar formation when topically applied to a surgical lesion. MMC has been applied to treat strictures in a variety of anatomical locations, including a variety of organs 3. The aim of this study was to prospectively evaluate both the feasibility and the safety of

  14. Thyroid cancer - papillary carcinoma

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/000331.htm Thyroid cancer - papillary carcinoma To use the sharing features on ... the lower neck. Causes About 80% of all thyroid cancers diagnosed in the United States are the papillary ...

  15. Prevalence of incidental pancreatic cyst on upper endoscopic ultrasound

    PubMed Central

    Martínez, Belén; Martínez, Juan F.; Aparicio, José R.

    2018-01-01

    Background: This study aimed to determine the prevalence of incidental pancreatic cysts in patients undergoing upper endoscopic ultrasound without a known pancreatic abnormality. Methods: This prospective study was conducted in two hospitals in Spain and enrolled consecutive patients referred for upper endoscopic ultrasound for a condition unrelated to the pancreas. Patients with a previous pancreatic anomaly, history of acute or chronic pancreatitis, evidence of acute pancreatitis, previous upper gastrointestinal surgery, or chronic abdominal pain suggestive of pancreatic origin were excluded. Univariate logistic regression was performed to evaluate individual covariates and the incidental pancreatic cyst risk. Results: A total of 298 patients were included, of whom 64 had pancreatic cysts (21.5%; 16.9-26.6%). The mean size of the cysts was 6.3±3.7 (range 3-25) mm. Six cysts (2%) were >10 mm and 16 (5.4%) were compatible with branch duct intraductal papillary mucinous neoplasm. The pancreatic cyst prevalence was similar in the two hospitals and increased significantly with age. Conclusion: The prevalence of incidental pancreatic cysts during endoscopic ultrasound was very high in our study population. PMID:29333072

  16. Intragastric Balloon Treatment for Obesity: Review of Recent Studies.

    PubMed

    Tate, Chinara M; Geliebter, Allan

    2017-08-01

    The FDA recently approved three intragastric balloon (IGB) devices, ReShape, ORBERA™, and Obalon for treatment of obesity. Given the high cost, complication risk, and invasiveness of bariatric surgery, IGB treatment may present a safer and lower cost option for weight reduction. IGBs are generally placed in the stomach endoscopically for up to 6 months to reduce gastric capacity, enhance feelings of fullness, and induce weight loss. The mechanism of action likely involves stimulation of gastric mechanoreceptors triggering short-acting vagal signals to brain regions implicated in satiety. Balloon efficacy may be influenced by balloon volume, patient gastric capacity, and treatment duration. This review focused on eight recent (2006-present) randomized controlled trials (RCTs) comparing percentage total body weight loss (%TBWL) between IGB and control groups including three reviewed by the FDA. %TBWL based on the reviewed studies was also compared with bariatric surgery and pharmacotherapy. Of the eight IGB studies, five had balloon treatment duration of 6 months. Efficacy at 6 months, based on a pooled weighted-mean %TBWL, was 9.7%, and the control-subtracted %TBWL was 5.6%. When one study without SDs was removed, the weighted mean %TBWL was 9.3 ± 5.7% SD, and control-subtracted %TBWL was 5.5 ± 7.8%, which was statistically greater than controls. IGB showed lower efficacy than bariatric surgery (median weight loss of 27% for Rouen-Y gastric bypass (RYGB). The control-subtracted %TBWL over 6 months of 5.5-5.6% is less than the most efficacious FDA-approved weight loss drug, Qsymia. At the recommended dose, Qsymia has a placebo-subtracted %TBWL at 6 months of approximately 6.6%. The weighted mean reported incidence of serious adverse events (SAEs) in the IGB group across all eight studies was 10.5%. Only six of the eight reviewed studies reported adverse events (AEs) in the IGB group, with a pooled reported incidence of 28.2%. Recently, the FDA reported new

  17. Papillary endothelial hyperplasia in angiokeratoma.

    PubMed

    Mehta, Anurag; Sayal, Satish Kumar; Raman, Deep Kumar; Sood, Aradhana

    2003-01-01

    Papillary endothelial hyperplasia (Masson's tumour) is a reactive proliferation of endothelium producing papillary structures with fibrovascular cores. Dilatation, stasis and accompanying inflammation have been incriminated as the inciting events, evident by the presence of this lesion in haemorrhoids, urethral caruncles and laryngeal polyps. We present here a case of papillary endothelial hyperplasia in angiokeratoma hitherto undescribed despite sharing common etiopathogenetic features of dilatation and stasis with other aforementioned lesions.

  18. Identifying DNA Methylation Biomarkers for Non-Endoscopic Detection of Barrett’s Esophagus

    PubMed Central

    Moinova, Helen R.; LaFramboise, Thomas; Lutterbaugh, James D.; Chandar, Apoorva Krishna; Dumot, John; Faulx, Ashley; Brock, Wendy; De la Cruz Cabrera, Omar; Guda, Kishore; Barnholtz-Sloan, Jill S.; Iyer, Prasad G.; Canto, Marcia I.; Wang, Jean S.; Shaheen, Nicholas J.; Thota, Prashanti N.; Willis, Joseph E.; Chak, Amitabh; Markowitz, Sanford D.

    2018-01-01

    We report a biomarker-based non-endoscopic method for detecting Barrett’s esophagus (BE), based on detecting methylated DNAs retrieved via a swallowable balloon-based esophageal sampling device. BE is the precursor of, and a major recognized risk factor for, developing esophageal adenocarcinoma (EAC). Endoscopy, the current standard for BE detection, is not cost-effective for population screening. We performed genome-wide screening to ascertain regions targeted for recurrent aberrant cytosine methylation in BE, identifying high-frequency methylation within the CCNA1 locus. We tested CCNA1 DNA methylation as a BE biomarker in cytology brushings of the distal esophagus from 173 individuals with or without BE. CCNA1 DNA methylation demonstrated an area under the curve (AUC)=0.95 for discriminating BE-related metaplasia and neoplasia cases versus normal individuals, performing identically to methylation of VIM DNA, an established BE biomarker. When combined, the resulting two biomarker panel was 95% sensitive and 91% specific. These results were replicated in an independent validation cohort of 149 individuals, who were assayed using the same cutoff values for test positivity established in the training population. To progress toward non-endoscopic esophageal screening, we engineered a well-tolerated, swallowable, encapsulated balloon device able to selectively sample the distal esophagus within 5 minutes. In balloon samples from 86 individuals, tests of CCNA1 plus VIM DNA methylation detected BE metaplasia with 90.3% sensitivity and 91.7% specificity. Combining the balloon sampling device with molecular assays of CCNA1 plus VIM DNA methylation enables an efficient, well-tolerated, sensitive, and specific method of screening at-risk populations for BE. PMID:29343623

  19. Distinction between papillary thyroid hyperplasia and papillary thyroid carcinoma by immunohistochemical staining for cytokeratin 19, galectin-3, and HBME-1.

    PubMed

    Casey, Mary B; Lohse, Christine M; Lloyd, Ricardo V

    2003-01-01

    The histopathology of papillary thyroid hyperplasia and papillary thyroid carcinoma is similar enough to cause a diagnostic dilemma in a few cases. Both lesions may have papillary fronds with fibrovascular cores, nuclear crowding, and nuclear anisocytosis. Formalin- fixed paraffin-embedded tissues from 30 randomly selected patients with papillary thyroid hyperplasia and an equal number from patients with papillary thyroid carcinoma were analyzed for expression of cytokeratin 19 (CK19), galectin-3, and HBME-1. Cases of papillary thyroid carcinoma had moderate to strong CK19, galectin-3, and HBME-1 reactivity although both CK19 and galectin-3 showed positive staining in a significant number of nonneoplastic thyroid cases. HBME-1 was uncommon in the nonneoplastic cases. These results indicate that HBME-1 may be useful in helping to distinguish papillary thyroid carcinoma from hyperplasia in diagnostically difficult cases.

  20. Endoscopic features of gastro-intestinal lymphomas: From diagnosis to follow-up

    PubMed Central

    Vetro, Calogero; Romano, Alessandra; Amico, Irene; Conticello, Concetta; Motta, Giovanna; Figuera, Amalia; Chiarenza, Annalisa; Di Raimondo, Cosimo; Giulietti, Giorgio; Bonanno, Giacomo; Palumbo, Giuseppe Alberto; Di Raimondo, Francesco

    2014-01-01

    Many progresses have been done in the management of gastrointestinal (GI) lymphomas during last decades, especially after the discovery of Helicobacter pylori-dependent lymphoma development. The stepwise implementation of new endoscopic techniques, by means of echoendoscopy or double-balloon enteroscopy, enabled us to more precisely describe the endoscopic features of GI lymphomas with substantial contribution in patient management and in tailoring the treatment strategy with organ preserving approaches. In this review, we describe the recent progresses in GI lymphoma management from disease diagnosis to follow-up with a specific focus on the endoscopic presentation according to the involved site and the lymphoma subtype. Additionally, new or emerging endoscopic technologies that have an impact on the management of gastrointestinal lymphomas are reported. We here discuss the two most common subtypes of GI lymphomas: the mucosa-associated lymphoid tissue and the diffuse large B cell lymphoma. A general outline on the state-of-the-art of the disease and on the role of endoscopy in both diagnosis and follow-up will be performed. PMID:25278693

  1. Recent Advances in the Classification of Low-grade Papillary-like Thyroid Neoplasms and Aggressive Papillary Thyroid Carcinomas: Evolution of Diagnostic Criteria.

    PubMed

    Guo, Zhenying; Ge, Minghua; Chu, Ying-Hsia; Asioli, Sofia; Lloyd, Ricardo V

    2018-07-01

    Papillary thyroid carcinomas account for ∼80% of well-differentiated thyroid tumors. During the past decade, several new variants of papillary-like thyroid neoplasms and papillary thyroid carcinomas have been recognized. Some of these neoplasms that were previously classified as malignant have been reclassified as low-grade neoplasms, as the diagnostic criteria have evolved. Similarly, some of the papillary thyroid carcinomas that were previously classified as conventional or classic papillary thyroid carcinomas have now been recognized as more aggressive variants of papillary thyroid carcinomas. Recognizing these differences becomes more important for the proper medical, surgical, and radiotherapeutic management of patients with these neoplasms.

  2. Renal papillary calcification and the development of calcium oxalate monohydrate papillary renal calculi: a case series study.

    PubMed

    Grases, Fèlix; Costa-Bauzá, Antonia; Prieto, Rafel M; Conte, Antonio; Servera, Antonio

    2013-03-11

    The objective of this study is to determine in a case series (four patients) how calcified deposits in renal papillae are associated with the development of calcium oxalate monohydrate (COM) papillary calculi. From the recently collected papillary calculi, we evaluated retrospectively patients, subjected to retrograde ureteroscopy, with COM papillary lithiasis. The COM papillary calculi were found to result from subepithelial injury. Many of these lesions underwent calcification by hydroxyapatite (HAP), with calculus morphology and the amount of HAP in the concave zone dependent on the location of the calcified injury. Most of these HAP deposits grew, eroding the epithelium covering the renal papillae, coming into contact with urine and starting the development of COM calculi. Subepithelial HAP plaques may alter the epithelium covering the papillae, resulting in the deposit of COM crystals directly onto the epithelium. Tissue calcification depends on a pre-existing injury, the continuation of this process is due to modulators and/or crystallization inhibitors deficiency. Since calculus morphology and the amount of detected HAP are dependent on the location and widespread of calcified injury, all types of papillary COM calculi can be found in the same patient. All patients had subepithelial calcifications, with fewer papillary calculi, demonstrating that some subepithelial calcifications did not further evolve and were reabsorbed. A high number of subepithelial calcifications increases the likelihood that some will be transformed into COM papillary calculi.

  3. Survival study of natural orifice translumenal endoscopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model.

    PubMed

    Sylla, Patricia; Sohn, Dae Kyung; Cizginer, Sevdenur; Konuk, Yusuf; Turner, Brian G; Gee, Denise W; Willingham, Field F; Hsu, Maylee; Mino-Kenudson, Mari; Brugge, William R; Rattner, David W

    2010-08-01

    The feasibility of transanal rectosigmoid resection with transanal endoscopic microsurgery (TEM) was previously demonstrated in a swine nonsurvival model in which transgastric endoscopic assistance also was shown to extend the length of colon mobilized transanally. A 2-week survival study evaluating transanal endoscopic rectosigmoid resection with stapled colorectal anastomosis was conducted with swine using the transanal approach alone (TEM group, n = 10) or a transanal approach combined with transgastric endoscopic assistance (TEM + TG group, n = 10). Gastrotomies were created using a needleknife and balloon dilation, then closed using prototype T-tags. Outcomes were evaluated and compared between the groups using Student's t-test and Fisher's exact test. Relative to the TEM group, the average length of rectosigmoid mobilized in the TEM + TG group was 15.6 versus 10.5 cm (p < 0.0005), the length of the resected specimen was 9 versus 6.2 cm (p < 0.0005), and the mean operative time was 254.5 versus 97.5 min (p < 0.0005). Intraoperatively, no organ injury or major bleeding was noted. Two T-tag misfires occurred during gastrotomy closure and four small staple line defects requiring transanal repair including one in the TEM group and three in the TEM + TG group (p = 0.2). Postoperatively, there was no mortality, and the animals gained an average of 3.4 lb. Two major complications (10%) were identified at necropsy in the TEM + TG group including an intraabdominal abscess and an abdominal wall hematoma related to T-tag misfire. Gastrotomy closure sites and colorectal anastomoses were all grossly healed, with adhesions noted in 60 and 70% and microabscesses in 50 and 20% of the gastrotomy sites and colorectal anastomoses, respectively. Natural orifice translumenal endoscopic surgery (NOTES) for rectosigmoid resection using TEM with or without transgastric endoscopic assistance is feasible and associated with low morbidity in a porcine survival model. Transgastric

  4. Design of an everting balloon to deploy a microendoscope to the fallopian tubes

    NASA Astrophysics Data System (ADS)

    Keenan, Molly; Howard, Caitlin; Tate, Tyler; McGuiness, Ian; Sauer-Budge, Alexis; Black, John; Utzinger, Urs; Barton, Jennifer K.

    2016-02-01

    The 5-year survival rate for ovarian cancer is only 45% largely due to lack of effective screening methods. Current methods include palpation, transvaginal ultrasound, and the CA-125 blood test. Finding disease reliably and at an early stage increase survival to 92%. We have designed and built a 0.7 mm endoscope for the early detection of ovarian cancer. Inserted transvaginally through the working channel of a hysteroscope, the falloposcope creates a minimally invasive procedure for the screening of high risk women. To improve the ease-of-use and safety of falloposcope deployment, we are working to create an everting balloon. Currently, the falloposcope would require a skilled user to operate due to the challenging anatomy of the fallopian tubes - a small opening from the uterus (< 1 mm), tortuous path, and delicate lumenal features. A balloon delivery system would gently open the fallopian tube and guide the falloposcope down the center of lumen. We show balloon design and discuss integration with the falloposcope prototype. We test possible mechanical damage to the tissue due to scraping, puncture, or overstretching. Successful introduction of the everting balloon to simplify falloposcope delivery could expand screening beyond specialized centers to smaller clinical locations.

  5. Postoperative vesicoureteral reflux after high-pressure balloon dilation of the ureterovesical junction in primary obstructive megaureter. Incidence, management and predisposing factors.

    PubMed

    García-Aparicio, Luis; Blázquez-Gómez, Eva; de Haro, Irene; Garcia-Smith, Natalie; Bejarano, Miguel; Martin, Oriol; Rodo, Joan

    2015-12-01

    To describe the incidence, predisposing factors and management of postoperative vesicoureteral reflux (VUR) after high-pressure balloon dilation to treat primary obstructive megaureter (POM). We have reviewed patients that underwent endoscopic treatment for POM from May 2008 to November 2013. All patients were evaluated with renal ultrasound, voiding cystourethrography and diuretic renogram. Endoscopic treatment was done with high-pressure balloon dilation of the ureterovesical junction under general anesthesia; a double-J stenting was done in all patients. Follow-up was performed with ultrasonography, voiding cystourethrography and a diuretic renogram in all patients. Fifteen boys and five girls with a mean age of 14.18 months (3-103) were reviewed. A total of 22 ureters underwent HPBD to treat POM. Ureterohydronephrosis improves in 19 ureters. After endoscopic treatment, six ureters developed VUR. Four ureters were managed surgically, and in the other two, VUR disappeared in a second cystogram. The presence of parameatal diverticulum in the preoperative cystography and those patients with bilateral POM are factors related to postoperative VUR (p < 0.05). Urinary tract infection after HPBD was observed in four patients, but only one of them was affected with VUR.

  6. Renal papillary calcification and the development of calcium oxalate monohydrate papillary renal calculi: a case series study

    PubMed Central

    2013-01-01

    Background The objective of this study is to determine in a case series (four patients) how calcified deposits in renal papillae are associated with the development of calcium oxalate monohydrate (COM) papillary calculi. Methods From the recently collected papillary calculi, we evaluated retrospectively patients, subjected to retrograde ureteroscopy, with COM papillary lithiasis. Results The COM papillary calculi were found to result from subepithelial injury. Many of these lesions underwent calcification by hydroxyapatite (HAP), with calculus morphology and the amount of HAP in the concave zone dependent on the location of the calcified injury. Most of these HAP deposits grew, eroding the epithelium covering the renal papillae, coming into contact with urine and starting the development of COM calculi. Subepithelial HAP plaques may alter the epithelium covering the papillae, resulting in the deposit of COM crystals directly onto the epithelium. Tissue calcification depends on a pre-existing injury, the continuation of this process is due to modulators and/or crystallization inhibitors deficiency. Conclusions Since calculus morphology and the amount of detected HAP are dependent on the location and widespread of calcified injury, all types of papillary COM calculi can be found in the same patient. All patients had subepithelial calcifications, with fewer papillary calculi, demonstrating that some subepithelial calcifications did not further evolve and were reabsorbed. A high number of subepithelial calcifications increases the likelihood that some will be transformed into COM papillary calculi. PMID:23497010

  7. Double-balloon endoscopy for retrograde cholangiography in patients with choledochojejunostomy and Roux-en-Y reconstruction.

    PubMed

    Pohl, J; May, A; Aschmoneit, I; Ell, C

    2009-02-01

    Choledochojejunal anastomoses with Roux-en-Y reconstruction excludes the biliary tract from conventional endoscopic retrograde cholangiography (ERC) with standard endoscopes due to the length of the interposed small bowel segment. Double-balloon enteroscopy (DBE) facilitates deep insertion into the small bowel and may be used to perform ERC in these patients. In the present case series we report our experience with diagnostic and therapeutic double-balloon ERC in patients with choledochojejunostomy to a long Roux-en-Y loop previously unavailable for standard length endoscopes. Between December 2004 and May 2008 15 patients (mean age: 60.2 years) with choledochojejunal anastomosis underwent a total of 25 DBE-ERC procedures. Cannulation of the bile ducts was achieved in 22 / 25 procedures (84 %). Twenty-one therapeutic interventions, including stone removal, biliary duct dilation, stent placement and removal of previously placed stents were performed during 16 procedures in 8 patients. The mean total duration time of the procedures was 74.6 +/- 25.0 minutes. Postinterventional self-limiting fever occurred after 4 procedures in 3 patients with cholangitis. After therapeutic interventions all patients had a significant drop of bilirubin levels and all except one patient were free of complaints (follow-up 10.4 +/- 8.6 months). The DBE system permits diagnostic and therapeutic ERC in surgically modified anatomy, previously unavailable for endoluminal access. In our experience this procedure is safe and has a high success rate with a favourable patient outcome.

  8. Endoscopic Cold Incision, Balloon Dilation, Mitomycin C Application, and Steroid Injection for Adult Laryngotracheal Stenosis

    PubMed Central

    Parker, Noah P.; Bandyopadhyay, Dipankar; Misono, Stephanie; Goding, George S.

    2017-01-01

    Objectives/Hypothesis To describe the presentation, stenosis characteristics, etiological differences, and outcomes of adult laryngotracheal stenosis treated with endoscopic cold incision, balloon dilation, topical mitomycin C application, and steroid injection. Study Design Retrospective chart review. Methods Demographic and clinical data were extracted for patients treated between March 2000 and December 2010. Prolonged intubation and idiopathic patient data were utilized for comparative analysis. Results Eighty patients (65 females; 15 males; 220 procedures; 2.9 years mean follow-up) presented with dyspnea (81%) and/or exercise intolerance (40%). Most commonly, etiologies were idiopathic (53 of 80; 66%) or prolonged intubation (14 of 80; 18%). Mean procedures per patient and interval between procedures were 2.8 procedures and 405 days, respectively. Mean stenosis length and distance from the caudal phonating edge of the true vocal folds were 9 mm and 19 mm. Complication, tracheotomy, and open-procedure rates were 1.8%, 1.4%, and 10.0%, respectively. Patients with more than two procedures demonstrated a mean 4-mm reduction in stenosis length and a 2-mm cephalad progression of stenosis over time. More caudal stenoses required more frequent procedures. Procedures were less frequent as more procedures were performed. Stenosis characteristics, interval between procedures, and total procedures were similar between idiopathic patients with or without intubation histories, but different between idiopathic and prolonged intubation patients. Conclusions This procedure was shown to be a viable option in adult laryngotracheal stenosis. Repeat dilation was likely, but was performed without adversely affecting stenosis characteristics. Stenoses farther from the vocal folds required procedures more frequently. Idiopathic patients with a history of brief, elective intubation had stenosis characteristics and responses to therapy similar to idiopathic patients without an

  9. Balloon-occluded Retrograde Transvenous Obliteration (BRTO): Preprocedural Evaluation and Imaging

    PubMed Central

    Al-Osaimi, Abdullah M. S.; Sabri, Saher S.; Caldwell, Stephen H.

    2011-01-01

    Patients undergoing balloon retrograde transvenous obliteration (BRTO) are mostly decompensated cirrhotic with either bleeding gastric varices (GV) or hepatic encephalopathy. It is crucial that clinicians are up-to-date with the assessments needed prior to BRTO to anticipate and prevent complications, and to deliver critical quality care. These patients will require preprocedural assessments and management, including endoscopic, clinical, laboratory, and imaging evaluation. Endoscopic evaluation is mandatory prior to BRTO, and it is highly recommended that it be performed at the same institution where BRTO will be performed. It is essential that clinicians are aware of the potential benefits and complications that may result from BRTO. These complications should be anticipated and prevented when possible. For GV bleeders, there should be consideration of a transvenous intrahepatic portosystemic shunt (TIPS) during or before BRTO in patients with refractory ascites or pleural effusion, as well as endoscopic banding or a TIPS in patients with high-risk esophageal varices. Patients undergoing BRTO are usually complicated and require a team approach. In this article, the authors address these assessment and preparatory management and planning procedures prior to the BRTO procedure as well as expected outcomes and potential complications. PMID:22942546

  10. Balloon catheter sinuplasty and adenoidectomy in children with chronic rhinosinusitis.

    PubMed

    Ramadan, Hassan H; Terrell, Andrew M

    2010-09-01

    Adenoidectomy is the first step in the surgical management of children with chronic rhinosinusitis (CRS). Adenoidectomy, however, is only effective in half of these children. Although endoscopic sinus surgery is effective for CRS, there is concern for facial growth retardation and major complications. We propose that balloon catheter sinuplasty (BCS) is a minimally invasive, effective procedure in the treatment of pediatric CRS. We undertook a nonrandomized, controlled, prospective review of children with failed medical management of CRS who underwent BCS or adenoidectomy. Outcomes were assessed at 1 year of follow-up and were based on SN-5 scores and the need for revision surgery. Forty-nine children who satisfied the inclusion criteria were reviewed. Thirty of the children had BCS. The age range was 4 to 11 years (mean, 7.7 years), and the mean computed tomography score (Lund-Mackay system) was 7.5. Twenty-four of the 30 patients (80%) who underwent BCS showed improvement of their symptoms after 12 months of follow-up, compared with 10 of the 19 patients (52.6%) who underwent adenoidectomy (p < 0.05). A multivariate analysis using logistic regression analysis with age, sex, asthma, and computed tomography score as covariables showed that BCS was also more effective than adenoidectomy in older children. None of the other variables showed statistical significance. Balloon catheter sinuplasty offers a procedure that is more effective than adenoidectomy and less invasive than endoscopic sinus surgery in the treatment of pediatric CRS.

  11. Biliary papillary neoplasm of the liver.

    PubMed

    Nakanuma, Y; Sasaki, M; Ishikawa, A; Tsui, W; Chen, T C; Huang, S F

    2002-01-01

    Biliary papillary neoplasia of the liver characterized by intraductal papillary growth of neoplastic biliary epithelia with a fine fibrovascular stalk has been sporadically reported, and includes intraductal growing cholangiocarcinoma and biliary papillomatosis. In addition, biliary papillary dysplasia and in situ and microinvasive carcinoma with papillary configuration reported in hepatolithiasis and in other chronic biliary diseases, could be included in this category. Usually, they arise in the intrahepatic large bile ducts, and the neoplastic and non-neoplastic parts of the intrahepatic biliary tree show saccular and segmental dilatation with mucin hypersecretion. This neoplasia frequently shows intraductal spreading and peribiliary glandular involvement. Acute repeated episodes of cholangitis or obstructive jaundice are a frequent clinical manifestation. Gastroenteric metaplasia with aberrant expression of cytokeratin 20, MUC2, MUC5AC, and/or MUC6, is frequent in the neoplastic parts, and biliary epithelial dysplasia with such metaplasia may give rise to in situ and then invasive carcinoma in hepatolithiasis. Interestingly, this type tends to contain foci of mucinous carcinoma elements, and this element may be predominant (mucinous carcinoma). Some may progress to "mucinous biliary cystadenocarcinoma" without ovarian mesenchymal stroma and with intraluminal continuous growth into the neighboring bile duct lumens. Interestingly, the biliary papillary neoplasm resembles histologically, phenotypically and clinically intraductal papillary mucinous neoplasm of the pancreas which is now being established as an infrequent, slow-growing pancreatic neoplasm. Recognition of such biliary papillary neoplasm with respect to the pancreatic equivalent may lead to a better understanding and further studies of the intrahepatic biliary neoplasm.

  12. Endoscopic Balloon Dilatation of Benign Esophageal Stricture—A Nonhazardous Procedure?

    PubMed Central

    Borgström, Anders; Fork, Frans-Thomas; Lövdahl, Eje

    1994-01-01

    Balloon dilatation of benign esophageal strictures has been widely used since its introduction. We have performed 224 dilatation procedures in 52 patients. Dilatation was done as an outpatient procedure. Strictures were due to reflux esophagitis in 25 patients, anastomatic stenosis in 6, achalasia in 5, complications of sclerotherapy in 5, corrosive lesions in 3, and long-standing nasogastric intubation in 2. The cause was unknown in 6 cases. The intention was to dilate all strictures up to 20 mm. Three major complications occurred, and one of these patients died. The risk of perforation seems to be higher after repeated procedures than during the first one. PMID:18493348

  13. Gastric Ulcer Hemorrhage - a Potential Life-Threatening Complication of Intragastric Balloon Treatment of Obesity.

    PubMed

    Mojkowska, Aleksandra; Gazdzinski, Stefan; Fraczek, Mariusz; Wyleżoł, Mariusz

    2017-01-01

    Some morbidly obese patients do not qualify for bariatric surgery due to general health contraindications. Intragastric balloon treatment might be a therapeutic option in the above-mentioned cases. It can prime super-obese patients with end-stage disease for bariatric surgery. As a neoadjuvant therapy before surgery, it leads to a downstage of the disease by preliminary weight reduction, to an improvement in general health and, in summary, to a reduction of the perioperative risk. It is generally considered to be a safe method. However, due to the wide range of possible complications and unusual symptoms after intragastric balloon treatment, an interdisciplinary, instead of only a surgical or endoscopic, treatment and follow-up might be recommended in these patients. We here describe a potential life-threatening complication in the form of gastric bleeding as a consequence of intragastric balloon treatment and simultaneous aspirin taking and Helicobacter pylori infection. There have been reports of some complications of intragastric balloon treatment. However, to the best of our knowledge there were no reports concerning life-threatening hemorrhage from gastric ulcer. © 2017 The Author(s) Published by S. Karger GmbH, Freiburg.

  14. Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection

    PubMed Central

    Mizutani, Hiroya; Ono, Satoshi; Ohki, Daisuke; Takeuchi, Chihiro; Yakabi, Seiichi; Kataoka, Yosuke; Saito, Itaru; Sakaguchi, Yoshiki; Minatsuki, Chihiro; Tsuji, Yosuke; Niimi, Keiko; Kodashima, Shinya; Yamamichi, Nobutake; Fujishiro, Mitsuhiro; Koike, Kazuhiko

    2017-01-01

    Colorectal endoscopic submucosal dissection (ESD) is now a well-established endoscopic treatment for early-stage colorectal neoplasms, especially in Asian countries, including Japan. Despite the spread of colorectal ESD, there are still situations in which achieving successful submucosal dissection is difficult. Various novel techniques and devices have been developed to overcome these difficulties, and past reports have shown that some of these strategies can be applied to colorectal ESD. We review several recent developments in the field. The techniques reviewed include the pocket creation method and traction methods and the devices reviewed include the overtube with balloon and electrosurgical knives with water-jet function. These improved techniques and devices can facilitate safer, more reliable ESDs and expand its applicability and acceptability all over the world. PMID:29207854

  15. Partial stent-in-stent placement of biliary metallic stents using a short double-balloon enteroscopy.

    PubMed

    Tsutsumi, Koichiro; Kato, Hironari; Tomoda, Takeshi; Matsumoto, Kazuyuki; Sakakihara, Ichiro; Yamamoto, Naoki; Noma, Yasuhiro; Sonoyama, Takayuki; Okada, Hiroyuki; Yamamoto, Kazuhide

    2012-12-07

    Endoscopic intervention is less invasive than percutaneous or surgical approaches and should be considered the primary drainage procedure in most cases with obstructive jaundice. Recently, therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using double-balloon enteroscopy (DBE) has been shown to be feasible and effective, even in patients with surgically altered anatomies. On the other hand, endoscopic partial stent-in-stent (PSIS) placement of self-expandable metallic stents (SEMSs) for malignant hilar biliary obstruction in conventional ERCP has also been shown to be feasible, safe and effective. We performed PSIS placement of SEMSs for malignant hilar biliary obstruction due to liver metastasis using a short DBE in a patient with Roux-en-Y anastomosis and achieved technical and clinical success. This procedure can result in quick relief from obstructive jaundice in a single session and with short-term hospitalization, even in patients with surgically altered anatomies.

  16. Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience.

    PubMed

    Lee, Kyu Eun; Rao, Jaideepraj; Youn, Yeo-Kyu

    2009-06-01

    Robotic surgery is useful in areas with difficult access like the pelvis. The ideal indications for robotic surgery are still to be established. The neck area, especially the thyroid gland poses a difficult challenge for many endoscopic surgeons. Robotic surgery is useful in this area due to its excellent magnification and endowrist function. We present our initial experience with robotic endoscopic thyroidectomy using the bilateral axillary breast approach (BABA). Between March and May 2008, 15 patients diagnosed with papillary thyroid cancer underwent robotic-assisted endoscopic thyroidectomy using the BABA technique. The mean operating time was 218 minutes. There was a steady decrease in operative time from the initial case to the 15th case. The blood loss was minimal. The recurrent laryngeal nerve and parathyroid glands were identified in great detail with ease and preserved in all cases. There were no postoperative complications in any case. Robotic endoscopic thyroidectomy using the BABA technique is a feasible procedure and can be performed safely. It provides an excellent operative field view enabling easy identification of vital structures. It also gives the desired cosmetic results and minimal postoperative pain similar to conventional endoscopic thyroid surgery using the BABA technique.

  17. Ballooning Then...and Ballooning Now.

    ERIC Educational Resources Information Center

    Journal of Aerospace Education, 1978

    1978-01-01

    Describes the history of hot-air balloon travel, starting with its French origins and continuing through to the 1978 national championship. An address for Balloon Federation of America membership is included. (MA)

  18. Reduction effect of bacterial counts by preoperative saline lavage of the stomach in performing laparoscopic and endoscopic cooperative surgery.

    PubMed

    Mori, Hirohito; Kobara, Hideki; Tsushimi, Takaaki; Fujihara, Shintaro; Nishiyama, Noriko; Matsunaga, Tae; Ayaki, Maki; Yachida, Tatsuo; Tani, Joji; Miyoshi, Hisaaki; Morishita, Asahiro; Masaki, Tsutomu

    2014-11-14

    To investigate the effects of gastric lavage with 2000 mL of saline in laparoscopic and endoscopic cooperative surgery. Twenty two patients who were diagnosed with a gastric gastrointestinal stromal tumor were enrolled. In former term, irrigations of the stomach were conducted whenever it was necessary, not systematically (Non systemic lavage group). In latter term, the stomach was thoroughly cleaned with 2000 mL of saline using an endoscope with a water jet, and Duodenal balloon occlusion was conducted to prevent refluxed bile and pancreatic juice (Systemic lavage+balloon occlusion group). The gastric wall was sprayed with 20 mL of distilled water, and 20 mL of gastric juice was collected in a sterile tube and submitted for culture. 20 mL of ascites was also collected from the laparoscopic ports and submitted for culture. We compared WBC, CRP, BT between two groups, and verify the reduction effect of bacterial counts in Systemic lavage+balloon occlusion group. WBC count before, 1 d after, and 3 d after laparoscopic and endoscopic cooperative surgery (LECS) were 5060 (95%CI: 4250-9640), 12140 (6050-14110), and 6910 (5320-12520) in Non systemic lavage group, 4400 (3660-7620), 8910 (6480-10980), and 5950 (4840-7860) in Systemic lavage+balloon occlusion group. Significant differences between two groups at the day after LECS (P = 0.029) and the 3 d after LECS (P = 0.042). CRP levels in Non systemic lavage group and in Systemic lavage+balloon occlusion group were significantly different at the day after LECS (P = 0.005) and the 3 d after LECS (P = 0.028). BTs (°C) in Non systemic lavage group and in Systemic lavage+balloon occlusion group were also significantly different at the day after LECS (P = 0.004) and the 3 d after LECS (P = 0.006). In a logarithmic comparison, bacterial load before gastric lavage, after lavage, and ascites culture were 6.08 (95%CI: 4.04-6.97), 0.48 (0-0.85), and 0.21 (0-0.56). The bacterial counts before and after gastric lavage were

  19. Pancreatobiliary fistula associated with intraductal papillary mucinous carcinoma accompanying obstructive jaundice: A case report.

    PubMed

    Komo, Toshiaki; Oishi, Koichi; Kohashi, Toshihiko; Hihara, Jun; Kanou, Mikihiro; Nakashima, Akira; Kaneko, Mayumi; Mukaida, Hidenori; Hirabayashi, Naoki

    2018-06-04

    Intraductal papillary mucinous neoplasms (IPMNs) occasionally involve formation of fistulas with other adjacent organs. Pancreatobiliary fistulas associated with IPMNs are rare, but affected patients often develop obstructive jaundice and cholangitis. A 79-year-old man was referred to our hospital for evaluation of abnormal biliary enzymes. Contrast-enhanced computed tomography and endoscopic retrograde cholangiopancreatography demonstrated multiple cystic lesions with septa in the pancreatic head and fistulas between the cystic lesions and common bile duct. The clinical diagnosis was pancreatobiliary fistula associated with a mixed-type IPMN and accompanying obstructive jaundice. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy. The resected specimen showed fistulas between the cystic lesions and common bile duct. Histopathological examination showed that the main and branch ducts of the pancreatic head were dilated and filled with mucus. The epithelia of the pancreatic ducts revealed papillary proliferation and an invasive adenocarcinoma arising from an intraductal neoplasm. Immunohistochemistry examination showed CDX2- and MUC2-positive reactions. The final diagnosis was an intraductal papillary mucinous carcinoma of the intestinal-type. The patient remained disease-free for 9 months postoperatively. The causes of death in patients who have pancreatobiliary fistulas associated with IPMNs without resection are cholangitis or hepatic insufficiency. Nonoperative treatment is limited for cases with obstructive jaundice. It is necessary to prevent obstructive jaundice and cholangitis due to a large quantity of mucinous material. Surgical resection should be considered, if possible, in patients with pancreatobiliary fistulas associated with IPMNs. A better prognosis is expected with prevention of obstructive jaundice or cholangitis. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. Direct peroral cholangioscopy using an ultraslim upper endoscope for management of residual stones after mechanical lithotripsy for retained common bile duct stones.

    PubMed

    Lee, Y N; Moon, J H; Choi, H J; Min, S K; Kim, H I; Lee, T H; Cho, Y D; Park, S-H; Kim, S-J

    2012-09-01

    The incidence of residual stones after mechanical lithotripsy for retained common bile duct (CBD) stones is relatively high. Peroral cholangioscopy using a mother-baby system may be useful for confirming complete extraction of stones, but has several limitations regarding routine use. We evaluated the role of direct peroral cholangioscopy (DPOC) using an ultraslim upper endoscope for the evaluation and removal of residual CBD stones after mechanical lithotripsy. From August 2006 to November 2010, 48 patients who had undergone mechanical lithotripsy for retained CBD stones with no evidence of filling defects in balloon cholangiography were recruited. The bile duct was inspected by DPOC after balloon cholangiography. Detected residual CBD stones were directly retrieved with a basket or balloon catheter under DPOC. The incidence of residual stones detected by DPOC, and the success rate of residual stone retrieval under DPOC were investigated. DPOC was successfully performed in 46 of the 48 patients (95.8%). Of these, 13 patients (28.3%) had residual CBD stones (mean number 1.4, range 1-3; mean diameter 4.5 mm, range 2.3-9.6). The residual stones were removed directly under DPOC in 11 of these patients (84.6%). There were no complications associated with DPOC or stone removal. DPOC using an ultraslim upper endoscope is a useful endoscopic procedure for the evaluation and extraction of residual stones after mechanical lithotripsy for retained CBD stones. © Georg Thieme Verlag KG Stuttgart · New York.

  1. The many faces and mimics of papillary thyroid carcinoma.

    PubMed

    Albores-Saavedra, Jorge; Wu, Jianhua

    2006-01-01

    This article provides an overview of the 15 histologic variants of papillary thyroid carcinoma listed by the 2004 World Health Organization (WHO) monograph on endocrine tumors. The histologic features, differential diagnosis, and clinical course of each variant are discussed in some detail. The follicular variants (conventional and macrofollicular) constitute a morphologic challenge because the majority of these tumors are encapsulated and, also, because, in many tumors, not all neoplastic cells show the nuclear features considered to be diagnostic of papillary carcinoma. As a result, most of these tumors are missed even by experienced pathologists. Moreover, hyperplastic thyroid lesions, follicular adenomas, and Hashimoto's thyroiditis may contain cells with clear nuclei resembling those of papillary carcinoma. Papillary carcinomas composed entirely of hyperchromatic cells have been overlooked. The WHO monograph defines papillary carcinoma with focal spindle and giant cell carcinoma components but its clinical behavior is unknown. Papillary carcinoma with an insular pattern that does not show the artifactual separation of the cell nests has been misinterpreted as the solid variant of papillary carcinoma. Papillary microcarcinomas include not only the conventional type and the follicular variants but also the tall cell and columnar cell variants.

  2. Balloon-occluded retrograde transvenous obliteration versus endoscopic injection sclerotherapy for isolated gastric varices: a comparative study.

    PubMed

    Emori, Keigo; Toyonaga, Atsushi; Oho, Kazuhiko; Kumamoto, Masafumi; Haruta, Tsuyoshi; Inoue, Hiroto; Morita, Yukihiko; Mitsuyama, Keiichi; Tsuruta, Osamu; Sata, Michio

    2014-01-01

    Isolated gastric varices (IGV) have a lower risk of bleeding than esophageal varices, however IGV bleeding is associated with a higher mortality than bleeding of esophageal varices. In recent years, two widely used treatments for IGV have been balloon-occluded retrograde transvenous obliteration (B-RTO) and endoscopic injection sclerotherapy (EIS) using cyanoacrylate or ethanolamine oleate (EO). This study compared these two treatment methods for IGV. The subjects were 112 patients who were treated at our hospital for IGV bleeding between October 1990 and December 2003. Forty-nine (49) patients were treated with B-RTO and 63 patients with EIS. These two patient groups were compared as regards content of treatment, post-treatment incidence of variceal bleeding, incidence of IGV rebleeding, survival rate, cause of death, and complications. Multivariate analysis was performed on post-treatment variceal bleeding and survival. Although EO was used in higher amounts in the B-RTO group than in the EIS group, the B-RTO group had a significantly lower number of treatment sessions and a significantly shorter treatment period (p<0.05). The EIS group had significantly more patients with IGV rebleeding after treatment than the B-RTO group. Treatment method was the only independent prognostic factor of IGV bleeding after treatment (p=0.024). The two groups did not differ significantly in the percentage of patients with aggravated esophageal varices after treatment. Bleeding from ectopic varices was not observed in any patient. There was no significant difference in survival by treatment method. The presence of hepatocellular carcinoma was the only independent prognostic factor for survival (p=0.003). It is concluded that B-RTO was more effective than EIS in the eradication of IGV and prevention of IGV recurrence and rebleeding.

  3. Analysis of papillary renal adenocarcinoma.

    PubMed

    Mydlo, J H; Bard, R H

    1987-12-01

    A retrospective review was conducted comparing the angiographic findings, tumor volumes, staging, and survival of patients with papillary renal adenocarcinoma as compared with the more common clear and granular cell renal adenocarcinoma. The data suggest that the papillary histopathologic organization confers an improved prognosis, which concurs with previous findings. We speculate on why this tumor behaves differently from clear cell carcinoma.

  4. Endoscopic electrocautery dilation of benign anastomotic colonic strictures: a single-center experience.

    PubMed

    Bravi, Ivana; Ravizza, Davide; Fiori, Giancarla; Tamayo, Darina; Trovato, Cristina; De Roberto, Giuseppe; Genco, Chiara; Crosta, Cristiano

    2016-01-01

    Benign anastomotic colonic stenosis sometimes occur after surgery and usually require surgical or endoscopic dilation. Endoscopic dilation of anastomotic colonic strictures by using balloon or bougie-type dilators has been demonstrated to be safe and effective in multiple uncontrolled series. However, few data are available on safety and efficacy of endoscopic electrocautery dilation. The aim of our study was to retrospectively investigate safety and efficacy of endoscopic electrocautery dilation of postsurgical benign anastomotic colonic strictures. Sixty patients (37 women; median age 63.6 years, range 22.6-81.7) with benign anastomotic colonic or rectal strictures treated with endoscopic electrocautery dilation between June 2001 and February 2013 were included in the study. Anastomotic stricture was defined as a narrowed anastomosis through which a standard colonoscope could not be passed. Only annular anastomotic strictures were considered suitable for electrocautery dilation which consisted of radial incisions performed with a precut sphincterotome. Treatment was considered successful if the colonic anastomosis could be passed by a standard colonoscope immediately after dilation. Recurrence was defined as anastomotic stricture reappearance during follow-up. The time interval between colorectal surgery and the first endoscopic evaluation or symptoms development was 7.3 months (1.3-60.7). Electrocautery dilation was successful in all the patients. There were no procedure-related complications. Median follow-up was 35.5 months (2.0-144.0). Anastomotic stricture recurrence was observed in three patients who were successfully treated with electrocautery dilation and Savary dilation. Endoscopic electrocautery dilation is a safe and effective treatment for annular benign anastomotic postsurgical colonic strictures.

  5. Prevention of esophageal strictures after endoscopic submucosal dissection

    PubMed Central

    Kobayashi, Shinichiro; Kanai, Nobuo; Ohki, Takeshi; Takagi, Ryo; Yamaguchi, Naoyuki; Isomoto, Hajime; Kasai, Yoshiyuki; Hosoi, Takahiro; Nakao, Kazuhiko; Eguchi, Susumu; Yamamoto, Masakazu; Yamato, Masayuki; Okano, Teruo

    2014-01-01

    Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have recently been accepted as less invasive methods for treating patients with early esophageal cancers such as squamous cell carcinoma and dysplasia of Barrett’s esophagus. However, the large defects in the esophageal mucosa often cause severe esophageal strictures, which dramatically reduce the patient’s quality of life. Although preventive endoscopic balloon dilatation can reduce dysphagia and the frequency of dilatation, other approaches are necessary to prevent esophageal strictures after ESD. This review describes several strategies for preventing esophageal strictures after ESD, with a particular focus on anti-inflammatory and tissue engineering approaches. The local injection of triamcinolone acetonide and other systemic steroid therapies are frequently used to prevent esophageal strictures after ESD. Tissue engineering approaches for preventing esophageal strictures have recently been applied in basic research studies. Scaffolds with temporary stents have been applied in five cases, and this technique has been shown to be safe and is anticipated to prevent esophageal strictures. Fabricated autologous oral mucosal epithelial cell sheets to cover the defective mucosa similarly to how commercially available skin products fabricated from epidermal cells are used for skin defects or in cases of intractable ulcers. Fabricated autologous oral-mucosal-epithelial cell sheets have already been shown to be safe. PMID:25386058

  6. Prevention of stone migration with the Accordion during endoscopic ureteral lithotripsy.

    PubMed

    Pagnani, Christopher J; El Akkad, Magdy; Bagley, Demetrius H

    2012-05-01

    Endoscopic lithotripsy is often prolonged secondary to the retrograde migration of calculous fragments. Various balloons, baskets, and other devices have been used to prevent this migration. Our purpose is to analyze the effect of the Accordion(®) on stone migration and overall efficiency during lithotripsy. We prospectively evaluated 21 patients with a total of 23 distal ureteral stones. Patients underwent lithotripsy using an endoscopic impact lithotriptor. The Accordion was randomly used in 11 of these 21 patients. Data were collected regarding stone migration, stone size, stone ablation, ureteral clearing, and lengths of time for various stages of each procedure. Patients who were treated with the Accordion device experienced significantly less retrograde migration during fragmentation (P=0.0064). When stone volume was taken into account (but not on a per stone basis), ablation and ureteral clearing were also expedited, and fewer lithotripter "hits" and basket "sweeps" were needed. The Accordion device is effective in preventing the migration of stone fragments during endoscopic ureteral lithotripsy. Our data suggest that this device may also increase efficiency of the fragmentation and clearance of ureteral calculi.

  7. Percutaneous Transhepatic Endoscopic Holmium Laser Lithotripsy for Intrahepatic and Choledochal Biliary Stones

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rimon, Uri, E-mail: rimonu@sheba.health.gov.il; Kleinmann, Nir; Bensaid, Paul

    2011-12-15

    Purpose: To report our approach for treating complicated biliary calculi by percutaneous transhepatic endoscopic biliary holmium laser lithotripsy (PTBL). Patients and Methods: Twenty-two symptomatic patients (11 men and 11 women, age range 51 to 88 years) with intrahepatic or common bile duct calculi underwent PTBL. Nine patients had undergone previous gastrectomy and small-bowel anastomosis, thus precluding endoscopic retrograde cholangiopancreatography. In the other 13 patients, stone removal attempts by ERCP failed due to failed access or very large calculi. We used a 7.5F flexible ureteroscope and a 200-{mu}m holmium laser fiber by way of a percutaneous transhepatic tract, with graded fluoroscopy,more » to fragment the calculi with direct vision. Balloon dilatation was added when a stricture was seen. The procedure was performed with the patient under general anaesthesia. A biliary drainage tube was left at the end of the procedure. Results: All stones were completely fragmented and flushed into the small bowel under direct vision except for one patient in whom the procedure was aborted. In 18 patients, 1 session sufficed, and in 3 patients, 2 sessions were needed. In 7 patients, balloon dilatation was performed for benign stricture after Whipple operation (n = 3), for choledochalenteric anastomosis (n = 3), and for recurrent cholangitis (n = 1). Adjunctive 'balloon push' (n = 4) and 'rendezvous' (n = 1) procedures were needed to completely clean the biliary tree. None of these patients needed surgery. Conclusion: Complicated or large biliary calculi can be treated successfully using PTBL. We suggest that this approach should become the first choice of treatment before laparoscopic or open surgery is considered.« less

  8. Endoscopic balloon catheter dilatation via retrograde or static technique is safe and effective for cricopharyngeal dysfunction

    PubMed Central

    Chandrasekhara, Vinay; Koh, Joyce; Lattimer, Lakshmi; Dunbar, Kerry B; Ravich, William J; Clarke, John O

    2017-01-01

    AIM To evaluate the safety and efficacy of upper esophageal sphincter (UES) dilatation for cricopharyngeal (CP) dysfunction. To determine if: (1) indication for dilatation; or (2) technique of dilatation correlated with symptom improvement. METHODS All balloon dilatations performed at our institution from over a 3-year period were retrospectively analyzed for demographics, indication and dilatation site. All dilatations involving the UES underwent further review to determine efficacy, complications, and factors that predict success. Dilatation technique was separated into static (stationary balloon distention) and retrograde (brusque pull-back of a fully distended balloon across the UES). RESULTS Four hundred and eighty-eight dilatations were reviewed. Thirty-one patients were identified who underwent UES dilatation. Median age was 63 years (range 27-81) and 55% of patients were male. Indications included dysphagia (28 patients), globus sensation with evidence of UES dysfunction (2 patients) and obstruction to echocardiography probe with cricopharyngeal (CP) bar (1 patient). There was evidence of concurrent oropharyngeal dysfunction in 16 patients (52%) and a small Zenker’s diverticula (≤ 2 cm) in 7 patients (23%). Dilator size ranged from 15 mm to 20 mm. Of the 31 patients, 11 had dilatation of other esophageal segments concurrently with UES dilatation and 20 had UES dilatation alone. Follow-up was available for 24 patients for a median of 2.5 mo (interquartile range 1-10 mo), of whom 19 reported symptomatic improvement (79%). For patients undergoing UES dilatation alone, follow-up was available for 15 patients, 12 of whom reported improvement (80%). Nineteen patients underwent retrograde dilatation (84% response) while 5 patients had static dilatation (60% response); however, there was no significant difference in symptom improvement between the techniques (P = 0.5). Successful symptom resolution was also not significantly affected by dilator size

  9. Treatment of a giant pulmonary emphysematous cyst with primary bronchoalveolar papillary carcinoma in a Shih Tzu dog.

    PubMed

    Park, Jiyoung; Lee, Hae-Beom; Jeong, Seong Mok

    2017-01-01

    To report the surgical treatment of a pulmonary emphysematous cyst concurrent with primary pulmonary bronchoalveolar papillary carcinoma in a dog. Clinical case report. 12-year-old 6.4 kg spayed female Shih Tzu dog. The dog presented for surgical treatment of pulmonary emphysema. Radiography revealed that more than half of the left caudal lung lobe was enlarged and hyperlucent and computed tomography (CT) confirmed the presence of an emphysematous space. Thoracoscopic lung lobectomy was attempted but was converted to an intercostal thoracotomy due to poor visualization and pleural adhesions. A left caudal total lung lobectomy was performed using a self-cutting endoscopic stapler. The dog recovered uneventfully and a postoperative histopathologic diagnosis of pulmonary cystic bronchoalveolar papillary carcinoma was made. Re-evaluation using a CT scan with contrast study on postoperative days 27 and 177 revealed no evidence of residual, metastatic, or recurrent lesions. The dog has been doing well since surgery during the 11 month follow-up period. This case report suggests a potential relationship between pulmonary emphysematous diseases and primary lung tumors in dogs. © 2016 The American College of Veterinary Surgeons.

  10. Endotherapy for severe and complete pharyngo-esophageal post-radiation stenosis using wires, balloons and pharyngo-esophageal puncture (PEP) (with videos).

    PubMed

    Tang, Shou-jiang; Singh, Shailender; Truelson, John M

    2010-01-01

    Pharyngo-esophageal stenosis (PES) and upper esophageal stricture are common in patients who receive radiation therapy for laryngeal and hypopharyngeal cancers. In severe or complete stenosis, the patients generally have complete dysphagia with inability to swallow their saliva. Diagnostic and therapeutic esophagogastroduodenoscopy (EGD) plays an important role in investigating the dysphagia and in managing the underlying stenosis. We translate endoscopic retrograde cholangiopancreatography (ERCP) techniques and skills in approaching pancreaticobiliary obstruction in the management of severe and complete PES. We select and report three cases of severe or complete PES in which flexible endoscopic therapy was successfully provided by using fluoroscopy, ERCP wire guides, endoscopic balloons, and by performing pharyngo-esophageal puncture (PEP). We propose the term PEP in managing complete PES. We believe this approach can offer safety and efficiency with very high success rate.

  11. Advances in endoscopic management of biliary complications after living donor liver transplantation: Comprehensive review of the literature

    PubMed Central

    Shin, Milljae; Joh, Jae-Won

    2016-01-01

    Apart from noticeable improvements in surgical techniques and immunosuppressive agents, biliary complications remain the major causes of morbidity and mortality after living donor liver transplantation (LDLT). Bile leakage and stricture are the predominant complications. The reported incidence of biliary complications is 15%-40%, and these are known to occur more frequently in living donors than in deceased donors. Despite the absence of a confirmed therapeutic algorithm, many approaches have been used for treatment, including surgical, endoscopic, and percutaneous transhepatic techniques. In recent years, nonsurgical approaches have largely replaced reoperation. Among these, the endoscopic approach is currently the preferred initial treatment for patients who undergo duct-to-duct biliary reconstruction. Previously, endoscopic management was achieved most optimally through balloon dilatation and single or multiple stents placement. Recently, there have been significant developments in endoscopic devices, such as novel biliary stents, as well as advances in endoscopic technologies, including deep enteroscopy, the rendezvous technique, magnetic compression anastomosis, and direct cholangioscopy. These developments have resulted in almost all patients being managed by the endoscopic approach. Multiple recent publications suggest superior long-term results, with overall success rates ranging from 58% to 75%. This article summarizes the advances in endoscopic management of patients with biliary complications after LDLT. PMID:27468208

  12. Balloon-assisted enteroscopy for suspected Meckel’s diverticulum and indefinite diagnostic imaging workup

    PubMed Central

    Gomes, Guilherme Francisco; Bonin, Eduardo Aimore; Noda, Rafael William; Cavazzola, Leandro Totti; Bartholomei, Thiago Ferreira

    2016-01-01

    Meckel’s diverticulum (MD) is estimated to affect 1%-2% of the general population, and it represents a clinically silent finding of a congenital anomaly in up to 85% of the cases. In adults, MD may cause symptoms, such as overt occult lower gastrointestinal bleeding. The diagnostic imaging workup includes computed tomography scan, magnetic resonance imaging enterography, technetium 99m scintigraphy (99mTc) using either labeled red blood cells or pertechnetate (known as the Meckel’s scan) and angiography. The preoperative detection rate of MD in adults is low, and many patients ultimately undergo exploratory laparoscopy. More recently, however, endoscopic identification of MD has been possible with the use of balloon-assisted enteroscopy via direct luminal access, which also provides visualization of the diverticular ostium. The aim of this study was to review the diagnosis by double-balloon enteroscopy of 4 adults with symptomatic MD but who had negative diagnostic imaging workups. These cases indicate that balloon-assisted enteroscopy is a valuable diagnostic method and should be considered in adult patients who have suspected MD and indefinite findings on diagnostic imaging workup, including negative Meckel’s scan. PMID:27803776

  13. Endoscopic therapy of posttransplant biliary stenoses after right-sided adult living donor liver transplantation.

    PubMed

    Zoepf, Thomas; Maldonado-Lopez, Evelyn J; Hilgard, Philip; Schlaak, Joerg; Malago, Massimo; Broelsch, Christoph E; Treichel, Ulrich; Gerken, Guido

    2005-11-01

    Endoscopic treatment of biliary strictures after liver transplantation is a therapeutic challenge. In particular, outcomes of endoscopic therapy of biliary complications in the case of duct-to-duct anastomosis after living related liver transplantation are limited. The aim of this study was to evaluate the feasibility and success of an endoscopic treatment approach to posttransplant biliary strictures (PTBS) after right-sided living donor liver transplantation (RLDLT) with duct-to-duct anastomosis. Ninety patients who received adult-to-adult RLDLT in our center were screened retrospectively with respect to endoscopic treatment of PTBS. Therapy was judged as successful when cholestasis parameters returned to normal and bile duct narrowing was reduced significantly after the completion of therapy. Forty of 90 RLDLT patients received duct-to-duct anastomosis, 12 (30%) showed PTBS. Seven of 12 patients were treated successfully by endoscopy; the remaining 5 patients were treated primarily by surgery. Most patients were treated by balloon dilatation followed by insertion of endoprostheses. A median of 2.5 dilatation sessions were necessary and the median treatment duration was 8 months. One patient developed endoscopy-treatable recurrent stenosis, no surgical intervention was necessary. Mild pancreatitis occurred in 7.9% and cholangitis in 5.3% of the procedures. One minor bleeding episode occurred during sphincterotomy. Bleeding was managed endoscopically. Endoscopic therapy of adult-to-adult right living related liver transplantation with duct-to-duct anastomosis is feasible and frequently is successful. The duct-to-duct anastomosis offers the possibility of endoscopic treatment. Endoscopic treatment of posttransplant biliary strictures is safe, with a low specific complication rate.

  14. Expression of AID, P53, and Mlh1 proteins in endoscopically resected differentiated-type early gastric cancer

    PubMed Central

    Takeda, Yohei; Yashima, Kazuo; Hayashi, Akihiro; Sasaki, Shuji; Kawaguchi, Koichiro; Harada, Kenichi; Murawaki, Yoshikazu; Ito, Hisao

    2012-01-01

    AIM: To analyze the expression of the tumor-related proteins in differentiated-type early gastric carcinoma (DEGC) samples. METHODS: Tumor specimens were obtained from 102 patients (75 males and 27 females) who had received an endoscopic tumor resection at Tottori University Hospital between 2007 and 2009. Ninety-one cancer samples corresponded to noninvasive or intramucosal carcinoma according to the Vienna classification system, and 11 samples were submucosal invasive carcinomas. All of the EGCs were histologically differentiated carcinomas. All patients were classified as having Helicobacter pylori (H. pylori) infections by endoscopic atrophic changes or by testing seropositive for H. pylori IgG. All of the samples were histopathologically classified as either tubular or papillary adenocarcinoma according to their structure. The immunohistochemical staining was performed in a blinded manner with respect to the clinical information. Two independent observers evaluated protein expression. All data were statistically analyzed then. RESULTS: The rates of aberrant activation-induced cytidine deaminase (AID) expression and P53 overexpression were both 34.3% in DEGCs. The expression of Mlh1 was lost in 18.6% of DEGCs. Aberrant AID expression was not significantly associated with P53 overexpression in DEGCs. However, AID expression was associated with the severity of mononuclear cell activity in the non-cancerous mucosa adjacent to the tumor (P = 0.064). The rate of P53 expression was significantly greater in flat or depressed tumors than in elevated tumors. The frequency of Mlh1 loss was significantly increased in distal tumors, elevated gross-type tumors, papillary histological-type tumors, and tumors with a severe degree of endoscopic atrophic gastritis (P < 0.05). CONCLUSION: Aberrant AID expression, P53 overexpression, and the loss of Mlh1 were all associated with clinicopathological features and gastric mucosal alterations in DEGCs. The aberrant expression of AID

  15. Can the learning curve of totally endoscopic robotic mitral valve repair be short-circuited?

    PubMed

    Yaffee, David W; Loulmet, Didier F; Kelly, Lauren A; Ward, Alison F; Ursomanno, Patricia A; Rabinovich, Annette E; Neuburger, Peter J; Krishnan, Sandeep; Hill, Frederick T; Grossi, Eugene A

    2014-01-01

    A concern with the initiation of totally endoscopic robotic mitral valve repair (TERMR) programs has been the risk for the learning curve. To minimize this risk, we initiated a TERMR program with a defined team and structured learning approach before clinical implementation. A dedicated team (two surgeons, one cardiac anesthesiologist, one perfusionist, and two nurses) was trained with clinical scenarios, simulations, wet laboratories, and "expert" observation for 3 months. This team then performed a series of TERMRs of varying complexity. Thirty-two isolated TERMRs were performed during the first programmatic year. All operations included mitral valve repair, left atrial appendage exclusion, and annuloplasty device implantation. Additional procedures included leaflet resection, neochordae insertion, atrial ablation, and papillary muscle shortening. Longer clamp times were associated with number of neochordae (P < 0.01), papillary muscle procedures (P < 0.01), and leaflet resection (P = 0.06). Sequential case number had no impact on cross-clamp time (P = 0.3). Analysis of nonclamp time demonstrated a 71.3% learning percentage (P < 0.01; ie, 28.7% reduction in nonclamp time with each doubling of case number). There were no hospital deaths or incidences of stroke, myocardial infarction, unplanned reoperation, respiratory failure, or renal failure. Median length of stay was 4 days. All patients were discharged home. Totally endoscopic robotic mitral valve repair can be safely performed after a pretraining regimen with emphasis on experts' current practice and team training. After a pretraining regimen, cross-clamp times were not subject to learning curve phenomena but were dependent on procedural complexity. Nonclamp times were associated with a short learning curve.

  16. Papillary bile duct dysplasia in primary sclerosing cholangitis.

    PubMed

    Ludwig, J; Wahlstrom, H E; Batts, K P; Wiesner, R H

    1992-06-01

    A 62-year-old man with a 20-year history of chronic ulcerative colitis and a 9-year history of primary sclerosing cholangitis (PSC) underwent orthotopic liver transplantation because of symptoms related to PSC and cholangiographic features compatible with a biliary neoplasm. Study of the excised liver revealed papillary mucosal lesions in the common hepatic duct and the right and left hepatic ducts as well as cholangiectases and other features typically associated with PSC. The papillary lesions consisted of abundant fibrovascular stroma covered by biliary epithelium with low-grade and high-grade dysplasia. Some periductal glands were also dysplastic. These features distinguished papillary dysplasia from classic biliary papillomatosis. Only one focus of microinvasion was found; there were no metastases. Among 60 cases of PSC in whom the entire liver could be studied after orthotopic liver transplantation, this was the only instance of unequivocal dysplasia. However, in one specimen, papillary hyperplasia was found. Detailed macroscopic and microscopic rereview of 23 livers from our patients with the longest history of PSC (range, 5-24 years) failed to reveal any additional cases with dysplasia. It is concluded that (a) papillary mucosal lesions in PSC may represent papillary dysplasia without invasion; (b) these lesions may evolve from papillary hyperplasia; (c) the process may be largely, if not entirely, in situ; and (d) the prevalence of dysplasia and carcinoma of bile ducts may be less than the 7%-9% reported in the literature for malignancies associated with PSC.

  17. Not all occult papillary carcinomas are minimal

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Allo, M.D.; Christianson, W.; Koivunen, D.

    1988-12-01

    Occult papillary carcinomas are characterized as small papillary tumors of less than 1.5 cm in maximum diameter, with or without bulky metastatic deposits in cervical nodes. The primary lesion is usually not palpable, and although the clinical behavior usually follows a benign course, tumors with unfavorable histologic features (invasiveness, multifocality) or extrathyroidal disease or a combination of both may not do so. In this report six cases are presented to illustrate this entity. No patient had a history of irradiation to the head or neck. All had primary lesions smaller than 1.5 cm. None had a palpable nodule or abnormalmore » thyroid scan results, and the diagnosis of thyroid cancer was based on cervical lymph node or lung biopsy specimens, which revealed papillary thyroid cancer. All of the patients underwent total or near-total thyroidectomies and were found to have small, invasive papillary lesions with additional metastases to cervical nodes noted at the time of thyroidectomy. Adjunctive treatment consisted of a 5 mCi iodine-131 scan, ablative iodine-131 therapy, and suppression with L-thyroxine. Although distant metastasis to lung or other organs is uncommon and the mortality rate is low (as in larger papillary cancers), these invasive lesions--despite their small size--have a high propensity for recurrence and should be considered to behave more like encapsulated papillary tumors with extrathyroidal extension than like their small, unencapsulated intrathyroidal counterparts.« less

  18. An unusual location of a papillary fibroelastoma.

    PubMed

    Bajaj, Sharad; Nandigam, Harish; Gupta, Nishant; Alkhouri, Yazan; Galldin, Lars M; Parikh, Nalini S; Patel, Nilesh; Shamoon, Fayez

    2014-03-01

    Papillary fibroelastomas are benign, avascular tumors and 90 % of them are attached to the cardiac valves. We present an unusual case, where papillary fibroelastoma was found attached to the interventricular septum, flopping in and out of the left ventricular outflow tract.

  19. Japanese Balloon Program

    NASA Astrophysics Data System (ADS)

    Yoshida, Tetsuya; Fuke, Hideyuki; Shoji, Yasuhiro; Iijima, Issei; Izutsu, Naoki; Kato, Yoichi; Matsuzaka, Yukihiko; Mizuta, Eiichi; Sato, Takatoshi; Tamura, Keisuke; Saito, Yoshitaka; Kakehashi, Yuya

    2012-07-01

    Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency conducts domestic balloon campaigns at Taiki Aerospace Research Field (TARF) in Hokkaido since 2008. The ballooning at TARF becomes stable after four year operation. Because the field faces to the Pacific Ocean, heavy balloons and payloads can be launched safely using a very unique sliding launcher. Recoveries at the inshore along the Tokachi coast can be done very quickly and smoothly. Unfortunately, flight opportunities are recently limited due to unfriendly weather condition. Unstable Jet stream also prevents us to have so-called `boomerang flight' to achieve long flight duration more than several hours. Six balloon-borne experiments were carried out in 2010 and 2011. Three of them were demonstrations of challenges of space engineering, two were in-situ atmospheric observation, and one was the technical flight of new high-resolution γ-ray telescope. In addition to these flights, we carried out two launches for next generation balloons: one for Tawara-shaped superpressure balloon and the other for ultra-thin high-altitude balloon. In this paper, recent activities of the Japanese scientific balloon program will be introduced. On-going development of the balloon system will also be presented.

  20. Utility of the balloon-overtube-assisted modified over-the-wire stenting technique to treat post-sleeve gastrectomy complications.

    PubMed

    Ponte, Ana; Pinho, Rolando; Proença, Luísa; Silva, Joana; Rodrigues, Jaime; Sousa, Mafalda; Silva, João Carlos; Carvalho, João

    2017-06-16

    To describe a modified technique of deployment of stents using the overtube developed for balloon-assisted enteroscopy in post-sleeve gastrectomy (SG) complications. Between January 2010 and December 2015, all patients submitted to an endoscopic stenting procedure to treat a post-SG stenosis or leakage were retrospectively collected. Procedures from patients in which the stent was deployed using the balloon-overtube-assisted modified over-the-wire (OTW) stenting technique were described. The technical success, corresponding to proper placement of the stent in the stomach resulting in exclusion of the SG leak or the stenosis, was evaluated. Complications related to stenting were also reported. Five procedures were included to treat 2 staple line leaks and 3 stenoses. Two types of stents were used, including a fully covered self-expandable metal stent designed for the SG anatomy (Hanarostent, ECBB-30-240-090; M.I. Tech, Co., Ltd, Seoul, South Korea) in 4 procedures and a biodegradable stent (BD stent 019-10A-25/20/25-080, SX-ELLA, Hradec Kralove, Czech Republic) in the remaining procedure. In all cases, an overtube was advanced with the endoscope through the SG to the duodenum. After placement of the guidewire and removal of the endoscope, the stent was easily advanced through the overtube. The overtube was pulled back and the stent was successfully deployed under fluoroscopic guidance. Technical success was achieved in all patients. The adoption of a modified technique of deployment of OTW stents using an overtube may represent an effective option in the approach of SG complications.

  1. Utility of the balloon-overtube-assisted modified over-the-wire stenting technique to treat post-sleeve gastrectomy complications

    PubMed Central

    Ponte, Ana; Pinho, Rolando; Proença, Luísa; Silva, Joana; Rodrigues, Jaime; Sousa, Mafalda; Silva, João Carlos; Carvalho, João

    2017-01-01

    AIM To describe a modified technique of deployment of stents using the overtube developed for balloon-assisted enteroscopy in post-sleeve gastrectomy (SG) complications. METHODS Between January 2010 and December 2015, all patients submitted to an endoscopic stenting procedure to treat a post-SG stenosis or leakage were retrospectively collected. Procedures from patients in which the stent was deployed using the balloon-overtube-assisted modified over-the-wire (OTW) stenting technique were described. The technical success, corresponding to proper placement of the stent in the stomach resulting in exclusion of the SG leak or the stenosis, was evaluated. Complications related to stenting were also reported. RESULTS Five procedures were included to treat 2 staple line leaks and 3 stenoses. Two types of stents were used, including a fully covered self-expandable metal stent designed for the SG anatomy (Hanarostent, ECBB-30-240-090; M.I. Tech, Co., Ltd, Seoul, South Korea) in 4 procedures and a biodegradable stent (BD stent 019-10A-25/20/25-080, SX-ELLA, Hradec Kralove, Czech Republic) in the remaining procedure. In all cases, an overtube was advanced with the endoscope through the SG to the duodenum. After placement of the guidewire and removal of the endoscope, the stent was easily advanced through the overtube. The overtube was pulled back and the stent was successfully deployed under fluoroscopic guidance. Technical success was achieved in all patients. CONCLUSION The adoption of a modified technique of deployment of OTW stents using an overtube may represent an effective option in the approach of SG complications. PMID:28690770

  2. Primary obstructive megaureter: the role of high pressure balloon dilation.

    PubMed

    Romero, Rosa M; Angulo, Jose Maria; Parente, Alberto; Rivas, Susana; Tardáguila, Ana Rosa

    2014-05-01

    There is a growing interest in minimally invasive treatment of primary obstructive megaureter (POM) in children. The absence of long-term follow-up data, however, makes it difficult to establish the indication for an endoscopic approach. The aim of our study is to determine the long-term efficacy of endourologic high-pressure balloon dilation of the vesicoureteral junction (VUJ) in children with POM that necessitates surgical treatment. We retrospectively reviewed the clinical records from children with POM who were treated with endourologic high-pressure balloon dilation of the VUJ from March 2003 to April 2010. To determine the long-term, a cohort study was conducted in November 2011. Endourologic dilation of the VUJ was performed with a semicompliant high-pressure balloon (2.7 FG) with a minimum balloon size of 3 mm, followed by placement of a Double-J stent. We have treated 29 (32 renal units, left [n=16], right [n=10] and bilateral [n=3]) children with a diagnosis of POM within this period. The median age at the time of the endourologic treatment was 4.04 months (range 1.6-39 months). In three cases, an open ureteral reimplantation was needed, in two cases because of intraoperative technical failure and postoperative Double-J stent migration in one patient. The 26 children (29 renal units) who had a successful endourologic dilation of the VUJ were followed with ultrasonography and MAG-3-Lasix (furosemide) studies that showed a progressive improvement of both the ureterohydronephrosis and drainage in the first 18 months in 20 patients (23 renal units) (69%). In two patients who were treated with a 3 mm balloon, a further dilation was needed, with an excellent outcome. The cohort study (at a median follow-up of 47 months) showed that in all patients who had a good outcome at the 18-month follow-up after endourologic balloon dilation remained asymptomatic with resolution of ureterohydronephrosis on the US and good drainage on the renogram, in the children

  3. Comprehensive Molecular Characterization of Papillary Renal Cell Carcinoma

    PubMed Central

    Linehan, W. Marston; Spellman, Paul T.; Ricketts, Christopher J.; Creighton, Chad J.; Fei, Suzanne S.; Davis, Caleb; Wheeler, David A.; Murray, Bradley A.; Schmidt, Laura; Vocke, Cathy D.; Peto, Myron; Al Mamun, Abu Amar M.; Shinbrot, Eve; Sethi, Anurag; Brooks, Samira; Rathmell, W. Kimryn; Brooks, Angela N.; Hoadley, Katherine A.; Robertson, A. Gordon; Brooks, Denise; Bowlby, Reanne; Sadeghi, Sara; Shen, Hui; Weisenberger, Daniel J.; Bootwalla, Moiz; Baylin, Stephen B.; Laird, Peter W.; Cherniack, Andrew D.; Saksena, Gordon; Haake, Scott; Li, Jun; Liang, Han; Lu, Yiling; Mills, Gordon B.; Akbani, Rehan; Leiserson, Mark D.M.; Raphael, Benjamin J.; Anur, Pavana; Bottaro, Donald; Albiges, Laurence; Barnabas, Nandita; Choueiri, Toni K.; Czerniak, Bogdan; Godwin, Andrew K.; Hakimi, A. Ari; Ho, Thai; Hsieh, James; Ittmann, Michael; Kim, William Y.; Krishnan, Bhavani; Merino, Maria J.; Mills Shaw, Kenna R.; Reuter, Victor E.; Reznik, Ed; Shelley, Carl Simon; Shuch, Brian; Signoretti, Sabina; Srinivasan, Ramaprasad; Tamboli, Pheroze; Thomas, George; Tickoo, Satish; Burnett, Kenneth; Crain, Daniel; Gardner, Johanna; Lau, Kevin; Mallery, David; Morris, Scott; Paulauskis, Joseph D.; Penny, Robert J.; Shelton, Candace; Shelton, W. Troy; Sherman, Mark; Thompson, Eric; Yena, Peggy; Avedon, Melissa T.; Bowen, Jay; Gastier-Foster, Julie M.; Gerken, Mark; Leraas, Kristen M.; Lichtenberg, Tara M.; Ramirez, Nilsa C.; Santos, Tracie; Wise, Lisa; Zmuda, Erik; Demchok, John A.; Felau, Ina; Hutter, Carolyn M.; Sheth, Margi; Sofia, Heidi J.; Tarnuzzer, Roy; Wang, Zhining; Yang, Liming; Zenklusen, Jean C.; Zhang, Jiashan (Julia); Ayala, Brenda; Baboud, Julien; Chudamani, Sudha; Liu, Jia; Lolla, Laxmi; Naresh, Rashi; Pihl, Todd; Sun, Qiang; Wan, Yunhu; Wu, Ye; Ally, Adrian; Balasundaram, Miruna; Balu, Saianand; Beroukhim, Rameen; Bodenheimer, Tom; Buhay, Christian; Butterfield, Yaron S.N.; Carlsen, Rebecca; Carter, Scott L.; Chao, Hsu; Chuah, Eric; Clarke, Amanda; Covington, Kyle R.; Dahdouli, Mahmoud; Dewal, Ninad; Dhalla, Noreen; Doddapaneni, HarshaVardhan; Drummond, Jennifer; Gabriel, Stacey B.; Gibbs, Richard A.; Guin, Ranabir; Hale, Walker; Hawes, Alicia; Hayes, D. Neil; Holt, Robert A.; Hoyle, Alan P.; Jefferys, Stuart R.; Jones, Steven J.M.; Jones, Corbin D.; Kalra, Divya; Kovar, Christie; Lewis, Lora; Li, Jie; Ma, Yussanne; Marra, Marco A.; Mayo, Michael; Meng, Shaowu; Meyerson, Matthew; Mieczkowski, Piotr A.; Moore, Richard A.; Morton, Donna; Mose, Lisle E.; Mungall, Andrew J.; Muzny, Donna; Parker, Joel S.; Perou, Charles M.; Roach, Jeffrey; Schein, Jacqueline E.; Schumacher, Steven E.; Shi, Yan; Simons, Janae V.; Sipahimalani, Payal; Skelly, Tara; Soloway, Matthew G.; Sougnez, Carrie; Tam, Angela; Tan, Donghui; Thiessen, Nina; Veluvolu, Umadevi; Wang, Min; Wilkerson, Matthew D.; Wong, Tina; Wu, Junyuan; Xi, Liu; Zhou, Jane; Bedford, Jason; Chen, Fengju; Fu, Yao; Gerstein, Mark; Haussler, David; Kasaian, Katayoon; Lai, Phillip; Ling, Shiyun; Radenbaugh, Amie; Van Den Berg, David; Weinstein, John N.; Zhu, Jingchun; Albert, Monique; Alexopoulou, Iakovina; Andersen, Jeremiah J; Auman, J. Todd; Bartlett, John; Bastacky, Sheldon; Bergsten, Julie; Blute, Michael L.; Boice, Lori; Bollag, Roni J.; Boyd, Jeff; Castle, Erik; Chen, Ying-Bei; Cheville, John C.; Curley, Erin; Davies, Benjamin; DeVolk, April; Dhir, Rajiv; Dike, Laura; Eckman, John; Engel, Jay; Harr, Jodi; Hrebinko, Ronald; Huang, Mei; Huelsenbeck-Dill, Lori; Iacocca, Mary; Jacobs, Bruce; Lobis, Michael; Maranchie, Jodi K.; McMeekin, Scott; Myers, Jerome; Nelson, Joel; Parfitt, Jeremy; Parwani, Anil; Petrelli, Nicholas; Rabeno, Brenda; Roy, Somak; Salner, Andrew L.; Slaton, Joel; Stanton, Melissa; Thompson, R. Houston; Thorne, Leigh; Tucker, Kelinda; Weinberger, Paul M.; Winemiller, Cythnia; Zach, Leigh Anne; Zuna, Rosemary

    2016-01-01

    Background Papillary renal cell carcinoma, accounting for 15% of renal cell carcinoma, is a heterogeneous disease consisting of different types of renal cancer, including tumors with indolent, multifocal presentation and solitary tumors with an aggressive, highly lethal phenotype. Little is known about the genetic basis of sporadic papillary renal cell carcinoma; no effective forms of therapy for advanced disease exist. Methods We performed comprehensive molecular characterization utilizing whole-exome sequencing, copy number, mRNA, microRNA, methylation and proteomic analyses of 161 primary papillary renal cell carcinomas. Results Type 1 and Type 2 papillary renal cell carcinomas were found to be different types of renal cancer characterized by specific genetic alterations, with Type 2 further classified into three individual subgroups based on molecular differences that influenced patient survival. MET alterations were associated with Type 1 tumors, whereas Type 2 tumors were characterized by CDKN2A silencing, SETD2 mutations, TFE3 fusions, and increased expression of the NRF2-ARE pathway. A CpG island methylator phenotype (CIMP) was found in a distinct subset of Type 2 papillary renal cell carcinoma characterized by poor survival and mutation of the fumarate hydratase (FH) gene. Conclusions Type 1 and Type 2 papillary renal cell carcinomas are clinically and biologically distinct. Alterations in the MET pathway are associated with Type 1 and activation of the NRF2-ARE pathway with Type 2; CDKN2A loss and CIMP in Type 2 convey a poor prognosis. Furthermore, Type 2 papillary renal cell carcinoma consists of at least 3 subtypes based upon molecular and phenotypic features. PMID:26536169

  4. Clinical usefulness of a short-type, prototype single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy: preliminary experiences.

    PubMed

    Kawamura, Takuji; Uno, Koji; Suzuki, Azumi; Mandai, Koichiro; Nakase, Kojiro; Tanaka, Kiyohito; Yasuda, Kenjiro

    2015-01-01

    A limited number of endoscopic retrograde cholangiopancreatography (ERCP) accessories are compatible with the conventional single-balloon enteroscope (SBE) because of the latter's dimensions. The aim of the present study was to assess the utility of a prototype SBE that has a shorter working length and a wider channel than the conventional SBE. ERCP procedures carried out between January 2012 and July 2013 using the short SBE prototype were reconstructions such as Billroth II (B-II), post-gastrectomy with Roux-en-Y (RY-G), and post-choledochojejunostomy with Roux-en-Y (RY-CJ). We retrospectively analyzed the rate of reaching the blind end of the intestine, the diagnostic success rate, the interventional success rate, and the frequency of related complications. Twenty-seven ERCP procedures on 18 patients analyzed comprised two B-II, 15 RY-G, and 10 RY-CJ reconstructions. With a mean procedure time of 56 min (range 40-150 min), the rate of reaching the blind end, the diagnostic success rate, and the interventional success rate were 24/27 (89%), 20/27 (74%), and 19/27 (70%), respectively. There were no major ERCP-related complications in any patient. The prototype short-type SBE appears safe and effective for use in ERCP, and is compatible with conventional endoscopy accessories. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

  5. Papillary fibroblasts differentiate into reticular fibroblasts after prolonged in vitro culture.

    PubMed

    Janson, David; Saintigny, Gaëlle; Mahé, Christian; El Ghalbzouri, Abdoelwaheb

    2013-01-01

    The dermis can be divided into two morphologically different layers: the papillary and reticular dermis. Fibroblasts isolated from these layers behave differently when cultured in vitro. During skin ageing, the papillary dermis decreases in volume. Based on the functional differences in vitro, it is hypothesized that the loss of papillary fibroblasts contributes to skin ageing. In this study, we aimed to mimic certain aspects of skin ageing by using high-passage cultures of reticular and papillary fibroblasts and investigated the effect of these cells on skin morphogenesis in reconstructed human skin equivalents. Skin equivalents generated with reticular fibroblasts showed a reduced terminal differentiation and fewer proliferating basal keratinocytes. Aged in vitro papillary fibroblasts had increased expression of biomarkers specific to reticular fibroblasts. The phenotype and morphology of skin equivalents generated with high-passage papillary fibroblasts resembled that of reticular fibroblasts. This demonstrates that papillary fibroblasts can differentiate into reticular fibroblasts in vitro. Therefore, we hypothesize that papillary fibroblasts represent an undifferentiated phenotype, while reticular fibroblasts represent a more differentiated population. The differentiation process could be a new target for anti-skin-ageing strategies. © 2013 John Wiley & Sons A/S.

  6. Comprehensive Molecular Characterization of Papillary Renal-Cell Carcinoma.

    PubMed

    Linehan, W Marston; Spellman, Paul T; Ricketts, Christopher J; Creighton, Chad J; Fei, Suzanne S; Davis, Caleb; Wheeler, David A; Murray, Bradley A; Schmidt, Laura; Vocke, Cathy D; Peto, Myron; Al Mamun, Abu Amar M; Shinbrot, Eve; Sethi, Anurag; Brooks, Samira; Rathmell, W Kimryn; Brooks, Angela N; Hoadley, Katherine A; Robertson, A Gordon; Brooks, Denise; Bowlby, Reanne; Sadeghi, Sara; Shen, Hui; Weisenberger, Daniel J; Bootwalla, Moiz; Baylin, Stephen B; Laird, Peter W; Cherniack, Andrew D; Saksena, Gordon; Haake, Scott; Li, Jun; Liang, Han; Lu, Yiling; Mills, Gordon B; Akbani, Rehan; Leiserson, Mark D M; Raphael, Benjamin J; Anur, Pavana; Bottaro, Donald; Albiges, Laurence; Barnabas, Nandita; Choueiri, Toni K; Czerniak, Bogdan; Godwin, Andrew K; Hakimi, A Ari; Ho, Thai H; Hsieh, James; Ittmann, Michael; Kim, William Y; Krishnan, Bhavani; Merino, Maria J; Mills Shaw, Kenna R; Reuter, Victor E; Reznik, Ed; Shelley, Carl S; Shuch, Brian; Signoretti, Sabina; Srinivasan, Ramaprasad; Tamboli, Pheroze; Thomas, George; Tickoo, Satish; Burnett, Kenneth; Crain, Daniel; Gardner, Johanna; Lau, Kevin; Mallery, David; Morris, Scott; Paulauskis, Joseph D; Penny, Robert J; Shelton, Candace; Shelton, W Troy; Sherman, Mark; Thompson, Eric; Yena, Peggy; Avedon, Melissa T; Bowen, Jay; Gastier-Foster, Julie M; Gerken, Mark; Leraas, Kristen M; Lichtenberg, Tara M; Ramirez, Nilsa C; Santos, Tracie; Wise, Lisa; Zmuda, Erik; Demchok, John A; Felau, Ina; Hutter, Carolyn M; Sheth, Margi; Sofia, Heidi J; Tarnuzzer, Roy; Wang, Zhining; Yang, Liming; Zenklusen, Jean C; Zhang, Jiashan; Ayala, Brenda; Baboud, Julien; Chudamani, Sudha; Liu, Jia; Lolla, Laxmi; Naresh, Rashi; Pihl, Todd; Sun, Qiang; Wan, Yunhu; Wu, Ye; Ally, Adrian; Balasundaram, Miruna; Balu, Saianand; Beroukhim, Rameen; Bodenheimer, Tom; Buhay, Christian; Butterfield, Yaron S N; Carlsen, Rebecca; Carter, Scott L; Chao, Hsu; Chuah, Eric; Clarke, Amanda; Covington, Kyle R; Dahdouli, Mahmoud; Dewal, Ninad; Dhalla, Noreen; Doddapaneni, Harsha V; Drummond, Jennifer A; Gabriel, Stacey B; Gibbs, Richard A; Guin, Ranabir; Hale, Walker; Hawes, Alicia; Hayes, D Neil; Holt, Robert A; Hoyle, Alan P; Jefferys, Stuart R; Jones, Steven J M; Jones, Corbin D; Kalra, Divya; Kovar, Christie; Lewis, Lora; Li, Jie; Ma, Yussanne; Marra, Marco A; Mayo, Michael; Meng, Shaowu; Meyerson, Matthew; Mieczkowski, Piotr A; Moore, Richard A; Morton, Donna; Mose, Lisle E; Mungall, Andrew J; Muzny, Donna; Parker, Joel S; Perou, Charles M; Roach, Jeffrey; Schein, Jacqueline E; Schumacher, Steven E; Shi, Yan; Simons, Janae V; Sipahimalani, Payal; Skelly, Tara; Soloway, Matthew G; Sougnez, Carrie; Tam, Angela; Tan, Donghui; Thiessen, Nina; Veluvolu, Umadevi; Wang, Min; Wilkerson, Matthew D; Wong, Tina; Wu, Junyuan; Xi, Liu; Zhou, Jane; Bedford, Jason; Chen, Fengju; Fu, Yao; Gerstein, Mark; Haussler, David; Kasaian, Katayoon; Lai, Phillip; Ling, Shiyun; Radenbaugh, Amie; Van Den Berg, David; Weinstein, John N; Zhu, Jingchun; Albert, Monique; Alexopoulou, Iakovina; Andersen, Jeremiah J; Auman, J Todd; Bartlett, John; Bastacky, Sheldon; Bergsten, Julie; Blute, Michael L; Boice, Lori; Bollag, Roni J; Boyd, Jeff; Castle, Erik; Chen, Ying-Bei; Cheville, John C; Curley, Erin; Davies, Benjamin; DeVolk, April; Dhir, Rajiv; Dike, Laura; Eckman, John; Engel, Jay; Harr, Jodi; Hrebinko, Ronald; Huang, Mei; Huelsenbeck-Dill, Lori; Iacocca, Mary; Jacobs, Bruce; Lobis, Michael; Maranchie, Jodi K; McMeekin, Scott; Myers, Jerome; Nelson, Joel; Parfitt, Jeremy; Parwani, Anil; Petrelli, Nicholas; Rabeno, Brenda; Roy, Somak; Salner, Andrew L; Slaton, Joel; Stanton, Melissa; Thompson, R Houston; Thorne, Leigh; Tucker, Kelinda; Weinberger, Paul M; Winemiller, Cynthia; Zach, Leigh Anne; Zuna, Rosemary

    2016-01-14

    Papillary renal-cell carcinoma, which accounts for 15 to 20% of renal-cell carcinomas, is a heterogeneous disease that consists of various types of renal cancer, including tumors with indolent, multifocal presentation and solitary tumors with an aggressive, highly lethal phenotype. Little is known about the genetic basis of sporadic papillary renal-cell carcinoma, and no effective forms of therapy for advanced disease exist. We performed comprehensive molecular characterization of 161 primary papillary renal-cell carcinomas, using whole-exome sequencing, copy-number analysis, messenger RNA and microRNA sequencing, DNA-methylation analysis, and proteomic analysis. Type 1 and type 2 papillary renal-cell carcinomas were shown to be different types of renal cancer characterized by specific genetic alterations, with type 2 further classified into three individual subgroups on the basis of molecular differences associated with patient survival. Type 1 tumors were associated with MET alterations, whereas type 2 tumors were characterized by CDKN2A silencing, SETD2 mutations, TFE3 fusions, and increased expression of the NRF2-antioxidant response element (ARE) pathway. A CpG island methylator phenotype (CIMP) was observed in a distinct subgroup of type 2 papillary renal-cell carcinomas that was characterized by poor survival and mutation of the gene encoding fumarate hydratase (FH). Type 1 and type 2 papillary renal-cell carcinomas were shown to be clinically and biologically distinct. Alterations in the MET pathway were associated with type 1, and activation of the NRF2-ARE pathway was associated with type 2; CDKN2A loss and CIMP in type 2 conveyed a poor prognosis. Furthermore, type 2 papillary renal-cell carcinoma consisted of at least three subtypes based on molecular and phenotypic features. (Funded by the National Institutes of Health.).

  7. Balloons and Science Kit.

    ERIC Educational Resources Information Center

    Balloon Council, Washington, DC.

    This document provides background information on balloons including: (1) the history of balloons; (2) balloon manufacturing; (3) biodegradability; (4) the fate of latex balloons; and (5) the effect of balloons on the rainforest and sea mammals. Also included as part of this instructional kit are four fun experiments that allow students to…

  8. Circumferential optical coherence tomography angiography imaging of the swine esophagus using a micromotor balloon catheter.

    PubMed

    Lee, Hsiang-Chieh; Ahsen, Osman Oguz; Liang, Kaicheng; Wang, Zhao; Cleveland, Cody; Booth, Lucas; Potsaid, Benjamin; Jayaraman, Vijaysekhar; Cable, Alex E; Mashimo, Hiroshi; Langer, Robert; Traverso, Giovanni; Fujimoto, James G

    2016-08-01

    We demonstrate a micromotor balloon imaging catheter for ultrahigh speed endoscopic optical coherence tomography (OCT) which provides wide area, circumferential structural and angiographic imaging of the esophagus without contrast agents. Using a 1310 nm MEMS tunable wavelength swept VCSEL light source, the system has a 1.2 MHz A-scan rate and ~8.5 µm axial resolution in tissue. The micromotor balloon catheter enables circumferential imaging of the esophagus at 240 frames per second (fps) with a ~30 µm (FWHM) spot size. Volumetric imaging is achieved by proximal pullback of the micromotor assembly within the balloon at 1.5 mm/sec. Volumetric data consisting of 4200 circumferential images of 5,000 A-scans each over a 2.6 cm length, covering a ~13 cm(2) area is acquired in <18 seconds. A non-rigid image registration algorithm is used to suppress motion artifacts from non-uniform rotational distortion (NURD), cardiac motion or respiration. En face OCT images at various depths can be generated. OCT angiography (OCTA) is computed using intensity decorrelation between sequential pairs of circumferential scans and enables three-dimensional visualization of vasculature. Wide area volumetric OCT and OCTA imaging of the swine esophagus in vivo is demonstrated.

  9. A Case of Post Myocardial Infarction Papillary Muscle Rupture.

    PubMed

    Anuwatworn, Amornpol; Milnes, Christopher; Kumar, Vishesh; Raizada, Amol; Nykamp, Verlyn; Stys, Adam

    2016-06-01

    Papillary muscle rupture is a rare, life-threatening post myocardial infarction mechanical complication. Without surgical intervention, prognosis is very poor. Clinicians need to recognize this complication early, as prompt therapy is crucial. We present a case of inferior ST elevation myocardial infarction complicated by posteromedial papillary muscle rupture resulting in severe acute mitral regurgitation (flail anterior mitral leaflet), acute pulmonary edema and cardiogenic shock. In our patient, a new mitral regurgitation murmur suggested this mechanical complication. Complete disruption of papillary muscle was visualized by transesophageal echocardiography. This case illustrates the importance of good physical examination for early diagnosis of papillary muscle rupture, so that life-saving treatment can be administered without delay.

  10. Aggressive Variants of Papillary Thyroid Carcinoma: Hobnail, Tall Cell, Columnar, and Solid.

    PubMed

    Nath, Meryl C; Erickson, Lori A

    2018-05-01

    Papillary thyroid carcinomas are the most common endocrine cancer and are usually associated with good survival. However, some variants of papillary thyroid carcinomas may behave more aggressively than classic papillary thyroid carcinomas. The tall cell variant of papillary thyroid carcinoma is the most common aggressive variant of papillary thyroid carcinoma. The aggressive behavior has been ascribed to the histologic subtype and/or to the clinicopathologic features, an issue that remains controversial. The columnar variant of papillary thyroid carcinoma can be aggressive, particularly in older patients, with larger tumors showing a diffusely infiltrative growth pattern and extrathyroidal extension. A papillary thyroid carcinoma is designated as solid/trabecular variant when all or nearly all of a tumor not belonging to any of the other variants has a solid, trabecular, or nested (insular) appearance. This tumor must be distinguished from poorly differentiated thyroid carcinoma which has the same growth pattern but lacks nuclear features of papillary thyroid carcinoma and may show tumor necrosis and high mitotic activity. New to the fourth edition of the WHO Classification of Tumours of Endocrine Organs, the hobnail variant of papillary thyroid carcinoma is a moderately differentiated papillary thyroid carcinoma variant with aggressive clinical behavior and significant mortality. All of these variants are histologically unique and important to recognize due to their aggressive behavior.

  11. Papillary Necrosis in Experimental Analgesic Nephropathy

    PubMed Central

    Saker, B. M.; Kincaid-Smith, Priscilla

    1969-01-01

    A proprietary aspirin, phenacetin, and caffeine preparation given to rats in a dose equivalent to that taken by patients with analgesic nephropathy produced papillary necrosis in 55%. There was a higher incidence in rats deprived of fluids overnight. Papillary necrosis was not noted in rats receiving twice as much phenacetin. These findings support the argument that phenacetin should not be singled out as the substance responsible for analgesic nephropathy in man. PMID:5762278

  12. Recent Developments in Balloon Support Instrumentation at TIFR Balloon Facility, Hyderabad.

    NASA Astrophysics Data System (ADS)

    Vasudevan, Rajagopalan

    2012-07-01

    The Balloon Facility of Tata Institute of Fundamental Research has been conducting stratospheric balloon flights regularly for various experiments in Space Astronomy and Atmospheric Sciences. A continuous improvement in Balloon flight Support instrumentation by the Control Instrumentation Group to keep in space with the growing complexities of the scientific payloads have contributed to the total success of balloon flights conducted recently. Recent improvements in display of Balloon position during balloon flight by showing on real time the balloon GPS position against Google TM maps is of immense help in selecting the right spot for payload landing and safe recovery . For further speeding up the payload recovery process, a new GPS-GSM payload system has been developed which gives SMS of the payload position information to the recovery team on their cell phones. On parallel footing, a new GPS- VHF system has been developed using GPS and Radio Modems for Balloon Tracking and also for obtaining the payload impact point. On the Telecommand side, a single board Telecommand/ Timer weighing less than 2 Kg has been specially developed for use in the mesosphere balloon test flight. The interference on the existing Short Range Telemetry System has been eliminated by introducing a Band Pass Filter and LNA in the Receiving system of the modules, thereby enhancing its reliability. In this paper , we present the details of the above mentioned developments.

  13. GHOST balloons around Antarctica

    NASA Technical Reports Server (NTRS)

    Stearns, Charles R.

    1988-01-01

    The GHOST balloon position as a function of time data shows that the atmospheric circulation around the Antarctic Continent at the 100 mb and 200 mb levels is complex. The GHOST balloons supposedly follow the horizontal trajectory of the air at the balloon level. The position of GHOST balloon 98Q for a three month period in 1968 is shown. The balloon moved to within 2 deg of the South Pole on 1 October 1968 and then by 9 December 1968 was 35 deg from the South Pole and close to its position on 1 September 1968. The balloon generally moved from west to east but on two occasions moved in the opposite direction for a few days. The latitude of GHOST balloons 98Q and 149Z which was at 200 mb is given. Both balloons tended to get closer to the South Pole in September and October. Other GHOST balloons at the same pressure and time period may not indicate similar behavior.

  14. [Giant papillary conjunctivitis].

    PubMed

    Bischoff, G

    2014-05-01

    Giant papillary conjunctivitis is an inflammation of the conjunctiva, which is associated with immunological-allergic disorders, but is difficult to integrate as a defined type of illness. The deposits of contact lenses are responsible in predisposed wearers. They induce a special immune answer to their biochemical ingredients. In addition, roughness of the superficial corneal layers and the conjunctiva, even without any contact lenses after filtrating glaucoma surgery, leads to mechanically induced papillary formations. In former days these symptoms of building giant papillae were seen mostly in wearers of soft hydrogel contact lenses. Nowadays manufacturers have developed contact lens systems with a variety of material components, with an increase of protein and lipid deposits. In combination with the observed non-compliance of wearers regarding lens exchange and contact lens hygiene, GPC is an issue which should be taken into consideration again. Georg Thieme Verlag KG Stuttgart · New York.

  15. Ballooning Comes of Age: Make Your Own Balloon.

    ERIC Educational Resources Information Center

    Eckford, Jim

    1983-01-01

    Provides instructions for building a working model of a hot-air balloon, offering suggestions for a successful flight. Indicates that children can be involved in the projects, for example, by filling in colors in the panels of a balloon drawing. (JN)

  16. Energy from solar balloons

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Grena, Roberto

    2010-04-15

    Solar balloons are hot air balloons in which the air is heated directly by the sun, by means of a black absorber. The lift force of a tethered solar balloon can be used to produce energy by activating a generator during the ascending motion of the balloon. The hot air is then discharged when the balloon reaches a predefined maximum height. A preliminary study is presented, along with an efficiency estimation and some considerations on possible realistic configurations. (author)

  17. Endoscopic findings and treatment outcome in cases presenting with dysphagia.

    PubMed

    Hafeez, Muhammad; Salamat, Amjad; Saeed, Farrukh; Zafar, Hafiz; Hassan, Fayyaz; Farooq, Asif

    2011-01-01

    Dysphagia results from impeded transport of liquids, solids, or both from the pharynx to the stomach. Among the malignant lesions, carcinoma of oesophagus is the commonest cause. Our objective was to find out the frequency of different endoscopic lesions and outcome of the endoscopic therapeutic interventions in patients presenting with dysphagia. This descriptive study was conducted at Department of Gastroenterology, Military Hospital Rawalpindi from June 2008 to May 2009. Patients of dysphagia after their consent were interviewed about the symptoms. Relevant biochemical investigations were done. Barium swallow and upper Gastrointestinal (GI) Endoscopy were carried out. Benign strictures were dilated with Savary Gilliard Dilators. Malignant strictures were further evaluated to decide treatment plan. In patients considered to have oesophageal dysmotility, pressure manometery was done before specific therapy. Seventy nine patients were enrolled. Twenty-five had malignant strictures, out of those commonest was adenocarcinoma 14 (56%). Twenty-nine had benign strictures the commonest being Gastro-oesophageal Reflux Disease (GERD) related peptic stricture 9 (31%). Fifteen had oesophageal dysmotility, and achalasia was present in 10 out of them. After evaluation 12 out of 25 patients with malignant strictures were considered fit for surgery. Self-expanding metal stents (SEMS) were passed in 5. All benign strictures were dilated with Savary-Gillard dilators. Pneumatic balloon dilation was done in patients of achalasia. The commonest malignant lesion resulting in dysphagia was adenocarcinoma while in benign it was GERD related peptic stricture. Achalasia was most frequent in oesophageal motility disorders. Standard of treatment for early oesophageal malignancy is surgical resection. SEMS is a reliable way to allay dysphagia in inoperable cases. Savary Gillard dilatation in benign, and pneumatic balloon achalasia dilatations are effective ways of treatment.

  18. Temporary placement of retrievable fully covered metallic stents versus percutaneous balloon dilation in the treatment of benign biliary strictures.

    PubMed

    Kim, Jin Hyoung; Gwon, Dong Il; Ko, Gi-Young; Sung, Kyu-Bo; Lee, Sung Koo; Yoon, Hyun-Ki; Shin, Ji Hoon; Song, Ho-Young

    2011-06-01

    To compare retrospectively percutaneous transhepatic primary placement of a retrievable self-expanding metallic stent with percutaneous balloon dilation for the treatment of benign biliary strictures. From 2005-2009, 66 patients with benign biliary strictures in whom an endoscopic approach failed or in whom such an approach was inaccessible were evaluated. Of 66 patients, 31 underwent balloon dilation, and 35 underwent temporary metallic stent placement. The etiologies of the benign strictures were anastomotic stricture after surgery (n = 54), stricture secondary to intraoperative injury (n = 9), inflammatory stricture (n = 2), and stricture secondary to trauma (n = 1). The primary patency rates were significantly better in the stent group (87% at 3 years) than in the balloon group (44% at 3 years; P = .022). The indwelling period of percutaneous transhepatic biliary drainage (PTBD) catheters after the initial procedure was able to be significantly reduced in the stent group (median 2.5 months) compared with the balloon group (median 4.5 months; P = .001). Significant bleeding (associated with PTBD) occurred in one patient in the balloon group. In the stent group, stent migration occurred in two patients, and one patient underwent surgery for stent removal after failure of removal under fluoroscopic guidance. Percutaneous primary placement of a retrievable self-expanding metallic stent showed superior intermediate-term results compared with percutaneous balloon dilation for the treatment of benign biliary strictures. In addition, the indwelling period of PTBD catheters can be significantly reduced using temporary stent placement. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  19. Gastric antral webs in adults: A case series characterizing their clinical presentation and management in the modern endoscopic era

    PubMed Central

    Morales, Shannon J; Nigam, Neha; Chalhoub, Walid M; Abdelaziz, Dalia I; Lewis, James H; Benjamin, Stanley B

    2017-01-01

    AIM To investigate the current management of gastric antral webs (GAWs) among adults and identify optimal endoscopic and/or surgical management for these patients. METHODS We reviewed our endoscopy database seeking to identify patients in whom a GAW was visualized among 24640 esophagogastroduodenoscopies (EGD) over a seven-year period (2006-2013) at a single tertiary care center. The diagnosis of GAW was suspected during EGD if aperture size of the antrum did not vary with peristalsis or if a “double bulb” sign was present on upper gastrointestinal series. Confirmation of the diagnosis was made by demonstrating a normal pylorus distal to the GAW. RESULTS We identified 34 patients who met our inclusion criteria (incidence 0.14%). Of these, five patients presented with gastric outlet obstruction (GOO), four of whom underwent repeated sequential balloon dilations and/or needle-knife incisions with steroid injection for alleviation of GOO. The other 29 patients were incidentally found to have a non-obstructing GAW. Age at diagnosis ranged from 30-87 years. Non-obstructing GAWs are mostly incidental findings. The most frequently observed symptom prompting endoscopic work-up was refractory gastroesophageal reflux (n = 24, 70.6%) followed by abdominal pain (n = 11, 33.4%), nausea and vomiting (n = 9, 26.5%), dysphagia (n = 6, 17.6%), unexplained weight loss, (n = 4, 11.8%), early satiety (n = 4, 11.8%), and melena of unclear etiology (n = 3, 8.82%). Four of five GOO patients were treated with balloon dilation (n = 4), four-quadrant needle-knife incision (n = 3), and triamcinolone injection (n = 2). Three of these patients required repeat intervention. One patient had a significant complication of perforation after needle-knife incision. CONCLUSION Endoscopic intervention for GAW using balloon dilation or needle-knife incision is generally safe and effective in relieving symptoms, however repeat treatment may be needed and a risk of perforation exists with thermal

  20. Targeting glutaminase-mediated glutamine dependence in papillary thyroid cancer.

    PubMed

    Yu, Yang; Yu, Xiaohui; Fan, Chenling; Wang, Hong; Wang, Renee; Feng, Chen; Guan, Haixia

    2018-06-25

    Papillary thyroid cancer is a prevalent endocrine malignancy. Although alterations in glutamine metabolism have been reported in several types of hematological and solid tumors, little is known about the functions of glutamine and glutaminolysis-associated proteins in papillary thyroid cancer. Here, we demonstrated the glutamine dependence of papillary thyroid cancer cells, and with the use of RT 2 -PCR arrays, we screened for the aberrant overexpression of glutaminase in human papillary thyroid cancer tissues and cells. These results were later confirmed via real-time PCR, Western blots, and immunohistochemical staining. We found that the levels of glutaminase were significantly correlated with extrathyroidal extension. Inhibition of GLS suppressed glutaminolysis and reduced mitochondrial respiration. The proliferative, viable, migratory, and invasive abilities of papillary thyroid cancer cells were impaired by both the pharmacological inhibition and the genetic knockdown of glutaminase. Additionally, the inhibition of glutaminase deactivated the mechanistic target of the rapamycin complex 1 (mTORC1) signaling pathway, promoting autophagy and apoptosis. Collectively, these findings show that glutaminase-mediated glutamine dependence may be a potential therapeutic target for papillary thyroid cancer. PTC cells are glutamine-dependent, and GLS is aberrantly overexpressed in PTC. Inhibition of GLS suppressed glutaminolysis and reduced mitochondrial respiration. Inhibition of GLS impairs the viability of PTC cells. GLS blockade causes deactivation of mTORC1 and induction of autophagy and apoptosis. GLS may be a potential therapeutic target for PTC.

  1. Predictors of short term treatment outcome in patients with achalasia following endoscopic or surgical therapy.

    PubMed

    Gheorghe, Cristian; Bancila, Ion; Tutuian, Radu; Iacob, Razvan; Tomulescu, Victor

    2012-01-01

    Pneumatic balloon dilation and surgical myotomy are the most effective treatments for achalasia. While there is controversy which method is best, the aim of the current study was to identify predictors of symptom recurrence after endoscopic or surgical therapy. Patients undergoing pneumatic balloon dilatation (30mm) or laparoscopic Heller myotomy with Dor fundoplication were included in the study. Analyzed parameters include total symptom score (sum of 0-5 point intensity for dysphagia, regurgitation and chest pain), width and height of esophageal column at 2 and 5 minutes after oral barium ingestion, lower esophageal sphincter (LES) length, resting (LESP) and residual pressure (LESRP) before and 3 months after intervention. Patients with symptoms score <3 at the 3-month follow-up visit were considered asymptomatic. Twenty-one patients underwent pneumatic dilation (14) or laparoscopic myotomy (7). Total symptom score improved (p<0.01) from pre- (7.2±2.7) to post-intervention (1.7±2.6). Eleven (85.8%) patients in the endoscopic group vs. 7 (100%) patients in the surgical group were symptom-free 3 months after intervention. Therapies improved LESP (24.4±8.2mmHg pre- vs. 15.4±10.3mmHg post-therapy; p=0.003) and mean LESRP (7.9±4.3mmHg pre- vs. 5.3±6.7mmHg post-therapy; p=0.03). Univariate linear regression analysis identified barium contrast column width >5cm at 2 minutes (p=0.04), LES length <2cm (p=0.003) and LESRP >10mmHg (p=0.02) as predictors for persistent symptoms. While >85% of achalasia patients responded well to 30mm pneumatic balloon dilation, patients with elevated LES pressure, short LES and wide esophagus should be considered as primary surgical candidates.

  2. Clinicopathological and immunohistochemical characterization of papillary proliferation of the endometrium: A single institutional experience.

    PubMed

    Park, Cheol Keun; Yoon, Gun; Cho, Yoon Ah; Kim, Hyun-Soo

    2016-06-28

    Papillary proliferation of the endometrium is an unusual lesion that is composed of papillae with fibrovascular stromal cores covered with benign-appearing glandular epithelium. We studied the clinicopathological and immunohistochemical features of four cases of endometrial papillary proliferations. All patients were postmenopausal. Two lesions were incidental findings in hysterectomy specimens, and two lesions were detected in endometrial curettage specimens. Based on the degree of architectural complexity and extent of proliferation, we classified papillary proliferations histopathologically into "simple" or "complex" growth patterns. Three cases were classified as simple papillary proliferation, and one case was classified as complex papillary proliferation. Simple papillary proliferations were characterized by slender papillae with delicate stromal cores. In contrast, complex papillary proliferations had intracystic papillary projections and cellular clusters with frequent branching and occasional cytological atypia. All cases showed coexistent metaplastic epithelial changes, including mucinous metaplasia, eosinophilic cell change, and ciliated cell metaplasia. One patient with simple papillary proliferations had coexistent well-differentiated endometrioid carcinoma. One patient had subsequent hyperplasia without atypia, and another patient had subsequent atypical hyperplasia/endometrioid intraepithelial neoplasia; both patients underwent total hysterectomy within four months. Our observations are consistent with previous data demonstrating that endometrial papillary proliferations coexist with or develop into atypical hyperplasia/endometrioid intraepithelial neoplasia or endometrioid carcinoma. It is very important for pathologists to discriminate papillary proliferations from neoplastic lesions (including atypical hyperplasia/endometrioid intraepithelial neoplasia and well-differentiated endometrioid carcinoma) and benign mimickers (including papillary

  3. Clinicopathological and immunohistochemical characterization of papillary proliferation of the endometrium: A single institutional experience

    PubMed Central

    Park, Cheol Keun; Yoon, Gun; Cho, Yoon Ah; Kim, Hyun-Soo

    2016-01-01

    Papillary proliferation of the endometrium is an unusual lesion that is composed of papillae with fibrovascular stromal cores covered with benign-appearing glandular epithelium. We studied the clinicopathological and immunohistochemical features of four cases of endometrial papillary proliferations. All patients were postmenopausal. Two lesions were incidental findings in hysterectomy specimens, and two lesions were detected in endometrial curettage specimens. Based on the degree of architectural complexity and extent of proliferation, we classified papillary proliferations histopathologically into “simple” or “complex” growth patterns. Three cases were classified as simple papillary proliferation, and one case was classified as complex papillary proliferation. Simple papillary proliferations were characterized by slender papillae with delicate stromal cores. In contrast, complex papillary proliferations had intracystic papillary projections and cellular clusters with frequent branching and occasional cytological atypia. All cases showed coexistent metaplastic epithelial changes, including mucinous metaplasia, eosinophilic cell change, and ciliated cell metaplasia. One patient with simple papillary proliferations had coexistent well-differentiated endometrioid carcinoma. One patient had subsequent hyperplasia without atypia, and another patient had subsequent atypical hyperplasia/endometrioid intraepithelial neoplasia; both patients underwent total hysterectomy within four months. Our observations are consistent with previous data demonstrating that endometrial papillary proliferations coexist with or develop into atypical hyperplasia/endometrioid intraepithelial neoplasia or endometrioid carcinoma. It is very important for pathologists to discriminate papillary proliferations from neoplastic lesions (including atypical hyperplasia/endometrioid intraepithelial neoplasia and well-differentiated endometrioid carcinoma) and benign mimickers (including

  4. Single balloon versus double balloon bipedicular kyphoplasty: a systematic review and meta-analysis.

    PubMed

    Jing, Zehao; Dong, Jianli; Li, Zhengwei; Nan, Feng

    2018-06-19

    Kyphoplasty has been widely used to treat vertebral compression fractures (VCFs). In standard procedure of kyphoplasty, two balloons were inserted into the vertebral body through bipedicular and inflated simultaneously, while using a single balloon two times is also a common method in clinic to lessen the financial burden of patients. However, the effect and safety of single balloon versus double balloon bipedicular kyphoplasty are still controversy. In this systematic review and meta-analysis, eligible studies were identified through a comprehensive literature search of PubMed, Cochrane library EMBASE, Web of Science, Wanfang, CNKI, VIP and CBM until January 1, 2018. Results from individual studies were pooled using a random or fixed effects model. Seven articles were included in the systematic review and five studies were consisted in meta-analysis. We observed no significant difference between single balloon and double balloon bipedicular kyphoplasty in visual analog scale (VAS), angle (kyphotic angle and Cobb angle), consumption (operation time, cement volume and volume of bleeding), vertebral height (anterior height, medium height and posterior height) and complications (cement leakage and new VCFs), while the cost of single balloon bipedicular kyphoplasty is lower than that of double balloon bipedicular kyphoplasty. The results of our meta-analysis also demonstrated that single balloon can significantly improve the VAS, angle and vertebral height of patients suffering from VCFs. This systematic review and meta-analysis collectively concludes that single balloon bipedicular kyphoplasty is as effective as double balloon bipedicular kyphoplasty in improving clinical symptoms, deformity and complications of VCFs but not so expensive. These slides can be retrieved under Electronic Supplementary Material.

  5. Circumferential optical coherence tomography angiography imaging of the swine esophagus using a micromotor balloon catheter

    PubMed Central

    Lee, Hsiang-Chieh; Ahsen, Osman Oguz; Liang, Kaicheng; Wang, Zhao; Cleveland, Cody; Booth, Lucas; Potsaid, Benjamin; Jayaraman, Vijaysekhar; Cable, Alex E.; Mashimo, Hiroshi; Langer, Robert; Traverso, Giovanni; Fujimoto, James G.

    2016-01-01

    We demonstrate a micromotor balloon imaging catheter for ultrahigh speed endoscopic optical coherence tomography (OCT) which provides wide area, circumferential structural and angiographic imaging of the esophagus without contrast agents. Using a 1310 nm MEMS tunable wavelength swept VCSEL light source, the system has a 1.2 MHz A-scan rate and ~8.5 µm axial resolution in tissue. The micromotor balloon catheter enables circumferential imaging of the esophagus at 240 frames per second (fps) with a ~30 µm (FWHM) spot size. Volumetric imaging is achieved by proximal pullback of the micromotor assembly within the balloon at 1.5 mm/sec. Volumetric data consisting of 4200 circumferential images of 5,000 A-scans each over a 2.6 cm length, covering a ~13 cm2 area is acquired in <18 seconds. A non-rigid image registration algorithm is used to suppress motion artifacts from non-uniform rotational distortion (NURD), cardiac motion or respiration. En face OCT images at various depths can be generated. OCT angiography (OCTA) is computed using intensity decorrelation between sequential pairs of circumferential scans and enables three-dimensional visualization of vasculature. Wide area volumetric OCT and OCTA imaging of the swine esophagus in vivo is demonstrated. PMID:27570688

  6. BRAF V600E mutations in papillary craniopharyngioma

    PubMed Central

    Brastianos, Priscilla K.; Santagata, Sandro

    2016-01-01

    Papillary craniopharyngioma is an intracranial tumor that results in high levels of morbidity. We recently demonstrated that the vast majority of these tumors harbor the oncogenic BRAF V600E mutation. The pathologic diagnosis of papillary craniopharyngioma can now be confirmed using mutation specific immunohistochemistry and targeted genetic testing. Treatment with targeted agents is now also a possibility in select situations. We recently reported a patient with a multiply recurrent papillary craniopharyngioma in whom targeting both BRAF and MEK resulted in a dramatic therapeutic response with a marked anti-tumor immune response. This work shows that activation of the MAPK pathway is the likely principal oncogenic driver of these tumors. We will now investigate the efficacy of this approach in a multicenter phase II clinical trial. Post-treatment resection samples will be monitored for the emergence of resistance mechanisms. Further advances in the non-invasive diagnosis of papillary craniopharyngioma by radiologic criteria and by cell-free DNA testing could someday allow neo-adjuvant therapy for this disease in select patient populations. PMID:26563980

  7. Selumetinib in Treating Patients With Papillary Thyroid Cancer That Did Not Respond to Radioactive Iodine

    ClinicalTrials.gov

    2016-12-02

    Recurrent Thyroid Gland Carcinoma; Stage I Thyroid Gland Papillary Carcinoma; Stage II Thyroid Gland Papillary Carcinoma; Stage III Thyroid Gland Papillary Carcinoma; Stage IV Thyroid Gland Papillary Carcinoma

  8. Balloon Design Software

    NASA Technical Reports Server (NTRS)

    Farley, Rodger

    2007-01-01

    PlanetaryBalloon Version 5.0 is a software package for the design of meridionally lobed planetary balloons. It operates in a Windows environment, and programming was done in Visual Basic 6. By including the effects of circular lobes with load tapes, skin mass, hoop and meridional stress, and elasticity in the structural elements, a more accurate balloon shape of practical construction can be determined as well as the room-temperature cut pattern for the gore shapes. The computer algorithm is formulated for sizing meridionally lobed balloons for any generalized atmosphere or planet. This also covers zero-pressure, over-pressure, and super-pressure balloons. Low circumferential loads with meridionally reinforced load tapes will produce shapes close to what are known as the "natural shape." The software allows for the design of constant angle, constant radius, or constant hoop stress balloons. It uses the desired payload capacity for given atmospheric conditions and determines the required volume, allowing users to design exactly to their requirements. The formulations are generalized to use any lift gas (or mixture of gases), any atmosphere, or any planet as described by the local acceleration of gravity. PlanetaryBalloon software has a comprehensive user manual that covers features ranging from, but not limited to, buoyancy and super-pressure, convenient design equations, shape formulation, and orthotropic stress/strain.

  9. Shear-Wave Elastography for the Differential Diagnosis of Breast Papillary Lesions

    PubMed Central

    Chung, Jin; Lee, Won Kyung; Cha, Eun-Suk; Lee, Jee Eun; Kim, Jeoung Hyun; Ryu, Young Hoon

    2016-01-01

    Objective To evaluate the diagnostic performance of shear-wave elastography (SWE) for the differential diagnosis of breast papillary lesions. Methods This study was an institutional review board-approved retrospective study, with a waiver of informed consent. A total of 79 breast papillary lesions in 71 consecutive women underwent ultrasound and SWE prior to biopsy. Ultrasound features and quantitative SWE parameters were recorded for each lesion. All lesions were surgically excised or excised using an ultrasound-guided vacuum-assisted method. The diagnostic performances of the quantitative SWE parameters were compared using the area under the receiver operating characteristic curve (AUC). Results Of the 79 lesions, six (7.6%) were malignant and 12 (15.2%) were atypical. Orientation, margin, and the final BI-RADS ultrasound assessments were significantly different for the papillary lesions (p < 0.05). All qualitative SWE parameters were significantly different (p < 0.05). The AUC values for SWE parameters of benign and atypical or malignant papillary lesions ranged from 0.707 to 0.757 (sensitivity, 44.4–94.4%; specificity, 42.6–88.5%). The maximum elasticity and the mean elasticity showed the highest AUC (0.757) to differentiate papillary lesions. Conclusion SWE provides additional information for the differential diagnosis of breast papillary lesions. Quantitative SWE features were helpful to differentiate breast papillary lesions. PMID:27893857

  10. Pheochromocytoma, papillary thyroid carcinoma.

    PubMed

    Nasser, Tariq; Qari, Faiza

    2009-08-01

    A 53-year-old woman presented with labile and difficult to control hypertension on 3 different anti-hypertensive medications. Abdominal computed tomography and ultrasonography of the thyroid gland showed a 1.8 cm thyroid nodule. Fine needle aspiration biopsy of the thyroid nodule revealed papillary thyroid carcinoma. Serum thyroid stimulating hormone and free thyroxine, calcitonin, carcinoembryonic antigen, intact parathyroid hormone, and calcium levels were within normal limits. A 24-hour urine metanephrine showed significant elevation in urine metanephrine of approximately 3 times the upper limit of normal, and the result of 131I-metaiodobenzyleguanjdjne (131I-MIBG) scintigraphy confirmed that the adrenal mass was pheochromocytoma. Right adrenalectomy and total thyroidectomy were performed. The final pathology was pheochromocytoma and papillary thyroid carcinoma. An analysis of c-ret porto-oncogene mutation yielded a negative result. This unusual association of 2 tumors represents a new entity.

  11. [Endoscopic dilatation of benign colon and rectum stenosis].

    PubMed

    Rivera Vega, Juan; Frisancho Velarde, Oscar; Cervera, Zenón; Ruiz, Edwin; Yoza, Max; Larrea, Pedro

    2002-01-01

    To determine the usefulness of endoscopic dilatation in dealing with benign stenosis of the anus, rectum and colon. PATIENTS AND METHODS USED: Thirty six (36) patients with stenosis, anus (8), rectum (22) and colon (6) were given endoscopic treatment using hydroneumatic balloons, electro incision (radiated cuts) or a combination of both. Rigid equipment (metal) was used for distal stenosis. Age ranged between 30 and 82 years. Twelve (12) patients were male and 24 female. The diameter of the stenosis was less than 13 mm in 18 of the patients and 11 patients carried colostomy. All 36 patients were subjected to a total of 113 dilatation sessions. The average number of sessions per patient for patients with anal stenosis was 2.5 and for patients with colorectal stenosis, 3.32. One patient with rectal stenosis required 21 sessions to achieve final objective. The result achieved was good in 31 patients, less than satisfactory in 3 patients and bad in one patient, who presented a stenosis which was over 5 cm long. We lost track of a patient in the follow up stage. Success in closing the colostomy was achieved in 9 patients, while one presented a complication due to the procedure (cervical emphysema) which remitted with medical attention. Endoscopic dilatation offers, through its different techniques, a safe and efficient method for the treatment of benign stenosis of the anus, rectum and colon and must be considered as a first class tool for the treatment of this kind of pathologies.

  12. Submucosal tunneling using endoscopic submucosal dissection for peritoneal access and closure in natural orifice transluminal endoscopic surgery: a porcine survival study.

    PubMed

    Yoshizumi, F; Yasuda, K; Kawaguchi, K; Suzuki, K; Shiraishi, N; Kitano, S

    2009-08-01

    Safe peritoneal access and gastric closure are the most important concerns in the clinical application of natural orifice transluminal endoscopic surgery (NOTES). We aimed to clarify the feasibility of a submucosal tunnel technique using endoscopic submucosal dissection (ESD) for transgastric peritoneal access and subsequent closure for NOTES. Seven female pigs, each weighing about 40 kg were included in the study. The following procedures were performed: (i) after injection of normal saline into the submucosa, the mucosa was cut with a flex knife; (ii) the submucosal layer was dissected using an insulation-tipped electrosurgical knife to make a narrow longitudinal 50-mm submucosal tunnel; (iii) a small incision was made at the end of the tunnel and enlarged with a dilation balloon. After transgastric peritoneoscopy, the mucosal incision site was closed with clips. The following outcome measures were used: (a) evaluation of the technical feasibility of making a submucosal tunnel; (b) clinical monitoring for 7 days; (c) follow-up endoscopy and necropsy; and (d) peritoneal fluid culture. Natural orifice transluminal endoscopic peritoneoscopy with a submucosal tunnel was successfully carried out in all pigs. The pigs recovered well, without signs of peritonitis. Follow-up endoscopy showed healing of mucosal incision sites without open defects. Necropsy revealed no findings of peritonitis, confirming completeness of gastric closure; there was a thin scar in one pig and adhesion of the omentum in six pigs. Peritoneal fluid culture demonstrated no bacterial growth. The submucosal tunnel technique is feasible and effective for transgastric peritoneal access and closure.

  13. Evaluation of the Distribution of Paclitaxel After Application of a Paclitaxel-Coated Balloon in the Rabbit Urethra.

    PubMed

    Barbalias, Dimitrios; Lappas, Georgios; Ravazoula, Panagiotia; Liourdi, Despoina; Kyriazis, Iason; Liatsikos, Evangelos; Kallidonis, Panagiotis

    2018-05-01

    Urethral strictures are a common urologic problem that could require complex reconstructive procedures. Urethral dilatation represents a frequent practiced intervention associated with high recurrence rates. Drug-coated percutaneous angioplasty balloons (DCBs) with cytostatic drugs have been effectively used for the prevention of vascular restenosis after balloon dilatation. To reduce restenosis rates of urethral dilatation, these balloons could be used in the urethra. Nevertheless, the urothelium is different than the endothelium and these drugs may not be distributed to the outer layers of the urethra. Thus, an experiment was performed to evaluate the distribution of paclitaxel (PTX) in the rabbit urethra after the inflation of a PTX-coated balloon (PCB). Eleven rabbits underwent dilatation of the posterior urethra with common endoscopic balloons after urethrography. Nine of these rabbits were additionally treated with PCB. The urethras of the two control animals were removed along with three more dilated with PCB urethras immediately after the dilatation. The remaining of the urethras were removed after 24 (n = 3) and 48 hours (n = 3). The posterior segments of the urethras were evaluated with hematoxylin and eosin staining as well as with immunohistochemistry with polyclonal anti-PTX antibody. The two control specimens showed denudation of the urothelium after balloon dilatations and no PTX was observed. All specimens from dilated PCB urethras showed distribution of PTX to all layers of the urethra. The specimens that were immediately removed exhibited denudation of the urothelium without any inflammation. The specimens removed at 24 and 48 hours showed mild acute inflammation. PTX was distributed to the urothelial, submucosal, and smooth muscle layers of the normal rabbit urethra immediately after dilatation with a DCB. PTX and mild inflammation were present at the site 24 and 48 hours after the dilatation.

  14. Incidence, treatment and outcome of rectal stenosis following transanal endoscopic microsurgery.

    PubMed

    Barker, J A; Hill, J

    2011-09-01

    As an alternative to more radical abdominal surgery, transanal endoscopic microsurgery (TEM) offers a minimally invasive solution for the excision of certain rectal polyps and early-stage rectal tumours. The patient benefits of TEM as compared to radical abdominal surgery are clear; nevertheless, some drawback is possible. The aim of our study was to determine the risk factors, treatment and outcomes of rectal stenosis following TEM. We analysed a series of 354 consecutive patients who underwent TEM for benign or malignant rectal tumours between 1997 and 2009. We recorded the maximum histological diameter of the lesion, and whether the lesion was circumferential. Rectal stenosis was defined as a rectal narrowing not allowing passage of a 12 mm sigmoidoscope. Histological results with a measured specimen diameter were available in 304 of the 354 cases. There were 11 stenoses in total (3.6%), 7 stenoses due to 9 circumferential lesions (78%) and 4 due to lesions with a maximum diameter ≥ 5 cm (3.2%). Two patients presented as emergencies, and the other 9 patients reported symptoms of increased stool frequency at follow-up. Three of the stenoses were associated with recurrent disease. All stenoses were treated by a combination of endoscopic/radiological balloon dilatation or surgically with Hegar's dilators. A median of two procedures were required to treat stenoses until resolution of symptoms. Rectal stenosis following TEM excision is rare. It is predictable in patients with circumferential lesions but is rare in patients with non-circumferential lesions with a maximum diameter ≥ 5 cm. It is effectively treated with surgical or balloon dilatation. Most patients require repeated treatments.

  15. The follicular variant of papillary thyroid cancer and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).

    PubMed

    Scharpf, Joseph; Kamani, Dipti; Sadow, Peter M; Randolph, Gregory W

    2017-01-01

    Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a new terminology proposed for encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). Recently, thyroid cancer incidence has increased dramatically, without affecting related mortality rate. This increase is widely attributed to the intensified surveillance leading to a substantial increase in the diagnosis of small classic papillary thyroid cancers and EFVPTCs. Recent studies emphasize the indolent behavior of the EFVPTC. Recently, there has been a reclassification of EFVPTC as NIFTP, a benign entity. The financial and emotional burden of 'cancer' diagnosis and treatment can be significant. This review recapitulates the literature supporting the reclassification of EFVPTC as NIFTP, a benign entity, and reviews standardized diagnostic criteria for EFVPTC. The information highlighted in this review will affect surgical decision making and may promote the offering of hemithyroidectomy over a total thyroidectomy to some patients with 'indeterminate' cytopathological category; postoperative radioiodine ablation will not be required for NIFTP patients.

  16. Endoscopic Management of Primary Obstructive Megaureter: A Systematic Review.

    PubMed

    Doudt, Alexander D; Pusateri, Chad R; Christman, Matthew S

    2018-06-01

    The gold standard treatment for primary obstructive megaureter (POM) with declining renal function, worsening obstruction, or recurrent infections is ureteral reimplantation with or without tapering. In infants, open surgery can be technically demanding and associated with significant morbidity. We conducted a systematic review of the literature with special interest in endoscopic management of POM and its outcomes. A search was conducted of the MEDLINE/Ovid, PubMed, Embase, and Web of Science databases. Only full-text articles written in the English language and involving greater than one reported pediatric case per publication were included. Two authors independently extracted data and assessed strength of evidence for each study. We found 11 retrospective and 1 prospective, single institution case series that met selection criteria, describing 222 patients with 237 obstructed renal units. Mean age at time of surgery was 24.6 months. The most common endoscopic approaches were cystoscopy+high-pressure balloon dilation+Double-J ureteral stent placement (49.5%), cystoscopy+incisional ureterotomy+Double-J ureteral stent placement (27.8%), and cystoscopy+Double-J ureteral stent placement (18.9%). For all approaches and age groups, anatomic and functional success rates were 79.3% (146/184) and 76.7% (132/172), respectively. Anatomic success rates were highest in children ≥12 months of age (82.3%, 117/142). Endoscopic retreatment was performed in 15.1% of cases with a 36.7% overall surgical reintervention rate. Forty-one ureters progressed to ureteral reimplantation. Complications were generally mild (Clavien-Dindo Grades I-II), but 12 ureters did develop vesicoureteral reflux. Mean follow-up period was 3.2 years. Endoscopic management for persistent or progressive POM in children ≥12 months of age is a minimally invasive alternative to ureteral reimplantation with modest success rates. In infants, it may best be utilized as a temporizing procedure. Approximately

  17. Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

    PubMed Central

    Wang, Fei; Xu, Boming; Li, Quanpeng; Zhang, Xiuhua; Jiang, Guobing; Ge, Xianxiu; Nie, Junjie; Zhang, Xiuyun; Wu, Ping; Ji, Jie; Miao, Lin

    2016-01-01

    Abstract Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is challenging. Results of ERCP in those patients varied. The aim of our study was to evaluate the safety and effectiveness of various endoscopes-assisted ERCP in patients with surgically altered anatomy. Fifty-two patients with Billroth II reconstruction (group A), 20 patients with subtotal or total gastrectomy with Roux-en-Y anastomosis (group B), 25 patients with pancreatoduodenectomy or Roux-en-Y hepaticojejunostomy reconstruction (group C) were included. Gastroscope, duodenoscope, colonoscope, and double-balloon enteroscope were used. The endoscope insertion success rate of groups A, B, C was 96.2% (50/52), 85.0% (17/20), 80% (20/25), respectively. χ2 test showed that there was no significant difference between the 3 groups (P = 0.068). The mean insertion time was 36.7, 68.4, and 84.0 minutes, respectively. One-way ANOVA showed that the insertion time of group C was significantly longer than that of groups B and C (both P <0.001). The endoscopic cannulation success rates of groups A, B, C were 90%, 82.4%, and 100%, respectively. χ2 test showed that there was no significant difference between the 3 groups (P = 0.144). The mean cannulation time was 19.4, 28.1, and 20.4 minutes, respectively. One-way ANOVA showed that the cannulation time of group B was longer than that of groups A and C (P <0.001, P = 0.001, respectively). In total, 74 patients with successful biliary cannulation achieved the therapeutic goal; thus, the clinical success rate was 76.3% (74/97). Our study showed that ERCP in patients with surgically altered anatomy was safe and feasible. PMID:28033284

  18. Morphological variations of papillary muscles in the mitral valve complex in human cadaveric hearts.

    PubMed

    Gunnal, Sandhya Arvind; Wabale, Rajendra Namdeo; Farooqui, Mujeebuddin Samsamuddin

    2013-01-01

    Papillary muscle rupture and dysfunction can lead to complications of prolapsed mitral valve and mitral regurgitation. Multiple operative procedures of the papillary muscles, such as resection, repositioning and realignment, are carried out to restore normal physiological function. Therefore, it is important to know both the variations and the normal anatomy of papillary muscles. This study was carried out on 116 human cadaveric hearts. The left ventricles were opened along the left border in order to view the papillary muscles. The number, shape, position and pattern of the papillary muscles were observed. In this series, the papillary muscles were mostly found in groups instead of in twos, as is described in standard textbooks. Four different shapes of papillary muscles were identified - conical, broad-apexed, pyramidal and fan-shaped. We also discovered various patterns of papillary muscles. No two mitral valve complexes have the same architectural arrangement. Each case seems to be unique. Therefore, it is important for scientists worldwide to study the variations in the mitral valve complex in order to ascertain the reason behind each specific architectural arrangement. This will enable cardiothoracic surgeons to tailor the surgical procedures according to the individual papillary muscle pattern.

  19. Natural orifice transluminal endoscopic surgery gastrotomy closure with an over-the-endoscope clip: a randomized, controlled porcine study (with videos).

    PubMed

    von Renteln, Daniel; Schmidt, Arthur; Vassiliou, Melina C; Gieselmann, Maria; Caca, Karel

    2009-10-01

    Secure endoscopic closure of transgastric natural orifice transluminal endoscopic surgery (NOTES) access is of paramount importance. The over-the-scope clip (OTSC) system has previously been shown to be effective for NOTES gastrotomy closure. To compare OTSC gastrotomy closure with surgical closure. Randomized, controlled animal study. Animal facility laboratory. Thirty-six female domestic pigs. Gastrotomies were created by using a needle-knife and an 18-mm balloon. The animals were subsequently randomized to either open surgical repair with interrupted sutures or endoscopic repair with 12-mm OTSCs. In addition, pressurized leak tests were performed in ex vivo specimens of 18-mm scalpel incisions closed with suture (n = 14) and of intact stomachs (n = 10). The mean time for endoscopic closure was 9.8 minutes (range 3-22, SD 5.5). No complications occurred during either type of gastrotomy closure. At necropsy, examination of all OTSC and surgical closures demonstrated complete sealing of gastrotomy sites without evidence of injury to adjacent organs. Pressurized leak tests showed a mean burst pressure of 83 mm Hg (range 30-140, SD 27) for OTSC closures and 67 mm Hg (range 30-130, SD 27.7) for surgical sutures. Ex vivo hand-sewn sutures of 18-mm gastrotomies (n = 14) exhibited a mean burst pressure of 65 mm Hg (range 20-140, SD 31) and intact ex vivo stomachs (n = 10) had a mean burst pressure of 126 mm Hg (range 90-170, SD 28). The burst pressure of ex vivo intact stomachs was significantly higher compared with OTSC closures (P < .01), in vivo surgical closures (P < .01), and ex vivo hand-sewn closures (P < .01). There was a trend toward higher burst pressures in the OTSC closures compared with surgical closures (P = .063) and ex vivo hand-sewn closures (P = .094). In vivo surgical closures demonstrated similar burst pressures compared with ex vivo hand-sewn closures (P = .848). Nonsurvival setting. Endoscopic closure by using the OTSC system is comparable to

  20. Inflammatory papillary hyperplasia: A systematic review

    PubMed Central

    Gual-Vaqués, Patricia; Jané-Salas, Enric; Egido-Moreno, Sonia; Ayuso-Montero, Raúl; Marí-Roig, Antoni

    2017-01-01

    Introduction Inflammatory papillary hyperplasia (IPH) is a benign lesion of the palatal mucosa. It is usually found in denture-wearers but also has been reported in patients without a history of use of a maxillary prosthesis use. Objetives The aim of this study is to review the literature to assess the prevalence of denture stomatitis and inflammatory papillary hyperplasia and the etiological factors associated. Material and Methods A search was carried out in PubMed (January 2005 to October 2015) with the key words “inflammatory papillary hyperplasia”, “denture stomatitis”, “granular stomatitis” and “Newton’s type III” The inclusion criteria were studies including at least a sample of 50 apparently healthy patients, articles published from 2005 to 2015 written in English. The exclusion criteria were reviews and non-human studies. Results Out of the 190 studies obtained initially from the search 16 articles were selected to be included in our systematic review. The prevalence of denture stomatitis was 29.56% and 4.44% for IPH. We found 5 cases of denture stomatitis among non-denture-wearer individuals. All IPH cases were associated with the use of prosthesis. Smoking and continued use of ill-fitting dentures turned out to be the most frequent risk factors for developing IPH. Conclusions IPH is a rare oral lesion and its pathogenesis still remains unclear. Its presentation among non-denture-wearers is extremely unusual. Key words:Inflammatory papillary hyperplasia, denture stomatitis, prevalence, granular stomatitis, Newton’s type III stomatitis. PMID:27918740

  1. Balloon dilation of the cartilaginous eustachian tube.

    PubMed

    Poe, Dennis S; Silvola, Juha; Pyykkö, Ilmari

    2011-04-01

    (1) To translate techniques developed in a previous cadaver study of balloon dilation of the cartilaginous eustachian tube (ET) into clinical treatment for refractory dilatory dysfunction and (2) to study the safety/efficacy of the technique in a pilot clinical trial. Prospective with subjects as their own historical controls since June 2009. Regional academic center. Eleven consecutive adult patients with longstanding otitis media with effusion (OME) who were unable to autoinsufflate their ET by Valsalva, swallow, or yawn and who had previous tympanostomies (average, 4.7). At the time of intervention, 5 of 11 had a tube; 2 of 11 had a tympanic membrane (TM) perforation. Four of 11 had intact TMs, 2 with OME and tympanogram type B and 2 with TM retraction and tympanogram types B and C. Balloon dilation of the cartilaginous ET was performed with sinus dilation instruments via transnasal endoscopic approach under general anesthesia in a day surgery setting. Inflation was to a maximum of 12 atm for 1 minute. ability to Valsalva, rating of ET mucosal inflammation, tympanogram, and otomicroscopy findings. All cases successfully dilated. Eleven of 11 could self-insufflate by Valsalva (P < .001); tympanograms were A (4/11), C (1/11), or open (6/11). All atelectases resolved. Procedures were well tolerated, without pain or complications related to dilation. Dilation of the cartilaginous ET appeared to be beneficial and without significant adverse effects in the treatment of ET dilatory dysfunction. Larger controlled trials with long-term results are now justified and needed.

  2. Efficacy, tolerance and safety of new intragastric air-filled balloon (Heliosphere BAG) for obesity: the experience of 17 cases.

    PubMed

    Trande, Paolo; Mussetto, Alessandro; Mirante, Vincenzo G; De Martinis, Elvira; Olivetti, Giampiero; Conigliaro, Rita L; De Micheli, Enrico A

    2010-09-01

    Overweight and obesity lead to serious health consequences, so that many strategies were recommended for preventing or curing this emerging problem. Treatments are various: diet, physical activity, psychotherapy, drugs, and bariatric surgery. Moreover, during these years, the use of intragastric balloon (BIB) to treat obesity increased rapidly, aimed to (1) reduce bariatric surgical risks; (2) reduce general surgical risks; (3) lead to a significant reduction in the prevalence of cardiovascular diseases, diabetes, musculoskeletal disorders and some cancers. Recently, a new device inflated with air to reduce weight has been developed since 2004 (Heliosphere BAG). Between March 2006 and September 2006, in our unit, intragastric air-filled balloon insertion was performed under general anesthesia and endoscopic control. The balloons were removed after 6 months. We evaluated efficacy, tolerance, and safety of this technique. Seventeen patients (eight men, nine women), with a mean age of 43 +/- 10 years (range 18-65), mean basal BMI of 46 +/- 8 (range 35-58) were included, after providing informed consent. Weight and BMI loss were evaluated in all patients. BMI decreased 4 +/- 3 (range +0.33/-11), weight loss was 11 +/- 9 kg (range +1/-29.5; 8.5%). 14/17 patients maintain a BMI > 35 at the time of balloon removal. The difference between initial weight and BMI was statistically significant (p = 0.02 for weight and p < 0.01 for BMI, T Student test). Tolerance was very good, limited only to some dyspeptic symptoms during the first 3 days after insertion. One asymptomatic gastric ulcer was seen at the removal of balloon. Only one severe adverse effect was registered at the time of insertion (acute coronary syndrome in patient with chronic coronary disease). No serious technical problems were noted at balloon insertion. Balloon removal was more difficult and successful in 15/17 cases (one distal migration and one patient led to surgery because of balloon fragmentation

  3. Scientific Balloons for Venus Exploration

    NASA Astrophysics Data System (ADS)

    Cutts, James; Yavrouian, Andre; Nott, Julian; Baines, Kevin; Limaye, Sanjay; Wilson, Colin; Kerzhanovich, Viktor; Voss, Paul; Hall, Jeffery

    Almost 30 years ago, two balloons were successfully deployed into the atmosphere of Venus as an element of the VeGa - Venus Halley mission conducted by the Soviet Union. As interest in further Venus exploration grows among the established planetary exploration agencies - in Europe, Japan, Russia and the United States, use of balloons is emerging as an essential part of that investigative program. Venus balloons have been proposed in NASA’s Discovery program and ESA’s cosmic vision program and are a key element in NASA’s strategic plan for Venus exploration. At JPL, the focus for the last decade has been on the development of a 7m diameter superpressure pressure(twice that of VeGa) capable of carrying a 100 kg payload (14 times that of VeGA balloons), operating for more than 30 days (15 times the 2 day flight duration of the VeGa balloons) and transmitting up to 20 Mbit of data (300 times that of VeGa balloons). This new generation of balloons must tolerate day night transitions on Venus as well as extended exposure to the sulfuric acid environment. These constant altitude balloons operating at an altitude of about 55 km on Venus where temperatures are benign can also deploy sondes to sound the atmosphere beneath the probe and deliver deep sondes equipped to survive and operate down to the surface. The technology for these balloons is now maturing rapidly and we are now looking forward to the prospects for altitude control balloons that can cycle repeatedly through the Venus cloud region. One concept, which has been used for tropospheric profiling in Antarctica, is the pumped-helium balloon, with heritage to the anchor balloon, and would be best adapted for flight above the 55 km level. Phase change balloons, which use the atmosphere as a heat engine, can be used to investigate the lower cloud region down to 30 km. Progress in components for high temperature operation may also enable investigation of the deep atmosphere of Venus with metal-based balloons.

  4. Scientific Ballooning Activities and Recent Developments in Technology and Instrumentation of the TIFR Balloon Facility, Hyderabad

    NASA Astrophysics Data System (ADS)

    Buduru, Suneel Kumar

    2016-07-01

    The Balloon Facility of Tata Institute of Fundamental Research (TIFR-BF) is a unique center of expertise working throughout the year to design, fabricate and launch scientific balloons mainly for space astronomy, atmospheric science and engineering experiments. Recently TIFR-BF extended its support to new user scientists for conducting balloon launches for biological and middle atmospheric sciences. For the first time two balloon launches conducted for sending live lab rats to upper stratosphere and provided launch support for different balloon campaigns such as Tropical Tropopause Dynamics (TTD) to study water vapour content in upper tropospheric and lower stratospheric regions over Hyderabad and the other balloon campaign to study the Asian Tropopause Aerosol Layer (BATAL) during the Indian summer monsoon season. BATAL is the first campaign to conduct balloon launches during active (South-West) monsoon season using zero pressure balloons of different volumes. TIFR-BF also provided zero pressure and sounding balloon support to various research institutes and organizations in India and for several international space projects. In this paper, we present details on our increased capability of balloon fabrication for carrying heavier payloads, development of high strength balloon load tapes and recent developments of flight control and safety systems. A summary of the various flights conducted in two years will be presented along with the future ballooning plans.

  5. Telescope Systems for Balloon-Borne Research

    NASA Technical Reports Server (NTRS)

    Swift, C. (Editor); Witteborn, F. C. (Editor); Shipley, A. (Editor)

    1974-01-01

    The proceedings of a conference on the use of balloons for scientific research are presented. The subjects discussed include the following: (1) astronomical observations with balloon-borne telescopes, (2) orientable, stabilized balloon-borne gondola for around-the-world flights, (3) ultraviolet stellar spectrophotometry from a balloon platform, (4) infrared telescope for balloon-borne infrared astronomy, and (5) stabilization, pointing, and command control of balloon-borne telescopes.

  6. Status of the NASA Balloon Program

    NASA Astrophysics Data System (ADS)

    Needleman, H. C.; Nock, R. S.; Bawcom, D. W.

    1993-02-01

    In the early 1980's the U.S. National Aeronautics and Space Administration (NASA) Balloon Program was faced with a problem of catastrophic balloon failures. In 1986 a balloon recovery program was initiated. This program included qualification of new balloon films, and investigations into materials, processing, structures and performance of balloons. This recovery program has been very successful. To date, more than 100 balloons manufactured of newly developed films have been flown with unprecedented success. There has been much progress made across the spectrum of balloon related disciplines. A new design philosophy has been developed and is being used for all NASA balloons. An updated balloon reliability and quality assurance program is in effect. The long duration balloon development project has been initiated with the first flight test having been conducted in December 1989 from Antarctica. A comprehensive research and development (R&D) effort has been initiated and is progressing well. The progress, status and future plans for these and other aspects of the NASA program, along with a description of the comprehensive balloon R&D activity, will be presented.

  7. The National Scientific Balloon Facility. [balloon launching capabilities of ground facility

    NASA Technical Reports Server (NTRS)

    Kubara, R. S.

    1974-01-01

    The establishment and operation of the National Scientific Balloon Facility are discussed. The balloon launching capabilities are described. The ground support systems, communication facilities, and meteorological services are analyzed.

  8. Investigation of hot air balloon fatalities.

    PubMed

    McConnell, T S; Smialek, J E; Capron, R G

    1985-04-01

    The rising popularity of the sport of hot air ballooning has been accompanied by several recent incidents, both in this country and other parts of the world, where mechanical defects and the improper operation of balloons have resulted in several fatalities. A study was conducted to identify the location and frequency of hot air ballooning accidents. Furthermore, the study attempted to identify those accidents that were the result of improper handling on the part of the balloon operators and those that were related to specific defects in the construction of the balloon. This paper presents a background of the sport of hot air ballooning, together with an analysis of the construction of a typical hot air balloon, pointing out the specific areas where defects may occur that could result in a potential fatal balloon crash. Specific attention is given to the two recent balloon crashes that occurred in Albuquerque, N.M., hot air balloon capital of the world, and that resulted in multiple fatalities.

  9. Endoscopic Management of Idiopathic Subglottic Stenosis.

    PubMed

    Shabani, Sepehr; Hoffman, Matthew R; Brand, William T; Dailey, Seth H

    2017-02-01

    To describe a homogeneous idiopathic subglottic stenosis (ISS) population undergoing endoscopic balloon dilation and evaluate factors affecting inter-dilation interval (IDI). Retrospective review of 37 patients. Co-morbidity prevalence versus normal population was evaluated using chi-square tests. Correlations were evaluated using Pearson product moment tests. Independent samples t tests/rank sum tests assessed differences between groups of interest. All patients were female aged 45.9 ± 15.4 years at diagnosis. Four required a tracheotomy during management. Most prevalent co-morbidity was gastroesophageal reflux disease (GERD) (64.9%; P = .036). Body mass indices (BMI) at first and most recent dilation were 29.8 and 30.8 ( P = .564). Degree of stenosis before first dilation was 53 ± 14%. Patients underwent 3.8 ± 1.8 dilations (range, 1-11). Average IDI was 635 ± 615 days (range, 49-3130 days), including 556 ± 397 days for patients receiving concomitant steroid injection and 283 ± 36 for those who did not ( P = .079). Inter-dilation interval was not correlated with BMI ( r = 0.0486; P = .802) or number of co-morbidities ( r = -0.225, P = .223). Most patients with ISS can be managed endoscopically, and IDI may be increased with steroid injection. Gastroesophageal reflux disease is a common co-morbidity. Body mass index did not change over time despite potential effects on exercise tolerance; BMI did not affect IDI. Methods to determine optimal timing for next intervention are warranted.

  10. The relationship between dermal papillary structure and skin surface properties, color, and elasticity.

    PubMed

    Mizukoshi, K; Nakamura, T; Oba, A

    2016-08-01

    The skin contains an undulating structure called the dermal papillary structure between the border of the epidermis and dermis. The physiological importance of the dermal papillary structures has been discussed, however, the dermal papillary structures have never been evaluated for their contribution to skin appearance. In this study, we investigated the correlation between the dermal papillary structure and skin color and elasticity. In addition, the relationship was validated with skin model experiments. The dermal papillary structures in the skin of the female cheek were quantitatively measured by in vivo confocal laser scanning microscopy images. In addition, the skin color and elasticity were measured at the same site. A skin model with dermal papilla-like structures was created by referring to the optical and shape properties of the skin using agar gel and a scattering sheet. Correlations were found between the dermal papillary structures and skin color irregularity and skin elasticity. These relationships were verified by the experiments employing a skin model. The results of this study indicated that the dermal papillary structure is also an important factor for skin appearance such as color and elasticity. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Passive-bending, short-type single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in Roux-en-Y anastomosis patients.

    PubMed

    Yamauchi, Hiroshi; Kida, Mitsuhiro; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Tokunaga, Shuko; Takezawa, Miyoko; Imaizumi, Hiroshi; Koizumi, Wasaburo

    2015-02-07

    To evaluate short-type-single-balloon enteroscope (SBE) with passive-bending, high-force transmission functions for endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anastomosis. Short-type SBE with this technology (SIF-Y0004-V01; working length, 1520 mm; channel diameter, 3.2 mm) was used to perform 50 ERCP procedures in 37 patients with Roux-en-Y anastomosis. The rate of reaching the blind end, time required to reach the blind end, diagnostic and therapeutic success rates, and procedure time and complications were studied retrospectively and compared with the results of 34 sessions of ERCP performed using a short-type SBE without this technology (SIF-Y0004; working length, 1520 mm; channel diameter, 3.2 mm) in 25 patients. The rate of reaching the blind end was 90% with SIF-Y0004-V01 and 91% with SIF-Y0004 (P = 0.59). The median time required to reach the papilla was significantly shorter with SIF-Y0004-V01 than with SIF-Y0004 (16 min vs 24 min, P = 0.04). The diagnostic success rate was 93% with SIF-Y0004-V01 and 84% with SIF-Y0004 (P = 0.17). The therapeutic success rate was 95% with SIF-Y0004-V01 and 96% with SIF-Y0004 (P = 0.68). The median procedure time was 40 min with SIF-Y0004-V01 and 36 min with SIF-Y0004 (P = 0.50). The incidence of hyperamylasemia was 6.0% in the SIF-Y0004-V01 group and 14.7% in the SIF-Y0004 group (P = 0.723). The incidence of pancreatitis was 0% in the SIF-Y0004-V01 group and 5.9% in the SIF-Y0004 group (P > 0.999). The incidence of gastrointestinal perforation was 2.0% (1/50) in the SIF-Y0004-V01 group and 2.9% (1/34) in the SIF-Y0004 group (P > 0.999). SIF-Y0004-V01 is useful for ERCP in patients with Roux-en-Y anastomosis and may reduce the time required to reach the blind end.

  12. A comparative study of internally and externally capped balloons using small scale test balloons

    NASA Technical Reports Server (NTRS)

    Bell, Douglas P.

    1994-01-01

    Caps have been used to structurally reinforce scientific research balloons since the late 1950's. The scientific research balloons used by the National Aeronautics and Space Administration (NASA) use internal caps. A NASA cap placement specification does not exist since no empirical information exisits concerning cap placement. To develop a cap placement specification, NASA has completed two in-hangar inflation tests comparing the structural contributions of internal caps and external caps. The tests used small scale test balloons designed to develop the highest possible stresses within the constraints of the hangar and balloon materials. An externally capped test balloon and an internally capped test balloon were designed, built, inflated and simulated to determine the structural contributions and benefits of each. The results of the tests and simulations are presented.

  13. Balloon dilation of the cartilaginous portion of the eustachian tube: initial safety and feasibility analysis in a cadaver model.

    PubMed

    Poe, Dennis S; Hanna, Bassem Matta Nashed

    2011-01-01

    Balloon catheter dilation of diseased sinus ostia has recently demonstrated efficacy and safety in the treatment of chronic sinus disease with 2 years of follow-up. Similar to sinus surgery, initial studies of partial resection of inflamed mucosa from within the cartilaginous eustachian tube (ET) have demonstrated efficacy and safety in the treatment of medically refractory otitis media with effusion. Therefore, balloon dilation of the cartilaginous ET was investigated as a possible treatment modality for otitis media. A protocol for sinus balloon catheter dilation was evaluated in each of the cartilaginous ETs in 8 fresh human cadaver heads. Computed tomographic scans and detailed endoscopic inspections with video or photographic documentation were performed pre- and posttreatment, and gross anatomical dissections were done to analyze the effects of treatment and to look for evidence of undesired injury. Catheters successfully dilated all cartilaginous ETs without any significant injuries. There were no bony or cartilaginous fractures, and 3 specimens showed minor mucosal tears in the anterolateral or inferior walls. Volumetric measurements of the cartilaginous ET lumens showed a change from an average of 0.16 to 0.49 cm(3) (SD, 0.12), representing an average increase of 357% (range, 20-965%). Balloon catheter dilation of the nasopharyngeal orifice of the ET was shown to be feasible and without evidence of untoward injury. A significant increase in volume of the cartilaginous ET was achieved. A clinical study is now indicated to determine whether balloon dilation will demonstrate lasting benefits and safety in the treatment of otitis media. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. High-quality endoscope reprocessing decreases endoscope contamination.

    PubMed

    Decristoforo, P; Kaltseis, J; Fritz, A; Edlinger, M; Posch, W; Wilflingseder, D; Lass-Flörl, C; Orth-Höller, D

    2018-02-24

    Several outbreaks of severe infections due to contamination of gastrointestinal (GI) endoscopes, mainly duodenoscopes, have been described. The rate of microbial endoscope contamination varies dramatically in literature. The aim of this multicentre prospective study was to evaluate the hygiene quality of endoscopes and automated endoscope reprocessors (AERs) in Tyrol/Austria. In 2015 and 2016, a total of 463 GI endoscopes and 105 AERs from 29 endoscopy centres were analysed by a routine (R) and a combined routine and advanced (CRA) sampling procedure and investigated for microbial contamination by culture-based and molecular-based analyses. The contamination rate of GI endoscopes was 1.3%-4.6% according to the national guideline, suggesting that 1.3-4.6 patients out of 100 could have had contacts with hygiene-relevant microorganisms through an endoscopic intervention. Comparison of R and CRA sampling showed 1.8% of R versus 4.6% of CRA failing the acceptance criteria in phase I and 1.3% of R versus 3.0% of CRA samples failing in phase II. The most commonly identified indicator organism was Pseudomonas spp., mainly Pseudomonas oleovorans. None of the tested viruses were detected in 40 samples. While AERs in phase I failed (n = 9, 17.6%) mainly due to technical faults, phase II revealed lapses (n = 6, 11.5%) only on account of microbial contamination of the last rinsing water, mainly with Pseudomonas spp. In the present study the contamination rate of endoscopes was low compared with results from other European countries, possibly due to the high quality of endoscope reprocessing, drying and storage. Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  15. Balloons Revisited

    ERIC Educational Resources Information Center

    Jeskova, Z.; Featonby, D.; Fekova, V.

    2012-01-01

    Whilst everyone is familiar with the process of blowing up a balloon, few of us have gone further to quantify the actual pressures involved at different stages in the inflation process. This paper seeks to describe experiments to fill some of those gaps and examine some of the apparently anomalous behaviour of connected balloons. (Contains 12…

  16. Unmanned powered balloons

    NASA Technical Reports Server (NTRS)

    Korn, A. O.

    1975-01-01

    In the late 1960's several governmental agencies sponsored efforts to develop unmanned, powered balloon systems for scientific experimentation and military operations. Some of the programs resulted in hardware and limited flight tests; others, to date, have not progressed beyond the paper study stage. Balloon system designs, materials, propulsion units and capabilities are briefly described, and critical problem areas are pointed out which require further study in order to achieve operational powered balloon systems capable of long duration flight at high altitudes.

  17. Differential effect of extracellular matrix derived from papillary and reticular fibroblasts on epidermal development in vitro.

    PubMed

    Janson, David; Rietveld, Marion; Mahé, Christian; Saintigny, Gaëlle; El Ghalbzouri, Abdoelwaheb

    2017-06-01

    Papillary and reticular fibroblasts have different effects on keratinocyte proliferation and differentiation. The aim of this study was to investigate whether these effects are caused by differential secretion of soluble factors or by differential generation of extracellular matrix from papillary and reticular fibroblasts. To study the effect of soluble factors, keratinocyte monolayer cultures were grown in papillary or reticular fibroblast-conditioned medium. To study the effect of extracellular matrix, keratinocytes were grown on papillary or reticular-derived matrix. Conditioned medium from papillary or reticular fibroblasts did not differentially affect keratinocyte viability or epidermal development. However, keratinocyte viability was increased when grown on matrix derived from papillary, compared with reticular, fibroblasts. In addition, the longevity of the epidermis was increased when cultured on papillary fibroblast-derived matrix skin equivalents compared with reticular-derived matrix skin equivalents. The findings indicate that the matrix secreted by papillary and reticular fibroblasts is the main causal factor to account for the differences in keratinocyte growth and viability observed in our study. Differences in response to soluble factors between both populations were less significant. Matrix components specific to the papillary dermis may account for the preferential growth of keratinocytes on papillary dermis.

  18. Papillary carcinoma in ectopic thyroid detected by Tl-201 scintigraphy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Michigishi, T.; Mizukami, Y.; Mura, T.

    1991-05-01

    A 37-year-old man with papillary carcinoma in an ectopic thyroid is presented. Excisional biopsy revealed the cervical mass to be a metastasis from thyroid cancer. X-ray, ultrasonography, and computed tomography, however, failed to identify the primary tumor in the thyroid. Incidental TI-201 uptake was noted in the midline of the anterior neck, and a palpable nodule was discovered in this area. Fine needle aspiration cytology demonstrated Class V papillary adenocarcinoma, and subsequent surgery confirmed a papillary carcinoma in the ectopic thyroid. This case suggests the usefulness of TI-201 scintigraphy for the detection of ectopic thyroid malignancy.

  19. Repair of esophageal atresia with proximal fistula using endoscopic magnetic compression anastomosis (magnamosis) after staged lengthening.

    PubMed

    Dorman, Robert M; Vali, Kaveh; Harmon, Carroll M; Zaritzky, Mario; Bass, Kathryn D

    2016-05-01

    We describe the treatment of a patient with long-gap esophageal atresia with an upper pouch fistula, mircogastria and minimal distal esophageal remnant. After 4.5 months of feeding via gastrostomy, a proximal fistula was identified by bronchoscopy and a thoracoscopic modified Foker procedure was performed reducing the gap from approximately 7-5 cm over 2 weeks of traction. A second stage to ligate the fistula and suture approximate the proximal and distal esophagus resulted in a gap of 1.5 cm. IRB and FDA approval was then obtained for endoscopic placement of 10-French catheter mounted magnets in the proximal and distal pouches promoting a magnetic compression anastomosis (magnamosis). Magnetic coupling occurred at 4 days and after magnet removal at 13 days an esophagram demonstrated a 10 French channel without leak. Serial endoscopic balloon dilation has allowed drainage of swallowed secretions as the baby learns bottling behavior at home.

  20. Pathological criteria and practical issues in papillary lesions of the breast - a review.

    PubMed

    Ni, Yun-Bi; Tse, Gary M

    2016-01-01

    Papillary lesions of the breast include a broad spectrum of lesions, ranging from benign papilloma, papilloma with atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) to papillary carcinoma. The accurate diagnosis of mammary papillary lesions is a challenge for pathologists, owing to the overlapping features among these lesions. In this review, some of the diagnostic criteria of papillary lesions are discussed, with special emphasis on some key morphological features, namely fibrovascular cores, epithelial proliferation in a solid pattern, intraductal papilloma complicated by ADH or DCIS, and invasion and its mimics. The roles of immunohistochemistry, and the interpretation of myoepithelial cell markers, hormone receptors, and high molecular weight cytokeratin, are addressed. Finally, novel biomarkers and genetic aberrations in papillary lesions are summarized. © 2015 John Wiley & Sons Ltd.

  1. Scientific Ballooning in India - Recent Developments

    NASA Astrophysics Data System (ADS)

    Manchanda, R. K.; Srinivasan, S.; Subbarao, J. V.

    Established in 1972, the National Balloon Facility operated by TIFR in Hyderabad, India is is a unique facility in the country, which provides a complete solution in scientific ballooning. It is also one of its kind in the world since it combines both, the in-house balloon production and a complete flight support for scientific ballooning. With a large team working through out the year to design, fabricate and launch scientific balloons, the Hyderabad Facility is a unique centre of expertise where the balloon design, Research and Development, the production and launch facilities are located under one roof. Our balloons are manufactured from 100% indigenous components. The mission specific balloon design, high reliability control and support instrumentation, in-house competence in tracking, telemetry, telecommand, data processing, system design and mechanics is a hallmark of the Hyderabad balloon facility. In the past few years we have executed a major programme of upgradation of different components of balloon production, telemetry and telecommand hardware and various support facilities. This paper focuses on our increased capability of balloon production of large sizes up to size of 780,000 M^3 using Antrix film, development of high strength balloon load tapes with the breaking strength of 182 kg, and the recent introduction of S-band telemetry and a commandable timer cut-off unit in the flight hardware. A summary of the various flights conducted in recent years will be presented along with the plans for new facilities.

  2. The oncocytic subtype is genetically distinct from other pancreatic intraductal papillary mucinous neoplasm subtypes

    PubMed Central

    Basturk, Olca; Tan, Marcus; Bhanot, Umesh; Allen, Peter; Adsay, Volkan; Scott, Sasinya N; Shah, Ronak; Berger, Michael F; Askan, Gokce; Dikoglu, Esra; Jobanputra, Vaidehi; Wrzeszczynski, Kazimierz O; Sigel, Carlie; Iacobuzio-Donahue, Christine; Klimstra, David S

    2017-01-01

    In 2010, the World Health Organization reclassified the entity originally described as intraductal oncocytic papillary neoplasm as the ‘oncocytic subtype’ of intraductal papillary mucinous neoplasm. Although several key molecular alterations of other intraductal papillary mucinous neoplasm subtypes have been discovered, including common mutations in KRAS, GNAS, and RNF3, those of oncocytic subtype have not been well characterized. We analyzed 11 pancreatic ‘oncocytic subtype’ of intraductal papillary mucinous neoplasms. Nine pancreatic ‘oncocytic subtype’ of intraductal papillary mucinous neoplasms uniformly exhibited typical entity-defining morphology of arborizing papillae lined by layers of cells with oncocytic cytoplasm, prominent, nucleoli, and intraepithelial lumina. The remaining two were atypical. One lacked the arborizing papilla and had flat oncocytic epithelium only; the other one had focal oncocytic epithelium in a background of predominantly intestinal subtype intraductal papillary mucinous neoplasm. Different components of this case were analyzed separately. Formalin-fixed, paraffin-embedded specimens of all cases were microdissected and subjected to high-depth-targeted next-generation sequencing for a panel of 300 key cancer-associated genes in a platform that enabled the identification of sequence mutations, copy number alterations, and select structural rearrangements involving all targeted genes. Fresh frozen specimens of two cases were also subjected to whole-genome sequencing. For the nine typical pancreatic ‘oncocytic subtype’ of intraductal papillary mucinous neoplasms, the number of mutations per case, identified by next-generation sequencing, ranged from 1 to 10 (median = 4). None of these cases had KRAS or GNAS mutations and only one had both RNF43 and PIK3R1 mutations. ARHGAP26, ASXL1, EPHA8, and ERBB4 genes were somatically altered in more than one of these typical ‘oncocytic subtype’ of intraductal papillary mucinous

  3. Percutaneous balloon pulmonary valvuloplasty (PBPV) of extreme pulmonary valve stenosis by the use of Accura balloon.

    PubMed

    Sinha, Santosh Kumar; Mishra, Vikas; Razi, Mahmadula; Jha, Mukesh Jitendra

    2017-10-04

    Transcatheter therapy of valvular pulmonary stenosis is one of first catheter interventions facilitating its application in field of structural heart disease and now treatment of choice for significant pulmonary stenosis. Myriads of balloon catheter have been used for this purpose starting from Diamond (Boston Scientific,Natick, MA USA), Marshal (Medi-Tech,Watertown MAUSA), Innoue balloon, Tyshak I and currently Tyshak II. Diameter and length of balloon depend on size of annulus and age group, respectively. Problem with shorter balloon is difficulty in keeping it across the annulus while inflation as it tends to slip distally whereas with longer balloon, potential of tricuspid leak or conduction block as it may impinge on adjacent structures. Potential advantage of Accura balloon over Tyshak balloon lies in its peculiar shape while inflation and variable diameter, making stepwise dilatation possible. Here, we report a case of successful balloon pulmonary valvuloplasty using Accura balloon (Vascular Concept, UK) with little modification of conventional technique. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Hot-Air Ballooning in Physics Teaching.

    ERIC Educational Resources Information Center

    Haugland, Ole Anton

    1991-01-01

    Describes the modern hot-air balloon and the physics of ballooning. Proposes that students construct their own hot-air balloon and presents an experiment calculating the time needed for a balloon to rise to the ceiling of a gymnasium. (MDH)

  5. [Clinico-pathological features of papillary thyroid cancer coexistent with Hashimoto's thyroiditis].

    PubMed

    Molnár, Sarolta; Győry, Ferenc; Nagy, Endre; Méhes, Gábor; Molnár, Csaba

    2017-02-01

    Former studies suggest the frequent coexistence of Hashimoto's thyreoditis with papillary thyroid cancer, frequently featured by multifocal carcinogenesis but lower clinical stages compared to thyroid cancers lacking thyroiditis. We examined the clinico-pathological correlations between Hashimoto's thyroditis and papillary thyroid cancer in our region in the North-Eastern part of Hungary. We included a total of 230 patients with papillary thyroid cancer who underwent thyroid surgery at the Surgical Department of the University of Debrecen. Patients' sex, age, multifocality of thyroid cancer and clinical stage were evaluated. Cases included 40 patients (17.4%) with (4 male, 36 female) and 190 (82.6%) patients without HT (44 male, 146 female). Hashimoto's thyroiditis related thyroid cancer was almost exclusively associated with the papillary histological type. Multifocality of papillary cancer was significantly more frequent with coexisting Hashimoto's thyroiditis (16/40; 40.0%) compared to cases uninvolved (45/190; 23.7%; p = 0.034). In contrast, lymph node metastasis was significantly less frequent among patients with Hashimoto's thyroiditis (4 pN1 [36.4%]; 7 pN0 [63.6%]) then without it (34 pN1 [82.9%]; 7 pN0 [17.1%]; p = 0.002). Higher frequency and multifocality of papillary thyroid cancer might be the consequence of preexisting Hashimoto's thyroiditis to be considered as a preneoplastic stimulus supporting carcinogenesis, though the exact pathomechanism of this correlation is not clear yet. Orv. Hetil., 2017, 158(5), 178-182.

  6. Increased expression of the sodium/iodide symporter in papillary thyroid carcinomas.

    PubMed Central

    Saito, T; Endo, T; Kawaguchi, A; Ikeda, M; Katoh, R; Kawaoi, A; Muramatsu, A; Onaya, T

    1998-01-01

    Iodide is concentrated to a much lesser extent by papillary thyroid carcinoma as compared with the normal gland. The Na+/I- symporter (NIS) is primarily responsible for the uptake of iodide into thyroid cells. Our objective was to compare NIS mRNA and protein expression in papillary carcinomas with those in specimens with normal thyroid. Northern blot analysis revealed a 2.8-fold increase in the level of NIS mRNA in specimens with papillary carcinoma versus specimens with normal thyroid. Immunoblot analysis using anti-human NIS antibody that was produced with a glutathione S-transferase fusion protein containing NIS protein (amino acids 466-522) showed the NIS protein at 77 kD. The NIS protein level was elevated in 7 of 17 cases of papillary carcinoma but was not elevated in the normal thyroid. Immunohistochemical staining revealed abundant NIS in 8 of 12 carcinomas, whereas NIS protein was barely detected in specimens with normal thyroid. Although considerable patient-to-patient variation was observed, our results indicate that NIS mRNA is elevated, and its protein tends to be more abundant, in a subset of papillary thyroid carcinomas than in normal thyroid tissue. PMID:9525971

  7. Optimum designs for superpressure balloons

    NASA Astrophysics Data System (ADS)

    Smith, M. S.; Rainwater, E. L.

    2004-01-01

    The elastica shape is now well known to be the best basic shape for superpressure balloon design. This shape, also known as the pumpkin, or natural shape for balloons, has been well understood since the early 1900s when it was applied to the determination of the shape of descending parachutes. The elastica shape was also investigated in the 1950s when high strength films were used to produce superpressure cylinder balloons. The need for uniform stress distribution in shells of early superpressure balloons led to a long period of the development of spherical superpressure balloons. Not until the late 1970s was the elastica shape revisited for the purpose of the producing superpressure balloons. This paper will review various development efforts in the field of superpressure design and will elaborate on the current state-of-the-art with suggestions for future developments.

  8. Marine-Lenhart syndrome with papillary thyroid carcinoma.

    PubMed

    Atmaca, Hulusi; Çolak, Ramis; Yazici, Zihni Acar; Kefeli, Mehmet; Tosun, Fevziye Canbaz

    2015-04-01

    Graves' disease with accompanying functioning nodules is known as Marine-Lenhart syndrome. Autonomously functioning thyroid nodules (AFTNs) also within Graves' thyroid tissue are almost always bening in nature. A 45-year-old man developed hyperthyroidism due to the coexistence of Graves' disease and AFTN. Total thyroidectomy was performed. The hyperfunctioning nodule with centrally hypoactive foci detected by technetium-99m thyroid scanning was histologically diagnosed as papillary thyroid carcinoma that was 2.5 cm in diameter. We report the presence of papillary thyroid carcinoma within AFTN in patients with Marine-Lenhart syndrome, which has not been reported so far.

  9. Flow Past a Descending Balloon

    NASA Technical Reports Server (NTRS)

    Baginski, Frank

    2001-01-01

    In this report, we present our findings related to aerodynamic loading of partially inflated balloon shapes. This report will consider aerodynamic loading of partially inflated inextensible natural shape balloons and some relevant problems in potential flow. For the axisymmetric modeling, we modified our Balloon Design Shape Program (BDSP) to handle axisymmetric inextensible ascent shapes with aerodynamic loading. For a few simple examples of two dimensional potential flows, we used the Matlab PDE Toolbox. In addition, we propose a model for aerodynamic loading of strained energy minimizing balloon shapes with lobes. Numerical solutions are presented for partially inflated strained balloon shapes with lobes and no aerodynamic loading.

  10. Status of the NASA Balloon Program

    NASA Technical Reports Server (NTRS)

    Needleman, H. C.; Nock, R. S.; Bawcom, D. W.

    1993-01-01

    The NASA Balloon Program (BP) is examined in an overview of design philosophy, R&D activities, flight testing, and the development of a long-duration balloon for Antarctic use. The Balloon Recovery Program was developed to qualify the use of existing films and to design improved materials and seals. Balloon flights are described for studying the supernova SN1987a, and systems were developed to enhance balloon campaigns including mobile launch vehicles and tracking/data-acquisition systems. The technical approach to long-duration ballooning is reviewed which allows the use of payloads of up to 1350 kg for two to three weeks. The BP is responsible for the development of several candidate polyethylene balloon films as well as design/performance standards for candidate balloons. Specific progress is noted in reliability and in R&D with respect to optimization of structural design, resin blending, and extrusion.

  11. Detection Rate and Clinical Relevance of Ink Tattooing during Balloon-Assisted Enteroscopy

    PubMed Central

    Ebigbo, A.; Schrempf, M.; Messmann, H.; Gölder, S. K.

    2017-01-01

    Background and Aims Balloon-assisted enteroscopy (BAE) is a well-established tool in the diagnosis and therapy of small bowel diseases. Ink tattooing of the small bowel is used to mark pathologic lesions or the depth of small bowel insertion. The purpose of this study was to determine the safety, the detection rate, and the clinical relevance of ink tattooing during BAE. Methods We performed a retrospective analysis of all 81 patients who received an ink tattooing during BAE between 2010 and 2015. Results In all patients, ink tattooing was performed with no complications. 26 patients received a capsule endoscopy after BAE. The tattoo could be detected via capsule endoscopy in 19 of these 26 patients. The tattoo of the previous BAE could be detected via opposite BAE in 2 of 11 patients. In 9 patients, ink tattooing influenced the choice of approach for reenteroscopy. In 7 patients, the tattoo was used for intraoperative localization and in 3 patients for intraoperative localization as well as for reenteroscopy. The intraoperative detection rate of the tattoo was 100%. Conclusion Ink tattooing of the small intestine is a safe endoscopic procedure to mark the depth of scope insertion or a pathologic lesion during balloon-assisted enteroscopy. PMID:29230241

  12. Papillary neoplasia of the breast: immunohistochemically defined myoepithelial cells in the diagnosis of benign and malignant papillary breast neoplasms.

    PubMed

    Raju, U B; Lee, M W; Zarbo, R J; Crissman, J D

    1989-11-01

    The presence or absence of myoepithelial cells (ME) has been considered as an important feature in the differential diagnosis of benign and malignant papillary lesions of the breast. We evaluated the distribution of myoepithelial cells in formalin-fixed paraffin-embedded tissue sections of 25 papillomas and 18 papillary carcinomas by ABC immunoperoxidase technique with antibodies to muscle actin (HHF-35) and high molecular weight (HMW) keratin (clone 34BE12, cytokeratins 1, 5, 10, and 14; reacting preferentially with ME cells) and an antiserum to S-100 protein. Also included in the study were eight cases of micropapillary ductal carcinoma in situ (DCIS) having a few fibrovascular cores and five peripheral papillomas with accompanying ductal carcinoma in situ or atypical hyperplasia. The antibodies to muscle actin were sensitive and relatively specific for ME cells of the breast and uniformly labeled ME cells in all 25 papillomas. ME cells were absent or extremely sparse in papillary carcinomas. They were present focally in some of the fibrovascular cores of the micropapillary DCIS, and a mixed pattern was observed in peripheral papillomas with areas of carcinoma. HMW keratin was variably expressed in ME cells in most cases with positive internal controls and was present in several normal ductal and papilloma epithelial cells but not in epithelial cells of papillary carcinomas. HMW keratin, although less specific for ME cells, was a useful adjunct because of its reactivity with ME cells as well as hyperplastic epithelial cells in papillomas, which resulted in a combined positive reaction.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Orbital endoscopic surgery

    PubMed Central

    Selva, Dinesh

    2008-01-01

    Minimally invasive ″keyhole″ surgery performed using endoscopic visualization is increasing in popularity and is being used by almost all surgical subspecialties. Within ophthalmology, however, endoscopic surgery is not commonly performed and there is little literature on the use of the endoscope in orbital surgery. Transorbital use of the endoscope can greatly aid in visualizing orbital roof lesions and minimizing the need for bone removal. The endoscope is also useful during decompression procedures and as a teaching aid to train orbital surgeons. In this article, we review the history of endoscopic orbital surgery and provide an overview of the technique and describe situations where the endoscope can act as a useful adjunct to orbital surgery. PMID:18158397

  14. Scientific ballooning in India Recent developments

    NASA Astrophysics Data System (ADS)

    Manchanda, R. K.

    Established in 1971, the National Balloon Facility operated by TIFR in Hyderabad, India, is a unique facility in the country, which provides a complete solution in scientific ballooning. It is also one of its kind in the world since it combines both, the in-house balloon production and a complete flight support for scientific ballooning. With a large team working through out the year to design, fabricate and launch scientific balloons, the Hyderabad Facility is a unique centre of expertise where the balloon design, research and development, the production and launch facilities are located under one roof. Our balloons are manufactured from 100% indigenous components. The mission specific balloon design, high reliability control and support instrumentation, in-house competence in tracking, telemetry, telecommand, data processing, system design and mechanics is its hallmark. In the past few years, we have executed a major programme of upgradation of different components of balloon production, telemetry and telecommand hardware and various support facilities. This paper focuses on our increased capability of balloon production of large sizes up to 780,000 m 3 using Antrix film, development of high strength balloon load tapes with the breaking strength of 182 kg, and the recent introduction of S-band telemetry and a commandable timer cut-off unit in the flight hardware. A summary of the various flights conducted in recent years will be presented along with the plans for new facilities.

  15. Solid papillary carcinoma with reverse polarity of the breast harbors specific morphologic, immunohistochemical and molecular profile in comparison with other benign or malignant papillary lesions of the breast: a comparative study of 9 additional cases.

    PubMed

    Alsadoun, Nadjla; MacGrogan, Gaëtan; Truntzer, Caroline; Lacroix-Triki, Magali; Bedgedjian, Isabelle; Koeb, Marie-Hélène; El Alam, Elsy; Medioni, Dan; Parent, Michel; Wuithier, Pascal; Robert, Isabelle; Boidot, Romain; Arnould, Laurent

    2018-05-21

    Solid papillary carcinoma with reverse polarity is a rare breast cancer of favorable prognosis that can be difficult to diagnose. We report here nine additional cases of this tumor, and we describe its morphologic, immunohistochemical and molecular profile in comparison to other types of papillary and micropapillary lesions of the breast that are intraductal papilloma with usual ductal hyperplasia, encapsulated papillary carcinoma, solid papillary carcinoma and invasive micropapillary carcinoma. We studied nine cases of this special papillary tumor and six of each other types mentioned above. We found that solid papillary carcinoma with reverse polarity harbor specific morphologic features as cuboid or tall cells with abundant eosinophilic cytoplasms located at the basal pole giving the impression of reverse nuclear polarity. Nuclei were sometimes grooved. Immunohistochemistry demonstrated the lack of myoepithelial cells, as in encapsulated papillary carcinoma and solid papillary carcinoma, questioning their invasive nature. Seven of nine solid papillary carcinoma with reverse polarity showed a low Ki67 proliferative index (Ki67 <5%). They showed expression of CK5/6 as in intraductal papilloma with usual ductal hyperplasia. They showed expression of calretinin and a low or lack of hormonal receptor (HR) expression that were not observed in other breast tumors studied. By whole-exome analysis, seven of nine solid papillary carcinomas with reverse polarity (78%) harbored a hotspot mutation in IDH2 (R172) that was totally absent in other groups. Six of nine tumors (67%) also harbored PRUNE2 mutation, including the two IDH2 wild-type cases. We also demonstrated for the first time in this breast tumor, immunostaining with a specific antibody IDH1/2 mutant R132/R172 (7/9) that can highlight IDH2 mutation. Moreover, transcriptomic analysis showed that proteoglycan pathway was significantly enriched. Our findings support the fact that solid papillary carcinoma with

  16. Ballooning for Biologists: Mission Essentials for Flying Experiments on Large NASA Balloons

    NASA Technical Reports Server (NTRS)

    Smith, David J.; Sowa, Marianne

    2017-01-01

    Despite centuries of scientific balloon flights, only a handful of experiments have produced biologically-relevant results. Yet unlike orbital spaceflight, it is much faster and cheaper to conduct biology research with balloons, sending specimens to the near space environment of Earths stratosphere. Samples can be loaded the morning of a launch and sometimes returned to the laboratory within one day after flying. The National Aeronautics and Space Administration (NASA) flies large, unmanned scientific balloons from all over the globe, with missions ranging from hours to weeks in duration. A payload in the middle portion of the stratosphere (approx. 35 km above sea level) will be exposed to an environment similar to the surface of Mars: temperatures generally around -36 C, atmospheric pressure at a thin 1 kPa, relative humidity levels <1%, and a harsh illumination of ultraviolet (UV) and cosmic radiation levels (about 100 W/sq m and 0.1 mGy/d, respectively) that can be obtained nowhere else on the surface of the Earth, including environmental chambers and particle accelerator facilities attempting to simulate space radiation effects. Considering the operational advantages of ballooning and the fidelity of space-like stressors in the stratosphere, researchers in aerobiology, astrobiology, and space biology can benefit from balloon flight experiments as an intermediary step on the extraterrestrial continuum (ground, low Earth orbit, and deep space studies). Our presentation targets biologists with no background or experience in scientific ballooning. We will provide an overview of large balloon operations, biology topics that can be uniquely addressed in the stratosphere, and a roadmap for developing payloads to fly with NASA.

  17. Diagnostic Pitfalls in Papillary Lesions of the Breast: Experience from a Single Tertiary Care Center

    PubMed Central

    Basavaiah, Sridevi Hanaganahalli; Sreeram, Saraswathy; Suresh, Pooja Kundapur; Kini, Hema; Adiga, Deepa; Sahu, Kausalya Kumari; Pai, Radha R

    2016-01-01

    Introduction Papillary neoplasms are a group of lesions that are characterized by presence of papillae supported by fibrovascular cores lined by epithelial cells with or without myoepithelial cell layer. These neoplasms may be benign, atypical or malignant. Aims This study was conducted to analyse the clinicopathological characteristics of papillary lesions of the breast. Materials and Methods A retrospective and prospective analysis of 34 cases of papillary lesions received over a period of 7 years from 2009 to 2015 was done. The patient’s clinical details were collected from medical archives and the histopathological findings were reviewed. The lesions were classified into benign, atypical and malignant categories. Results During the study period, there were 34 cases of papillary lesions of breast. The mean age was 58 years. The central quadrant was the most common location (66.6%). The most common presenting complaint was lump (76.5% cases). Papillary lesions presented more commonly as solitary lump (82.4%) rather than multifocal disease. Benign papillary lesions were more common than the atypical and malignant lesions. The most common papillary lesion accounting for 43% of the cases was intraductal papilloma. Malignant lesions accounted for 41.2% cases with intraductal papillary carcinoma and invasive papillary carcinoma constituting 14.7% cases each. Conclusion Diagnosis of papillary carcinoma is challenging and its classification includes different entities that have specific diagnostic criteria. Due to their heterozygosity in morphology with benign, atypical and malignant subtypes, morphological features such as type of fibrovascular core and continuity of myoepithelial layer along with immunohistochemical stains for myoepithelial cells should be considered for proper and accurate diagnosis. PMID:27656446

  18. A stress index model for ascending balloons

    NASA Technical Reports Server (NTRS)

    Smith, I. S.

    1986-01-01

    Attention is given to the development on the part of NASA of a simplified stress 'index' model to establish the relative stress magnitudes along a balloon's gore position as a function of altitude. Application of this model to several hundred balloon flights showed a good correlation between balloon failure rate and stress 'index' level. This model can be used during the balloon design process to lower the levels of stress in the balloon. By increasing the wall thickness of the balloon, adding caps, lengthening caps, or using external caps, lower stress can be accomplished. As a result, in January 1985, the NASA Balloon Program established a stress index specification to limit the design and flight stresses for NASA balloons.

  19. Increased Prevalence of Chronic Lymphocytic Thyroiditis in Korean Patients with Papillary Thyroid Cancer

    PubMed Central

    Oh, Chang-Mo; Park, Sohee; Lee, Joo Young; Won, Young-Joo; Shin, Aesun; Kong, Hyun-Joo; Choi, Kui-Sun; Lee, You Jin; Chung, Ki- Wook; Jung, Kyu-Won

    2014-01-01

    Background In recent years, some reports have suggested that papillary thyroid cancers are more frequently associated with lymphocytic thyroiditis or Hashimoto's thyroiditis. This study investigated a potential increase in the prevalence of chronic lymphocytic thyroiditis among papillary thyroid cancer patients. Materials and Methods We used national epidemiological survey data on thyroid cancer patients diagnosed in 1999, 2005, and 2008. A retrospective medical record survey was conducted by representative sampling of a national cancer incidence database. The analysis included 5,378 papillary thyroid cancer patients aged 20–79 years. We calculated the age-standardized prevalence and age-adjusted prevalence ratios using a binomial regression model with a log link for the prevalence of chronic lymphocytic thyroiditis among papillary thyroid cancer patients by sex for each year. Results The prevalence of chronic lymphocytic thyroiditis among papillary thyroid cancer patients was 4.0% and 12.8% for men and women in 1999, 6.5% and 24.6% in 2005, and 10.7% and 27.6% in 2008, respectively. Between 1999 and 2008, the age-standardized prevalence of chronic lymphocytic thyroiditis increased 4.1-fold in male patients and 2.0-fold in female patients with papillary thyroid cancer. The prevalence of other thyroid diseases, however, did not increase in either gender. Conclusions Among Korean papillary thyroid cancer patients, the prevalence of chronic lymphocytic thyroiditis increased between 1999 and 2008, whereas the prevalence of other thyroid disorders did not change. PMID:24927027

  20. Launching Garbage-Bag Balloons.

    ERIC Educational Resources Information Center

    Kim, Hy

    1997-01-01

    Presents a modification of a procedure for making and launching hot air balloons made out of garbage bags. Student instructions for balloon construction, launching instructions, and scale diagrams are included. (DDR)

  1. [Papillary cystadenoma of the epididymis. 2 case reports].

    PubMed

    Raimoldi, A; Berti, G L; Canclini, L; Giola, V; Leidi, G L; Maccaroni, A; Sironi, M; Veneroni, L; Bacchioni, A M; Assi, A

    1997-12-01

    Tumors of the epididymis are very rare. They are benign tumors in 75 per cent of the cases. Papillary cystadenoma represents 4-9 per cent of epididymal benign tumors. Often associated with the syndrome of von Hippel Lindau and infertility, histologically it can be confused with metastatic renal cell carcinoma. We report two cases of papillary cystadenoma located in the head of the right epididymis, with no concomitance with the syndrome of von Hippel Lindau, cured by the removal of the neoplastic nodule. There was no recidivation, in confirmation of the neoplastic benignity.

  2. Morphological three-dimensional analysis of papillary muscles in borderline left ventricles.

    PubMed

    Velasco Forte, Mari N; Nassar, Mohamed; Byrne, Nick; Silva Vieira, Miguel; Pérez, Israel V; Ruijsink, Bram; Simpson, John; Hussain, Tarique

    2017-09-01

    Mitral valve anatomy has a significant impact on potential surgical options for patients with hypoplastic or borderline left ventricle. Papillary muscle morphology is a major component regarding this aspect. The purpose of this study was to use cardiac magnetic resonance to describe the differences in papillary muscle anatomy between normal, borderline, and hypoplastic left ventricles. We carried out a retrospective, observational cardiac magnetic resonance study of children (median age 5.36 years) with normal (n=30), borderline (n=22), or hypoplastic (n=13) left ventricles. Borderline and hypoplastic cases had undergone an initial hybrid procedure. Morphological features of the papillary muscles, location, and arrangement were analysed and compared across groups. All normal ventricles had two papillary muscles with narrow pedicles; however, 18% of borderline and 46% of hypoplastic cases had a single papillary muscle, usually the inferomedial type. In addition, in borderline or hypoplastic ventricles, the supporting pedicle occasionally displayed a wide insertion along the ventricular wall. The length ratio of the superolateral support was significantly different between groups (normal: 0.46±0.08; borderline: 0.39±0.07; hypoplastic: 0.36±0.1; p=0.009). No significant difference, however, was found when analysing the inferomedial type (0.42±0.09; 0.38±0.07; 0.39±0.22, p=0.39). The angle subtended between supports was also similar among groups (113°±17°; 111°±51° and 114°±57°; p=0.99). A total of eight children with borderline left ventricle underwent biventricular repair. There were no significant differentiating features for papillary muscle morphology in this subgroup. The superolateral support can be shorter or absent in borderline or hypoplastic left ventricle cases. The papillary muscle pedicles in these patients often show a broad insertion. These changes have important implications on surgical options and should be described routinely.

  3. The efficacy of balloon dilation in achalasia is the result of stretching of the lower esophageal sphincter, not muscular disruption.

    PubMed

    Borhan-Manesh, F; Kaviani, M J; Taghavi, A R

    2016-04-01

    Pneumatic dilation (PD) of the lower esophageal sphincter (LES) in achalasia is a major palliative treatment. It is generally believed, although never substantiated, that therapeutic efficacy of ballooning in achalasia is the result of the disruption and tearing of the muscular layers of the LES. To clarify this issue, we investigated the frequency of muscular disruption at the LES, 24 hours after PD, by employing the endoscopic ultrasound (EUS), in a group of 43 consented patients with achalasia. Between July 2009 and March2012, 51 consecutive adult patients with tentative diagnosis of achalasia, some with recurrence of symptoms after an earlier treatment with balloon dilation, were evaluated and underwent PD, using Rigiflex balloon without major adverse effect. Out of the 51 evaluated, 43 eligible and consenting patients who underwent EUS, 24 hours after PD, using Olympus GF-UE 160 echoendoscope and an Aloka Prosound probe at 7.5 MHZ, are the subjects of this study. The EUS in 43 eligible patients revealed an intact LES in 36 (83.7%), small area of muscular disruption in 5 (11.6%) and small hematoma in 2 patients (4.6%). Our data convincingly demonstrate that the clinical effectiveness of balloon dilation in achalasia is not the result of muscular disruption, but of circumferential stretching of the LES. Our findings on the mechanism of action of PD in achalasia could result in modifying the current method of dilation for a safer procedure, by slowing the rate of inflation and allowing the sphincter to slowly stretch itself to the distending balloon. © 2015 The Authors. Diseases of the Esophagus published by Wiley Periodicals, Inc. on behalf of International Society for Diseases of the Esophagus.

  4. Effects of structural injure in the bile bacterial contamination after balloon transduodenal sphincteroplasty (papillary dilation) in dogs.

    PubMed

    Zavadinack Netto, Martin; Fagundes, Djalma José; Bandeira, César Orlando Peralta

    2006-01-01

    To evaluate, in dogs, the biliary sphincter subjected to dilation by hydrostatic balloon by the point of view of structural alterations of the papilla and the biochemestry and bacterial contamination of the bile. Twenty dogs were submitted to laparotomy, duodenotomy, and enlargement of the major duodenal papilla- GA(n=10) - with balloon of 8mm inflated with pressure of 0,5 atm, during 2 minutes or to the sham procedure - GB(n=10). Blood samples collected on times t(0 day), t(7 days) and t(28 days) were subjected to dosages of alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT) for cholestasis evaluation. The collected material from the gall bladder at the same times were registered and numbered to be submitted to culture in BHI, blood agar (rich, non-selective element) and Mac Conkey (selective element for Gram-negative bacillus. On the 28th day three fragments of the papilla were tranversally cut by the choledoc axis 3mm from the duodenal papilla and the cuts, stained with hematoxylin-eosin and Masson's tricome, were evaluated according to their inflammatory reaction. The GGT and ALP averages on the three periods in the groups A and B did not show significant differences, not being characterizes the cholestasis. The bacterian contamination was significantly higher in GA (2,19) than in GB (1,96); the contamination was lower in the initial time compared with 7 and 28 days (t0

  5. Cytomorphologic features of papillary lesions of the male breast: a study of 11 cases.

    PubMed

    Reid-Nicholson, Michelle D; Tong, Guoxia; Cangiarella, Joan F; Moreira, Andre L

    2006-08-25

    Breast masses occur in men far less commonly than women and are infrequently subjected to fine-needle aspiration (FNA) biopsy. Papillary lesions of the male breast are rare and are comprised of a spectrum of lesions ranging from papillary hyperplasia in gynecomastia to invasive papillary carcinoma. The following study describes the cytomorphology of papillary breast lesions in 11 men. The patients ranged in age from 23 to 78 years old and each presented with an unilateral subareolar or periareolar breast mass that varied in size from 0.5 to 3 cm. Two patients presented with bloody nipple discharge. Archival material (8-year period) from FNA biopsies of papillary lesions of the male breast was reviewed. The reviewed cases were correlated with appropriate clinicopathologic follow-up. The smears had variable cellularity but all showed papillary clusters of mammary epithelial cells with and without fibrovascular cores. Single epithelial cells with a high nuclear-to-cytoplasmic ratio and eccentric nuclei were seen in all smears; however, these were more numerous in cases of adenocarcinoma. Hemosiderin-laden macrophages were present in all cases. Nipple discharge was seen only in the 2 benign lesions. All adenocarcinomas occurred in older men. The only cytologic criteria that differentiated benign from malignant papillary lesions were marked cellularity and the presence of abundant 3-dimensional clusters. To the best of the authors' knowledge, the current series is the largest in the English literature to date that examines the cytomorphologic features of papillary breast lesions in men. Copyright 2006 American Cancer Society.

  6. Mechanical properties of ANTRIX balloon film and fabrication of single cap large volume balloons

    NASA Astrophysics Data System (ADS)

    Suneel Kumar, B.; Sreenivasan, S.; Subba Rao, J. V.; Manchanda, R. K.

    2008-11-01

    The zero pressure plastic balloons used for high altitude studies are generally made from polyethylene material. Tensile properties of the thin film polymer are the key parameters for material selection due to extremely low temperature of -90 °C encountered by the balloons in the tropopause region during the ascent at equatorial latitudes. The physical and structural properties of the material determine the uniformity of the stress distribution over the entire shell. Load stresses from the suspended load propagate via load tapes heat sealed along with the gore seals as per the balloon design. A balance between this heat seal strength and the film strength is a desirable property of the basic resin in terms of the bubble strength, gauge uniformity, and long-term storage properties. In addition, the design of the top shell of the balloon and its stress distribution play an important role since only a fraction of the balloon is deployed during the filling operation and the ascent. In this paper we describe the mechanical properties of the 'ANTRIX' film developed by us and the optimized design of single cap balloons, which have been successfully used in our experiments over the past 5 years.

  7. Juxtaglomerular cell tumor of the kidney: report of two cases with a papillary pattern.

    PubMed

    Têtu, B; Vaillancourt, L; Camilleri, J P; Bruneval, P; Bernier, L; Tourigny, R

    1993-11-01

    We report the clinicopathologic, immunohistochemical, and electron microscopic study of two cases of juxtaglomerular cell tumor of the kidney with a hitherto unreported dominant papillary pattern. Both tumors were associated with high blood pressure that did not respond to medical therapy, but that returned to normal after removal of the kidney. They were well delineated, tan, and had no necrosis. The cores of the papillary structures consisted of polygonal cells found to express renin by immunohistochemistry and to contain renin protogranules by electron microscopy. The papillary fronds were covered by one layer of cuboidal epithelial cells that did not stain for renin and had ultrastructural features reminiscent of the collecting duct epithelium. These tumors must be differentiated from malignant papillary tumors of the kidney, such as papillary clear cell carcinoma, transitional cell carcinoma, and collecting duct carcinoma.

  8. Successful application of endoscopic modified medial maxillectomy to orbital floor trapdoor fracture in a pediatric patient.

    PubMed

    Matsuda, Yasunori; Sakaida, Hiroshi; Kobayashi, Masayoshi; Takeuchi, Kazuhiko

    2016-10-01

    Although surgical treatment of orbital floor fractures can be performed by many different approaches, the application of endoscopic modified medial maxillectomy (EMMM) for this condition has rarely been described in the literature. We report on a case of a 7-year-old boy with a trapdoor orbital floor fracture successfully treated with the application of EMMM. The patient suffered trauma to the right orbit floor and the inferior rectus was entrapped at the orbital floor. Initially, surgical repair via endoscopic endonasal approach was attempted. However, we were unable to adequately access the orbital floor through the maxillary ostium. Therefore, an alternative route of access to the orbital floor was established by EMMM. With sufficient visualization and operating space, the involved orbital content was completely released from the entrapment site and reduced into the orbit. To facilitate wound healing, the orbital floor was supported with a water-inflated urethral balloon catheter for 8 days. At follow-up 8 months later, there was no gaze restriction or complications associated with the EMMM. This case illustrates the efficacy and safety of EMMM in endoscopic endonasal repair of orbital floor fracture, particularly for cases with a narrow nasal cavity such as in pediatric patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Broad fibrovascular cores may not be an exclusively benign feature in papillary lesions of the breast: a cautionary note.

    PubMed

    Yamaguchi, Rin; Tanaka, Maki; Tse, Gary M; Yamaguchi, Miki; Terasaki, Hiroshi; Nomura, Yoriko; Takenaka, Miki; Naito, Yoshiki; Akiba, Jun; Yano, Hirohisa

    2014-03-01

    A prominent fibrovascular stromal core is one of the widely accepted histological features of breast papillomas, but some papillary carcinomas also show such broad fibrovascular cores, leading to confusion in diagnosis, particularly in needle biopsy specimens. We investigated the histological characteristics of papillary lesions, focusing on broad fibrovascular cores and their relationship with the architectural patterns. Among 185 cases of needle biopsies of papillomas and papillary carcinomas, the number of cases with broad fibrovascular cores in each group was compared. The broad fibrovascular core density in the subsequently resected specimens was evaluated and compared between papillary predominant pattern (papillary structures >80% of tumours) and mixed pattern (papillary, solid, cribriform and others) within the lesions. Significantly more papillary carcinomas than papillomas and B3 atypical papillary lesions had broad fibrovascular cores (p=0.0091 and p=0.0164, respectively). The papillary predominant pattern was more prominent in carcinomas than in papillomas in the needle biopsies (p=0.048) and showed the same tendency in the resections (p=0.058). The broad fibrovascular core density was significantly lower in the 18 papillomas than in the 37 papillary carcinomas (p=0.0079) and was not significantly different between the papillary predominant and mixed patterns in carcinomas and papillomas. Broad fibrovascular cores in mammary papillary lesions are not specific for papillomas, as they are also present focally in papillary carcinomas. As the frequency of papillary carcinoma with broad fibrovascular cores is relatively high, caution in diagnosis has to be exercised, especially in needle biopsy specimens.

  10. Percutaneous Mitral Valve Dilatation: Single Balloon versus Double Balloon - A Finite Element Study

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Schievano, Silvia; Kunzelman, Karyn; Nicosia, Mark

    2009-01-01

    Background: Percutaneous mitral valve (MV) dilatation is performed with either a single balloon (SB) or double balloon (DB) technique. The aim of this study was to compare the two balloon system results using the finite element (FE) method. Methods and Results: An established FE model of the MV was modified by fusing the MV leaflet edges at commissure level to simulate a stenotic valve (orifice area=180mm2). A FE model of a 30mm SB (low-pressure, elastomeric balloon) and an 18mm DB system (high-pressure, non-elastic balloon) was created. Both SB and DB simulations resulted in splitting of the commissures and subsequent stenosismore » dilatation (final MV area=610mm2 and 560mm2 respectively). Stresses induced by the two balloon systems varied across the valve. At the end of inflation, SB showed higher stresses in the central part of the leaflets and at the commissures compared to DB simulation, which demonstrated a more uniform stress distribution. The higher stresses in the SB analysis were due to the mismatch of the round balloon shape with the oval mitral orifice. The commissural split was not easily accomplished with the SB due to its high compliance. The high pressure applied to the DB guaranteed the commissural split even when high forces were required to break the commissure welds. Conclusions: The FE model demonstrated that MV dilatation can be accomplished by both SB and DB techniques. However, the DB method resulted in higher probability of splitting of the fused commissures and less damage caused to the MV leaflets by overstretching.« less

  11. Technologies developed by CNES balloon team

    NASA Astrophysics Data System (ADS)

    Sosa-Sesma, Sergio; Charbonnier, Jean-Marc; Deramecourt, Arnaud

    CNES balloon team develops and operates all the components of this kind of vehicle: it means envelope and gondola. This abstract will point out only developments done for envelope. Nowadays CNES offers to scientists four types of envelops that cover a large range of mission demands. These envelops are: 1. Zero pressure balloons: Size going from 3,000m3 to 600,000m3, this kind of envelop is ideal for short duration flights (a few hours) but if we use an intelligent management of ballast consumption and if we chose the best launch site, it is possible to perform medium duration flights (10/20 days depending on the ballast on board). Flight train mass starts at 50kg for small balloons and reach 1000kg for larger ones. Zero pressure balloons are inflated with helium gas. 2. Super pressure balloons: Diameter going from 2.5m to 12m, this kind of envelop is ideal for long duration flights (1 to 6 months). Flight train is inside the envelop for small balloons, it means 2.5 diameter meters which is usually called BPCL (Super pressure balloon for Earth boundary layer) and it is about 3kg of mass. Larger ones could lift external flight trains about 50kg of mass. Super pressure balloons are inflated with helium gas. 3. MIR balloons: Size going from 36,000m3 to 46,000m3. Ceiling is reach with helium gas but after three days helium is no longer present inside and lift force is produced by difference of temperature between air inside and air of atmosphere. Flight trains must not be over 50kg. 4. Aero Clipper balloons: A concept to correlate measurements done in oceans and in nearest layers of atmosphere simultaneously. Flight train is made by a "fish" that drags inside water and an atmospheric gondola few meters above "fish", both pushed by a balloon which profits of the wind force. Materials used for construction and assembling depend on balloon type; they are usually made of polyester or polyethylene. Thickness varies from 12 micrometers to 120 micrometers. Balloon assembling

  12. Retrieval of impacted broken balloon by balloon inflation in guiding catheter.

    PubMed

    Mehta, Vimal; Pandit, Bhagya Narayan; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay; Tyagi, Sanjay

    2014-07-01

    Broken catheter fragment in a coronary artery during percutaneous coronary angioplasty is a rare complication. It can result in serious problems as a result of thrombus formation and embolization of broken fragment. We report an unusual complication of a broken balloon catheter during angioplasty, which was successfully retrieved by balloon inflation in guiding catheter technique.

  13. Renal papillary tip extract stimulates BNP production and excretion from cardiomyocytes

    PubMed Central

    Hashizume, Ryotaro; Suzuki, Noboru; Ito, Rie; Yamanaka, Keiichi; Saito, Hiromitsu; Kiyonari, Hiroshi; Tawara, Isao; Kageyama, Yuki; Ogihara, Yoshito; Ali, Yusuf; Yamada, Norikazu; Katayama, Naoyuki; Ito, Masaaki

    2018-01-01

    Background Brain natriuretic peptide (BNP) is an important biomarker for patients with cardiovascular diseases, including heart failure, hypertension and cardiac hypertrophy. It is also known that BNP levels are relatively higher in patients with chronic kidney disease and no heart disease; however, the mechanism remains unclear. Methods and results We developed a BNP reporter mouse and occasionally found that this promoter was activated specifically in the papillary tip of the kidneys, and its activation was not accompanied by BNP mRNA expression. No evidence was found to support the existence of BNP isoforms or other nucleotide expression apart from BNP and tdTomato. The pBNP-tdTomato-positive cells were interstitial cells and were not proliferative. Unexpectedly, both the expression and secretion of BNP increased in primary cultured neonatal cardiomyocytes after their treatment with an extract of the renal papillary tip. Intraperitoneal injection of the extract of the papillary tips reduced blood pressure from 210 mmHg to 165 mmHg, the decrease being accompanied by an increase in serum BNP and urinary cGMP production in stroke-prone spontaneously hypertensive (SHR-SP) rats. Furthermore the induction of BNP by the papillary extract from rats with heart failure due to myocardial infarction was increased in cardiomyocytes. Conclusions These results suggested that the papillary tip express a substance that can stimulate BNP production and secretion from cardiomyocytes. PMID:29734386

  14. Novel Concept of Attaching Endoscope Holder to Microscope for Two Handed Endoscopic Tympanoplasty.

    PubMed

    Khan, Mubarak M; Parab, Sapna R

    2016-06-01

    The well established techniques in tympanoplasty are routinely performed with operating microscopes for many decades now. Endoscopic ear surgeries provide minimally invasive approach to the middle ear and evolving new science in the field of otology. The disadvantage of endoscopic ear surgeries is that it is one-handed surgical technique as the non-dominant left hand of the surgeon is utilized for holding and manipulating the endoscope. This necessitated the need for development of the endoscope holder which would allow both hands of surgeon to be free for surgical manipulation and also allow alternate use of microscope during tympanoplasty. To report the preliminary utility of our designed and developed endoscope holder attachment gripping to microscope for two handed technique of endoscopic tympanoplasty. Prospective Non Randomized Clinical Study. Our endoscope holder attachment for microscope was designed and developed to aid in endoscopic ear surgery and to overcome the disadvantage of single handed endoscopic surgery. It was tested for endoscopic Tympanoplasty. The design of the endoscope holder attachment is described in detail along with its manipulation and manoeuvreing. A total of 78 endoholder assisted type 1 endoscopic cartilage tympanoplasties were operated to evaluate its feasibility for the two handed technique and to evaluate the results of endoscopic type 1 cartilage tympanoplasty. In early follow up period ranging from 6 to 20 months, the graft uptake was seen in 76 ears with one residual perforation and 1 recurrent perforations giving a success rate of 97.435 %. Our endocsope holder attachment for gripping microscope is a good option for two handed technique in endoscopic type 1 cartilage tympanoplasty. The study reports the successful application and use of our endoscope holder attachment for gripping microscope in two handed technique of endoscopic type 1 cartilage tympanoplasty and comparable results with microscopic techniques. IV.

  15. [Solid cystic papillary tumor of the pancreas].

    PubMed

    Bahri, I; Njim, L; Khabir, A; Mahmoudi, H; Ghorbel, A; Zakhama, A; Jlidi, R

    2001-11-01

    Solid cystic papillary tumors of the pancreas are rare; they occur most commonly in young women. Despite their characteristic microscopic appearance, their immunophenotype is not specific. Their prognosis is excellent after complete surgical resection. The study aim was to report two cases in female patients who were 15 and 20 years old; the first tumor was discovered fortuitously and the second girl presented with abdominal pain and vomiting. Both tumors were encapsulated and located in the tail of the pancreas. The histological study showed the papillary architecture mixed with solid areas. Immunohistochemical staining was positive only for vimentin in one case and positive for cytokeratin, chromogranin, synaptophysin, neuron specific enolase, vimentin and protein S100 in the second case.

  16. Air Force Cambridge Research Laboratories balloon operations

    NASA Technical Reports Server (NTRS)

    Danaher, T. J.

    1974-01-01

    The establishment and functions of the AFCRL balloon operations facility are discussed. The types of research work conducted by the facility are defined. The facilities which support the balloon programs are described. The free balloon and tethered balloon capabilities are analyzed.

  17. Morphological characterization of selected balloon films and its effects on balloon performances

    NASA Technical Reports Server (NTRS)

    Said, Magdi A.

    1994-01-01

    Morphological characterization of several polyethylene balloon films have been studied using various techniques. The objective is to determine, if any, differentiating structural or morphological features that can be related to the performance of these balloon film materials. The results of the study indicate that the films are composed of either linear low denstiy polyethylene (LLDPE) or low density polyethylene (LDPE). A selective examination of these data imply that films limited degree of branching and larger crystallites size (same % crystallinity) showed good mechanical properties that appear to correlate with their high level of success in balloon flights.

  18. Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers.

    PubMed

    Shimizu, Yasuhiro; Yamaue, Hiroki; Maguchi, Hiroyuki; Yamao, Kenji; Hirono, Seiko; Osanai, Manabu; Hijioka, Susumu; Hosoda, Waki; Nakamura, Yasushi; Shinohara, Toshiya; Yanagisawa, Akio

    2013-07-01

    The present study was a retrospective investigation of predictors of malignancy in intraductal papillary mucinous neoplasm (IPMN) of the pancreas. The subjects were 310 patients who underwent pancreatic resection at 3 high-volume centers. Preoperative laboratory and imaging findings were analyzed in logistic regression analyses. Endoscopic ultrasonography measurements were essential for the size of mural nodules, and a central review was conducted for pathological diagnosis. Pathological diagnosis was benign IPMN in 150 cases and malignant in 160 (noninvasive carcinoma, n = 100; invasive, n = 60). In multivariate analysis, size of mural nodules, diameter of main pancreatic duct, and cyst size of branch pancreatic duct were independent predictors of malignancy, and areas under the receiver operating characteristic curve for these 3 factors were 0.798, 0.643, and 0.601, respectively. With 7 mm taken as the cutoff value for the size of mural nodules, the diagnosis of malignant IPMN had sensitivity of 74.3% and specificity of 72.7%. Carcinoma without nodules was present in 15 patients (15/160 [9.4%]). The size of mural nodules measured with endoscopic ultrasonography showed high predictive ability. However, about 10% of carcinoma patients did not have nodules, and the handling of the diagnosis in such cases is a problem for the future.

  19. Automated high-level disinfection of nonchanneled flexible endoscopes: duty cycles and endoscope repair.

    PubMed

    Statham, Melissa McCarty; Willging, J Paul

    2010-10-01

    Guidelines issued by the Association of Operating Room Nurses and the Association of Professionals in Infection Control and Epidemiology recommend high-level disinfection (HLD) for semicritical instruments, such as flexible endoscopes. We aim to examine the durability of endoscopes to continued use and automated HLD. We report the number of duty cycles a flexible endoscope can withstand before repairs should be anticipated. Retrospective review. A total of 4,336 endoscopic exams and subsequent disinfection cycles were performed with 60 flexible endoscopes in an outpatient tertiary pediatric otolaryngology practice from 2005 to 2009. All endoscopes were systemically cleaned with mechanical cleansing followed by leak testing, enzymatic cleaning, and exposure to Orthophthaldehyde (0.55%) for 5 minutes at a temperature of at least 25°C, followed by rinsing for 3 minutes. A total of 77 repairs were performed, 48 major (average cost $3,815.97), and 29 minor (average cost $326.85). On average, the 2.2-mm flexible endoscopes were utilized for 61.9 examinations before major repair was needed, whereas the 3.6 mm endoscopes were utilized for 154.5 exams before needing minor repairs. No major repairs have been needed to date on the 3.6-mm endoscopes. Automated endoscope reprocessor use for HLD is an effective means to disinfect and process flexible endoscopes. This minimizes variability in the processing of the endoscopes and maximizes the rate of successful HLD. Even when utilizing standardized, automated HLD and limiting the number of personnel processing the endoscopes, smaller fiberoptic endoscopes demonstrate a shortened time interval between repairs than that seen with the larger endoscopes. Laryngoscope, 2010.

  20. The EUSO-Balloon pathfinder

    NASA Astrophysics Data System (ADS)

    Adams, J. H.; Ahmad, S.; Albert, J.-N.; Allard, D.; Anchordoqui, L.; Andreev, V.; Anzalone, A.; Arai, Y.; Asano, K.; Ave Pernas, M.; Baragatti, P.; Barrillon, P.; Batsch, T.; Bayer, J.; Bechini, R.; Belenguer, T.; Bellotti, R.; Belov, K.; Berlind, A. A.; Bertaina, M.; Biermann, P. L.; Biktemerova, S.; Blaksley, C.; Blanc, N.; Błȩcki, J.; Blin-Bondil, S.; Blümer, J.; Bobik, P.; Bogomilov, M.; Bonamente, M.; Briggs, M. S.; Briz, S.; Bruno, A.; Cafagna, F.; Campana, D.; Capdevielle, J.-N.; Caruso, R.; Casolino, M.; Cassardo, C.; Castellinic, G.; Catalano, C.; Catalano, G.; Cellino, A.; Chikawa, M.; Christl, M. J.; Cline, D.; Connaughton, V.; Conti, L.; Cordero, G.; Crawford, H. J.; Cremonini, R.; Csorna, S.; Dagoret-Campagne, S.; de Castro, A. J.; De Donato, C.; de la Taille, C.; De Santis, C.; del Peral, L.; Dell'Oro, A.; De Simone, N.; Di Martino, M.; Distratis, G.; Dulucq, F.; Dupieux, M.; Ebersoldt, A.; Ebisuzaki, T.; Engel, R.; Falk, S.; Fang, K.; Fenu, F.; Fernández-Gómez, I.; Ferrarese, S.; Finco, D.; Flamini, M.; Fornaro, C.; Franceschi, A.; Fujimoto, J.; Fukushima, M.; Galeotti, P.; Garipov, G.; Geary, J.; Gelmini, G.; Giraudo, G.; Gonchar, M.; González Alvarado, C.; Gorodetzky, P.; Guarino, F.; Guzmán, A.; Hachisu, Y.; Harlov, B.; Haungs, A.; Hernández Carretero, J.; Higashide, K.; Ikeda, D.; Ikeda, H.; Inoue, N.; Inoue, S.; Insolia, A.; Isgrò, F.; Itow, Y.; Joven, E.; Judd, E. G.; Jung, A.; Kajino, F.; Kajino, T.; Kaneko, I.; Karadzhov, Y.; Karczmarczyk, J.; Karus, M.; Katahira, K.; Kawai, K.; Kawasaki, Y.; Keilhauer, B.; Khrenov, B. A.; Kim, J.-S.; Kim, S.-W.; Kim, S.-W.; Kleifges, M.; Klimov, P. A.; Kolev, D.; Kreykenbohm, I.; Kudela, K.; Kurihara, Y.; Kusenko, A.; Kuznetsov, E.; Lacombe, M.; Lachaud, C.; Lee, J.; Licandro, J.; Lim, H.; López, F.; Maccarone, M. C.; Mannheim, K.; Maravilla, D.; Marcelli, L.; Marini, A.; Martinez, O.; Masciantonio, G.; Mase, K.; Matev, R.; Medina-Tanco, G.; Mernik, T.; Miyamoto, H.; Miyazaki, Y.; Mizumoto, Y.; Modestino, G.; Monaco, A.; Monnier-Ragaigne, D.; Morales de los Ríos, J. A.; Moretto, C.; Morozenko, V. S.; Mot, B.; Murakami, T.; Murakami, M. Nagano; Nagata, M.; Nagataki, S.; Nakamura, T.; Napolitano, T.; Naumov, D.; Nava, R.; Neronov, A.; Nomoto, K.; Nonaka, T.; Ogawa, T.; Ogio, S.; Ohmori, H.; Olinto, A. V.; Orleański, P.; Osteria, G.; Panasyuk, M. I.; Parizot, E.; Park, I. H.; Park, H. W.; Pastircak, B.; Patzak, T.; Paul, T.; Pennypacker, C.; Perez Cano, S.; Peter, T.; Picozza, P.; Pierog, T.; Piotrowski, L. W.; Piraino, S.; Plebaniak, Z.; Pollini, A.; Prat, P.; Prévôt, G.; Prieto, H.; Putis, M.; Reardon, P.; Reyes, M.; Ricci, M.; Rodríguez, I.; Rodríguez Frías, M. D.; Ronga, F.; Roth, M.; Rothkaehl, H.; Roudil, G.; Rusinov, I.; Rybczyński, M.; Sabau, M. D.; Sáez-Cano, G.; Sagawa, H.; Saito, A.; Sakaki, N.; Sakata, M.; Salazar, H.; Sánchez, S.; Santangelo, A.; Santiago Crúz, L.; Sanz Palomino, M.; Saprykin, O.; Sarazin, F.; Sato, H.; Sato, M.; Schanz, T.; Schieler, H.; Scotti, V.; Segreto, A.; Selmane, S.; Semikoz, D.; Serra, M.; Sharakin, S.; Shibata, T.; Shimizu, H. M.; Shinozaki, K.; Shirahama, T.; Siemieniec-Oziȩbło, G.; Silva López, H. H.; Sledd, J.; Słomińska, K.; Sobey, A.; Sugiyama, T.; Supanitsky, D.; Suzuki, M.; Szabelska, B.; Szabelski, J.; Tajima, F.; Tajima, N.; Tajima, T.; Takahashi, Y.; Takami, H.; Takeda, M.; Takizawa, Y.; Tenzer, C.; Tibolla, O.; Tkachev, L.; Tokuno, H.; Tomida, T.; Tone, N.; Toscano, S.; Trillaud, F.; Tsenov, R.; Tsunesada, Y.; Tsuno, K.; Tymieniecka, T.; Uchihori, Y.; Unger, M.; Vaduvescu, O.; Valdés-Galicia, J. F.; Vallania, P.; Valore, L.; Vankova, G.; Vigorito, C.; Villaseñor, L.; von Ballmoos, P.; Wada, S.; Watanabe, J.; Watanabe, S.; Watts, J.; Weber, M.; Weiler, T. J.; Wibig, T.; Wiencke, L.; Wille, M.; Wilms, J.; Włodarczyk, Z.; Yamamoto, T.; Yamamoto, Y.; Yang, J.; Yano, H.; Yashin, I. V.; Yonetoku, D.; Yoshida, K.; Yoshida, S.; Young, R.; Zotov, M. Yu.; Zuccaro Marchi, A.

    2015-11-01

    EUSO-Balloon is a pathfinder for JEM-EUSO, the Extreme Universe Space Observatory which is to be hosted on-board the International Space Station. As JEM-EUSO is designed to observe Ultra-High Energy Cosmic Rays (UHECR)-induced Extensive Air Showers (EAS) by detecting their ultraviolet light tracks "from above", EUSO-Balloon is a nadir-pointing UV telescope too. With its Fresnel Optics and Photo-Detector Module, the instrument monitors a 50 km2 ground surface area in a wavelength band of 290-430 nm, collecting series of images at a rate of 400,000 frames/sec. The objectives of the balloon demonstrator are threefold: a) perform a full end-to-end test of a JEM-EUSO prototype consisting of all the main subsystems of the space experiment, b) measure the effective terrestrial UV background, with a spatial and temporal resolution relevant for JEM-EUSO. c) detect tracks of ultraviolet light from near space for the first time. The latter is a milestone in the development of UHECR science, paving the way for any future space-based UHECR observatory. On August 25, 2014, EUSO-Balloon was launched from Timmins Stratospheric Balloon Base (Ontario, Canada) by the balloon division of the French Space Agency CNES. From a float altitude of 38 km, the instrument operated during the entire astronomical night, observing UV-light from a variety of ground-covers and from hundreds of simulated EASs, produced by flashers and a laser during a two-hour helicopter under-flight.

  1. Two Tethered Balloon Systems

    NASA Technical Reports Server (NTRS)

    Youngbluth, Otto; Owens, Thomas L.; Storey, Richard W.

    1990-01-01

    Systems take meteorological measurements for variety of research projects. Report describes work done by NASA Langley Research Center in atmospheric research using tethered balloon systems composed of commercially available equipment. Two separate tethered balloon systems described in report have payloads and configurations tailored to requirements of specific projects. Each system capable of measuring atmospheric parameter or species in situ and then telemetering this data in real time to ground station. Meteorological data and concentration of ozone typically measured. Indicates instrumented tethered balloon systems have distinct advantages over other systems for gathering data on troposphere.

  2. Endoscopic neurosurgery "around the corner" with a rigid endoscope. Technical note.

    PubMed

    Hopf, N J

    1999-03-01

    Endoscopically "working around the corner" is presently restricted to the use of flexible endoscopes or an endoscope-assisted microneurosurgical (EAM) technique. In order to overcome the limitations of these solutions, endoscopic equipment and techniques were developed for "working around the corner" with rigid endoscopes. A steering insert with a 5 French working channel is capable of steering instruments around the corner by actively bending the guiding track and consecutively the instrument. A special fixation device enables strict axial rotation of the endoscope in the operating field. Endoscopic procedures "around the corner", including aqueductal stenting, pellucidotomy, third ventriculostomy and biopsy were performed in human cadavers. Special features of the used pediatric neuroendoscope system, i.e., reliable fixation, axial rotation, and controlled steering of instruments, increase the safety and reduce the surgical traumatization in selected cases, such as obstructive hydrocephalus due to a mass lesion in the posterior third ventricle, since endoscopic third ventriculostomy and biopsy can be performed through the same burr hole trephination. Limitations of this technique are given by the size of the foramen of Monro and the height of the third ventricle as well as by the bending angle of the instruments (40-50 degrees).

  3. Mobile, high-wind, balloon-launching apparatus

    NASA Technical Reports Server (NTRS)

    Rust, W. David; Marshall, Thomas C.

    1989-01-01

    In order to place instruments for measuring meteorological and electrical parameters into thunderstorms, an inexpensive apparatus has been developed which makes it possible to inflate, transport, and launch balloons in high winds. The launching apparatus is a cylinder of bubble plastic that is made by joining the sides of the cylinder together with a velcro rip strip. A balloon is launched by pulling the rip strip rapidly. This allows the balloon to pop upward into the ambient low-level wind and carry its instrumentation aloft. Different-sized launch tubes are constructed to accommodate particular sizes of balloons. Balloons have been launched in winds of about 20 m/s.

  4. Universal stratospheric balloon gradiometer

    NASA Astrophysics Data System (ADS)

    Tsvetkov, Yury; Filippov, Sergey; Brekhov, Oleg; Nikolaev, Nikolay

    The study of the interior structure of the Earth and laws of its evolution is one of the most difficult problems of natural science. Among the geophysical fields the anomaly magnetic field is one of the most informational in questions of the Earth’s crust structure. Many important parameters of an environment are expedient for measuring at lower altitudes, than satellite ones. So, one of the alternatives is stratospheric balloon survey. The balloon flight altitudes cover the range from 20 to 50 km. At such altitudes there are steady zone air flows due to which the balloon flight trajectories can be of any direction, including round-the-world (round-the-pole). For investigation of Earth's magnetic field one of the examples of such sounding system have been designed, developed and maintained at IZMIRAN and MAI during already about 25 years. This system consists of three instrumental containers uniformly placed along a vertical 6 km line. Up today this set has been used only for geomagnetic purposes. So we describe this system on example of the measuring of the geomagnetic field gradient. System allows measuring a module and vertical gradient of the geomagnetic field along the whole flight trajectory and so one’s name is - stratospheric balloon magnetic gradiometer (SMBG). The GPS-receivers, located in each instrumental container, fix the flight coordinates to within several tens meters. Process of SBMG deployment, feature of the exit of rope from the magazine at the moment of balloon launching has been studied. Used magazine is cellular type. The hodograph of the measuring base of SBMG and the technique of correction of the deviations of the measuring base from the vertical line (introduction of the amendments for the deviation) during the flight have been investigated. It is shown that estimation of the normal level of values of the vertical gradient of the geomagnetic field is determined by the accuracy of determining the length of the measuring base SBMG

  5. The Great Balloon Controversy.

    ERIC Educational Resources Information Center

    Chase, Valerie

    1989-01-01

    Discusses the harmful effects of balloon launches and the dumping of plastic debris into oceans. Cites several examples of plastic materials being discovered inside the bodies of sick and/or dead marine animals. Offers alternative activities to releasing balloons into the atmosphere. (RT)

  6. Management of the Patient with Aggressive and Resistant Papillary Thyroid Carcinoma

    PubMed Central

    Miftari, Rame; Topçiu, Valdete; Nura, Adem; Haxhibeqiri, Valdete

    2016-01-01

    Purpose: Papillary carcinoma is the most frequent type of thyroid cancer and was considered the most benign of all thyroid carcinomas, with a low risk of distant metastases. However, there are some variants of papillary thyroid carcinoma that have affinity to spread in many organs, such as: lymph nodes, lungs and bones. Aim: The aim of this study was presentation of a case with papillary carcinoma of the thyroid gland, very persistent and resistant in treatment with I 131. Material and results: A man 56 years old were diagnosed with papillary carcinoma of thyroid gland. He underwent a surgical removal of the tumor and right lobe of thyroid gland. With histopathology examination, were confirmed follicular variant of papillary carcinoma pT4. Two weeks later he underwent total thyroidectomy and was treated with 100 mCi of J 131. Six months later, the value of thyroglobulin was found elevated above upper measured limits (more than 500 ng/ml). Patient underwent surgical removal of 10 metastatic lymph nodes in the left side of the neck and has been treated with 145 mCi of radioiodine I 131. The examination after 5 months shows elevation of thyroglobulin, more than 20000 ng/ml and focally uptake of J 131 in the left lung. Patient was treated once again with 150 mCi radioiodine J 131. Whole body scintigraphy was registered focal uptake of radioiodine in the middle of the left collarbone. After a month, patient refers the enlargement of the lymph node in the right side of the neck. Currently patient is being treated with kinase inhibitor drug sorafenib and ibandronate. We have identified first positive response in treatment. Enlarged lymph node in the neck was reduced and the patient began feeling better. Conclusion: This study suggests that some subtypes of papillary thyroid carcinoma appear to have more aggressive biological course. Subtypes of papillary thyroid carcinoma such as diffuse sclerosing carcinoma, tall cell or columnar cell and insular variants, appears to

  7. Endoscopic root canal treatment.

    PubMed

    Moshonov, Joshua; Michaeli, Eli; Nahlieli, Oded

    2009-10-01

    To describe an innovative endoscopic technique for root canal treatment. Root canal treatment was performed on 12 patients (15 teeth), using a newly developed endoscope (Sialotechnology), which combines an endoscope, irrigation, and a surgical microinstrument channel. Endoscopic root canal treatment of all 15 teeth was successful with complete resolution of all symptoms (6-month follow-up). The novel endoscope used in this study accurately identified all microstructures and simplified root canal treatment. The endoscope may be considered for use not only for preoperative observation and diagnosis but also for active endodontic treatment.

  8. Current trends of balloon laryngoplasty in Thailand.

    PubMed

    Moungthong, Greetha; Bunbanjerdsuk, Sacarin; Wright, Nida; Sathavornmanee, Thanakrit; Setabutr, Dhave

    2017-06-01

    To describe the current trend in balloon laryngoplasty usage and experience by practicing otolaryngologists in Thailand. Anonymous 11 question online and paper survey of otolaryngologists on their current balloon laryngoplasty practices. Current practices and experience in balloon laryngoplasty were queried with multiple choice and open-ended questions. Laser use is the most commonly utilized instrument to treat airway stenosis in Thailand. 86% of respondents do not have experience with balloon dilatation; yet, almost half (47.6%) report they perform a minimum of five airway surgeries per year. Most respondents had been in practice for less than 6 years (41%) and reported that they did not have exposure to balloon use during residency training. The largest barrier reported for the use of balloon instrumentation in the airway is inexperience (44.4%) followed by cost (38.3%), yet most feel that treatment in airway stenosis could benefit by usage of balloons (95.5%). Most otolaryngologists in Thailand do not have experience with the use of balloon dilatation and lack of exposure remains the largest barrier to its use. Otolaryngologists in Thailand feel that increased usage of balloons in the airway could improve airway stenosis treatment in the country.

  9. Application of "papillary-like main pancreatic duct invaginated" pancreaticojejunostomy for normal soft pancreas cases.

    PubMed

    Zhang, Bo; Xu, Jin; Liu, Chen; Long, Jiang; Liu, Liang; Xu, Yongfeng; Wu, Chuntao; Luo, Guopei; Ni, Quanxing; Li, Min; Yu, Xianjun

    2013-01-01

    Pancreaticojejunostomy is the key procedure of pancreaticoduodenectomy. Our study introduced a new pancreaticojejunal (PJ) anastomosis named "papillary-like main pancreatic duct invaginated" pancreaticojejunostomy. Nighty-two patients underwent pancreaticojejunostomy with either conventional duct-to-mucosa pancreaticojejunostomy or the new "papillary-like main pancreatic duct invaginated" techniques were analyzed retrospectively from January 2010 to September 2012. The incidence of pancreatic fistula was 15.7% (8/51) for the "papillary-like main pancreatic duct invaginated" group and 19.5% (8/41) for the duct-to-mucosa fashion respectively. It is noteworthy that the rate of grade B/C postoperative pancreatic fistula (POPF) in the "papillary-like main pancreatic duct invaginated" group was significantly lower than that of the duct-to-mucosa group (P = 0.039). There were no differences in the incidence of postoperative morbidity and mortality such as postoperative hemorrhage, delayed gastric emptying or remnant pancreatitis. The "papillary-like main pancreatic duct invaginated" pancreaticojejunostomy could provide a feasible option to pancreatic surgeons for patients with normal soft pancreas.

  10. Low-cost endoscopic third ventriculostomy simulator with mimetic endoscope.

    PubMed

    Garling, Richard Justin; Jin, Xin; Yang, Jianzhong; Khasawneh, Ahmad H; Harris, Carolyn Anne

    2018-05-11

    OBJECTIVE Hydrocephalus affects approximately 1 in 500 people in the US, yet ventricular shunting, the gold standard of treatment, has a nearly 85% failure rate. Endoscopic third ventriculostomy (ETV) is an alternative surgical approach for a specific subset of hydrocephalic patients, but can be limited by the inability of neurosurgical residents to practice prior to patient contact. The goal of this study was to create an affordable ETV model and endoscope for resident training. METHODS Open-source software was used to isolate the skull and brain from the CT and MR images of a 2-year-old boy with hydrocephalus. A 3D printer created the skull and a 3D mold of the brain. A mixture of silicone and silicone tactile mutator was used to cast the brain mold prior to subsequent compression and shearing modulus testing. A mimetic endoscope was then created from basic supplies and a 3D printed frame. A small cohort of neurosurgical residents and attending physicians evaluated the ETV simulator with mimetic endoscope. RESULTS The authors successfully created a mimetic endoscope and ETV simulator. After compression and shearing modulus testing, a silicone/Slacker ratio between 10:6 and 10:7 was found to be similar to that of human brain parenchyma. Eighty-seven percent of participants strongly agreed that the simulator was useful for resident training, and 93% strongly agreed that the simulator helped them understand how to orient themselves with the endoscope. CONCLUSIONS The authors created an affordable (US$123, excluding 3D printer), easy-to-use ETV simulator with endoscope. Previous models have required expensive software and costly operative endoscopes that may not be available to most residents. Instead, this attempt takes advantage of open-source software for the manipulation and fabrication of a patient-specific mold. This model can assist with resident development, allowing them to safely practice use of the endoscope in ETV.

  11. Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention.

    PubMed

    Nath, Anand; Yewale, Sayali; Tran, Tung; Brebbia, John S; Shope, Timothy R; Koch, Timothy R

    2016-12-21

    To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG). VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage. Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids. Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients.

  12. Reference level winds from balloon platforms

    NASA Technical Reports Server (NTRS)

    Lally, Vincent E.

    1985-01-01

    The superpressure balloon was developed to provide a method of obtaining global winds at all altitudes from 5 to 30 km. If a balloon could be made to fly for several weeks at a constant altitude, and if it could be tracked accurately on its global circuits, the balloon would provide a tag for the air parcel in which it was embedded. The Lagrangian data on the atmospheric circulation would provide a superior data input to the numerical model. The Global Atmospheric Research Program (GARP) was initiated in large part based on the promise of this technique coupled with free-floating ocean buoys and satellite radiometers. The initial name proposed by Charney for GARP was SABABURA 'SAtellite BAlloon BUoy RAdiometric system' (Charney, 1966). However, although the superpressure balloon exceeded its designers' expectations for flight duration in the stratosphere (longest flight duration of 744 days), flight duration below 10 km was limited by icing in super-cooled clouds to a few days. The balloon was relegated to a secondary role during the GARP Special Observing Periods. The several major superpressure balloon programs for global wind measurement are described as well as those new developments which make the balloon once again an attractive vehicle for measurement of global winds as a reference and bench-mark system for future satellite systems.

  13. Modelling Hot Air Balloons.

    ERIC Educational Resources Information Center

    Brimicombe, M. W.

    1991-01-01

    A macroscopic way of modeling hot air balloons using a Newtonian approach is presented. Misleading examples using a car tire and the concept of hot air rising are discussed. Pressure gradient changes in the atmosphere are used to explain how hot air balloons work. (KR)

  14. Balloon-augmented Onyx embolization of cerebral arteriovenous malformations using a dual-lumen balloon: a multicenter experience.

    PubMed

    Spiotta, Alejandro M; James, Robert F; Lowe, Stephen R; Vargas, Jan; Turk, Aquilla S; Chaudry, M Imran; Bhalla, Tarun; Janjua, Rashid M; Delaney, John J; Quintero-Wolfe, Stacey; Turner, Raymond D

    2015-10-01

    Conventional Onyx embolization of cerebral arteriovenous malformations (AVMs) requires lengthy procedure and fluoroscopy times to form an adequate 'proximal plug' which allows forward nidal penetration while preventing reflux and non-targeted embolization. We review our experience with balloon-augmented Onyx embolization of cerebral AVMs using a dual-lumen balloon catheter technique designed to minimize these challenges. Retrospectively acquired data for all balloon-augmented cerebral AVM embolizations performed between 2011 and 2014 were obtained from four tertiary care centers. For each procedure, at least one Scepter C balloon catheter was advanced into the AVM arterial pedicle of interest and Onyx embolization was performed through the inner lumen after balloon inflation via the outer lumen. Twenty patients underwent embolization with the balloon-augmented technique over 24 discreet treatment episodes. There were 37 total arterial pedicles embolized with the balloon-augmented technique, a mean of 1.9 per patient (range 1-5). The treated AVMs were heterogeneous in their location and size (mean 3.3±1.6 cm). Mean fluoroscopy time for each procedure was 48±26 min (28 min per embolized pedicle). Two Scepter C balloon catheter-related complications (8.3% of embolization sessions, 5.4% of pedicles embolized) were observed: an intraprocedural rupture of a feeding pedicle and fracture and retention of a catheter fragment. This multicenter experience represents the largest reported series of balloon-augmented Onyx embolization of cerebral AVMs. The technique appears safe and effective in the treatment of AVMs, allowing more efficient and controlled injection of Onyx with a decreased risk of reflux and decreased fluoroscopy times. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Solar research with stratospheric balloons

    NASA Astrophysics Data System (ADS)

    Vázquez, Manuel; Wittmann, Axel D.

    Balloons, driven by hot air or some gas lighter than air, were the first artificial machines able to lift payloads (including humans) from the ground. After some pioneering flights the study of the physical properties of the terrestrial atmosphere constituted the first scientific target. A bit later astronomers realized that the turbulence of the atmospheric layers above their ground-based telescopes deteriorated the image quality, and that balloons were an appropriate means to overcome, total or partially, this problem. Some of the most highly-resolved photographs and spectrograms of the sun during the 20th century were actually obtained by balloon-borne telescopes from the stratosphere. Some more recent projects of solar balloon astronomy will also be described.

  16. 21 CFR 870.1350 - Catheter balloon repair kit.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Catheter balloon repair kit. 870.1350 Section 870... repair kit. (a) Identification. A catheter balloon repair kit is a device used to repair or replace the balloon of a balloon catheter. The kit contains the materials, such as glue and balloons, necessary to...

  17. 21 CFR 870.1350 - Catheter balloon repair kit.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Catheter balloon repair kit. 870.1350 Section 870... repair kit. (a) Identification. A catheter balloon repair kit is a device used to repair or replace the balloon of a balloon catheter. The kit contains the materials, such as glue and balloons, necessary to...

  18. 21 CFR 870.1350 - Catheter balloon repair kit.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Catheter balloon repair kit. 870.1350 Section 870... repair kit. (a) Identification. A catheter balloon repair kit is a device used to repair or replace the balloon of a balloon catheter. The kit contains the materials, such as glue and balloons, necessary to...

  19. Calculating Payload for a Tethered Balloon System

    Treesearch

    Charles D. Tangren

    1980-01-01

    A graph method to calculate payload for a tethered balloon system, with the supporting helium lift and payload equations. is described. The balloon system is designed to collect emissions data during the convective-lift and no-convective-lift phases of a forest fire. A description of the balloon system and a list of factors affecting balloon selection are included....

  20. Papillary Carcinoma in Median Aberrant Thyroid (Ectopic) - Case Report

    PubMed Central

    K, Shashidhar; Deshmane, Vijaya Laxmi; Kumar, Veerendra; Arjunan, Ravi

    2014-01-01

    Median ectopic thyroid may be encountered anywhere from the foramen caecum to the diaphragm. Non lingual median aberrant thyroid (incomplete descent) usually found in the infrahyoid region and malignant transformation in this ectopic thyroid tissue is very rare. We report an extremely rare case of papillary carcinoma in non lingual median aberrant thyroid in a 25-year-old female. The differentiation between a carcinoma arising in the median ectopic thyroid tissue and a metastatic papillary carcinoma from an occult primary in the main thyroid gland is also discussed. PMID:25121039

  1. Papillary carcinoma in median aberrant thyroid (ectopic) - case report.

    PubMed

    Hebbar K, Ashwin; K, Shashidhar; Deshmane, Vijaya Laxmi; Kumar, Veerendra; Arjunan, Ravi

    2014-06-01

    Median ectopic thyroid may be encountered anywhere from the foramen caecum to the diaphragm. Non lingual median aberrant thyroid (incomplete descent) usually found in the infrahyoid region and malignant transformation in this ectopic thyroid tissue is very rare. We report an extremely rare case of papillary carcinoma in non lingual median aberrant thyroid in a 25-year-old female. The differentiation between a carcinoma arising in the median ectopic thyroid tissue and a metastatic papillary carcinoma from an occult primary in the main thyroid gland is also discussed.

  2. Endoscopic ultrasound

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/007646.htm Endoscopic ultrasound To use the sharing features on this page, please enable JavaScript. Endoscopic ultrasound is a type of imaging test. It is ...

  3. Warthin-like papillary carcinoma of the thyroid: a case series and review of the literature.

    PubMed

    Erşen, Ayça; Durak, Merih Güray; Canda, Tülay; Sevınç, Ali Ibrahim; Saydam, Serdar; Koçdor, Mehmet Ali

    2013-01-01

    Warthin-like tumor of the thyroid is a recently described rare variant of thyroid papillary carcinoma. The distinguishing histological feature of this variant is papillary foldings lined by oncocytic neoplastic cells with clear nuclei and nuclear pseudoinclusions, accompanied by prominent lymphocytic infiltrate in the papillary stalks. Its prognosis has been reported to be almost similar to conventional papillary carcinoma. In this case series, we report four cases with Warthin-like papillary carcinoma of the thyroid, diagnosed at Dokuz Eylul University Faculty of Medicine Department of Pathology in 2008 and 2009. Three patients were female. The mean patient age was 39 years (range, 20-56) and the mean tumor size was 1.7 cm (range, 0.9-2.0 cm). All of the cases had lymphocytic thyroiditis in the background. None of the tumors showed lymphovascular invasion. The patients are free of any recurrence and/or distant metastasis with a mean follow-up of 25 months. This rare variant of thyroid papillary carcinoma with distinct histopathological features should be indicated in pathology reports. Further studies and long-term follow-up of patients are needed to highlight the biological behavior of this variant.

  4. Flight Qualification of the NASA's Super Pressure Balloon

    NASA Astrophysics Data System (ADS)

    Cathey, Henry; Said, Magdi; Fairbrother, Debora

    Designs of new balloons to support space science require a number of actual flights under various flight conditions to qualify them to as standard balloon flight offerings to the science community. Development of the new Super Pressure Balloon for the National Aeronautics and Space Administration’s Balloon Program Office has entailed employing new design, analysis, and production techniques to advance the state of the art. Some of these advances have been evolutionary steps and some have been revolutionary steps requiring a maturing understanding of the materials, designs, and manufacturing approaches. The NASA Super Pressure Balloon development end goal is to produce a flight vehicle that is qualified to carry a ton of science instrumentation, at an altitude greater than 33 km while maintaining a near constant pressure altitude for extended periods of up to 100 days, and at any latitude on the globe. The NASA’s Balloon Program Office has pursued this development in a carefully executed incremental approach by gradually increasing payload carrying capability and increasing balloon volume to reach these end goal. A very successful test flight of a ~200,700 m3 balloon was launch in late 2008 from Antarctica. This balloon flew for over 54 days at a constant altitude and circled the Antarctic continent almost three times. A larger balloon was flown from Antarctica in early 2011. This ~422,400 m3 flew at a constant altitude for 22 days making one circuit around Antarctica. Although the performance was nominal, the flight was terminated via command to recover high valued assets from the payload. The balloon designed to reach the program goals is a ~532,200 m3 pumpkin shaped Super Pressure Balloon. A test flight of this balloon was launched from the Swedish Space Corporation’s Esrange Balloon Launch Facilities near Kiruna, Sweden on 14 August, 2012. This flight was another success for this development program. Valuable information was gained from this short test

  5. Endoscope field of view measurement.

    PubMed

    Wang, Quanzeng; Khanicheh, Azadeh; Leiner, Dennis; Shafer, David; Zobel, Jurgen

    2017-03-01

    The current International Organization for Standardization (ISO) standard (ISO 8600-3: 1997 including Amendment 1: 2003) for determining endoscope field of view (FOV) does not accurately characterize some novel endoscopic technologies such as endoscopes with a close focus distance and capsule endoscopes. We evaluated the endoscope FOV measurement method (the FOV WS method) in the current ISO 8600-3 standard and proposed a new method (the FOV EP method). We compared the two methods by measuring the FOV of 18 models of endoscopes (one device for each model) from seven key international manufacturers. We also estimated the device to device variation of two models of colonoscopes by measuring several hundreds of devices. Our results showed that the FOV EP method was more accurate than the FOV WS method, and could be used for all endoscopes. We also found that the labelled FOV values of many commercial endoscopes are significantly overstated. Our study can help endoscope users understand endoscope FOV and identify a proper method for FOV measurement. This paper can be used as a reference to revise the current endoscope FOV measurement standard.

  6. Endoscope field of view measurement

    PubMed Central

    Wang, Quanzeng; Khanicheh, Azadeh; Leiner, Dennis; Shafer, David; Zobel, Jurgen

    2017-01-01

    The current International Organization for Standardization (ISO) standard (ISO 8600-3: 1997 including Amendment 1: 2003) for determining endoscope field of view (FOV) does not accurately characterize some novel endoscopic technologies such as endoscopes with a close focus distance and capsule endoscopes. We evaluated the endoscope FOV measurement method (the FOVWS method) in the current ISO 8600-3 standard and proposed a new method (the FOVEP method). We compared the two methods by measuring the FOV of 18 models of endoscopes (one device for each model) from seven key international manufacturers. We also estimated the device to device variation of two models of colonoscopes by measuring several hundreds of devices. Our results showed that the FOVEP method was more accurate than the FOVWS method, and could be used for all endoscopes. We also found that the labelled FOV values of many commercial endoscopes are significantly overstated. Our study can help endoscope users understand endoscope FOV and identify a proper method for FOV measurement. This paper can be used as a reference to revise the current endoscope FOV measurement standard. PMID:28663840

  7. Future Development of Endoscopic Accessories for Endoscopic Submucosal Dissection

    PubMed Central

    Jang, Jae-Young

    2017-01-01

    Endoscopic submucosal dissection (ESD) has recently been accepted as a standard treatment for patients with early gastric cancer (EGC), without lymph node metastases. Given the rise in the number of ESDs being performed, new endoscopic accessories are being developed and existing accessories modified to facilitate the execution of ESD and reduce complication rates. This paper examines the history underlying the development of these new endoscopic accessories and indicates future directions for the development of these accessories. PMID:28609819

  8. Preoperative Cytologic Diagnosis of Warthin-like Variant of Papillary Thyroid Carcinoma.

    PubMed

    Kim, Jisup; Lim, Beom Jin; Hong, Soon Won; Pyo, Ju Yeon

    2018-03-01

    Warthin-like variant of papillary thyroid carcinoma (WLV-PTC) is a relatively rare variant of papillary thyroid carcinoma with favorable prognosis. However, preoperative diagnosis using fine-needle aspiration (FNA) specimens is challenging especially with lymphocytic thyroiditis characterized by Hürthle cells and lymphocytic background. To determine a helpful cytological differential point, we compared WLV-PTC FNA findings with conventional papillary thyroid carcinoma with lymphocytic thyroiditis (PTC-LT) and conventional papillary thyroid carcinoma without lymphocytic thyroiditis (PTC) regarding infiltrating inflammatory cells and their distribution. Preoperative diagnosis or potential for WLV-PTC will be helpful for surgeons to decide the scope of operation. Of the 8,179 patients treated for papillary thyroid carcinoma between January 2007 and December 2012, 16 patients (0.2%) were pathologically confirmed as WLV-PTC and four cases were available for cytologic review. For comparison, we randomly selected six PTC-LT cases and five PTC cases during the same period. The number of intratumoral and background lymphocytes, histiocytes, neutrophils, and the presence of giant cells were evaluated and compared using conventional smear and ThinPrep preparations. WLV-PTC showed extensive lymphocytic smear with incorporation of thyroid follicular tumor cell clusters and frequent histiocytes. WLV-PTC was associated with higher intratumoral and background lymphocytes and histiocytes compared with PTC-LT or PTC. The difference was more distinct in liquid-based cytology. The lymphocytic smear pattern and the number of inflammatory cells of WLV-PTC are different from those of PTC-LT or PTC and will be helpful for the differential diagnosis of WLV-PTC in preoperative FNA.

  9. Warthin tumor-like papillary thyroid carcinoma with a minor dedifferentiated component: report of a case with clinicopathologic considerations.

    PubMed

    Amico, Paolo; Lanzafame, Salvatore; Li Destri, Giovanni; Greco, Paolo; Caltabiano, Rosario; Vecchio, Giada Maria; Magro, Gaetano

    2010-01-01

    Warthin tumor-like papillary thyroid carcinoma is an uncommon variant of papillary thyroid carcinoma. We report a rare case of Warthin tumor-like variant of papillary thyroid carcinoma with a dedifferentiated component consisting of a solid tumor area composed of neoplastic cells with a spindle to tall cell morphology associated with marked nuclear pleomorphism, atypical mitoses, and foci of necrosis. Although our patient presented with a locally aggressive disease (T3 N1b Mo), she is disease-free without radioiodine therapy after a 23-month follow-up period. We emphasize that Warthin tumor-like papillary thyroid carcinoma, like other morphological variants of papillary carcinoma, may occasionally undergo dedifferentiation. As this component may be only focally detectable, we suggest an extensive sampling of all large-sized (>3 cm) papillary thyroid carcinoma. Recognition of any dedifferentiated component in a Warthin tumor-like papillary thyroid carcinoma should be reported, including its percentage, because it may reflect a more aggressive clinical course.

  10. Warthin Tumor-Like Papillary Thyroid Carcinoma with a Minor Dedifferentiated Component: Report of a Case with Clinicopathologic Considerations

    PubMed Central

    Amico, Paolo; Lanzafame, Salvatore; Li Destri, Giovanni; Greco, Paolo; Caltabiano, Rosario; Vecchio, Giada Maria; Magro, Gaetano

    2010-01-01

    Warthin tumor-like papillary thyroid carcinoma is an uncommon variant of papillary thyroid carcinoma. We report a rare case of Warthin tumor-like variant of papillary thyroid carcinoma with a dedifferentiated component consisting of a solid tumor area composed of neoplastic cells with a spindle to tall cell morphology associated with marked nuclear pleomorphism, atypical mitoses, and foci of necrosis. Although our patient presented with a locally aggressive disease (T3 N1b Mo), she is disease-free without radioiodine therapy after a 23-month follow-up period. We emphasize that Warthin tumor-like papillary thyroid carcinoma, like other morphological variants of papillary carcinoma, may occasionally undergo dedifferentiation. As this component may be only focally detectable, we suggest an extensive sampling of all large-sized (>3 cm) papillary thyroid carcinoma. Recognition of any dedifferentiated component in a Warthin tumor-like papillary thyroid carcinoma should be reported, including its percentage, because it may reflect a more aggressive clinical course. PMID:20593036

  11. Early Cosmic Ray Research with Balloons

    NASA Astrophysics Data System (ADS)

    Walter, Michael

    2013-06-01

    The discovery of cosmic rays by Victor Hess during a balloon flight in 1912 at an altitude of 5350 m would not have been possible without the more than one hundred years development of scientific ballooning. The discovery of hot air and hydrogen balloons and their first flights in Europe is shortly described. Scientific ballooning was mainly connected with activities of meteorologists. It was also the geologist and meteorologist Franz Linke, who probably observed first indications of a penetrating radiation whose intensity seemed to increase with the altitude. Karl Bergwitz and Albert Gockel were the first physicists studying the penetrating radiation during balloon flights. The main part of the article deals with the discovery of the extraterrestrial radiation by V. Hess and the confirmation by Werner Kolhörster.

  12. Current recommendations for surveillance and surgery of intraductal papillary mucinous neoplasms may overlook some patients with cancer.

    PubMed

    Nguyen, Andrew H; Toste, Paul A; Farrell, James J; Clerkin, Barbara M; Williams, Jennifer; Muthusamy, V Raman; Watson, Rabindra R; Tomlinson, James S; Hines, O Joe; Reber, Howard A; Donahue, Timothy R

    2015-02-01

    The 2012 Sendai Criteria recommend that patients with 3 cm or larger branch duct intraductal papillary mucinous neoplasms (BD-IPMN) without any additional "worrisome features" or "high-risk stigmata" may undergo close observation. Furthermore, endoscopic ultrasound (EUS) is not recommended for BD-IPMN <2 cm. These changes have generated concern among physicians treating patients with pancreatic diseases. The purposes of this study were to (i) apply the new Sendai guidelines to our institution's surgically resected BD-IPMN and (ii) reevaluate cyst size cutoffs in identifying patients with lesions harboring high-grade dysplasia or invasive cancer. We retrospectively reviewed 150 patients at a university medical center with preoperatively diagnosed and pathologically confirmed IPMNs. Sixty-six patients had BD-IPMN. Pathologic grade was dichotomized into low-grade (low or intermediate grade dysplasia) or high-grade/invasive (high-grade dysplasia or invasive cancers). Fisher's exact test, chi-square test, student's t test, linear regression, and receiver operating characteristic (ROC) analyses were performed. The median BD-IPMN size on imaging was 2.4 cm (interquartile range 1.5-3.0). Fifty-one (77 %) low-grade and 15 (23 %) high-grade/invasive BD-IPMN were identified. ROC analysis demonstrated that cyst size on preoperative imaging is a reasonable predictor of grade with an area under the curve of 0.691. Two-thirds of high-grade/invasive BD-IPMN were <3 cm (n = 10). Compared to a cutoff of 3, 2 cm was associated with higher sensitivity (73.3 vs. 33.3 %) and negative predictive value (83.3 vs. 80 %, NPV) for high-grade/invasive BD-IPMN. Mural nodules on endoscopic ultrasound (EUS) or atypical cells on endoscopic ultrasound-fine needle aspiration (EUS-FNA) were identified in all cysts <2 and only 50 % of those <3 cm. Forty percent of cysts >3 cm were removed based on size alone. Our results suggest that "larger" size on noninvasive imaging can indicate high

  13. History and perspectives of scientific ballooning

    NASA Astrophysics Data System (ADS)

    Lefevre, Frank

    2001-08-01

    Prehistory: Robertson, Biot and Gay-Lussac; Glaisher and the first studies of the atmosphere; Flammarion. The rebirth of scientific ballooning: polyethylene and mylar vehicles at Minneapolis. Super-pressurized balloons. The CNES and the Nasa programs; meteorology, aeronomy and astronomy, The Eole program. The Venus and Mars balloons in the French-Soviet space program. The future.

  14. Decitabine in Treating Patients With Metastatic Papillary Thyroid Cancer or Follicular Thyroid Cancer Unresponsive to Iodine I 131

    ClinicalTrials.gov

    2014-08-20

    Recurrent Thyroid Cancer; Stage IVA Follicular Thyroid Cancer; Stage IVA Papillary Thyroid Cancer; Stage IVB Follicular Thyroid Cancer; Stage IVB Papillary Thyroid Cancer; Stage IVC Follicular Thyroid Cancer; Stage IVC Papillary Thyroid Cancer

  15. Histopathology of balloon-dilation Eustachian tuboplasty.

    PubMed

    Kivekäs, Ilkka; Chao, Wei-Chieh; Faquin, William; Hollowell, Monica; Silvola, Juha; Rasooly, Tali; Poe, Dennis

    2015-02-01

    Surgical intervention of the Eustachian tube (ET) has become increasingly common in the past decade, and balloon dilation has shown promising results in recent studies. It is unclear how balloon dilation enhances ET function. Our aim was to evaluate histological changes in the ET's mucosal lumen comparing before balloon dilation, immediately after, and postoperatively. Case series. Thirteen patients with bilateral ET dysfunction were enrolled. Biopsies of the ET mucosa were obtained just before balloon dilation; immediately after; and in three cases, 5 to 12 weeks postoperatively. Specimens were retrospectively examined under light microscopy by two pathologists blinded to the clinical information and whether specimens were pre- or postballoon dilation. Preoperative biopsies were characterized by inflammatory changes within the epithelium and submucosal layer. Immediate response to balloon dilation was thinning of the mucosa, shearing of epithelium and crush injury to the submucosa, especially to lymphocytic infiltrates. Postoperative biopsies demonstrated healthy pseudocolumnar epithelium and replacement of lymphocytic infiltrate with a thinner layer of fibrous tissue. Reduction of inflammatory epithelial changes and submucosal inflammatory infiltrate appeared to be the principal result of balloon dilation. The balloon may shear or crush portions of inflamed epithelium but usually spared the basal layer, allowing for rapid healing. Additionally, it appeared to effectively crush lymphocytes and lymphocytic follicles that may become replaced with thinner fibrous scar. Histopathology of the ET undergoing balloon dilation demonstrated effects that could reduce the overall inflammatory burden and may contribute to clinical improvement in ET function. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  16. Association of human papilloma virus with atypical and malignant oral papillary lesions.

    PubMed

    McCord, Christina; Xu, Jing; Xu, Wei; Qiu, Xin; Muhanna, Nidal; Irish, Jonathan; Leong, Iona; McComb, Richard John; Perez-Ordonez, Bayardo; Bradley, Grace

    2014-06-01

    This study aimed to examine atypical and malignant papillary oral lesions for low- and high-risk human papillomavirus (HPV) infection and to correlate HPV infection with clinical and pathologic features. Sections of 28 atypical papillary lesions (APLs) and 14 malignant papillary lesions (MPLs) were examined for HPV by in situ hybridization and for p16 and MIB-1 by immunohistochemistry; 24 conventional papillomas were studied for comparison. Low-risk HPV was found in 10 of 66 cases, including 9 APLs and 1 papilloma. All low-risk HPV-positive cases showed suprabasilar MIB-1 staining, and the agreement was statistically significant (P < .0001). Diffuse p16 staining combined with high-risk HPV was not seen in any of the cases. A subset of HPV(-) APLs progressed to carcinoma. Oral papillary lesions are a heterogeneous group. Low-risk HPV infection is associated with a subset of APLs with a benign clinical course. Potentially malignant APLs and MPLs are not associated with low- or high-risk HPV. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Effect of intra-aortic balloon pump on coronary blood flow during different balloon cycles support: A computer study.

    PubMed

    Aye, Thin Pa Pa; Htet, Zwe Lin; Singhavilai, Thamvarit; Naiyanetr, Phornphop

    2015-01-01

    Intra-aortic balloon pump (IABP) has been used in clinical treatment as a mechanical circulatory support device for patients with heart failure. A computer model is used to study the effect on coronary blood flow (CBF) with different balloon cycles under both normal and pathological conditions. The model of cardiovascular and IABP is developed by using MATLAB SIMULINK. The effect on coronary blood flow has been studied under both normal and pathological conditions using different balloon cycles (balloon off; 1:4; 1:2; 1:1). A pathological heart is implemented by reducing the left ventricular contractility. The result of this study shows that the rate of balloon cycles is related to the level of coronary blood flow.

  18. Flexible endoscopes: structure and function: the endoscopic retrograde cholangiopancreatography elevator system.

    PubMed

    Holland, Pat; Shoop, Nancy M

    2002-01-01

    Flexible endoscopes are complex medical instruments that are easily damaged. In order to maintain the flexible endoscope in optimum working condition, the user must have a thorough understanding of the structure and function of the instrument. This is the fourth in a series of articles presenting an in-depth look at the care and handling of the flexible endoscope. The first three articles discussed the air-water system, the suction channel system, and the mechanical system. This article will focus specifically on the endoscopic retrograde cholangiopancreatography elevator system.

  19. Simple and complex hyperplastic papillary proliferations of the endometrium: a clinicopathologic study of nine cases of apparently localized papillary lesions with fibrovascular stromal cores and epithelial metaplasia.

    PubMed

    Lehman, M B; Hart, W R

    2001-11-01

    The clinicopathologic features of nine cases of papillary proliferation of the endometrium devoid of malignant nuclear features were studied. The patients ranged in age from 33 to 71 years (median 57 years). All were postmenopausal, except the youngest. The most common symptom was postmenopausal bleeding. Two patients were receiving hormonal replacement therapy and two were taking megestrol acetate. Two lesions were incidental findings in a hysterectomy specimen. Seven were diagnosed in endometrial biopsy or curettage specimens. In six cases (67%) the lesion involved an endometrial polyp. In all cases the papillae had fibrovascular stromal cores and variable degrees of branching. Two architectural patterns were found. A simple papillary pattern with involvement of only a few glands and little epithelial proliferation occurred in five cases, including three that were entirely intracystic. A complex papillary pattern with more extensive involvement of endometrial glands, a greater degree of branching of the papillae, and cellular tufting occurred in four cases. One or more metaplastic epithelial changes occurred in all cases, including endocervical-type mucinous metaplasia in nine cases (90%), eosinophilic cell change in eight (89%), ciliated cell change in seven (70%), focal squamous metaplasia in two cases (22%), and hobnail cell change in two (22%). Mitotic figures were found in three cases. In four lesions (44%), all with a complex papillary pattern, the proliferating cells had mild nuclear atypia. Three of these patients underwent hysterectomy within 5 months. Simple nonpapillary hyperplasia and two endometrial polyps were found in one patient, complex nonpapillary hyperplasia in one, and atrophic endometrium in the other. Two patients had additional endometrial samplings within 4 months that contained small residual simple papillary lesions. One of these had another biopsy at 16 months that showed only atrophy. One patient had no subsequent diagnostic or

  20. Endoscopic diagnosis of extrahepatic bile duct carcinoma: Advances and current limitations

    PubMed Central

    Tamada, Kiichi; Ushio, Jun; Sugano, Kentaro

    2011-01-01

    The accurate diagnosis of extrahepatic bile duct carcinoma is difficult, even now. When ultrasonography (US) shows dilatation of the bile duct, magnetic resonance cholangiopancreatography followed by endoscopic US (EUS) is the next step. When US or EUS shows localized bile duct wall thickening, endoscopic retrograde cholangiopancreatography should be conducted with intraductal US (IDUS) and forceps biopsy. Fluorescence in situ hybridization increases the sensitivity of brush cytology with similar specificity. In patients with papillary type bile duct carcinoma, three biopsies are sufficient. In patients with nodular or infiltrating-type bile duct carcinoma, multiple biopsies are warranted, and IDUS can compensate for the limitations of biopsies. In preoperative staging, the combination of dynamic multi-detector low computed tomography (MDCT) and IDUS is useful for evaluating vascular invasion and cancer depth infiltration. However, assessment of lymph nodes metastases is difficult. In resectable cases, assessment of longitudinal cancer spread is important. The combination of IDUS and MDCT is useful for revealing submucosal cancer extension, which is common in hilar cholangiocarcinoma. To estimate the mucosal extension, which is common in extrahepatic bile duct carcinoma, the combination of IDUS and cholangioscopy is required. The utility of current peroral cholangioscopy is limited by the maneuverability of the “baby scope”. A new baby scope (10 Fr), called “SpyGlass” has potential, if the image quality can be improved. Since extrahepatic bile duct carcinoma is common in the Far East, many researchers in Japan and Korea contributed these studies, especially, in the evaluation of longitudinal cancer extension. PMID:21611097

  1. NASA balloon design and flight - Philosophy and criteria

    NASA Technical Reports Server (NTRS)

    Smith, I. S., Jr.

    1993-01-01

    The NASA philosophy and criteria for the design and flight of scientific balloons are set forth and discussed. The thickness of balloon films is standardized at 20.3 microns to isolate potential film problems, and design equations are given for specific balloon parameters. Expressions are given for: flight-stress index, total required thickness, cap length, load-tape rating, and venting-duct area. The balloon design criteria were used in the design of scientific balloons under NASA auspices since 1986, and the resulting designs are shown to be 95 percent effective. These results represent a significant increase in the effectiveness of the balloons and therefore indicate that the design criteria are valuable. The criteria are applicable to four balloon volume classes in combination with seven payload ranges.

  2. Long-Duration Altitude-Controlled Balloons for Venus: A Feasibility Study Informed by Balloon Flights in Remote Environments on Earth

    NASA Astrophysics Data System (ADS)

    Voss, P. B.; Nott, J.; Cutts, J. A.; Hall, J. L.; Beauchamp, P. M.; Limaye, S. S.; Baines, K. H.; Hole, L. R.

    2013-12-01

    In situ exploration of the upper atmosphere of Venus, approximately 65-77 km altitude, could answer many important questions (Limaye 2013, Crisp 2013). This region contains a time-variable UV absorber of unknown composition that controls many aspects of the heat balance on Venus. Understanding the composition and dynamics of this unknown absorber is an important science goal; in situ optical and chemical measurements are needed. However, conventional approaches do not provide access to this altitude range, repeated traverses, and a mission lifetime of several months needed to effectively carry out the science. This paper examines concepts for altitude-controlled balloons not previously flown on planetary missions that could potentially provide the desired measurements. The concepts take advantage of the fact that at 60 km altitude, for example, the atmospheric density on Venus is about 40% of the sea-level density on earth and the temperature is a moderate 230 K. The solar flux is approximately double that on earth, creating some thermal challenges, but making photovoltaic power highly effective. Using a steady-state thermodynamic model and flight data from Earth, we evaluate the suitability of two types of altitude-controlled balloons for a potential mission on Venus. Such balloons could repeatedly measure profiles, avoid diurnal temperature extremes, and navigate using wind shear. The first balloon design uses air ballast (AB) whereby ambient air can be compressed into or released from a constant-volume balloon, causing it to descend or ascend accordingly. The second design uses lift-gas compression (LGC) to change the volume of a zero-pressure balloon, thereby changing its effective density and altitude. For an altitude range of 60-75 km on Venus, we find that the superpressure volume for a LGC balloon is about 5% of that needed for an AB balloon while the maximum pressurization is the same for both systems. The compressor work per km descent of the LGC balloon

  3. Robot-assisted endoscope guidance versus manual endoscope guidance in functional endonasal sinus surgery (FESS).

    PubMed

    Eichhorn, Klaus Wolfgang; Westphal, Ralf; Rilk, Markus; Last, Carsten; Bootz, Friedrich; Wahl, Friedrich; Jakob, Mark; Send, Thorsten

    2017-10-01

    Having one hand occupied with the endoscope is the major disadvantage for the surgeon when it comes to functional endoscopic sinus surgery (FESS). Only the other hand is free to use the surgical instruments. Tiredness or frequent instrument changes can thus lead to shaky endoscopic images. We collected the pose data (position and orientation) of the rigid 0° endoscope and all the instruments used in 16 FESS procedures with manual endoscope guidance as well as robot-assisted endoscope guidance. In combination with the DICOM CT data, we tracked the endoscope poses and workspaces using self-developed tracking markers. All surgeries were performed once with the robot and once with the surgeon holding the endoscope. Looking at the durations required, we observed a decrease in the operating time because one surgeon doing all the procedures and so a learning curve occurred what we expected. The visual inspection of the specimens showed no damages to any of the structures outside the paranasal sinuses. Robot-assisted endoscope guidance in sinus surgery is possible. Further CT data, however, are desirable for the surgical analysis of a tracker-based navigation within the anatomic borders. Our marker-based tracking of the endoscope as well as the instruments makes an automated endoscope guidance feasible. On the subjective side, we see that RASS brings a relief for the surgeon.

  4. The Obalon swallowable intragastric balloon in pediatric and adolescent morbid obesity

    PubMed Central

    De Peppo, Francesco; Caccamo, Romina; Adorisio, Ottavio; Ceriati, Emanuela; Marchetti, Paola; Contursi, Antonio; Alterio, Arianna; Della Corte, Claudia; Manco, Malnia; Nobili, Valerio

    2017-01-01

    Background and study aims Incidence of morbid obesity has grown dramatically in the last half century and this phenomenon affects with particular severity the pediatric population. Dietary restrictions and careful programs to improve lifestyle are often ineffective to manage this particular group of patients, due to poor compliance typical of the adolescence. The aim of this study was to evaluate the effectiveness of a new intragastric balloon for treatment of morbidly obese children. Patients and methods A new swallowable intragastric balloon (Obalon) has been used for the first time in 17 obese children in order to assess its safety and effectiveness in terms of reduction in excess weight. In 9 of 17 children a second balloon was placed 30 to 40 days after the first insertion. All devices were endoscopically removed after a mean time of 18 weeks. Results In the group of 16 patients who completed the study (1 patient still under treatment) mean weight decreased from 95.8 ± 18.4 Kg to 83.6 ± 27.1 (P < 0.05). Mean body mass index (BMI) decreased from 35.27± 5.89 (range 30.4 – 48) to 32.25 ± 7.1 (range 23.5 – 45.7) (P > 0.05); mean excess weight, calculated according to Cole’s curves for pediatric populations, decreased from 36.2 ± 15.9 to 29.4 ± 18.3 Kg (P = 0.14), with an %EWL of 20.1 ± 9.8 (range 2.3 – 35.1). Waist circumference decreased from 109 ± 12.3 cm to 99 ± 10.5 cm (P < 0.05). Conclusions Obalon can be administered easily without complications, inducing an appreciable weight loss with a statistically significant reduction in BMI and an improvement in associated comorbidities. PMID:28180149

  5. Intraductal papillary neoplasm of the bile duct: a case report.

    PubMed

    Peeters, Karen; Delvaux, Peter; Huysentruyt, Frederik

    2017-08-01

    Intraductal papillary neoplasm of the bile duct (IPNB) is a rare variant of bile duct tumors, characterized by papillary growth within the bile duct lumen and is regarded as a biliary counterpart of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. IPNBs are mainly found in patients from Far Eastern areas, where hepatolithiasis and clonorchiasis are endemic. The Western experience, however, remains limited. In this article, we report a 56-year-old man, referred to our hospital because of deranged liver function tests. Further imaging modalities showed a cystic lesion of 9 cm diameter, arising from the left hepatic duct. Inlying was a heterogeneous, lobulated mass. The patient underwent a left hemihepatectomy and adjuvant chemotherapy. Despite recent advanced technologies, diagnosis of IPNB is still challenging, especially in western countries due to its rarity. Early identification and resection of lesions, even in asymptomatic or minimally symptomatic patients, are however important prognostic factors.

  6. Power supplies for long duration balloon flights

    NASA Astrophysics Data System (ADS)

    Lichfield, Ernest W.

    Long duration balloon flights require more electrical power than can be carried in primary batteries. This paper provides design information for selecting rechargeable batteries and charging systems. Solar panels for recharging batteries are discussed, with particular emphasis on cells mounting suitable for balloon flights and panel orientation for maximum power collection. Since efficient utilization of power is so important, modern DC to DC power conversion techniques are presented. On short flights of 1 day or less, system designers have not been greatly concerned with battery weight. But, with the advent of long duration balloon flights using superpressure balloons, anchor balloon systems, and RACOON balloon techniques, power supplies and their weight become of prime importance. The criteria for evaluating power systems for long duration balloon flights is performance per unit weight. Instrumented balloon systems have flown 44 days. For these very long duration flights, batteries recharged from solar cells are the only solution. For intermediate flight duration, say less than 10 days, the system designer should seriously consider using primary cells. The National Center for Atmospheric Research is sponsored by the National Science Foundation. Any opinions, findings and conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the National Science Foundation.

  7. Gondola development for CNES stratospheric balloons

    NASA Astrophysics Data System (ADS)

    Vargas, A.; Audoubert, J.; Cau, M.; Evrard, J.; Verdier, N.

    The CNES has been supporting scientific ballooning since its establishment in 1962. The two main parts of the balloon system or aerostat are the balloon itself and the flight train, comprising the house-keeping gondola, for the control of balloon flight (localization and operational telemetry & telecommand - TM/TC), and the scientific gondola with its dedicated telecommunication system. For zero pressure balloon, the development of new TM/TC system for the housekeeping and science data transmission are going on from 1999. The main concepts are : - for balloon house-keeping and low rate scientific telemetry, the ELITE system, which is based on single I2C bus standardizing communication between the different components of the system : trajectography, balloon control, power supply, scientific TM/TC, .... In this concept, Radio Frequency links are developed between the house keeping gondola and the components of the aerostat (balloon valve, ballast machine, balloon gas temperature measurements, ...). The main objectives are to simplify the flight train preparation in term of gondola testing before flight, and also by reducing the number of long electrical cables integrated in the balloon and the flight train; - for high rate scientific telemetry, the use of functional interconnection Internet Protocol (IP) in interface with the Radio Frequency link. The main idea is to use off-the-shelf IP hardware products (routers, industrial PC, ...) and IP software (Telnet, FTP, Web-HTTP, ...) to reduce the development costs; - for safety increase, the adding, in the flight train, of a totally independent house keeping gondola based on the satellite Inmarsat M and Iridium telecommunication systems, which permits to get real time communications between the on-board data mobile and the ground station, reduced to a PC computer with modem connected to the phone network. These GEO and LEO telecommunication systems give also the capability to operate balloon flights over longer distance

  8. The application of dermal papillary rings in dermatology by in vivo confocal laser scanning microscopy

    NASA Astrophysics Data System (ADS)

    Xiang, W. Z.; Xu, A. E.; Xu, J.; Bi, Z. G.; Shang, Y. B.; Ren, Q. S.

    2010-08-01

    Confocal laser scanning microscopy (CLSM) allows noninvasive visualization of human skin in vivo, without needing to fix or section the tissue. Melanocytes and pigmented keratinocytes at the level of the basal layer form bright dermal papillary rings which are readily amenable to identify in confocal images. Our purpose was to explore the role of dermal papillary rings in assessment of lesion location, the diagnosis, differential diagnosis of lesions and assessment of therapeutic efficacy by in vivo CLSM. Seventy-one patients were imaged with the VivaScope 1500 reflectance confocal microscope provided by Lucid, Inc. The results indicate that dermal papillary rings can assess the location of lesion; the application of dermal papillary rings can provide diagnostic support and differential diagnosis for vitiligo, nevus depigmentosus, tinea versicolor, halo nevus, common nevi, and assess the therapeutic efficacy of NBUVB phototherapy plus topical 0.1 percent tacrolimus ointment for vitiligo. In conclusion, our findings indicate that the dermal papillary rings play an important role in the assessment the location of lesion, diagnosis, differential diagnosis of lesions and assessment of therapeutic efficacy by in vivo CLSM. CLSM may be a promising tool for noninvasive examination in dermatology. However, larger studies are needed to expand the application of dermal papillary rings in dermatology.

  9. The Clinical Accuracy of Endoscopic Ultrasonography and White Light Imaging in Gastric Endoscopic Submucosal Dissection

    PubMed Central

    Park, Soon Hong; Sung, Sang Hun; Lee, Seung Jun; Jung, Min Kyu; Kim, Sung Kook

    2012-01-01

    Purpose Gastric mucosal neoplastic lesions should have characteristic endoscopic features for successful endoscopic submucosal dissection. Materials and Methods Out of the 1,010 endoscopic submucosal dissection, we enrolled 62 patients that had the procedure cancelled. Retrospectively, whether the reasons for cancelling the endoscopic submucosal dissection were consistent with the indications for an endoscopic submucosal dissection were assessed by analyzing the clinical outcomes of the patients that had the surgery. Results The cases were divided into two groups; the under-diagnosed group (30 cases; unable to perform an endoscopic submucosal dissection) and the over-diagnosed group (32 cases; unnecessary to perform an endoscopic submucosal dissection), according to the second endoscopic findings, compared with the index conventional white light image. There were six cases in the under-diagnosed group with advanced gastric cancer on the second conventional white light image endoscopy, 17 cases with submucosal invasion on endoscopic ultrasonography findings, 5 cases with a size greater than 3 cm and ulcer, 1 case with diffuse infiltrative endoscopic features, and 1 case with lymph node involvement on computed tomography. A total of 25 patients underwent a gastrectomy to remove a gastric adenocarcinoma. The overall accuracy of the decision to cancel the endoscopic submucosal dissection was 40% (10/25) in the subgroup that had the surgery. Conclusions The accuracy of the decision to cancel the endoscopic submucosal dissection, after conventional white light image and endoscopic ultrasonography, was low in this study. Other diagnostic options are needed to arrive at an accurate decision on whether to perform a gastric endoscopic submucosal dissection. PMID:22792522

  10. Ileal polypoid lymphangiectasia bleeding diagnosed and treated by double balloon enteroscopy

    PubMed Central

    Park, Min Seon; Lee, Beom Jae; Gu, Dae Hoe; Pyo, Jeung-Hui; Kim, Kyeong Jin; Lee, Yun Ho; Joo, Moon Kyung; Park, Jong-Jae; Kim, Jae Seon; Bak, Young-Tae

    2013-01-01

    Intestinal lymphangiectasia is a rare disease characterized by focal or diffuse dilated enteric lymphatics with impaired lymph drainage. It causes protein-losing enteropathy and may lead to gastrointestinal bleeding. Commonly, lymphangiectasia presents as whitish spots or specks. To our knowledge, small bowel bleeding resulting from polypoid intestinal lymphangiectasia has not been reported. Here, we report a rare case of active bleeding from the small bowel caused by polypoid lymphangiectasia with a review of the relevant literature. An 80-year-old woman was hospitalized for melena. Esophagogastroduodenoscopy could not identify the source of bleeding. Subsequent colonoscopy showed fresh bloody material gushing from the small bowel. An abdominal-pelvic contrast-enhanced computed tomography scan did not reveal any abnormal findings. Video capsule endoscopy showed evidence of active and recent bleeding in the ileum. To localize the bleeding site, we performed double balloon enteroscopy by the anal approach. A small, bleeding, polypoid lesion was found in the distal ileum and was successfully removed using endoscopic snare electrocautery. PMID:24363538

  11. Endoscopic injection therapy.

    PubMed

    Kim, Sang Woon; Lee, Yong Seung; Han, Sang Won

    2017-06-01

    Since the U.S. Food and Drug Administration approved dextranomer/hyaluronic acid copolymer (Deflux) for the treatment of vesicoureteral reflux, endoscopic injection therapy using Deflux has become a popular alternative to open surgery and continuous antibiotic prophylaxis. Endoscopic correction with Deflux is minimally invasive, well tolerated, and provides cure rates approaching those of open surgery (i.e., approximately 80% in several studies). However, in recent years a less stringent approach to evaluating urinary tract infections (UTIs) and concerns about long-term efficacy and complications associated with endoscopic injection have limited the use of this therapy. In addition, there is little evidence supporting the efficacy of endoscopic injection therapy in preventing UTIs and vesicoureteral reflux-related renal scarring. In this report, we reviewed the current literature regarding endoscopic injection therapy and provided an updated overview of this topic.

  12. Cell division cycle 45 promotes papillary thyroid cancer progression via regulating cell cycle.

    PubMed

    Sun, Jing; Shi, Run; Zhao, Sha; Li, Xiaona; Lu, Shan; Bu, Hemei; Ma, Xianghua

    2017-05-01

    Cell division cycle 45 was reported to be overexpressed in some cancer-derived cell lines and was predicted to be a candidate oncogene in cervical cancer. However, the clinical and biological significance of cell division cycle 45 in papillary thyroid cancer has never been investigated. We determined the expression level and clinical significance of cell division cycle 45 using The Cancer Genome Atlas, quantitative real-time polymerase chain reaction, and immunohistochemistry. A great upregulation of cell division cycle 45 was observed in papillary thyroid cancer tissues compared with adjacent normal tissues. Furthermore, overexpression of cell division cycle 45 positively correlates with more advanced clinical characteristics. Silence of cell division cycle 45 suppressed proliferation of papillary thyroid cancer cells via G1-phase arrest and inducing apoptosis. The oncogenic activity of cell division cycle 45 was also confirmed in vivo. In conclusion, cell division cycle 45 may serve as a novel biomarker and a potential therapeutic target for papillary thyroid cancer.

  13. Determinants of papillary cancer of the thyroid

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wingren, G.; Hatschek, T.; Axelson, O.

    1993-10-01

    Determinants of papillary thyroid cancer were evaluated in a questionnaire-based case-control study from southeastern Sweden. A total of 104 cases, diagnosed from 1977 to 1987, and 387 randomly selected controls were included in the analyses. Female subjects with papillary cancer reported a work history as dentists/dental assistants, telephone operators, teachers, and day nursery personnel, and an occupational contact with chemicals and video display terminals more often than did controls. The 11 male cases more often reported working as mechanics and metal workers and having occupational contact with solvents. Other factors associated with increased risk for female papillary cancer were havingmore » private well water at the birth address; leisure time exposure to combustion smoke; low intake of cruciferous vegetables and seafood; and a family history of goiter, heart disease, biliary disorder, or female genital cancer. Diagnostic radiographic examinations, especially to the head, neck, or upper back/chest area, or repeated dental examinations, were also found to be associated with this form of cancer. With regard to the possible influence from hormonal factors among women less than age 50 years at time of diagnosis, an increased risk was found for a pregnancy soon after puberty. Tendencies toward a decreasing risk with increasing age at first pregnancy as well as an increasing risk with increasing number of pregnancies were found as well. Multiparity seemed to potentiate the effect from prior radiographic examinations.« less

  14. Clinical usefulness of single-balloon endoscopy in patients with previously incomplete colonoscopy

    PubMed Central

    Kobayashi, Kiyonori; Mukae, Miyuki; Ogawa, Taishi; Yokoyama, Kaoru; Sada, Miwa; Koizumi, Wasaburo

    2013-01-01

    AIM: To evaluate the clinical usefulness of single-balloon endoscopy (SBE) in patients in whom a colonoscope was technically difficult to insert previously. METHODS: The study group comprised 15 patients (8 men and 7 women) who underwent SBE for colonoscopy (30 sessions). The number of SBE sessions was 1 in 7 patients, 2 in 5 patients, 3 in 1 patient, 4 in 1 patient, and 6 in 1 patient. In all patients, total colonoscopy was previously unsuccessful. The reasons for difficulty in scope passage were an elongated colon in 6 patients, severe intestinal adhesions after open surgery in 4, an elongated colon and severe intestinal adhesions in 2, a left inguinal hernia in 2, and multiple diverticulosis of the sigmoid colon in 1. Three endoscopists were responsible for SBE. The technique for inserting SBE in the colon was basically similar to that in the small intestine. The effectiveness of SBE was assessed on the basis of the success rate of total colonoscopy and the presence or absence of complications. We also evaluated the diagnostic and treatment outcomes of colonoscopic examinations with SBE. RESULTS: Total colonoscopy was successfully accomplished in all sessions. The mean insertion time to the cecum was 22.9 ± 8.9 min (range 9 to 40). Abnormalities were found during 21 sessions of SBE. The most common abnormality was colorectal polyps (20 sessions), followed by radiation colitis (3 sessions) and diverticular disease of the colon (3 sessions). Colorectal polyps were resected endoscopically in 15 sessions. A total of 42 polyps were resected endoscopically, using snare polypectomy in 32 lesions, hot biopsy in 7 lesions, and endoscopic mucosal resection in 3 lesions. Fifty-six colorectal polyps were newly diagnosed on colonoscopic examination with SBE. Histopathologically, these lesions included 2 intramucosal cancers, 42 tubular adenomas, and 2 tubulovillous adenomas. The mean examination time was 48.2 ± 20.0 min (range 25 to 90). Colonoscopic examination or

  15. Endovascular balloon-assisted embolization of intracranial and cervical arteriovenous malformations using dual-lumen coaxial balloon microcatheters and Onyx: initial experience.

    PubMed

    Jagadeesan, Bharathi D; Grigoryan, Mikayel; Hassan, Ameer E; Grande, Andrew W; Tummala, Ramachandra P

    2013-12-01

    Ethylene vinyl alcohol copolymer (Onyx) is widely used for the embolization of arteriovenous malformations (AVMs) of the brain, head, and neck. Balloon-assisted Onyx embolization may provide additional unique advantages in the treatment of AVMs in comparison with traditional catheter-based techniques. To report our initial experience in performing balloon-assisted AVM embolization for brain and neck AVMs with the use of the new Scepter-C and Scepter-XC coaxial dual-lumen balloon microcatheters. Balloon-assisted transarterial embolization was performed in a series of 7 patients with AVMs (4 with brain AVMs, 1 with a dural arteriovenous fistula, and 2 with neck AVMs) by using Onyx delivered through the lumen of Scepter-C or Scepter XC coaxial balloon microcatheters. Following the initial balloon-catheter navigation into a feeding artery and the subsequent inflation of the balloon, the embolization was performed by using Onyx 18, Onyx 34, or both. A total of 12 embolization sessions were performed via 17 arterial feeders in these 7 patients. In 1 patient, there was an arterial perforation from the inflation of the balloon; in all others, the embolization goals were successfully achieved with no adverse events. The balloon microcatheters showed excellent navigability, and there were no problems with retrieval or with the repeated inflation and deflation of the balloons. A proximal Onyx plug, which is crucial in many AVM embolizations, was not necessary with this technique. Additionally, fluoroscopy and procedural times seemed lower with this technique compared with conventional embolization methods.

  16. Therapeutic peroral direct cholangioscopy using a single balloon enteroscope in patients with Roux-en-Y anastomosis (with videos).

    PubMed

    Yamauchi, Hiroshi; Kida, Mitsuhiro; Okuwaki, Kosuke; Miyazawa, Shiro; Matsumoto, Takaaki; Uehara, Kazuho; Miyata, Eiji; Hasegawa, Rikiya; Kaneko, Toru; Laopeamthong, Issaree; Lei, Yang; Iwai, Tomohisa; Imaizumi, Hiroshi; Koizumi, Wasaburo

    2018-01-01

    Peroral cholangioscopic lithotripsy is a useful procedure in patients with a normal gastrointestinal anatomy who have difficult-to-treat stones. We evaluated the usefulness of peroral direct cholangioscopy (PDCS) using single-balloon enteroscope (SBE) in patients with difficult-to-treat stones who had undergone Roux-en-Y reconstruction. Among 118 patients (169 sessions) who underwent SBE-assisted endoscopic retrograde cholangiopancreatography to treat biliary stones after Roux-en-Y reconstruction, patients in whom it was difficult to remove biliary stones via a transpapillary or transanastomotic approach and difficult to switch to ultra-slim endoscope, were retrospectively enrolled. The biliary insertion success rate, procedure success rate, procedure time, and procedural complications were assessed. The SBE was inserted into the bile-duct, first using a free-hand technique, second using a guide wire, and third using the large balloon anchoring and deflation (LBAD) technique. A total of 11 patients (14 sessions) were enrolled in this study. The biliary insertion success rate was 100%. Bile-duct insertion was performed using a free-hand technique in 4 sessions, a guide wire in 3 sessions (rendezvous technique, 2 sessions), and the LBAD technique in 7 sessions. The procedure success rate was 86% in first session, and 100% in second session. The median procedure time was 81 min (range 49-137). The median procedure time in the bile-duct was 21.5 min (range 6-60). Mild pancreatitis occurred as a complication in one patient. The median follow-up was 528 days (range 282-764). No patient had stone recurrence. PDCS using SBE is a useful procedure in patients with Roux-en-Y reconstruction. The LBAD technique is an useful technique of inserting SBE into the bile-duct.

  17. Preoperative Cytologic Diagnosis of Warthin-like Variant of Papillary Thyroid Carcinoma

    PubMed Central

    Kim, Jisup; Lim, Beom Jin; Hong, Soon Won; Pyo, Ju Yeon

    2018-01-01

    Background Warthin-like variant of papillary thyroid carcinoma (WLV-PTC) is a relatively rare variant of papillary thyroid carcinoma with favorable prognosis. However, preoperative diagnosis using fine-needle aspiration (FNA) specimens is challenging especially with lymphocytic thyroiditis characterized by Hürthle cells and lymphocytic background. To determine a helpful cytological differential point, we compared WLV-PTC FNA findings with conventional papillary thyroid carcinoma with lymphocytic thyroiditis (PTC-LT) and conventional papillary thyroid carcinoma without lymphocytic thyroiditis (PTC) regarding infiltrating inflammatory cells and their distribution. Preoperative diagnosis or potential for WLV-PTC will be helpful for surgeons to decide the scope of operation. Methods Of the 8,179 patients treated for papillary thyroid carcinoma between January 2007 and December 2012, 16 patients (0.2%) were pathologically confirmed as WLV-PTC and four cases were available for cytologic review. For comparison, we randomly selected six PTC-LT cases and five PTC cases during the same period. The number of intratumoral and background lymphocytes, histiocytes, neutrophils, and the presence of giant cells were evaluated and compared using conventional smear and ThinPrep preparations. Results WLV-PTC showed extensive lymphocytic smear with incorporation of thyroid follicular tumor cell clusters and frequent histiocytes. WLV-PTC was associated with higher intratumoral and background lymphocytes and histiocytes compared with PTC-LT or PTC. The difference was more distinct in liquid-based cytology. Conclusions The lymphocytic smear pattern and the number of inflammatory cells of WLV-PTC are different from those of PTC-LT or PTC and will be helpful for the differential diagnosis of WLV-PTC in preoperative FNA. PMID:29429327

  18. Are drug-coated balloons cost effective for femoropopliteal occlusive disease? A comparison of bare metal stents and uncoated balloons.

    PubMed

    Poder, Thomas G; Fisette, Jean-François

    2016-07-01

    To perform a cost-effectiveness analysis to help hospital decision-makers with regard to the use of drug-coated balloons compared with bare metal stents and uncoated balloons for femoropopliteal occlusive disease. Clinical outcomes were extracted from the results of meta-analyses already published, and cost units are those used in the Quebec healthcare network. The literature review was limited to the last four years to obtain the most recent data. The cost-effectiveness analysis was based on a 2-year perspective, and risk factors of reintervention were considered. The cost-effectiveness analysis indicated that drug-coated balloons were generally more efficient than bare metal stents, particularly for patients with higher risk of reintervention (up to CAD$1686 per patient TASC II C or D). Compared with uncoated balloons, results indicated that drug-coated balloons were more efficient if the reintervention rate associated with uncoated balloons is very high and for patients with higher risk of reintervention (up to CAD$3301 per patient). The higher a patient's risk of reintervention, the higher the savings associated with the use of a drug-coated balloon will be. For patients at lower risk, the uncoated balloon strategy is still recommended as a first choice for endovascular intervention.

  19. Management of obstructed balloon catheters.

    PubMed Central

    Browning, G G; Barr, L; Horsburgh, A G

    1984-01-01

    Failure of a balloon catheter to deflate is not uncommon and prevents its removal. Methods of overcoming the problem include traction, bursting the balloon by overinflation, dissolving it with solvents, puncturing it percutaneously with a needle, or puncturing it with a wire stylet passed through the catheter. All except the last technique have major disadvantages and are of questionable safety. Transcatheter puncture of the balloon was used in 16 patients to remove obstructed balloon catheters without any technical difficulty, distress to the patient, or complication. The procedure is safe, simple, and does not require an anaesthetic. If necessary it could be performed safely by nursing or paramedical staff without the patient having to be admitted to hospital. It is the method of choice for the management of this problem. Images FIG 1 FIG 2 FIG 3 FIG 4 PMID:6428691

  20. A Case of Solitary Well-Differentiated Papillary Mesothelioma with Invasive Foci in the Pleura.

    PubMed

    Shimizu, Shigeki; Yoon, Hyung-Eun; Ito, Norimasa; Tsuji, Taisuke; Funakoshi, Yasunobu; Utsumi, Tomoki; Sakaguchi, Masahiro; Tsujimura, Toru; Kasai, Takahiko; Hiroshima, Kenzo; Matsumura, Akihide

    2017-01-01

    Well-differentiated papillary mesothelioma (WDPM) is a rare, distinct tumor consisting of mesothelial cells with a papillary architecture, bland cytological features, and a tendency toward superficial spread without invasion. Rare cases with superficial invasion are termed WDPM with invasive foci. We report a case of solitary WDPM with invasive foci in the pleura. A 61-year-old woman presented with a lung adenocarcinoma. A small papillary lesion measuring 29 × 10 × 8 mm was incidentally found in the parietal pleura during a lobectomy for the lung adenocarcinoma. The fibrovascular core of the small papillary lesion was surrounded by a single layer of cuboidal cells with mild to moderate atypia and large nucleoli. Atypical mesothelial cells focally invaded the submesothelial layer. The cells of the papillary lesion were positive for cytokeratins and mesothelial markers. The Ki67 index was <1 %. The lesion did not show p16 loss on fluorescence in situ hybridization. We could not detect atypical mesothelial cells in the specimen from an extrapleural pneumonectomy. WDPM with invasive foci is prone to multifocality; however, our case represents a solitary case in the pleura. © 2016 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.

  1. Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention

    PubMed Central

    Nath, Anand; Yewale, Sayali; Tran, Tung; Brebbia, John S; Shope, Timothy R; Koch, Timothy R

    2016-01-01

    AIM To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG). METHODS VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage. RESULTS Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids. CONCLUSION Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients. PMID:28058017

  2. Balloon Ascent: 3-D Simulation Tool for the Ascent and Float of High-Altitude Balloons

    NASA Technical Reports Server (NTRS)

    Farley, Rodger E.

    2005-01-01

    The BalloonAscent balloon flight simulation code represents a from-scratch development using Visual Basic 5 as the software platform. The simulation code is a transient analysis of balloon flight, predicting the skin and gas temperatures along with the 3-D position and velocity in a time and spatially varying environment. There are manual and automated controls for gas valving and the dropping of ballast. Also, there are many handy calculators, such as appropriate free lift, and steady-state thermal solutions with temperature gradients. The strength of this simulation model over others in the past is that the infrared environment is deterministic rather than guessed at. The ground temperature is specified along with the emissivity, which creates a ground level IR environment that is then partially absorbed as it travels upward through the atmosphere to the altitude of the balloon.

  3. [Experimental mitral regurgitation in ischemia-induced papillary muscle dysfunction].

    PubMed

    Matsuzaki, M; Yonezawa, F; Toma, Y; Miura, T; Katayama, K; Fujii, T; Kohtoku, N; Otani, N; Ono, S; Tateno, S

    1988-01-01

    Mitral regurgitation (MR) reportedly develops by ischemia of the papillary muscles, which is called papillary muscle dysfunction. This report deals with the roles of papillary muscles and left ventricular walls on the pathogenesis of MR using graded injuries of these structures in 23 dogs. Implanted ultrasonic microcrystal and occluder with an electromagnetic flowmetry for the left circumflex coronary artery were the main experimental setting. Graded occlusion of the artery was done by the six-step approach regarding coronary blood flow (CBF) reduction (C1-C6). Left ventricular (LV) pressure, systolic thickening (%W: sonomicrometry) of the LV anterior (AW) and posterior walls (PW), and systolic longitudinal shortening (%S: sonomicrometry) of both the anterior and posterior papillary muscles (PPM) were measured. MR was assessed by left ventricular contrast two-dimensional echocardiography. In eight dogs, all the data were adequate for analysis. In category 3 (C3: 55-70% CBF of control), %S in PPM decreased, but %W did not change significantly, and only mild MR developed in three of the eight dogs. MR clearly developed in category 4 (C4: 40-54% CBF as compared with the control stage), where %S was replaced by holosystolic lengthening and %W reduced to 50% of the control state, and total occlusion (C6) accompanied by significant thinning of both the PW and AW. Thus, the asynergy of the LVPW was needed to induce the MR in seven of the eight dogs. It was concluded that the injury of the PPM alone is not sufficient to cause MR, and the associated ischemic changes of the LV free wall as well as LV dilatation are necessary to induce severe MR.

  4. [Cellular architecture of papillary and nonpapillary transitional cell carcinoma].

    PubMed

    Moriyama, M

    1989-07-01

    To characterize the cellular architecture of papillary and nonpapillary transitional cell carcinoma. 2 normal ureters, 6 papillary bladder cancers and 5 nonpapillary bladder cancers were subjected to light and electron microscopic study as well as three dimensional reconstruction by 0.5 microns thick serial sections. Normal urothelium consisted of three cell layers of the basal, intermediate and superficial cells, each of which was morphologically characterized in terms of cell shape and development of cell organelles. Over 90% of the epithelial cells were proved to be connected to the uniform basement membrane directly or with long, fine cytoplasmic processes, forming hemidesmosomes at the junctional portion. Papillary tumors had, as a rule, the same cellular architecture as that of normal epithelium in terms of the regularity of cellular polarity, arrangement and differentiation, and the connection to the basement membrane. But, in G2 tumors, the connection between the intermediate and superficial cells and the basement membrane failed to be confirmed in 7 to 44% of the cells, suggesting the heterogeneity of the tumors. In contrast, nonpapillary tumors showed a high irregularity of the cellular architecture in both lesions of stromal and intra-epithelial invasion. The development of the basement membrane was indefinite, often showing thinning or disruption where occasional cytoplasmic protrusion of the tumor cells into the lamina propria was found. Nearly all of the intermediate and superficial cells in the intraepithelial lesions proved not to communicate with the basement membrane. The present results indicate distinct differences of cellular architecture between the papillary and nonpapillary urothelial tumors, which may reflect not only the growth pattern but also the biological behaviour of the individual tumors.

  5. Enteroscopy

    MedlinePlus

    Small bowel biopsy; Push enteroscopy; Double-balloon enteroscopy; Capsule enteroscopy ... into the upper gastrointestinal tract. During a double-balloon enteroscopy, balloons attached to the endoscope can be ...

  6. The Role of the Papillary Epithelium in Stone Growth

    NASA Astrophysics Data System (ADS)

    Bergsland, Kristin J.

    2007-04-01

    The papillary surface epithelium (PSE) covers the renal papilla in mammalian kidneys and serves as a diffusion barrier between the urine on the apical surface and the interstitium on the basolateral surface. The PSE also plays a physiological role in transport of solutes between the urine and interstitium both by active transport and paracellular pathways. Permeability of the PSE may be affected by alterations in specific transporters, components of intercellular tight junctions, cell surface glycosaminoglycans and urine composition. In idiopathic calcium oxalate (CaOx) stone formers, apatite deposits known as Randall's plaque form in the papillary interstitium and lodge beneath the PSE. The presence of plaque may perturb the normal function of the PSE, possibly by provoking the up-regulation of pro-inflammatory cytokines such as TNFα in the interstitium. Disruption of the epithelial barrier may lead to increased permeability and exposure of the plaque matrix to urine constituents, followed by loss of the PSE and growth of CaOx stone over the plaque. To investigate the role of the PSE in stone development, new experimental systems are needed, including animal models of plaque formation as well as cell culture systems for papillary epithelial cells.

  7. Meeting the Challenge to Balloon Science

    NASA Astrophysics Data System (ADS)

    Jones, W. Vernon

    The promise of superpressure ballooning is helping the balloon program evolve toward a cost-effective means for frequent access to near-space. Superpressure balloons fabricated from strong, light-weight composite materials have the potential for increasing flight times of ton-class payloads to 100 days or more at altitudes above 5 mbars at essentially any geographic latitude. Although this new capability is still in an embryonic stage, its potential has already had an impact. Specifically, a new NASA Office of Space Science policy for University-class Explorer missions allows balloon investigations to compete on an equal basis with other low-cost missions requiring expendable launch vehicles. The new challenge for the science community is to design winning payloads that can be built within the cost cap of $13 M, including launch costs, and be developed within two to three years from selection to launch. Defining the international trajectories and getting the overflight agreements for balloon flights that make several circumnavigations of Earth will also be a challenge

  8. Application of “Papillary-Like Main Pancreatic Duct Invaginated” Pancreaticojejunostomy for Normal Soft Pancreas Cases

    PubMed Central

    Zhang, Bo; Xu, Jin; Liu, Chen; Long, Jiang; Liu, Liang; Xu, Yongfeng; Wu, Chuntao; Luo, Guopei; Ni, Quanxing; Li, Min; Yu, Xianjun

    2013-01-01

    Pancreaticojejunostomy is the key procedure of pancreaticoduodenectomy. Our study introduced a new pancreaticojejunal (PJ) anastomosis named “papillary-like main pancreatic duct invaginated” pancreaticojejunostomy. Nighty-two patients underwent pancreaticojejunostomy with either conventional duct-to-mucosa pancreaticojejunostomy or the new “papillary-like main pancreatic duct invaginated” techniques were analyzed retrospectively from January 2010 to September 2012. The incidence of pancreatic fistula was 15.7% (8/51) for the “papillary-like main pancreatic duct invaginated” group and 19.5% (8/41) for the duct-to-mucosa fashion respectively. It is noteworthy that the rate of grade B/C postoperative pancreatic fistula (POPF) in the “papillary-like main pancreatic duct invaginated” group was significantly lower than that of the duct-to-mucosa group (P = 0.039). There were no differences in the incidence of postoperative morbidity and mortality such as postoperative hemorrhage, delayed gastric emptying or remnant pancreatitis. The “papillary-like main pancreatic duct invaginated” pancreaticojejunostomy could provide a feasible option to pancreatic surgeons for patients with normal soft pancreas. PMID:23797701

  9. Double-balloon enteroscopy: Indications, approaches, diagnostic and therapeutic yield, and safety. Early experience at a single center.

    PubMed

    García-Correa, J J E; Ramírez-García, J J; García-Contreras, L F; Fuentes-Orozco, C; Irusteta-Jiménez, L; Michel-Espinoza, L R; Carballo Uribe, A S; Torres Chávez, J A; González-Ojeda, A

    Double-balloon enteroscopy has been improving the visualization of the entire intestine for more than a decade. It is a complementary method in the study of intestinal diseases that enables biopsies to be taken and treatments to be administered. Our aim was to describe its main indications, insertion routes, diagnostic/therapeutic yield, and complications. All patients referred to our unit with suspected small bowel pathology were included. The insertion route (oral/anal) was determined through diagnostic suspicion. The variables measured were: insertion route, small bowel examination extent, endoscopic diagnosis/treatment, biopsy/histopathology report, complications, and surgical findings. The study included 28 double-balloon enteroscopies performed on 23 patients, of which 10 were women and 13 were men (mean age of 52.95 years). The oral approach was the most widely used (n=21), the main indication was overt small bowel bleeding (n=16), and the general diagnostic yield was 65.21%. The therapeutic intervention rate was 39.1% and the procedure was effective in all the cases. The most widely used treatment was argon plasma therapy (n=7). The complication rate was 8.6%; one patient presented with low blood pressure due to active bleeding and another had deep mucosal laceration caused by the argon plasma. Double-balloon enteroscopy is a safe and efficacious method for the study and management of small bowel diseases, with an elevated diagnostic and therapeutic yield. Copyright © 2017 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  10. The French balloon and sounding rocket space program

    NASA Astrophysics Data System (ADS)

    Coutin/Faye, S.; Sadourny, I.

    1987-08-01

    Stratospheric and long duration flight balloon programs are outlined. Open stratospheric balloons up to 1 million cu m volume are used to carry astronomy, solar system, aeronomy, stratosphere, biology, space physics, and geophysics experiments. The long duration balloons can carry 50 kg payloads at 20 to 30 km altitude for 10 days to several weeks. Pressurized stratospheric balloons, and infrared hot air balloons are used. They are used to study the dynamics of stratospheric waves and atmospheric water vapor. Laboratories participating in sounding rocket programs are listed.

  11. TMBM: Tethered Micro-Balloons on Mars

    NASA Technical Reports Server (NTRS)

    Sims, M. H.; Greeley, R.; Cutts, J. A.; Yavrouian, A. H.; Murbach, M.

    2000-01-01

    The use of balloons/aerobots on Mars has been under consideration for many years. Concepts include deployment during entry into the atmosphere from a carrier spacecraft, deployment from a lander, use of super-pressurized systems for long duration flights, 'hot-air' systems, etc. Principal advantages include the ability to obtain high-resolution data of the surface because balloons provide a low-altitude platform which moves relatively slowly. Work conducted within the last few years has removed many of the technical difficulties encountered in deployment and operation of balloons/aerobots on Mars. The concept proposed here (a tethered balloon released from a lander) uses a relatively simple approach which would enable aspects of Martian balloons to be tested while providing useful and potentially unique science results. Tethered Micro-Balloons on Mars (TMBM) would be carried to Mars on board a future lander as a stand-alone experiment having a total mass of one to two kilograms. It would consist of a helium balloon of up to 50 cubic meters that is inflated after landing and initially tethered to the lander. Its primary instrumentation would be a camera that would be carried to an altitude of up to tens of meters above the surface. Imaging data would be transmitted to the lander for inclusion in the mission data stream. The tether would be released in stages allowing different resolutions and coverage. In addition during this staged release a lander camera system may observe the motion of the balloon at various heights above he lander. Under some scenarios upon completion of the primary phase of TMBM operations, the tether would be cut, allowing TMBM to drift away from the landing site, during which images would be taken along the ground.

  12. Advances in Scientific Balloon Thermal Modeling

    NASA Technical Reports Server (NTRS)

    Bohaboj, T.; Cathey, H. M., Jr.

    2004-01-01

    The National Aeronautics and Space Administration's Balloon Program office has long acknowledged that the accurate modeling of balloon performance and flight prediction is dependant on how well the balloon is thermally modeled. This ongoing effort is focused on developing accurate balloon thermal models that can be used to quickly predict balloon temperatures and balloon performance. The ability to model parametric changes is also a driver for this effort. This paper will present the most recent advances made in this area. This research effort continues to utilize the "Thrmal Desktop" addition to AUTO CAD for the modeling. Recent advances have been made by using this analytical tool. A number of analyses have been completed to test the applicability of this tool to the problem with very positive results. Progressively detailed models have been developed to explore the capabilities of the tool as well as to provide guidance in model formulation. A number of parametric studies have been completed. These studies have varied the shape of the structure, material properties, environmental inputs, and model geometry. These studies have concentrated on spherical "proxy models" for the initial development stages and then to transition to the natural shaped zero pressure and super pressure balloons. An assessment of required model resolution has also been determined. Model solutions have been cross checked with known solutions via hand calculations. The comparison of these cases will also be presented. One goal is to develop analysis guidelines and an approach for modeling balloons for both simple first order estimates and detailed full models. This papa presents the step by step advances made as part of this effort, capabilities, limitations, and the lessons learned. Also presented are the plans for further thermal modeling work.

  13. Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder (neoplastic polyps, adenomas, and papillary neoplasms that are ≥1.0 cm): clinicopathologic and immunohistochemical analysis of 123 cases.

    PubMed

    Adsay, Volkan; Jang, Kee-Taek; Roa, Juan Carlos; Dursun, Nevra; Ohike, Nobuyuki; Bagci, Pelin; Basturk, Olca; Bandyopadhyay, Sudeshna; Cheng, Jeanette D; Sarmiento, Juan M; Escalona, Oscar Tapia; Goodman, Michael; Kong, So Yeon; Terry, Paul

    2012-09-01

    The literature on the clinicopathologic characteristics of tumoral intraepithelial neoplasms (neoplastic polyps) of the gallbladder (GB) is fairly limited, due in part to the variability in definition and terminology. Most reported adenomas (pyloric gland type and others) were microscopic and thus regarded as clinically inconsequential, whereas papillary in situ carcinomas have been largely considered a type of invasive adenocarcinoma under the heading of "papillary adenocarcinomas." In this study, 123 GB cases that have a well-defined exophytic preinvasive neoplasm measuring ≥1 cm were analyzed. The patients were predominantly female (F/M=2:1) with a mean age of 61 y and a median tumor size of 2.2 cm. Half of the patients presented with pain, and in the other half the neoplasm was detected incidentally. Other neoplasms, most being gastrointestinal tract malignancies, were present in 22% of cases. Gallstones were identified in only 20% of cases. Radiologically, almost half were diagnosed as "cancer," roughly half with polypoid tumor, and in 10% the lesion was missed. Pathologic findings: (1) The predominant configuration was papillary in 43%, tubulopapillary in 31%, tubular in 26%. (2) Each case was assigned a final lineage type on the basis of the predominant pattern (>75% of the lesion) on morphology, and supported with specific immunohistochemical cell lineage markers. The predominant cell lineage could be identified as biliary in 50% (66% of which were MUC1), gastric foveolar in 16% (all were MUC5AC), gastric pyloric in 20% (92% MUC6), intestinal in 8% (100% CK20; 75% CDX2; 50%, MUC2), and oncocytic in 6% (17% HepPar and 17% MUC6); however, 90% of cases had some amount of secondary or unclassifiable pattern and hybrid immunophenotypes. (3) Of the cases that would have qualified as "pyloric gland adenoma," 21/24 (88%) had at least focal high-grade dysplasia and 18% had associated invasive carcinoma. Conversely, 8 of 47 "papillary adenocarcinoma"-type cases

  14. Thermal performance modeling of NASA s scientific balloons

    NASA Astrophysics Data System (ADS)

    Franco, H.; Cathey, H.

    The flight performance of a scientific balloon is highly dependant on the interaction between the balloon and its environment. The balloon is a thermal vehicle. Modeling a scientific balloon's thermal performance has proven to be a difficult analytical task. Most previous thermal models have attempted these analyses by using either a bulk thermal model approach, or by simplified representations of the balloon. These approaches to date have provided reasonable, but not very accurate results. Improvements have been made in recent years using thermal analysis tools developed for the thermal modeling of spacecraft and other sophisticated heat transfer problems. These tools, which now allow for accurate modeling of highly transmissive materials, have been applied to the thermal analysis of NASA's scientific balloons. A research effort has been started that utilizes the "Thermal Desktop" addition to AUTO CAD. This paper will discuss the development of thermal models for both conventional and Ultra Long Duration super-pressure balloons. This research effort has focused on incremental analysis stages of development to assess the accuracy of the tool and the required model resolution to produce usable data. The first stage balloon thermal analyses started with simple spherical balloon models with a limited number of nodes, and expanded the number of nodes to determine required model resolution. These models were then modified to include additional details such as load tapes. The second stage analyses looked at natural shaped Zero Pressure balloons. Load tapes were then added to these shapes, again with the goal of determining the required modeling accuracy by varying the number of gores. The third stage, following the same steps as the Zero Pressure balloon efforts, was directed at modeling super-pressure pumpkin shaped balloons. The results were then used to develop analysis guidelines and an approach for modeling balloons for both simple first order estimates and detailed

  15. Introduction and use of video-assisted endoscopic thyroidectomy for patients in Belarus affected by the Chernobyl nuclear disaster.

    PubMed

    Igarashi, Takehito; Shimizu, Kazuo; Yakubouski, Siarhei; Akasu, Haruki; Okamura, Ritsuko; Sugitani, Iwao; Jikuzono, Tomoo; Danilova, Larisa

    2013-11-01

    We developed video-assisted neck surgery (VANS) - a feasible, simple, and safe endoscopic thyroid procedure with cosmetic benefits - in 1998. To date, we have performed this procedure 633 times. We have also introduced the VANS method in Belarus, a country that was left contaminated by the Chernobyl nuclear disaster. From a mass screening, nine Belarusian patients, including two with papillary carcinoma of the thyroid, were selected to undergo an operation using the VANS method, performed by a single surgeon (author Shimizu). We compared indicating factors for minimally invasive surgery, specifically the operating time and blood loss, between the Belarusian cases and the 33 most recent cases performed at our institute in Tokyo. The procedures in Belarus were performed under very different working conditions than in Japan. However, operating time and blood loss improved for the Belarusian cases as the surgeon gained experience in this environment; all the cosmetic outcomes were excellent. Subsequently, over a 2-year period, surgeons in Belarus performed the VANS method, with modification, for 29 cases of thyroid tumor. The VANS method is easily learned by inexperienced surgeons without major technical problems. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  16. Development of a super-pressure balloon with a diamond-shaped net --- result of a ground inflation test of a 2,000 cubic-meter balloon ---

    NASA Astrophysics Data System (ADS)

    Saito, Yoshitaka; Nakashino, Kyoichi; Akita, Daisuke; Matsushima, Kiyoho; Shimadu, Shigeyuki; Goto, Ken; Hashimoto, Hiroyuki; Matsuo, Takuma

    2016-07-01

    A light super-pressure balloon has been developed using a method to cover a balloon with a diamond-shaped net of high-tensile fibers. The goal is to fly a payload of 900 kg to the altitude of 37 km with a 300,000 m^{3} balloon. Beginning from a demonstration test of the net-balloon with a 10 m^{3} balloon in 2010, we have been polished the net-balloon through ground inflation tests and flight tests, including a flight test of a 3,000 m ^{3} balloon in the tandem balloon configuration with a 15,000 m^{3} zero-pressure balloon in 2012, and a flight test of a 10 m^{3} balloon in the tandem balloon configuration with a 2 kg rubber balloon in 2013, as reported in the last COSPAR. In 2014, we developed a 5,000 m^{3} balloon and performed a ground inflation test to find that the balloon burst from a lip panel for termination with a differential pressure of 425 Pa. It was due to a stress concentration at the edge of a thick tape attached along the termination mechanism. In 2015, we modified the balloon by adding tapes on the lip panel to avoid the stress concentration, and also shorten the net length to leave some margin of the film and performed a ground inflation test again to find the balloon showed asymmetrical deployment and burst from the edge of the net with a differential pressure of 348 Pa. We consider it is due to the margin of the film along the circumferential direction, and proposed a gore shape which circumference length is kept as determined by the pumpkin shape of the balloon but setting meridian length longer than that. We developed a 10 m^{3} balloon with the gore design to find that the balloon deployed symmetrically and showed the burst pressure of 10,000 Pa. In 2016, we are going to develop a 2,000 m^{3} balloon with the gore design and perform its ground inflation test. In this paper, we are going to report its result with the sequence of the development.

  17. Sparse aperture endoscope

    DOEpatents

    Fitch, J.P.

    1999-07-06

    An endoscope is disclosed which reduces the volume needed by the imaging part, maintains resolution of a wide diameter optical system, while increasing tool access, and allows stereographic or interferometric processing for depth and perspective information/visualization. Because the endoscope decreases the volume consumed by imaging optics such allows a larger fraction of the volume to be used for non-imaging tools, which allows smaller incisions in surgical and diagnostic medical applications thus produces less trauma to the patient or allows access to smaller volumes than is possible with larger instruments. The endoscope utilizes fiber optic light pipes in an outer layer for illumination, a multi-pupil imaging system in an inner annulus, and an access channel for other tools in the center. The endoscope is amenable to implementation as a flexible scope, and thus increases it's utility. Because the endoscope uses a multi-aperture pupil, it can also be utilized as an optical array, allowing stereographic and interferometric processing. 7 figs.

  18. Sparse aperture endoscope

    DOEpatents

    Fitch, Joseph P.

    1999-07-06

    An endoscope which reduces the volume needed by the imaging part thereof, maintains resolution of a wide diameter optical system, while increasing tool access, and allows stereographic or interferometric processing for depth and perspective information/visualization. Because the endoscope decreases the volume consumed by imaging optics such allows a larger fraction of the volume to be used for non-imaging tools, which allows smaller incisions in surgical and diagnostic medical applications thus produces less trauma to the patient or allows access to smaller volumes than is possible with larger instruments. The endoscope utilizes fiber optic light pipes in an outer layer for illumination, a multi-pupil imaging system in an inner annulus, and an access channel for other tools in the center. The endoscope is amenable to implementation as a flexible scope, and thus increases the utility thereof. Because the endoscope uses a multi-aperture pupil, it can also be utilized as an optical array, allowing stereographic and interferometric processing.

  19. Immediate Outcome of Balloon Mitral Valvuloplasty with JOMIVA Balloon during Pregnancy

    PubMed Central

    Ramasamy, Ramona; Kaliappan, Tamilarasu; Gopalan, Rajendiran; Palanimuthu, Ramasmy; Anandhan, Premkrishna

    2017-01-01

    Introduction Rheumatic mitral stenosis is the most common Valvular Heart Disease encountered during pregnancy. Balloon Mitral Valvuloplasty (BMV) is one of the treatment option available if the symptoms are refractory to the medical management and the valve anatomy is suitable for balloon dilatation. BMV with Inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique using Joseph Mitral Valvuloplasty (JOMIVA) balloon catheter which is being followed in certain centres. Aim To assess the immediate post procedure outcome of over the wire BMV with JOMIVA balloon. Materials and Methods Clinical and echocardiographic parameters of pregnant women with significant mitral stenosis who underwent elective BMV with JOMIVA balloon in our institute from 2005 to 2015 were analysed retrospectively. Severity of breathlessness (New York Heart Association Functional Class), and duration of pregnancy was included in the analysis. Pre procedural echocardiographic parameters which included severity of mitral stenosis and Wilkin’s scoring were analysed. Clinical, haemodynamic and echocardiographic outcomes immediately after the procedure were analysed. Results Among the patients who underwent BMV in our Institute 38 were pregnant women. Twenty four patients (63%) were in New York Heart Association (NYHA) Class III. All of them were in sinus rhythm except two (5%) who had atrial fibrillation. Thirty four patients (89.5%) were in second trimester of pregnancy at the time of presentation and four (10.5%) were in third trimester. Echocardiographic analysis of the mitral valve showed that the mean Wilkin’s score was 7.3. Mean mitral valve area pre procedure was 0.8 cm2. Mean gradient across the valve was 18 mmHg. Ten patients (26.5%) had mild mitral regurgitation and none had more than mild mitral regurgitation. Thirty six patients had pulmonary hypertension as assessed by tricuspid regurgitation jet velocity. All of them underwent BMV

  20. A Methane Balloon Inflation Chamber

    ERIC Educational Resources Information Center

    Czerwinski, Curtis J.; Cordes, Tanya J.; Franek, Joe

    2005-01-01

    The various equipments, procedure and hazards in constructing the device for inflating a methane balloon using a standard methane outlet in a laboratory are described. This device is fast, safe, inexpensive, and easy to use as compared to a hydrogen gas cylinder for inflating balloons.

  1. Intravascular papillary endothelial hyperplasia of the foot.

    PubMed

    Cisco, R W; McCormac, R M

    1994-01-01

    Intravascular papillary endothelial hyperplasia is a rare benign reactive lesion usually found in thrombosed subcutaneous blood vessels. The lesion resembles malignant angiosarcoma clinically and histopathologically, and must be diagnosed correctly to avoid inappropriate treatment. The following is a case presentation involving the foot.

  2. Evaluation of the presence of Epstein-Barr virus (EBV) in Iranian patients with thyroid papillary carcinoma.

    PubMed

    Homayouni, Maryam; Mohammad Arabzadeh, Seyed Ali; Nili, Fatemeh; Razi, Farideh; Amoli, Mahsa Mohammad

    2017-07-01

    Papillary thyroid carcinoma (PTC) is the most common thyroid cancer. EBV is one of the most important viruses related to different types of malignancies. This study investigated the relationship between EBV and papillary thyroid carcinoma. In this study the presence of Epstein-Barr Nuclear Antigen 1 (EBNA1) gene in papillary thyroid carcinoma tissues were examined by nested-PCR method. Paraffin-embedded tissues (N=41) blocks of thyroid cancer were used. DNA was extracted from all samples and then samples were evaluated for the presence of EBV gene. In 41 samples, EBNA1 was detected in 65.8% of patients with papillary thyroid carcinoma which was significantly higher in younger ages. The significant presence of EBV genome in papillary thyroid carcinoma suggests that this virus may play a role in this cancer especially in younger ages. As a result, monitoring of patients with EBV latent infection for PTC can be very important. Copyright © 2017 Elsevier GmbH. All rights reserved.

  3. Balloon pulmonary valvotomy--not just a simple balloon dilatation.

    PubMed

    Mohanty, Subhendu; Pandit, Bhagya Narayan; Tyagi, Sanjay

    2014-01-01

    Balloon pulmonary valvotomy is the preferred mode of treatment in patients with isolated pulmonary valvar stenosis and has shown good long term results. It is generally considered a safe procedure with few complications. There have been however, case reports of potentially fatal acute severe pulmonary edema occurring after the procedure in some patients. The cause of this complication and its pathophysiology is still not clear. Its occurrence is also infrequent with less than 5 cases reported till now. We report a case of pulmonary valvar stenosis which developed acute severe refractory pulmonary edema immediately after balloon pulmonary valvotomy. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  4. Cardiac mesothelial papillary hyperplasia in four dogs.

    PubMed

    Kirejczyk, Shannon G; Burnum, Anne L; Brown, Corrie C; Sakamoto, Kaori; Rissi, Daniel R

    2018-05-01

    Mesothelial papillary hyperplasia (MPH) has been described as an incidental finding on the epicardial surface of clinically normal laboratory Beagle dogs. We describe MPH in 4 dogs diagnosed with acute cardiac tamponade (1 case) or chronic cardiac disease (3 cases). Cardiac MPH appeared as distinct, soft, irregular villous plaques on the epicardial surface of the auricles and occasionally the ventricles. Histologically, areas of MPH were composed of multiple papillary fronds arising from the epicardial surface and projecting into the pericardial space. Fronds were covered by cuboidal and occasionally vacuolated mesothelial cells and were supported by loose fibrovascular stroma with various degrees of edema and inflammation. Although these may represent incidental findings with no clinical significance, the gross appearance warrants differentiation from other conditions. Additional insight into the pathogenesis of MPH is needed to fully understand its significance in the face of concurrent cardiac disease.

  5. 14 CFR 61.115 - Balloon rating: Limitations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... takes a practical test in a balloon with an airborne heater: (1) The pilot certificate will contain a limitation restricting the exercise of the privileges of that certificate to a balloon with an airborne... removed when the person obtains the required aeronautical experience in a balloon with an airborne heater...

  6. Gradient magnetometer system balloons

    NASA Astrophysics Data System (ADS)

    Korepanov, Valery; Tsvetkov, Yury

    2005-08-01

    Earth's magnetic field study still remains one of the leading edges of experimental geophysics. Thus study is executed on the Earth surface, including ocean bottom, and on satellite heights using component, mostly flux-gate magnetometers. But balloon experiments with component magnetometers are very seldom, first of all because of great complexity of data interpretation. This niche still waits for new experimental ideology, which will allow to get the measurements results with high accuracy, especially in gradient mode. The great importance of precise balloon-borne component magnetic field gradient study is obvious. Its technical realization is based both on the available at the marked high-precision non-magnetic tiltmeters and on recent achievements of flux-gate magnetometry. The scientific goals of balloon-borne magnetic gradiometric experiment are discussed and its practical realization is proposed.

  7. Coexistence of papillary thyroid cancer and Hashimoto thyroiditis in children: report of 3 cases.

    PubMed

    Koibuchi, Harumi; Omoto, Kiyoka; Fukushima, Noriyoshi; Toyotsuji, Tomonori; Taniguchi, Nobuyuki; Kawano, Mikihiko

    2014-07-01

    This report documents 3 pediatric papillary thyroid carcinoma cases with associated Hashimoto thyroiditis. In all 3 cases, hypoechoic nodules accompanied by multiple echogenic spots were noted on sonography of the thyroid. Hashimoto thyroiditis was suspected on the basis of positive thyroid autoantibody test results and pathologic examinations of thyroidectomy specimens, which revealed chronic thyroiditis with lymphocytic infiltration as the background of papillary thyroid carcinoma development. The potential for papillary carcinoma development warrants close follow-up, and meticulous sonographic examinations must be performed in children with Hashimoto thyroiditis. © 2014 by the American Institute of Ultrasound in Medicine.

  8. Laser welding of balloon catheters

    NASA Astrophysics Data System (ADS)

    Flanagan, Aidan J.

    2003-03-01

    The balloon catheter is one of the principal instruments of non-invasive vascular surgery. It is used most commonly for angioplasty (and in recent years for delivering stents) at a multitude of different sites in the body from small arteries in the heart to the bilary duct. It is composed of a polymer balloon that is attached to a polymer shaft at two points called the distal and proximal bonds. The diverse utility of balloon catheters means a large range of component sizes and materials are used during production; this leads to a complexity of bonding methods and technology. The proximal and distal bonds have been conventionally made using cyanoacrylate or UV curing glue, however with performance requirements of bond strength, flexibility, profile, and manufacturing costs these bonds are increasingly being made by welding using laser, RF, and Hot Jaw methods. This paper describes laser welding of distal and proximal balloon bonds and details beam delivery, bonding mechanisms, bond shaping, laser types, and wavelength choice.

  9. NASA Langley Research Center tethered balloon systems

    NASA Technical Reports Server (NTRS)

    Owens, Thomas L.; Storey, Richard W.; Youngbluth, Otto

    1987-01-01

    The NASA Langley Research Center tethered balloon system operations are covered in this report for the period of 1979 through 1983. Meteorological data, ozone concentrations, and other data were obtained from in situ measurements. The large tethered balloon had a lifting capability of 30 kilograms to 2500 meters. The report includes descriptions of the various components of the balloon systems such as the balloons, the sensors, the electronics, and the hardware. Several photographs of the system are included as well as a list of projects including the types of data gathered.

  10. Well-differentiated papillary mesothelioma with invasion to the chest wall.

    PubMed

    Torii, Ikuko; Hashimoto, Masaki; Terada, Takayuki; Kondo, Nobuyuki; Fushimi, Hiroaki; Shimazu, Kohki; Takeda, Shin-Ichi; Takuwa, Teruhisa; Okumura, Yoshitomo; Sato, Ayuko; Yamamoto, Tadashi; Fukuoka, Kazuya; Tanaka, Fumihiro; Nishigami, Takashi; Nakano, Takashi; Hasegawa, Seiki; Tsujimura, Tohru

    2010-02-01

    Well-differentiated papillary mesothelioma (WDPM) is an uncommon tumor with a papillary architecture, bland cytologic features, a tendency toward superficial spread without invasion, and good prognosis with prolonged survival. WDPM occurs primarily in the peritoneum of women, but also rarely in the pleura. We here report a case of 48-year-old woman who developed WDPM in the pleura with no history of asbestos exposure. Tumors were multifocal and widespread with a velvety appearance on the surface of parietal and visceral pleurae resected by extrapleural pneumonectomy (EPP). Tumors showed papillary structures with fibrovascular cores and lined by epithelioid cells. Immunohistochemically, these epithelioid tumor cells were positive for epithelial membrane antigen (EMA), a marker of malignant mesothelioma, with more than 50% positive for p53. Tumor cells microinvaded into subpleural parenchyma of the lung and minimally spread to adipose tissues of the mediastinal lesion. In addition, tumor cells invaded into the chest wall with a trabecular or glandular architecture. Based on these findings, this case is pathologically considered as WDPM of the pleura with malignant potential. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  11. [A Case of Metachronous Multiple Thyroid Papillary Carcinoma with FAP].

    PubMed

    Tajima, Yusuke; Kumamoto, Kensuke; Yamamoto, Azusa; Chika, Noriyasu; Watanabe, Yuichiro; Matsuzawa, Takeaki; Ishibashi, Keiichiro; Mochiki, Erito; Iwama, Takeo; Akagi, Kiwamu; Ishida, Hideyuki

    2015-11-01

    Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited disorder, the result of a germ line mutation in the adenomatous polyposis coli (APC) gene. FAP can be associated with various extracolonic lesions, including thyroid cancer, which frequently occurs in women. We report the case of a 36-year-old woman diagnosed as having FAP with multiple metachronous thyroid papillary carcinomas. She underwent left thyroidectomy at the age of 19 years without a diagnosis of FAP. Multiple polyps in her stomach were detected by medical examination and more than 100 polyps in the colon were found by colonoscopy. She was referred to our hospital after a diagnosis of non-profuse FAP. Multiple tumors with a maximum diameter of 10mm were detected in the right lobe of the thyroid gland during the preoperative examination. Papillary carcinoma was suspected based on fine-needle aspiration cytology. We performed a right thyroidectomy after prophylactic colectomy. Pathological findings revealed a cribriform-morula variant of papillary thyroid carcinoma. The patient remains well after 2 year 6 months with no recurrence.

  12. Clear cell papillary renal cell carcinoma as part of histologically discordant multifocal renal cell carcinoma: A case report and review of literature.

    PubMed

    Shao, Tiffany; Yousef, Peter; Shipilova, Irina; Saleeb, Rola; Lee, Jason Y; Krizova, Adriana

    2016-03-01

    Multifocal renal cell carcinoma of different histological subtypes within a single kidney is rare. We report a recently classified clear cell (tubulo) papillary renal cell carcinoma as part of an unusual case of multifocal renal cell carcinoma of discordant histological subtypes. A 57 year-old-man was found to have multiple renal tumors and cysts on imaging and underwent a laparoscopic left radical nephrectomy. Pathological review showed multifocal renal cell carcinoma (clear cell (tubulo) papillary, clear cell and papillary renal cell carcinomas and papillary adenomas). Morphology of clear cell papillary renal cell carcinoma was supported by immunohistochemical profile (CK7+, HMWK+, CAIX+, AMACR-, CD10-, TFE3-). This is the first report of clear cell papillary renal cell carcinoma as part of multifocal renal cell carcinoma of different histological subtypes. Related lineage of clear cell renal cell carcinoma and papillary renal cell carcinoma is supported by the highest prevalence of their combination within multifocal renal cell carcinoma of different histological subtypes along with their molecular interconnection. Clear cell papillary renal cell carcinoma may be uniquely placed between clear cell and papillary renal cell carcinomas since it shows morphological features intermediate between clear cell and papillary renal cell carcinoma along with overlapping but unique immunohistochemical profile. Clear cell papillary renal cell carcinoma may be molecularly related to clear cell and papillary renal cell carcinomas since the tumors overexpress markers of HIF pathway activation with normal/elevated VHL mRNA expression and some tumors show losses of chromosome 3. Due to the overlapping morphology, it is possible that cases of clear cell papillary renal cell carcinoma may have been misclassified as papillary or clear cell renal cell carcinoma in the literature, incorrectly increasing their reported prevalence. Identification of multifocal RCCs may be related to the

  13. Heat Transfer Model for Hot Air Balloons

    NASA Astrophysics Data System (ADS)

    Llado-Gambin, Adriana

    A heat transfer model and analysis for hot air balloons is presented in this work, backed with a flow simulation using SolidWorks. The objective is to understand the major heat losses in the balloon and to identify the parameters that affect most its flight performance. Results show that more than 70% of the heat losses are due to the emitted radiation from the balloon envelope and that convection losses represent around 20% of the total. A simulated heating source is also included in the modeling based on typical thermal input from a balloon propane burner. The burner duty cycle to keep a constant altitude can vary from 10% to 28% depending on the atmospheric conditions, and the ambient temperature is the parameter that most affects the total thermal input needed. The simulation and analysis also predict that the gas temperature inside the balloon decreases at a rate of -0.25 K/s when there is no burner activity, and it increases at a rate of +1 K/s when the balloon pilot operates the burner. The results were compared to actual flight data and they show very good agreement indicating that the major physical processes responsible for balloon performance aloft are accurately captured in the simulation.

  14. Biliary and pancreatic duct pressures measured by ERCP manometry in patients with suspected papillary stenosis.

    PubMed

    Bar-Meir, S; Geenen, J E; Hogan, W J; Dodds, W J; Stewart, E T; Arndorfer, R C

    1979-03-01

    Papillary stenosis is an imprecisely defined clinical syndrome which eludes definitive diagnosis. In this study we evaluated 26 patients with suspected papillary stenosis by manometric examination of the sphincter of Oddi done during ERCP examination. Basal pressure in the sphincter of Oddi was elevated in 14 of the patients. Of these 14 patients, 10 underwent sphincterotomy and all experienced improvement in clinical symptoms after their surgery. We suggest that ERCP manometry is a useful procedure for identifying patients with papillary stenosis who may benefit from sphincterotomy.

  15. Eustachian Tube Dilation via a Transtympanic Approach in 6 Cadaver Heads: A Feasibility Study.

    PubMed

    Dean, Marc; Chao, Wei-Chieh; Poe, Dennis

    2016-10-01

    The goal of this study was to evaluate the feasibility of endoscopic transtympanic balloon dilation of the cartilaginous eustachian tube. To accomplish this, transtympanic balloon dilation of the cartilaginous eustachian tube was performed on 11 eustachian tubes (6 cadaver heads). The balloon catheter was introduced and passed through the protympanic orifice of the eustachian tube transtympanically under endoscopic view and cannulated without incident in all cadavers. Computed tomography was then performed postprocedure to evaluate for inadvertent dilation of the bony eustachian tube, adverse placement of the balloon, or any bony fractures. The balloon was seen to be successfully inflated in the cartilaginous portion without damage to surrounding structures in all cases. This demonstrates that under endoscopic guidance, the protympanic orifice of the eustachian tube can be feasibly cannulated and reliably traversed, allowing for targeted dilation of the cartilaginous eustachian tube from a transtympanic approach. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  16. Balloon Borne Ultraviolet Spectrometer.

    DTIC Science & Technology

    1978-12-28

    n.c.aaary ond lden lfy by block numb.r) ultraviolet ground support equipment (GSE) spectrometers flight electronics instrumentation balloons \\ solar ...Assembly 4 Fig. 3 Solar Balloon Experiment Ass ’y 7 Fig. 4 Mechanical Interface , UV Spectrometer 8 Fig . 5 Spectrometer Body Assemb ly 10 Fig. 6...Diagram, GSE )bnitor 48 Selector and Battery Charger Fig. 25 Schematic Diagram, GSE Serial to 49 Parallel Data Converter Fig. 26 Schematic Diagram

  17. Determination of balloon drag

    NASA Technical Reports Server (NTRS)

    Conrad, George R.; Robbins, Edward J.

    1991-01-01

    The evolution of an empirical drag relationship that has stimulated rethinking regarding the physics of balloon drag phenomena is discussed. Combined parasitic drag from all sources in the balloon system are estimated to constitute less than 10 percent of the total system drag. It is shown that the difference between flight-determined drag coefficients and those based on the spherical assumption should be related to the square of the Froude number.

  18. Yellow Balloon in a Briar Patch.

    ERIC Educational Resources Information Center

    Cooper, Frank; Fitzmaurice, Robert W.

    1978-01-01

    As part of a meteorology unit, sixth grade science students launched helium balloons with attached return postcards. This article describes Weather Service monitoring of the balloons and postcard return results. (MA)

  19. 21 CFR 874.4100 - Epistaxis balloon.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    .... An epistaxis balloon is a device consisting of an inflatable balloon intended to control internal... (general controls). The device is exempt from the premarket notification procedures in subpart E of part...

  20. Synchronous papillary thyroid carcinoma and primary hyperparathyroidism: diagnosis and management issues.

    PubMed

    Vysetti, Suneetha; Sridhar, Preethi; Theckedath, Boby; Gilden, Janice L; Morawiecki, Peter

    2012-10-01

    The occurrence of a papillary thyroid carcinoma in a patient with primary hyperparathyroidism is rare. Awareness of this condition will enable clinicians to evaluate for possible thyroid pathology in patients with primary hyperparathyroidism. Both of these endocrine conditions could then be managed with a single surgery involving concomitant resection of the thyroid and parathyroid glands. We report a case of a 53-year-old woman with a parathyroid adenoma and a unilateral papillary thyroid carcinoma, and detail the clinical features, diagnosis, and management.

  1. Auditory Risk of Exploding Hydrogen-Oxygen Balloons

    ERIC Educational Resources Information Center

    Gee, Kent L.; Vernon, Julia A.; Macedone, Jeffrey H.

    2010-01-01

    Although hydrogen-oxygen balloon explosions are popular demonstrations, the acoustic impulse created poses a hearing damage risk if the peak level exceeds 140 dB at the listener's ear. The results of acoustical measurements of hydrogen-oxygen balloons of varying volume and oxygen content are described. It is shown that hydrogen balloons may be…

  2. Balloon cell nevus of the iris.

    PubMed

    Morcos, Mohib W; Odashiro, Alexandre; Bazin, Richard; Pereira, Patricia Rusa; O'Meara, Aisling; Burnier, Miguel N

    2014-12-01

    Balloon cell nevus is a rare histopathological lesion characterized by a predominance of large, vesicular and clear cells, called balloon cells. There is only 1 case of balloon cell nevus of the iris reported in the literature. A 55 year-old man presented a pigmented elevated lesion in the right iris since the age of 12 years old. The lesion had been growing for the past 2 years and excision was performed. Histopathological examination showed a balloon cell nevus composed of clear and vacuolated cells without atypia. A typical spindle cell nevus of the iris was also observed. The differential diagnosis included xanthomatous lesions, brown adipocyte or other adipocytic lesions, clear cell hidradenoma, metastatic clear cell carcinoma of the kidney and clear cell sarcoma. The tumor was positive for Melan A, S100 protein and HMB45. Balloon cell nevus of the iris is rare but should be considered in the differential diagnosis of melanocytic lesions of the iris. Copyright © 2014 Elsevier GmbH. All rights reserved.

  3. The Steris Reliance EPS endoscope processing system: a new automated endoscope reprocessing technology.

    PubMed

    2007-01-01

    In this Evaluation, we examine whether the Steris Reliance EPS--a flexible endoscope reprocessing system that was recently introduced to the U.S. market--offers meaningful advantages over "traditional" automated endoscope reprocessors (AERs). Most AERs on the market function similarly to one another. The Reliance EPS, however, includes some unique features that distinguish it from other AERs. For example, it incorporates a "boot" technology for loading the endoscopes into the unit without requiring a lot of endoscope-specific connectors, and it dispenses the germicide used to disinfect the endoscopes from a single-use container. This Evaluation looks at whether the unique features of this model make it a better choice than traditional AERs for reprocessing flexible endoscopes. Our study focuses on whether the Reliance EPS is any more likely to be used correctly-thereby reducing the likelihood that an endoscope will be reprocessed inadequately-and whether the unit possesses any design flaws that could lead to reprocessing failures. We detail the unit's advantages and disadvantages compared with other AERs, and we describe what current users have to say. Our conclusions will help facilities determine whether to select the Reliance EPS.

  4. Endoscopic Skull Base Surgery

    PubMed Central

    Senior, Brent A

    2008-01-01

    Endoscopic skull base surgery has undergone rapid advancement in the past decade moving from pituitary surgery to suprasellar lesions and now to a myriad of lesions extending from the cribriform plate to C2 and laterally out to the infratemporal fossa and petrous apex. Evolution of several technological advances as well as advances in understanding of endoscopic anatomy and the development of surgical techniques both in resection and reconstruction have fostered this capability. Management of benign disease via endoscopic methods is largely accepted now but more data is needed before the controversy on the role of endoscopic management of malignant disease is decided. Continued advances in surgical technique, navigation systems, endoscopic imaging technology, and robotics assure continued brisk evolution in this expanding field. PMID:19434274

  5. The papillary muscles as shock absorbers of the mitral valve complex. An experimental study.

    PubMed

    Joudinaud, Thomas M; Kegel, Corrine L; Flecher, Erwan M; Weber, Patricia A; Lansac, Emmanuel; Hvass, Ulrich; Duran, Carlos M G

    2007-07-01

    Although it is known that the papillary muscles ensure the continuity between the left ventricle (LV) and the mitral apparatus, their precise mechanism needs further study. We hypothesize that the papillary muscles function as shock absorbers to maintain a constant distance between their tips and the mitral annulus during the entire cardiac cycle. Sonomicrometry crystals were implanted in five sheep in the mitral annulus at the trigones (T1 and T2), mid anterior annulus (AA) mid posterior annulus (PA), base of the posterior lateral scallops (P1 and P2), tips of papillary muscles (M1 and M2), and LV apex. LV and aortic pressures were simultaneously recorded and used to define the different phases of the cardiac cycle. No significant distance changes were found during the cardiac cycle between each papillary muscle tip and their corresponding mitral hemi-annulus: M1-T1, (3.5+/-2%); M1-P1 (5+/-2%); M1-PA (5+/-3%); M2-T2 (2.7+/-2%); M2-P2 (6.1+/-3%); and M2-AA (4.2+/-3%); (p>0.05, ANOVA). Significant changes were observed in distances between each papillary muscle tip and the contralateral hemi-mitral annulus: M1-T2 (1.7+/-3%); M1-P2 (23+/-6%); M1-AA (6+/-3%); M2-T1 (8+/-3%); M2-P1 (10.5+/-6%); and M2-PA (12.6+/-8%); (p<0.05 ANOVA). The distance changes between LV apex and each papillary muscle tip were significantly different: apex-M1 (12.9+/-1%) and apex-M2 (10.5+/-1%) and different from the averaged distance change between the LV apex and each annulus crystal (8.3+/-1%) with p<0.05. The papillary muscles seem to be independent mechanisms designed to work as shock absorbers to maintain the basic mitral valve geometry constant during the cardiac cycle.

  6. Late complications of percutaneous tracheostomy using the balloon dilation technique.

    PubMed

    Araujo, J B; Añón, J M; García de Lorenzo, A; García-Fernandez, A M; Esparcia, M; Adán, J; Relanzon, S; Quiles, D; de Paz, V; Molina, A

    2018-04-01

    The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. A prospective, observational cohort study was carried out. Two medical-surgical intensive care units (ICU). All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. All patients underwent PT according to the Ciaglia Blue Dolphin ® method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. Percutaneous tracheostomy using the Ciaglia Blue Dolphin ® technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  7. Warthin-Like Papillary Carcinoma of the Thyroid Gland: Case Report and Review of the Literature

    PubMed Central

    Paliogiannis, Panagiotis; Attene, Federico; Trogu, Federica; Trignano, Mario

    2012-01-01

    We present a case of Warthin-like papillary thyroid carcinoma in a 22-year-old woman and a review of the literature on the topic. The patient had the occasional discovery of a hypoechoic thyroid nodule of approximately 18 mm, characterized by irregular margins, hyperechoic spots, rich intra- and perilesional vascularization, and a suspicious enlarged right laterocervical lymph node. Fine-needle aspiration was performed for both lesions and the diagnosis of papillary thyroid carcinoma without lymph node involvement was made. The patient underwent thyroidectomy and central neck lymphadenectomy without complications. Histopathological examination suggested a Warthin-like papillary carcinoma of the thyroid gland, with all the removed lymph nodes being free of disease. The patient subsequently underwent iodine ablative therapy and she remains free of disease one year after surgery. Warthin-like papillary thyroid carcinoma is a recently described variant of papillary thyroid cancer that is frequently associated with lymphocytic thyroiditis. Morphologically, it resembles Warthin tumors of the salivary glands, with T and B lymphocytes infiltrating the stalks of papillae lined with oncocytic cells. Surgical and postoperative management is identical to that of classic differentiated thyroid cancer, while prognosis seems to be favourable. PMID:23243533

  8. Warthin-like papillary carcinoma of the thyroid gland: case report and review of the literature.

    PubMed

    Paliogiannis, Panagiotis; Attene, Federico; Trogu, Federica; Trignano, Mario

    2012-01-01

    We present a case of Warthin-like papillary thyroid carcinoma in a 22-year-old woman and a review of the literature on the topic. The patient had the occasional discovery of a hypoechoic thyroid nodule of approximately 18 mm, characterized by irregular margins, hyperechoic spots, rich intra- and perilesional vascularization, and a suspicious enlarged right laterocervical lymph node. Fine-needle aspiration was performed for both lesions and the diagnosis of papillary thyroid carcinoma without lymph node involvement was made. The patient underwent thyroidectomy and central neck lymphadenectomy without complications. Histopathological examination suggested a Warthin-like papillary carcinoma of the thyroid gland, with all the removed lymph nodes being free of disease. The patient subsequently underwent iodine ablative therapy and she remains free of disease one year after surgery. Warthin-like papillary thyroid carcinoma is a recently described variant of papillary thyroid cancer that is frequently associated with lymphocytic thyroiditis. Morphologically, it resembles Warthin tumors of the salivary glands, with T and B lymphocytes infiltrating the stalks of papillae lined with oncocytic cells. Surgical and postoperative management is identical to that of classic differentiated thyroid cancer, while prognosis seems to be favourable.

  9. The French Balloon Program 2013 - 2017

    NASA Astrophysics Data System (ADS)

    Dubourg, Vincent; Vargas, André; Raizonville, Philippe

    2016-07-01

    With over 50 years' experience in the field, the French Centre National d'Etudes Spatiales (CNES) goes on supporting - as designer and operator - a significant scientific ballooning program. In particular so because balloons still give a unique and valuable access to near space science. From 2008 to 2013, an important renovation effort was achieved, beginning by Zero Pressure Balloons (ZPB) systems, to comply with more stringent Safety constraints and to the growing reliability and performance requirements from scientific missions. The paper will give an overview of the CNES new capabilities and services for operational balloon activities, and their availability status. The scientific launch campaigns of the past two years will be presented. A focus will be made on the results of the Stratoscience 2015 flight campaign from Timmins, Ontario, using the NOSYCA command and control system for ZPB, qualified in flight in 2013. In particular, the PILOT telescope successfully flew during the 2015 campaign, key figures about the flight and mission will be given. An outlook of the new stratospheric long duration flight systems currently in process of developement at CNES will be given, as well as the presentation of the Stratéole 2 project, dedicated to the survey of the low stratosphere and upper troposphere in equatorial regions, with a fleet of small suprer pressure balloons (SPB). As far as tropospheric balloons are concerned, the Aeroclipper initiative will be presented, aiming at qualifying a quasi-tethered balloon, pushed by the winds close to the sea surface, for the study of cyclones. The scientific launch campaigns and the main payloads in the study for the near future will also be presented.

  10. Vertical sounding balloons for stratospheric photochemistry

    NASA Astrophysics Data System (ADS)

    Pommereau, J. P.

    The use of vertical sounding balloons for stratospheric photochemistry studies is illustrated by the use of a vertical piloted gas balloon for the search of NO2 diurnal variations. It is shown that the use of montgolfieres (hot air balloons) can enhance the vertical sounding technique. Particular attention is given to a sun-heated montgolfiere and to the more sophisticated infrared montgolfiere that is able to perform three to four vertical excursions per day and to remain aloft for weeks or months.

  11. Balloon mania: news in the air.

    PubMed

    Kim, Mi Gyung

    2004-12-01

    The hot-air balloon, invented by the Montgolfier brothers in 1783, enabled the French King to project his glory, the nobility to exhibit their valor, the literary public to transmit the ideal of the Enlightenment and the plebian public to rejoice in a scientific spectacle. The ensuing balloon mania helped create an integrated public that, because of its size and composition, can only be described as 'democratic' just a few years before the French Revolution. The monumental impact of the balloon was well represented in a flood of poetry, pamphlets, books, journal reports, academic papers and consumer items. Sifting through these artifacts and considering the crowd that witnessed the ascent of the balloon will bring us to the historical moment when things, spectacles, and events (rather than words) shaped public and popular opinion.

  12. Clinical experience with the Monorail balloon catheter for coronary angioplasty.

    PubMed

    Finci, L; Meier, B; Roy, P; Steffenino, G; Rutishauser, W

    1988-01-01

    The Monorail balloon catheter is distinctly different from other current balloon catheters: the guidewire passes through the balloon itself, exits the catheter proximal to the balloon, and runs alongside its small shaft (3 French) through the guiding catheter. Monorail coronary angioplasty was attempted in 61 patients on 73 lesions with balloons from 2.0 to 3.7 mm. Angiographic success was obtained in 66 lesions (90%). For 15 lesions, balloon exchanges were needed. In three lesions, the Monorail balloon failed to cross the lesion, while a standard balloon succeeded; two lesions could not be crossed with any balloon. Vessel occlusion occurred in four patients: two had emergency surgery without infarct (one died suddenly 4 days later and one had a stroke 1 day later), one was recanalized with a standard balloon, and one had a myocardial infarct. Continuous infusion of urokinase was used until patient 3 in whom problems with the delivery system led to cardiocerebral air embolization (with complete recovery). No thrombotic complications were observed in the subsequent 58 patients with only a bolus of 10,000 U of heparin. The Monorail balloon facilitates contrast injections and balloon exchanges but appears more difficult to pass through tight lesions. Omission of the previously recommended infusion with a thrombolytic agent proved safe.

  13. Use of monorail PTCA balloon catheter for local drug delivery.

    PubMed

    Trehan, Vijay; Nair, Girish M; Gupta, Mohit D

    2007-01-01

    We report the use of monorail coronary balloon as an infusion catheter to give bailout abciximab selectively into the site of stent thrombosis as an adjunct to plain old balloon angioplasty (POBA) in a patient of subacute stent thrombosis of the left anterior descending coronary artery. The balloon component (polyamide material) of the monorail balloon catheter was shaved off the catheter so that abciximab injected through the balloon port of the catheter exited out the shaft of the balloon catheter at the site from where the balloon material was shaved off. We believe that selective infusion with abciximab along with POBA established antegrade flow and relieved the patient's ischemia. In the absence of essential hardware to give intracoronary drugs in an emergency situation, one may employ our technique of infusion through a monorail balloon catheter after shaving the balloon component from the catheter.

  14. Endoscopic Devices for Obesity.

    PubMed

    Sampath, Kartik; Dinani, Amreen M; Rothstein, Richard I

    2016-06-01

    The obesity epidemic, recognized by the World Health Organization in 1997, refers to the rising incidence of obesity worldwide. Lifestyle modification and pharmacotherapy are often ineffective long-term solutions; bariatric surgery remains the gold standard for long-term obesity weight loss. Despite the reported benefits, it has been estimated that only 1% of obese patients will undergo surgery. Endoscopic treatment for obesity represents a potential cost-effective, accessible, minimally invasive procedure that can function as a bridge or alternative intervention to bariatric surgery. We review the current endoscopic bariatric devices including space occupying devices, endoscopic gastroplasty, aspiration technology, post-bariatric surgery endoscopic revision, and obesity-related NOTES procedures. Given the diverse devices already FDA approved and in development, we discuss the future directions of endoscopic therapies for obesity.

  15. Application of Electrocautery Needle Knife Combined with Balloon Dilatation versus Balloon Dilatation in the Treatment of Tracheal Fibrotic Scar Stenosis.

    PubMed

    Bo, Liyan; Li, Congcong; Chen, Min; Mu, Deguang; Jin, Faguang

    Electrocautery needle knives can largely reduce scar and granulation tissue hyperplasia and play an important role in treating patients with benign stricture. The aim of this retrospective study was to evaluate the efficacy and safety of electrocautery needle knife combined with balloon dilatation versus balloon dilatation alone in the treatment of tracheal stenosis caused by tracheal intubation or tracheotomy. We retrospectively analysed the clinical data of 43 patients with tracheal stenosis caused by tracheotomy or tracheal intubation in our department from January 2013 to January 2016. Among these 43 patients, 23 had simple web-like stenosis and 20 had complex steno sis. All patients were treated under general anaesthesia, and the treatment methods were (1) balloon dilatation alone, (2) needle knife excision of fibrotic tissue combined with balloon dilatation, and (3) needle knife radial incision of fibrotic tissue combined with balloon dilatation. After treatment the symptoms, such as shortness of breath, were markedly improved immediately in all cases. The stenosis degree of patients who were treated with the elec-trocautery needle knife combined with balloon dilatation had better improvement compared with that of those treated with balloon dilatation treatment alone after 3 months (0.45 ± 0.04 vs. 0.67 ± 0.05, p < 0.01), and the proportion of restenosis occurrence that required further treatment was decreased at 6 months (46.9 vs. 81.8%), especially for the web-like stenosis patients, as most of their stenoses dilated with no obvious restenosis and achieved clinical cure. Electrocautery needle knife combined with balloon dilatation is an effective and safe treatment for tracheal fibrotic stenosis compared with balloon dilatation alone. © 2017 S. Karger AG, Basel.

  16. Patient Response to Endoscopic Therapy for Gastroesophageal Varices Based on Endoscopic Ultrasound Findings.

    PubMed

    Tseng, Yujen; Ma, Lili; Luo, Tiancheng; Zeng, Xiaoqing; Li, Feng; Li, Na; Wei, Yichao; Chen, Shiyao

    2018-04-27

    Gastroesophageal variceal hemorrhage is a common complication of portal hypertension. Endoscopic therapy is currently recommended for preventing gastroesophageal variceal rebleed. However, the rate of variceal rebleed and its associated mortality remain concerning. This study is aimed at differentiating patient response to endoscopic therapy based on endoscopic ultrasound (EUS) findings. One-hundred seventy patients previously treated with repeat endoscopic therapy for secondary prophylaxis were enrolled and classified into two groups based on treatment response. Prior to consolidation therapy, all patients received an EUS examination to observe for extraluminal phenomena. All available follow-up endoscopic examination records were retrieved to validate study results. Of the 170 subjects, 106 were poor responders, while 64 were good responders. The presence of para-gastric, gastric perforating, and esophageal perforating veins was associated with poor patient response (p<0.001). The odds ratio for para-gastric veins was 5.374. Follow-up endoscopic findings for poor responders with incomplete variceal obliteration was closely correlated with the presence of para-gastric veins (p=0.002). The presence of para-gastric veins is a characteristic of poor response to endoscopic therapy for treating gastroesophageal varices. Early identification of this subgroup necessitates a change in course of treatment to improve overall patient outcome.

  17. Global electrodynamics from superpressure balloons

    NASA Technical Reports Server (NTRS)

    Holzworth, R. H.; Hu, H.

    1995-01-01

    Electric field and conductivity measurements in the stratosphere between November 1992 and March 1993 have been made using superpressure balloons in the southern hemisphere. Over 400 payload-days of data have been made during a record setting experiment called ELBBO (Extended Life Balloon Borne Observatories). This experiment resulted in 4 flights aloft simultaneously for over 2 months including one flight which lasted over 4 months. Electrodynamical coupling between the atmosphere and ionosphere is studied using the measured electric fields, and a simple empirical model of the stratospheric conductivity. Altitude profiles of conductivity have been obtained from several superpressure balloon flights using the large end-of-flight altitude swings on the last few days of each flight (as the balloon begins to loose superpressure). Coupling between the fields and atmospheric inertial waves has been observed. Effects and dynamics of the global circuit suggest that standard models are missing significant phenomena. Large scale ionospheric convection activity has been studied from the polar cap to the middle latitudes. Cusp latitude fields have been continuously measured for many days in a row.

  18. NASA Scientific Balloon in Antarctica

    NASA Image and Video Library

    2017-12-08

    NASA image captured December 25, 2011 A NASA scientific balloon awaits launch in McMurdo, Antarctica. The balloon, carrying Indiana University's Cosmic Ray Electron Synchrotron Telescope (CREST), was launched on December 25. After a circum-navigational flight around the South Pole, the payload landed on January 5. The CREST payload is one of two scheduled as part of this seasons' annual NASA Antarctic balloon Campaign which is conducted in cooperation with the National Science Foundation's Office of Polar Programs. The campaign's second payload is the University of Arizona's Stratospheric Terahertz Observatory (STO). You can follow the flights at the Columbia Scientific Balloon Facility's web site at www.csbf.nasa.gov/antarctica/ice.htm Credit: NASA NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

  19. endoscope-i: an innovation in mobile endoscopic technology transforming the delivery of patient care in otolaryngology.

    PubMed

    Mistry, N; Coulson, C; George, A

    2017-11-01

    Digital and mobile device technology in healthcare is a growing market. The introduction of the endoscope-i, the world's first endoscopic mobile imaging system, allows the acquisition of high definition images of the ear, nose and throat (ENT). The system combines the e-i Pro camera app with a bespoke engineered endoscope-i adaptor which fits securely onto the iPhone or iPod touch. Endoscopic examination forms a salient aspect of the ENT work-up. The endoscope-i therefore provides a mobile and compact alternative to the existing bulky endoscopic systems currently in use which often restrict the clinician to the clinic setting. Areas covered: This article gives a detailed overview of the endoscope-i system together with its applications. A review and comparison of alternative devices on the market offering smartphone adapted endoscopic viewing systems is also presented. Expert commentary: The endoscope-i fulfils unmet needs by providing a compact, highly portable, simple to use endoscopic viewing system which is cost-effective and which makes use of smartphone technology most clinicians have in their pocket. The system allows real-time feedback to the patient and has the potential to transform the way that healthcare is delivered in ENT as well as having applications further afield.

  20. Development of a Super-Pressure Balloon with an Improved Design

    NASA Astrophysics Data System (ADS)

    Izutsu, Naoki; Akita, Daisuke; Fuke, Hideyuki; Iijima, Issei; Kato, Yoichi; Kawada, Jiro; Matsushima, Kiyoho; Matsuzaka, Yukihiko; Mizuta, Eiichi; Nakada, Takashi; Nonaka, Naoki; Saito, Yoshitaka; Takada, Atsushi; Tamura, Keisuke; Yamada, Kazuhiko; Yoshida, Tetsuya

    A zero-pressure balloon used for scientific observation in the stratosphere has an unmanageable limitation that its floating altitude decreases during a nighttime because of temperature drop of the lifting gas. Since a super-pressure balloon may not change its volume, the lifetime can extend very long. We had introduced so called the ‘lobed-pumpkin’ type of super-pressure balloon that can realize a full-scale long-duration balloon and it will be in practical use in the very near future. As for larger super-pressure balloons, however, we still have some potential difficulties to be resolved. We here propose a new design suitable for a larger super-pressure balloon, which is roughly ‘lobed pumpkin with lobed cylinder’ and can adapt a single design for balloons of a wide range of volumes. Indoor inflation tests were successfully carried out with balloons designed and made by the method. It has been shown that the limit of the resisting pressure differential for a new designed balloon is same as that of a normal lobed-pumpkin balloon.

  1. Evolution of scientific ballooning and its impact on astrophysics research

    NASA Astrophysics Data System (ADS)

    Jones, William Vernon

    2014-05-01

    As we celebrate the centennial year of the discovery of cosmic rays on a manned balloon, it seems appropriate to reflect on the evolution of ballooning and its scientific impact. Balloons have been used for scientific research since they were invented in France more than 200 years ago. Ballooning was revolutionized in 1950 with the introduction of the so-called natural shape balloon with integral load tapes. This basic design has been used with more or less continuously improved materials for scientific balloon flights for more than a half century, including long-duration balloon (LDB) flights around Antarctica for the past two decades. The U.S. National Aeronautics and Space Administration (NASA) is currently developing the next generation super-pressure balloon that would enable extended duration missions above 99.5% of the Earth's atmosphere at any latitude. The Astro2010 Decadal Survey report supports super-pressure balloon development and the giant step forward it offers with ultra-long-duration balloon (ULDB) flights at constant altitudes for about 100 days.

  2. Absorption spectrometer balloon flight and iodine investigations

    NASA Technical Reports Server (NTRS)

    1970-01-01

    A high altitude balloon flight experiment to determine the technical feasibility of employing absorption spectroscopy to measure SO2 and NO2 gases in the earth's atmosphere from above the atmospheric ozone layer is discussed. In addition to the balloon experiment the contract includes a ground-based survey of natural I emissions from geological sources and studies of the feasibility of mapping I2 from spacecraft. This report is divided into three major sections as follows: (1) the planning engineering and execution of the balloon experiment, (2) data reduction and analysis of the balloon data, and (3) the results of the I2 phase of the contract.

  3. Aerodynamics of a Party Balloon

    ERIC Educational Resources Information Center

    Cross, Rod

    2007-01-01

    It is well-known that a party balloon can be made to fly erratically across a room, but it can also be used for quantitative measurements of other aspects of aerodynamics. Since a balloon is light and has a large surface area, even relatively weak aerodynamic forces can be readily demonstrated or measured in the classroom. Accurate measurements…

  4. Endoscopic management of colorectal adenomas.

    PubMed

    Meier, Benjamin; Caca, Karel; Fischer, Andreas; Schmidt, Arthur

    2017-01-01

    Colorectal adenomas are well known precursors of invasive adenocarcinoma. Colonoscopy is the gold standard for adenoma detection. Colonoscopy is far more than a diagnostic tool, as it allows effective treatment of colorectal adenomas. Endoscopic resection of colorectal adenomas has been shown to reduce the incidence and mortality of colorectal cancer. Difficult resection techniques are available, such as endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic full-thickness resection. This review aims to provide an overview of the different endoscopic resection techniques and their indications, and summarizes the current recommendations in the recently published guideline of the European Society of Gastrointestinal Endoscopy.

  5. Endoscopic management of colorectal adenomas

    PubMed Central

    Meier, Benjamin; Caca, Karel; Fischer, Andreas; Schmidt, Arthur

    2017-01-01

    Colorectal adenomas are well known precursors of invasive adenocarcinoma. Colonoscopy is the gold standard for adenoma detection. Colonoscopy is far more than a diagnostic tool, as it allows effective treatment of colorectal adenomas. Endoscopic resection of colorectal adenomas has been shown to reduce the incidence and mortality of colorectal cancer. Difficult resection techniques are available, such as endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic full-thickness resection. This review aims to provide an overview of the different endoscopic resection techniques and their indications, and summarizes the current recommendations in the recently published guideline of the European Society of Gastrointestinal Endoscopy. PMID:29118553

  6. Aggressive Digital Papillary Adenocarcinoma in a Young Female-a Rare Presentation.

    PubMed

    Gole, Gautam Nandkumar; Tati, Shekhar Y; Deshpande, Ashok Kumar; Gole, Sheetal G

    2011-06-01

    A 20 year old female presented with a recurrent soft tissue swelling over the medial aspect of proximal phalanx of left little finger. It had recurred one year after excision. There was no lymphadenopathy or bony involvement. Previous histopathology reports were not available. After excision histopathological diagnosis was aggressive digital papillary adenocarcinoma. Later Ray's amputation of little finger was planned. Aggressive digital papillary adenocarcinomas are rare sweat gland tumors which occur on hands, fingers, and toes. They have high local recurrence rate and may metastasize to lungs and lymph nodes.

  7. Endoscopic treatments for portal hypertension.

    PubMed

    Lo, Gin-Ho

    2018-02-01

    Acute esophageal variceal hemorrhage is a dreaded complication of portal hypertension. Its management has evolved rapidly in recent years. Endoscopic therapy is often employed to arrest bleeding varices as well as to prevent early rebleeding. The combination of vasoconstrictor and endoscopic therapy is superior to vasoconstrictor or endoscopic therapy alone for control of acute esophageal variceal hemorrhage. After control of acute variceal bleeding, combination of banding ligation and beta-blockers is generally recommended to prevent variceal rebleeding. To prevent the catastrophic event of acute variceal bleeding, endoscopic banding ligation is an important tool in the prophylaxis of first bleeding. Endoscopic obturation with cyanoacrylate is usually utilized to arrest acute gastric variceal hemorrhage as well as to prevent rebleeding. It can be concluded that endoscopic therapies play a pivotal role in management of portal hypertensive bleeding.

  8. Optimizing logistics for balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices by doing away with the indwelling balloon: concept and techniques.

    PubMed

    Saad, Wael E; Nicholson, David B

    2013-06-01

    Since the conception of balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices 25 years ago, the placement of an indwelling balloon for hours has been central to the BRTO procedure. Numerous variables and variations of the BRTO procedure have been described, including methods to reduce sclerosant, combining percutaneous transhepatic obliteration, varying sclerosant, and using multiple sclerosants within the same procedure. However, the consistent feature of BRTO has always remained the indwelling balloon. Placing an indwelling balloon over hours for the BRTO procedure is a logistical burden that taxes the interventional radiology team and hospital resources. Substituting the balloon with hardware (coils or Amplatzer vascular plugs [AVPs] or both) is technically feasible and its risks most likely correlate with gastrorenal shunt (GRS) size. The current authors use packed 0.018- or 0.035-in coils or both for small gastric variceal systems (GRS size A and B) and AVPs for GRS sizes up to size E (from size A-E). The current authors recommend an indwelling balloon (no hardware substitute) for very large gastric variceal system (GRS size F). Substituting the indwelling balloon for hardware in size F and potentially size E GRS can also be risky. The current article describes the techniques of placing up to 16-mm AVPs through balloon occlusion guide catheters and then deflating the balloon once it has been substituted with the AVPs. In addition, 22-mm AVPs can be placed through sheaths once the balloon occlusion catheters are removed to further augment the 16-mm Amplatzer occlusion. To date, there are no studies describing, let alone evaluating, the clinical feasibility of performing BRTO without indwelling balloons. The described techniques have been successfully performed by the current authors. However, the long-term safety and effectiveness of these techniques is yet to be determined. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Feasibility of Newly Developed Endoscopic Ultrasound with Zone Sonography Technology for Diagnosis of Pancreatic Diseases

    PubMed Central

    Itoh, Akihiro; Kawashima, Hiroki; Ohno, Eizaburo; Itoh, Yuya; Nakamura, Yosuke; Hiramatsu, Takeshi; Sugimoto, Hiroyuki; Sumi, Hajime; Hayashi, Daijiro; Ohmiya, Naoki; Miyahara, Ryoji; Nakamura, Masanao; Funasaka, Kohei; Ishigami, Masatoshi; Katano, Yoshiaki; Goto, Hidemi

    2013-01-01

    Background/Aims To confirm the feasibility of using newly developed endoscopic ultrasound (EUS) with Zone sonography™ technology (ZST; Fujifilm Corp.). Methods Seventy-five patients with pancreatic disorders were enrolled: 45 with intraductal papillary mucinous neoplasm; 15 with ductal carcinoma; five with neuroendocrine tumors; three with serous cystic neoplasms; and seven with simple cysts. The endoscopes used were EG-530UR2 and EG-530UT2 (Fujifilm Corp.). Two items were evaluated: visualization depth among four frequencies and image quality after automatic adjustment of sound speed (AASS), assessed using a 5-scale Likert scale by two endosonographers blinded to disease status. Because sound speed could be manually controlled, besides AASS, image quality at sound speeds of 1,440 and 1,600 m/sec were also assessed. Results In all cases, sufficient images were obtained in the range of 3 cm from the EUS probe. Judgments of image quality before AASS were 3.49±0.50, 3.65±0.48, respectively. After AASS, A and B scored 4.36±0.48 and 4.40±0.49 (p<0.0001). There were significant differences in the data before and after AASS and plus 60 m/sec, but no significant difference between the datasets were seen after AASS and at sound speeds manually set for minus 100 m/sec. Conclusions EUS with ZST was shown to be feasible in this preliminary experiment. Further evaluation of this novel technology is necessary and awaited. PMID:23898392

  10. Feasibility of newly developed endoscopic ultrasound with zone sonography technology for diagnosis of pancreatic diseases.

    PubMed

    Hirooka, Yoshiki; Itoh, Akihiro; Kawashima, Hiroki; Ohno, Eizaburo; Itoh, Yuya; Nakamura, Yosuke; Hiramatsu, Takeshi; Sugimoto, Hiroyuki; Sumi, Hajime; Hayashi, Daijiro; Ohmiya, Naoki; Miyahara, Ryoji; Nakamura, Masanao; Funasaka, Kohei; Ishigami, Masatoshi; Katano, Yoshiaki; Goto, Hidemi

    2013-07-01

    To confirm the feasibility of using newly developed endoscopic ultrasound (EUS) with Zone sonography™ technology (ZST; Fujifilm Corp.). Seventy-five patients with pancreatic disorders were enrolled: 45 with intraductal papillary mucinous neoplasm; 15 with ductal carcinoma; five with neuroendocrine tumors; three with serous cystic neoplasms; and seven with simple cysts. The endoscopes used were EG-530UR2 and EG-530UT2 (Fujifilm Corp.). Two items were evaluated: visualization depth among four frequencies and image quality after automatic adjustment of sound speed (AASS), assessed using a 5-scale Likert scale by two endosonographers blinded to disease status. Because sound speed could be manually controlled, besides AASS, image quality at sound speeds of 1,440 and 1,600 m/sec were also assessed. In all cases, sufficient images were obtained in the range of 3 cm from the EUS probe. Judgments of image quality before AASS were 3.49±0.50, 3.65±0.48, respectively. After AASS, A and B scored 4.36±0.48 and 4.40±0.49 (p<0.0001). There were significant differences in the data before and after AASS and plus 60 m/sec, but no significant difference between the datasets were seen after AASS and at sound speeds manually set for minus 100 m/sec. EUS with ZST was shown to be feasible in this preliminary experiment. Further evaluation of this novel technology is necessary and awaited.

  11. Concepts for autonomous flight control for a balloon on Mars

    NASA Technical Reports Server (NTRS)

    Heinsheimer, Thomas F.; Friend, Robyn C.; Siegel, Neil G.

    1988-01-01

    Balloons operating as airborne rovers have been suggested as ideal candidates for early exploration of the Martian surface. An international study team composed of scientists from the U.S.S.R., France, and the U.S.A. is planning the launching in 1994 of a balloon system to fly on Mars. The current likely design is a dual thermal/gas balloon that consists of a gas balloon suspended above a solar-heated thermal balloon. At night, the thermal balloon provides no lift, and the balloon system drifts just above the Martian surface; the lift of the gas balloon is just sufficient to prevent the science payload from hitting the ground. During the day, the balloon system flies at an altitude of 4 to 5 kilometers, rising due to the added lift provided by the thermal balloon. Over the course of a single Martian day, there may be winds in several directions, and in fact it can be expected that there will be winds simultaneously in different directions at different altitudes. Therefore, a balloon system capable of controlling its own altitude, via an autonomous flight control system, can take advantage of these different winds to control its direction, thereby greatly increasing both its mission utility and its longevity.

  12. NONINVASIVE FOLLICULAR TUMOR WITH PAPILLARY-LIKE NUCLEAR FEATURES: NOT A TEMPEST IN A TEAPOT.

    PubMed

    Agrawal, Nidhi; Abbott, Collette E; Liu, Cheng; Kang, Stella; Tipton, Laura; Patel, Kepal; Persky, Mark; King, Lizabeth; Deng, Fang-Ming; Bannan, Michael; Ogilvie, Jennifer B; Heller, Keith; Hodak, Steven P

    2017-04-02

    Encapsulated non-invasive follicular variant papillary thyroid cancer (ENIFVPTC) has recently been retermed noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This designation specifically omits the word "cancer" to encourage conservative treatment since patients with NIFTP tumors have been shown to derive no benefit from completion thyroidectomy or adjuvant radio-active iodine (RAI) therapy. This was a retrospective study of consecutive cases of tumors from 2007 to 2015 that met pathologic criteria for NIFTP. The conservative management (CM) group included patients managed with lobectomy alone or appropriately indicated total thyroidectomy. Those included in the aggressive management (AM) group received either completion thyroidectomy or RAI or both. From 100 consecutive cases of ENIFVPTC reviewed, 40 NIFTP were included for the final analysis. Of these, 10 (27%) patients treated with initial lobectomy received completion thyroidectomy and 6 of 40 (16%) also received postsurgical adjuvant RAI. The mean per-patient cost of care in the AM group was $17,629 ± 2,865, nearly twice the $8,637 ± 309 costs in the CM group, and was largely driven by the cost of completion thyroidectomy and RAI. The term NIFTP has been recently promulgated to identify a type of thyroid neoplasm, formerly identified as a low-grade cancer, for which initial surgery represents adequate treatment. We believe that since the new NIFTP nomenclature intentionally omits the word "cancer," the clinical indolence of these tumors will be better appreciated, and cost savings will result from more conservative and appropriate clinical management. AM = aggressive management CM = conservative management ENIFVPTC = encapsulated noninvasive form of FVPTC FVPTC = follicular variant of papillary thyroid carcinoma NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features PTC = papillary thyroid carcinoma PTMC = papillary thyroid microcarcinoma RAI

  13. Foot-controlled robotic-enabled endoscope holder for endoscopic sinus surgery: A cadaveric feasibility study.

    PubMed

    Chan, Jason Y K; Leung, Iris; Navarro-Alarcon, David; Lin, Weiyang; Li, Peng; Lee, Dennis L Y; Liu, Yun-hui; Tong, Michael C F

    2016-03-01

    To evaluate the feasibility of a unique prototype foot-controlled robotic-enabled endoscope holder (FREE) in functional endoscopic sinus surgery. Cadaveric study. Using human cadavers, we investigated the feasibility, advantages, and disadvantages of the robotic endoscope holder in performing endoscopic sinus surgery with two hands in five cadaver heads, mimicking a single nostril three-handed technique. The FREE robot is relatively easy to use. Setup was quick, taking less than 3 minutes from docking the robot at the head of the bed to visualizing the middle meatus. The unit is also relatively small, takes up little space, and currently has four degrees of freedom. The learning curve for using the foot control was short. The use of both hands was not hindered by the presence of the endoscope in the nasal cavity. The tremor filtration also aided in the smooth movement of the endoscope, with minimal collisions. The FREE endoscope holder in an ex-vivo cadaver test corroborated the feasibility of the robotic prototype, which allows for a two-handed approach to surgery equal to a single nostril three-handed technique without the holder that may reduce operating time. Further studies will be needed to evaluate its safety profile and use in other areas of endoscopic surgery. NA. Laryngoscope, 126:566-569, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Stratospheric Balloons for Planetary Science and the Balloon Observation Platform for Planetary Science (BOPPS) Mission Summary

    NASA Technical Reports Server (NTRS)

    Kremic, Tibor; Cheng, Andrew F.; Hibbitts, Karl; Young, Eliot F.; Ansari, Rafat R.; Dolloff, Matthew D.; Landis, Rob R.

    2015-01-01

    NASA and the planetary science community have been exploring the potential contributions approximately 200 questions raised in the Decadal Survey have identified about 45 topics that are potentially suitable for addressing by stratospheric balloon platforms. A stratospheric balloon mission was flown in the fall of 2014 called BOPPS, Balloon Observation Platform for Planetary Science. This mission observed a number of planetary targets including two Oort cloud comets. The optical system and instrumentation payload was able to provide unique measurements of the intended targets and increase our understanding of these primitive bodies and their implications for us here on Earth. This paper will discuss the mission, instrumentation and initial results and how these may contribute to the broader planetary science objectives of NASA and the scientific community. This paper will also identify how the instrument platform on BOPPS may be able to contribute to future balloon-based science. Finally the paper will address potential future enhancements and the expected science impacts should those enhancements be implemented.

  15. How to perform combined cutting balloon and high pressure balloon valvuloplasty for dogs with subaortic stenosis.

    PubMed

    Kleman, Mandi E; Estrada, Amara H; Maisenbacher, Herbert W; Prošek, Robert; Pogue, Brandon; Shih, Andre; Paolillo, Joseph A

    2012-01-01

    Subvalvular aortic stenosis (SAS) is one of the most common congenital cardiac malformations in dogs. Unfortunately, the long term success rate and survival data following either open heart surgery or catheter based intervention has been disappointing in dogs with severe subaortic stenosis. Medical therapy is currently the only standard recommended treatment option. A cutting balloon dilation catheter has been used successfully for resistant coronary artery and peripheral pulmonary arterial stenoses in humans. This catheter is unique in that it has the ability to cut, or score, the stenotic region prior to balloon dilatation of the stenosis. The use of cutting balloon valvuloplasty combined with high pressure valvuloplasty for dogs with severe subaortic stenosis has recently been reported to be a safe and feasible alternative therapeutic option. The following report describes this technique, outlines the materials required, and provides some 'tips' for successful percutaneous subaortic balloon valvuloplasty. Copyright © 2012 Elsevier B.V. All rights reserved.

  16. Principles of endoscopic ear surgery.

    PubMed

    Tarabichi, Muaaz; Kapadia, Mustafa

    2016-10-01

    The aim of this review is to study the rationale, limitations, techniques, and long-term outcomes of endoscopic ear surgery. The article discusses the advantages of endoscopic ear surgery in treating cholesteatoma and how the hidden sites like facial recess, sinus tympani, and anterior epitympanum are easily accessed using the endoscope. Transcanal endoscopic approach allows minimally invasive removal of cholesteatoma with results that compare well to traditional postauricular tympanomastoidectomy.

  17. Fracture, inflation and floatation embolisation of PTCA balloon.

    PubMed

    O'Neill, Louisa; Sowbhaga, Vinay; Owens, Patrick

    2015-01-09

    This case outlines an unusual complication of coronary intervention, the likely mechanisms leading to this and possible retrieval options. It is the first case to the best of our knowledge reporting this complication. A 78-year-old Caucasian man underwent coronary stenting. During the procedure kinking and subsequent fracture of a non-compliant percutaneous transluminal coronary angioplasty (PTCA) balloon occurred. Injection of contrast down the guide to opacify the coronary arteries resulted in 'inflation' of the balloon with air, and embolisation of the inflated balloon into the proximal left anterior descending artery. The embolised balloon was retrieved by removal of the guide catheter and wire as a unit. The patient had a good angiographic outcome. This case highlights risks associated with usage of kinked balloons catheters, and describes for the first time to our knowledge, the inflation of a PTCA balloon with air from its shaft within the catheter, causing 'floatation' embolisation into the coronary artery. 2015 BMJ Publishing Group Ltd.

  18. Fracture, inflation and floatation embolisation of PTCA balloon

    PubMed Central

    O'Neill, Louisa; Sowbhaga, Vinay; Owens, Patrick

    2015-01-01

    This case outlines an unusual complication of coronary intervention, the likely mechanisms leading to this and possible retrieval options. It is the first case to the best of our knowledge reporting this complication. A 78-year-old Caucasian man underwent coronary stenting. During the procedure kinking and subsequent fracture of a non-compliant percutaneous transluminal coronary angioplasty (PTCA) balloon occurred. Injection of contrast down the guide to opacify the coronary arteries resulted in ‘inflation’ of the balloon with air, and embolisation of the inflated balloon into the proximal left anterior descending artery. The embolised balloon was retrieved by removal of the guide catheter and wire as a unit. The patient had a good angiographic outcome. This case highlights risks associated with usage of kinked balloons catheters, and describes for the first time to our knowledge, the inflation of a PTCA balloon with air from its shaft within the catheter, causing ‘floatation’ embolisation into the coronary artery. PMID:25576524

  19. Genetic drivers of papillary renal cell carcinoma - TCGA

    Cancer.gov

    A comprehensive genomic analysis of 161 tumors from people with papillary renal cell carcinoma (PRCC) – the second most common form of kidney cancer –provided insights into the molecular basis of this cancer and may inform its classification and treatment.

  20. Single Fluid-Filled Intragastric Balloon Safe and Effective for Inducing Weight Loss in a Real-World Population.

    PubMed

    Vargas, Eric J; Pesta, Carl M; Bali, Ahmad; Ibegbu, Eric; Bazerbachi, Fateh; Moore, Rachel L; Kumbhari, Vivek; Sharaiha, Reem Z; Curry, Trace W; DosSantos, Gina; Schmitz, Ramsey; Agnihotri, Abhishek; Novikov, Aleksey A; Pitt, Tracy; Dunlap, Margo K; Herr, Andrea; Aronne, Louis; Ledonne, Erin; Kadouh, Hoda C; Cheskin, Lawrence J; Mundi, Manpreet S; Acosta, Andres; Gostout, Christopher J; Abu Dayyeh, Barham K

    2018-07-01

    at the time of balloon placement was associated with increased odds of removal before 6 months (odds ratio, 3.92; 95% CI, 1.24-12.41). Total body weight lost at 3 months was 8.5% ± 4.9% (n = 204), at 6 months was 11.8% ± 7.5% (n = 199), and at 9 months was 13.3% ± 10% (n = 47). At 6 months, total body weight losses of 5%, 10%, and 15% were achieved by 88%, 62%, and 31% of patients, respectively. Number of follow-up visits and weight loss at 3 months were associated with increased weight loss at 6 months (β = 0.5 and 1.2, respectively) (P < .05). Mean levels of cholesterol, triglycerides, low-density lipoprotein, and hemoglobin A1c, as well as systolic and diastolic blood pressure, were significantly improved at 6 months after OIB placement (P < .05). In an analysis of a database of patients who received endoscopic placement of the OIB, we found it to be safe, effective at inducing weight loss, and to reduce obesity-related comorbidities in a real-world clinical population. Rates of early removal (before 8 weeks) did not differ significantly between clinical trials and the real-world population, but were affected by use of medications. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

  1. NASA’s BARREL Mission Launches 20 Balloons

    NASA Image and Video Library

    2017-12-08

    A BARREL balloon floats into the sky as it is partially filled. When fully inflated, each balloon is 90 feet in diameter and carries an instrument suite that weighs 50 pounds. This is small for an Antarctica balloon launch, which can have balloons Typical balloons l the size of a football field with payloads of some 3,000 pounds. Credit: NASA --- In Antarctica in January, 2013 – the summer at the South Pole – scientists launched 20 balloons up into the air to study an enduring mystery of space weather: when the giant radiation belts surrounding Earth lose material, where do the extra particles actually go? The mission is called BARREL (Balloon Array for Radiation belt Relativistic Electron Losses) and it is led by physicist Robyn Millan of Dartmouth College in Hanover, NH. Millan provided photographs from the team’s time in Antarctica. The team launched a balloon every day or two into the circumpolar winds that circulate around the pole. Each balloon floated for anywhere from 3 to 40 days, measuring X-rays produced by fast-moving electrons high up in the atmosphere. BARREL works hand in hand with another NASA mission called the Van Allen Probes, which travels through the Van Allen radiation belts surrounding Earth. The belts wax and wane over time in response to incoming energy and material from the sun, sometimes intensifying the radiation through which satellites must travel. Scientists wish to understand this process better, and even provide forecasts of this space weather, in order to protect our spacecraft. As the Van Allen Probes were observing what was happening in the belts, BARREL tracked electrons that precipitated out of the belts and hurtled down Earth’s magnetic field lines toward the poles. By comparing data, scientists will be able to track how what’s happening in the belts correlates to the loss of particles – information that can help us understand this mysterious, dynamic region that can impact spacecraft. Having launched balloons in

  2. Novel and safer endoscopic cholecystectomy using only a flexible endoscope via single port

    PubMed Central

    Mori, Hirohito; Kobayashi, Nobuya; Kobara, Hideki; Nishiyama, Noriko; Fujihara, Shintaro; Chiyo, Taiga; Ayaki, Maki; Nagase, Takashi; Masaki, Tsutomu

    2016-01-01

    AIM: To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or not. METHODS: Two dogs (11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port. RESULTS: The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one port. CONCLUSION: We are sure of great feasibility of endoscopic cholecystectomy via single port for human. PMID:27053847

  3. 21 CFR 884.5050 - Metreurynter-balloon abortion system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

  4. 21 CFR 884.5050 - Metreurynter-balloon abortion system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

  5. 21 CFR 884.5050 - Metreurynter-balloon abortion system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

  6. 21 CFR 884.5050 - Metreurynter-balloon abortion system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

  7. 21 CFR 884.5050 - Metreurynter-balloon abortion system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

  8. Aortic valve replacement for papillary fibroelastoma.

    PubMed

    Arikan, Ali Ahmet; Omay, Oğuz; Aydın, Fatih; Kanko, Muhip; Gür, Sibel; Derviş, Emir; Yılmaz, Cansu Eda; Müezzinoğlu, Bahar

    2017-06-01

    Surgery is indicated for symptomatic patients with papillary fibroelastomas (PFE) on the aortic valve. The valve is commonly spared during tumor excision. Rarely, aortic valve replacement (AVR) is needed. We present a case requiring AVR for an aortic valve PFE and review the literature to determine the risk factors for failure of aortic valve-sparing techniques in patients with PFE. © 2017 Wiley Periodicals, Inc.

  9. Struma Ovarii with Papillary Thyroid Carcinoma

    PubMed Central

    Alvarez, Daniel M.; Lee, Victor; Bhatt, Shweta; Dogra, Vikram S.

    2011-01-01

    Struma ovarii is an uncommon condition, in which thyroid tissue is the predominant or exclusive element in an ovarian teratoma. Thyroid tissue may demonstrate the same spectrum of pathological features as in the normal thyroid including benign and malignant changes. We present a case of papillary thyroid carcinoma arising in a struma ovarii of the left ovary in a 21-year-old female. PMID:22315711

  10. Ileal polypoid lymphangiectasia bleeding diagnosed and treated by double balloon enteroscopy.

    PubMed

    Park, Min Seon; Lee, Beom Jae; Gu, Dae Hoe; Pyo, Jeung-Hui; Kim, Kyeong Jin; Lee, Yun Ho; Joo, Moon Kyung; Park, Jong-Jae; Kim, Jae Seon; Bak, Young-Tae

    2013-12-07

    Intestinal lymphangiectasia is a rare disease characterized by focal or diffuse dilated enteric lymphatics with impaired lymph drainage. It causes protein-losing enteropathy and may lead to gastrointestinal bleeding. Commonly, lymphangiectasia presents as whitish spots or specks. To our knowledge, small bowel bleeding resulting from polypoid intestinal lymphangiectasia has not been reported. Here, we report a rare case of active bleeding from the small bowel caused by polypoid lymphangiectasia with a review of the relevant literature. An 80-year-old woman was hospitalized for melena. Esophagogastroduodenoscopy could not identify the source of bleeding. Subsequent colonoscopy showed fresh bloody material gushing from the small bowel. An abdominal-pelvic contrast-enhanced computed tomography scan did not reveal any abnormal findings. Video capsule endoscopy showed evidence of active and recent bleeding in the ileum. To localize the bleeding site, we performed double balloon enteroscopy by the anal approach. A small, bleeding, polypoid lesion was found in the distal ileum and was successfully removed using endoscopic snare electrocautery. © 2013 Baishideng Publishing Group Co., Limited. All rights reserved.

  11. Endoscopic Evacuation of Subdural Collections.

    PubMed

    Boyaci, Suat; Gumustas, Oguzhan Guven; Korkmaz, Serdar; Aksoy, Kaya

    2016-01-01

    Intraoperative use of the endoscope is a hot topic in neurosurgery and it gives broader visualization of critical and hardlyreached areas. Endoscope-assisted surgical approach to chronic subdural haematoma (SDH) is a minimally invasive technique and may give an expansion to the regular method of burr-hole haematoma drainage. Endoscope-assisted haematoma drainage with mini-craniotomy was performed over a 24-month period, and prospectively collected data is reviewed. A total of 10 procedures (8 patients) were performed using the endoscopeassisted technique. Four of them were chronic SDH and six were subacute SDH. Procedures were extended 20 minutes in average because of endoscopic intervention. There was no extra-morbidity through the study as a consequence of endoscopic assessment. Endoscope-assisted techniques can make the operation safe in selected circumstances with improved intraoperative visualization. It may likewise take into consideration the identification and destruction of neo-membranes, septums and solid clots. In addition, the source of bleeding can be easily coagulated. The endoscope-assisted techniques, with all of these features, can alter the pre- and intra-operative decision-making for selected patients.

  12. Investigating Diffusion and Entropy with Carbon Dioxide-Filled Balloons

    ERIC Educational Resources Information Center

    Jadrich, James; Bruxvoort, Crystal

    2010-01-01

    Fill an ordinary latex balloon with helium gas and you know what to expect. Over the next day or two the volume will decrease noticeably as helium escapes from the balloon. So what happens when a latex balloon is filled with carbon dioxide gas? Surprisingly, carbon dioxide balloons deflate at rates as much as an order of magnitude faster than…

  13. Dose Reduction Study in Vaginal Balloon Packing Filled With Contrast for HDR Brachytherapy Treatment;HDR; Uterine cervix cancer; Vaginal balloon packing; Contrast; Monte Carlo

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Saini, Amarjit S.; Zhang, Geoffrey G., E-mail: geoffrey.zhang@moffitt.org; Finkelstein, Steven E.

    2011-07-15

    Purpose: Vaginal balloon packing is a means to displace organs at risk during high dose rate brachytherapy of the uterine cervix. We tested the hypothesis that contrast-filled vaginal balloon packing reduces radiation dose to organs at risk, such as the bladder and rectum, in comparison to water- or air-filled balloons. Methods and Materials: In a phantom study, semispherical vaginal packing balloons were filled with air, saline solution, and contrast agents. A high dose rate iridium-192 source was placed on the anterior surface of the balloon, and the diode detector was placed on the posterior surface. Dose ratios were taken withmore » each material in the balloon. Monte Carlo (MC) simulations, by use of the MC computer program DOSXYZnrc, were performed to study dose reduction vs. balloon size and contrast material, including commercially available iodine- and gadolinium-based contrast agents. Results: Measured dose ratios on the phantom with the balloon radius of 3.4 cm were 0.922 {+-} 0.002 for contrast/saline solution and 0.808 {+-} 0.001 for contrast/air. The corresponding ratios by MC simulations were 0.895 {+-} 0.010 and 0.781 {+-} 0.010. The iodine concentration in the contrast was 23.3% by weight. The dose reduction of contrast-filled balloon ranges from 6% to 15% compared with water-filled balloon and 11% to 26% compared with air-filled balloon, with a balloon size range between 1.4 and 3.8 cm, and iodine concentration in contrast of 24.9%. The dose reduction was proportional to the contrast agent concentration. The gadolinium-based contrast agents showed less dose reduction because of much lower concentrations in their solutions. Conclusions: The dose to the posterior wall of the bladder and the anterior wall of the rectum can be reduced if the vaginal balloon is filled with contrast agent in comparison to vaginal balloons filled with saline solution or air.« less

  14. Parametric imaging of clear cell and papillary renal cell carcinoma using contrast-enhanced ultrasound (CEUS).

    PubMed

    Rübenthaler, J; Reimann, R; Hristova, P; Staehler, M; Reiser, M; Clevert, D A

    2015-10-16

    The aim of this study was to analyse clear cell and papillary renal cell carcinoma (RCC) examined with contrast-enhanced ultrasound (CEUS) and a second generation blood pool agent (SonoVue®, Bracco, Milan, Italy) before clinical intervention. A total of 41 patients with histologically proven subtypes of RCC were examined. 29 patients had a clear cell RCC and 12 patients showed a papillary RCC. Average size in the clear cell RCC group was 6.07 cm and 1.88 cm in the papillary RCC group. An experienced radiologist examined all patients with CEUS. The following parameters were analysed: maximum signal intensity (PEAK), time elapsed until PEAK is reached (MTT), local blood flow (RBF), area under the time intensity curve (AUC) and the signal intensity (SI) during the course of time. For both groups all comparisons were made based on healthy renal parenchyma. In the clear cell RCC significant differences (significance level p < 0.05) between cancerous tissue and the healthy renal parenchyma were noticed in all four parameters. The clear cell RCC showed a significant reduced blood volume. It reached the PEAK reading relatively rapidly and its signal intensity was always lower than that of the healthy renal parenchyma. In the arterial phase retarded absorption of the contrast agent was observed, followed by fast washing out of the contrast agent bubbles.In the papillary RCC group, significant findings as to PEAK and RBF as well as a slightly significant difference as to AUC were recorded. The papillary RCC had a lower blood supply and reached its PEAK reading later. Its signal intensity was also reduced. The signal intensity of papillary NCC was significantly lower compared with clear cell RCC; absorption and washing out of the contrast agent was delayed. CEUS seems to be an useful additional method to clinically differentiate between clear cell and papillary RCC. In daily clinical use, patients with contraindication for other imaging methods, especially the

  15. 21 CFR 876.1500 - Endoscope and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes... endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope, and...

  16. 21 CFR 876.1500 - Endoscope and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes... endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope, and...

  17. 21 CFR 876.1500 - Endoscope and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes... endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope, and...

  18. 21 CFR 876.1500 - Endoscope and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes... endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope, and...

  19. 21 CFR 876.1500 - Endoscope and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes... endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope, and...

  20. Under Pressure: Intraluminal Filling Pressures of Postpartum Hemorrhage Tamponade Balloons

    PubMed Central

    Antony, Kathleen M.; Racusin, Diana A.; Belfort, Michael A.; Dildy, Gary A.

    2017-01-01

    Objective Uterine tamponade by fluid-filled balloons is now an accepted method of controlling postpartum hemorrhage. Available tamponade balloons vary in design and material, which affects the filling attributes and volume at which they rupture. We aimed to characterize the filling capacity and pressure-volume relationship of various tamponade balloons. Study Design Balloons were filled with water ex vivo. Intraluminal pressure was measured incrementally (every 10 mL for the Foley balloons and every 50 mL for all other balloons). Balloons were filled until they ruptured or until 5,000 mL was reached. Results The Foley balloons had higher intraluminal pressures than the larger-volume balloons. The intraluminal pressure of the Sengstaken-Blakemore tube (gastric balloon) was initially high, but it decreased until shortly before rupture occurred. The Bakri intraluminal pressure steadily increased until rupture occurred at 2,850 mL. The condom catheter, BT-Cath, and ebb all had low intraluminal pressures. Both the BT-Cath and the ebb remained unruptured at 5,000 mL. Conclusion In the setting of acute hemorrhage, expeditious management is critical. Balloons that have a low intraluminal pressure-volume ratio may fill more rapidly, more easily, and to greater volumes. We found that the BT-Cath, the ebb, and the condom catheter all had low intraluminal pressures throughout filling. PMID:28497006

  1. Overview of the Scientific Balloon Activity in Sweden

    NASA Astrophysics Data System (ADS)

    Abrahamsson, Mattias; Kemi, Stig; Lockowandt, Christian; Andersson, Kent

    SSC, formerly known as Swedish Space Corporation, is a Swedish state-owned company working in several different space related fields, including scientific stratospheric balloon launches. Esrange Space Centre (Esrange in short) located in the north of Sweden is the launch facility of SSC, where both sounding rocket launches and stratospheric balloon launches are conducted. At Esrange there are also facilities for satellite communication, including one of the largest civilian satellite data reception stations in the world. Stratospheric balloons have been launched from Esrange since 1974, when the first flights were performed together with the French space agency CNES. These balloon flights have normally flown eastward either only over Sweden or into Finland. Some flights have also had permission to fly into Russia, as far as the Ural Mountains. Normal flight times are from 4 to 12 hours. These eastward flights are conducted during the winter months (September to May). Long duration flights have been flown from ESC since 2005, when NASA flew the BLAST payload from Sweden to north Canada. The prevailing westerly wind pattern is very advantageous for trans-Atlantic flights during summer (late May to late July). The long flight times are very beneficial for astronomical payloads, such as telescopes that need long observation times. In 2013 two such payloads were flown, the first called SUNRISE was a German/US solar telescope, and the other called PoGOLite with a Swedish gamma-ray telescope. In 14 days PoGOLite, which had permission to fly over Russia, made an almost complete circumpolar flight. Typical scientific balloon payload fields include atmospheric research, including research on ozone depletion, astronomical and cosmological research, and research in technical fields such as aerodynamics. University students from all over Europe are involved in flights from Esrange under a Swedish/German programme called BEXUS. Two stratospheric balloons are flown with student

  2. [Clinical experience of combined laparoscopic-endoscopic Heller myotomy and modified Dor fundoplication for cardiochalasia].

    PubMed

    Qiao, Xiaofang; Li, Jinlong; Xu, Hua; Wan, Xin; Zhu, Jiaming

    2017-08-25

    To investigate the efficacy of combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication for cardiochalasia patients. Clinical data of 11 cardiochalasia patients who underwent combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication by the same medical team from January 2015 to December 2016 at The Second Hospital of Jilin University were retrospectively analyzed. The procedure was as follows: an incision was made in the anterior wall of esophagus and dissection of esophageal muscular layer was performed, then the bulged esophageal mucosa was covered by the fundus after 180 degrees fold to the right (fundoplication), finally the gastric fundus was joined to the right diaphragmatic foot by 3 to 5 knotted suture. The efficacy was judged by the Eckardt scoring standard: the postoperative Eckardt score ≤3 points indicated effectiveness, otherwise the treatment was invalid. Combined laparoscopic-endoscopic lower esophageal sphincterotomy and modified Dor fundoplication was completed successfully in all the 11 patients without any subsequent laparotomy and death. The mean operative time was 85 (78 to 137) min, blood loss was 15 (5 to 35) ml, and no upper digestive tract perforation occurred. The mean postoperative hospital stay was 7.0(6 to 9) d. After the operation, the pressure of lower esophageal sphincter decreased significantly compared to that before operation [(5.31±6.23) mmHg vs. (35.72±17.13) mmHg, P<0.05], and the Eckardt score decreased significantly as well (0.53±0.56 vs. 6.17±1.17, P<0.05). During the follow-up of 2 to 23 months, there was no postoperative mortality. One case experienced mild gastroesophageal reflux 6 months after operation, and another patient had recurrent dysphagia 17 months after operation, who both were improved after receiving proton pump inhibitors or gastric dynamic drugs, and balloon dilation. Combined laparoscopic-endoscopic lower esophageal

  3. Endoscopic submucosal dissection for locally recurrent colorectal lesions after previous endoscopic mucosal resection.

    PubMed

    Zhou, Pinghong; Yao, Liqing; Qin, Xinyu; Xu, Meidong; Zhong, Yunshi; Chen, Weifeng

    2009-02-01

    The objective of this study was to determine the efficacy and safety of endoscopic submucosal dissection for locally recurrent colorectal cancer after previous endoscopic mucosal resection. A total of 16 patients with locally recurrent colorectal lesions were enrolled. A needle knife, an insulated-tip knife and a hook knife were used to resect the lesion along the submucosa. The rate of the curative resection, procedure time, and incidence of complications were evaluated. Of 16 lesions, 15 were completely resected with endoscopic submucosal dissection, yielding an en bloc resection rate of 93.8 percent. Histologic examination confirmed that lateral and basal margins were cancer-free in 14 patients (87.5 percent). The average procedure time was 87.2 +/- 60.7 minutes. None of the patients had immediate or delayed bleeding during or after endoscopic submucosal dissection. Perforation in one patient (6.3 percent) was the only complication and was managed conservatively. The mean follow-up period was 15.5 +/- 6.8 months; none of the patients experienced lesion residue or recurrence. Endoscopic submucosal dissection appears to be effective for locally recurrent colorectal cancer after previous endoscopic mucosal resection, making it possible to resect whole lesions and provide precise histologic information.

  4. Simulating clefts in pumpkin balloons

    NASA Astrophysics Data System (ADS)

    Baginski, Frank; Brakke, Kenneth

    2010-02-01

    The geometry of a large axisymmetric balloon with positive differential pressure, such as a sphere, leads to very high film stresses. These stresses can be significantly reduced by using a tendon re-enforced lobed pumpkin-like shape. A number of schemes have been proposed to achieve a cyclically symmetric pumpkin shape, including the constant bulge angle (CBA) design, the constant bulge radius (CBR) design, CBA/CBR hybrids, and NASA’s recent constant stress (CS) design. Utilizing a hybrid CBA/CBR pumpkin design, Flight 555-NT in June 2006 formed an S-cleft and was unable to fully deploy. In order to better understand the S-cleft phenomenon, a series of inflation tests involving four 27-m diameter 200-gore pumpkin balloons were conducted in 2007. One of the test vehicles was a 1/3-scale mockup of the Flight 555-NT balloon. Using an inflation procedure intended to mimic ascent, the 1/3-scale mockup developed an S-cleft feature strikingly similar to the one observed in Flight 555-NT. Our analysis of the 1/3-scale mockup found it to be unstable. We compute asymmetric equilibrium configurations of this balloon, including shapes with an S-cleft feature.

  5. Multifocality and Bilaterality of Papillary Thyroid Microcarcinoma

    PubMed Central

    So, Yoon Kyoung; Kim, Myung Woo

    2015-01-01

    Objectives Papillary thyroid carcinomas frequently occur as two or more separate foci within the thyroid gland (18%-87%). However, those multifocal tumors are easy to be undetected by preoperative radiologic evaluations, which lead to remnant disease after initial surgery. We aimed to study the incidence of multifocal papillary thyroid microcarcinomas (PTMCs), diagnostic accuracy of preoperative radiologic evaluation, predictive factors, and the chance of bilateral tumors. Methods Two hundred and seventy-seven patients with PTMC were included in this study. All patients underwent total thyroidectomy as an initial treatment. Medical records, pathologic reports, and radiological reports were reviewed for analysis. Results Multifocal PTMCs were detected in 100 of 277 patients (36.1%). The mean number of tumors in each patient was 1.6±1.1, ranging from 1 to 10. The additional tumor foci were significantly smaller (0.32±0.18 cm) than the primary tumors (0.63±0.22 cm) (P<0.001). There was no significant relationship between primary tumor size and the presence of contralateral tumors. With more tumors detected in one lobe, there was greater chance of contralateral tumors; 18.8% with single tumor focus, 30.2% with 2 tumor foci, and 46.2% with 3 or more tumor foci in one lobe. Sensitivity of preoperative sonography was 42.7% for multifocal tumors and 49.0% for bilateral tumors. With multivariate analysis, nodular hyperplasia was the only significant factor for multifocal tumors. Conclusion In cases of PTMCs, the incidence of multifocal tumors is high. However, additional tumor foci are too small to be diagnosed preoperatively, especially under the recent guidelines on radiologic screening tests for papillary thyroid carcinoma. Multifocal PTMCs have high risk of bilateral tumors, necessitating more extensive surgery or more thorough follow-up. PMID:26045918

  6. Endoscopic management of sinonasal hemangiopericytoma.

    PubMed

    Tessema, Belachew; Eloy, Jean Anderson; Folbe, Adam J; Anstead, Amy S; Mirani, Neena M; Jourdy, Deya N; Joudy, Deya N; Ruiz, Jose W; Casiano, Roy R

    2012-03-01

    Sinonasal hemangiopericytomas (SNHPCs) are rare perivascular tumors with low-grade malignant potential. Traditionally, these tumors have been treated with open approaches such as lateral rhinotomy, Caldwell-Luc, or transfacial approaches. Increased experience with endoscopic management of benign and malignant sinonasal tumors has led to a shift in management of SNHPC. The authors present their experience in the largest series of patients with SNHPC managed endoscopically. Case series at a tertiary care medical center. A retrospective chart review of all patients undergoing endoscopic management of SNHPC at the University of Miami between 1999 and 2008 was conducted. All endoscopic resections were performed with curative intent. Twelve patients with the diagnosis of SNHPC were treated endoscopically. Mean age was 62.5 years (range, 51-83 years). There were 6 men and 6 women. The mean follow-up was 41 months (range, 15-91 months). Seven (58.3%) presented with nasal obstruction, whereas 4 (41.6%) had epistaxis as their initial presenting symptom. Preoperative angiography or embolization was not performed in any case. Mean estimated blood loss was 630 mL (range, 100-1500 mL). Six patients underwent endonasal endoscopic anterior skull base resection; 4 had complete endoscopic resection all with negative margins. None underwent postoperative adjuvant treatment. No recurrence or metastatic disease was observed in this patient population. Endoscopic management of SNHPC is a feasible approach and did not compromise outcomes in this experience. In this series, familiarity with advance endoscopic sinus surgery was necessary to manage these patients. Postoperative adjuvant therapy was not necessary in this cohort.

  7. GNAq mutations are not identified in papillary thyroid carcinomas and hyperfunctioning thyroid nodules.

    PubMed

    Cassol, Clarissa A; Guo, Miao; Ezzat, Shereen; Asa, Sylvia L

    2010-12-01

    Activating mutations of GNAq protein in a hotspot at codon 209 have been recently described in uveal melanomas. Since these neoplasms share with thyroid carcinomas a high frequency of MAP kinase pathway-activating mutations, we hypothesized whether GNAq mutations could also play a role in the development of thyroid carcinomas. Additionally, activating mutations of another subtype of G protein (GNAS1) are frequently found in hyperfunctioning thyroid adenomas, making it plausible that GNAq-activating mutations could also be found in some of these nodules. To investigate thyroid papillary carcinomas and thyroid hyperfunctioning nodules for GNAq mutations in exon 5, codon 209, a total of 32 RET/PTC, BRAF, and RAS negative thyroid papillary carcinomas and 13 hyperfunctioning thyroid nodules were evaluated. No mutations were identified. Although plausible, GNAq mutations seem not to play an important role in the development of thyroid follicular neoplasms, either benign hyperfunctioning nodules or malignant papillary carcinomas. Our results are in accordance with the literature, in which no GNAq hotspot mutations were found in thyroid papillary carcinomas, as well as in an extensive panel of other tumors. The molecular basis for MAP-kinase pathway activation in RET-PTC/BRAF/RAS negative thyroid carcinomas remains to be determined.

  8. Retained intraaortic balloon. Case report and review of the literature.

    PubMed

    Grande, A M; Martinelli, L; Graffigna, A; Viganò, M

    1995-01-01

    We report a case of intraaortic balloon entrapment in a 70-year-old man who underwent emergency triple coronary bypass. Intraaortic balloon rupture caused the formation of a clot inside the balloon that eventually was responsible for the balloon's entrapment at the aortic bifurcation. The patient had severe atherosclerosis of the aorta and iliac arteries. Balloon removal required aorto-iliac exposure and aorto-bifemoral bypass. After 16 months, he is symptom free and at home.

  9. Incorporation of Scientific Ballooning into Science Education

    NASA Astrophysics Data System (ADS)

    Chanover, N.; Stochaj, S.; Petty, C.

    1999-12-01

    We are augmenting the science curriculum of the Roswell Independent School District in Roswell, NM, to take advantage of the proximity of a NASA scientific balloon base. The basic science related to balloon experimentation is being incorporated into the K-12 science curriculum via the discussion of topics such as atmospheric properties, weather, phases of matter, plotting skills, and communications in the context of a high-altitude balloon flight. These efforts will culminate in the construction of balloon-borne instruments by high school students, which will be launched during the spring of 2000. A demonstration flight, launched in the spring of 1999, was used to build student enthusiasm and community support for this program, which is funded by the NASA/IDEAS program.

  10. Nimbus 4/IRLS Balloon Interrogation Package (BIP)

    NASA Technical Reports Server (NTRS)

    1971-01-01

    The balloon interrogation package (BIP), an integral part of the overall interrogation, recording, and location subsystems (IRLS) for the Nimbus 4 program, is described. The BIP is a self-contained, integrated transponder designed to be carried aloft by a constant altitude, superpressure balloon to an altitude of 67,000 or 78,000 feet. After launch the BIP senses high-altitude balloon overpressure and temperature, and upon receipt of an interrogated command from the IRLS aboard the Nimbus 4 satellite, the BIP enodes the data on a real-time basis into a pulse-code modulation (PCM) format and transmits this data to the satellite. A summary of the program activity to produce 30 BIP systems and to support balloon launches from Ascension Island is presented.

  11. An unusual metastasis of a papillary thyroidian carcinoma with follicular pattern.

    PubMed

    Coconu, M; Berdan, G; Roşculescu, I; Herlea, V

    1998-01-01

    The case of a 67-year-old man is presented. He was admitted for the presence of a left parietal tumour with progressive growing, without any other objective or subjective symptomatology. CT-scan detects a left parietal osteolytic area. The histopathological aspect suggested an adenocarcinomatous metastasis with papillary pattern, moderately differentiated. With the purpose of diagnosing the original tumour, immunnohistochemical techniques were performed, which led to a diagnosis of a thyroidian carcinoma. At the histological examination of the surgical extirpated thyroid, it was proved to be a papillary carcinoma (Chan, 1990, Hay, 1990), the follicular pattern.

  12. Scientific balloons: historical remarks.

    NASA Astrophysics Data System (ADS)

    Ubertini, P.

    The paper is an overview of the Human attempt to fly, from the myth of Daedalus and his son Icarus to the first "aerostatic" experiment by Joseph-Michel and Jaques-Etienne Montgolfier. Then, via a jump of about 200 years, we arrive to the era of the modern stratospheric ballooning that, from the beginning of the last century, have provided a unique flight opportunity for aerospace experiments. In particular, the Italian scientific community has employed stratospheric balloons since the '50s for cosmic rays and high energy astrophysical experiments with initial launches performed from Cagliari Helmas Airport (Sardinia). More recently an almost ideal location was found in the area of Trapani-Milo (Sicily, Italy), were an old abandoned airport was refurbished to be used as a new launch site that became operative at the beginning of the '70s. Finally, we suggest a short reminiscence of the first transatlantic experiment carried out on August 1975 in collaboration between SAS-CNR (Italy) and NSBF-NASA (USA). The reason why the Long Duration Balloon has been recently re-oriented in a different direction is analysed and future perspectives discussed. Finally, the spirit of the balloon launch performed by the Groups lead by Edoardo Amaldi, Livio Scarsi and other Italian pioneers, with payloads looking like "refrigerators" weighting a few tens of kg is intact and the wide participation to the present Workshop is the clear demonstration.

  13. Balloon augmented Onyx embolization utilizing a dual lumen balloon catheter: utility in the treatment of a variety of head and neck lesions.

    PubMed

    Spiotta, Alejandro M; Miranpuri, Amrendra S; Vargas, Jan; Magarick, Jordan; Turner, Raymond D; Turk, Aquilla S; Chaudry, M Imran

    2014-09-01

    Endovascular embolization for tumors and vascular malformations has emerged as an important preoperative adjunct prior to resection. We describe the advantages of utilizing a recently released dual lumen balloon catheter for ethylene vinyl alcohol copolymer, also known as Onyx (ev3, Irvine, California, USA), embolization for a variety of head and neck pathologies. A retrospective review of all cases utilizing the Scepter C balloon catheter (MicroVention Inc, Tustin, California, USA) for use in balloon augmented embolization was performed over a 4 month period from October 2012 to February 2013 at the Medical University of South Carolina, Charleston, South Carolina, USA. Charts and angiographic images were reviewed. Representative cases involving diverse pathologies are summarized and illustrate the observed advantages of balloon augmented Onyx embolization with a dual lumen balloon catheter. Balloon augmented Onyx embolization utilizing a novel dual lumen balloon catheter was employed to treat both ruptured and unruptured arteriovenous malformations, intracranial dural arteriovenous fistulae, intracranial neoplasms, carotid body tumors, a thyroid mass, and an extracranial arteriovenous fistula. The dual lumen balloon catheter has several advantages for use with Onyx embolization over older devices, including more efficient proximal plug formation and enhanced navigability for placement deep within the pedicles. The balloon augmented Onyx embolization technique represents a valuable tool to add to the armamentarium of the neurointerventionalist to address a variety of head and neck lesions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Balloon Exoplanet Nulling Interferometer (BENI)

    NASA Technical Reports Server (NTRS)

    Lyon, Richard G.; Clampin, Mark; Woodruff, Robert A.; Vasudevan, Gopal; Ford, Holland; Petro, Larry; Herman, Jay; Rinehart, Stephen; Carpenter, Kenneth; Marzouk, Joe

    2009-01-01

    We evaluate the feasibility of using a balloon-borne nulling interferometer to detect and characterize exosolar planets and debris disks. The existing instrument consists of a 3-telescope Fizeau imaging interferometer with 3 fast steering mirrors and 3 delay lines operating at 800 Hz for closed-loop control of wavefront errors and fine pointing. A compact visible nulling interferometer is under development which when coupled to the imaging interferometer would in-principle allow deep suppression of starlight. We have conducted atmospheric simulations of the environment above 100,000 feet and believe balloons are a feasible path forward towards detection and characterization of a limited set of exoplanets and their debris disks. Herein we will discuss the BENI instrument, the balloon environment and the feasibility of such as mission.

  15. Endoscopic therapy of neoplasia related to Barrett's esophagus and endoscopic palliation of esophageal cancer.

    PubMed

    Vignesh, Shivakumar; Hoffe, Sarah E; Meredith, Kenneth L; Shridhar, Ravi; Almhanna, Khaldoun; Gupta, Akshay K

    2013-04-01

    Barrett's esophagus (BE) is the most important identifiable risk factor for the progression to esophageal adenocarcinoma. This article reviews the current endoscopic therapies for BE with high-grade dysplasia and intramucosal cancer and briefly discusses the endoscopic palliation of advanced esophageal cancer. The diagnosis of low-grade or high-grade dysplasia (HGD) is based on several cytologic criteria that suggest neoplastic transformation of the columnar epithelium. HGD and carcinoma in situ are regarded as equivalent. The presence of dysplasia, particularly HGD, is also a risk factor for synchronous and metachronous adenocarcinoma. Dysplasia is a marker of adenocarcinoma and also has been shown to be the preinvasive lesion. Esophagectomy has been the conventional treatment for T1 esophageal cancer and, although debated, is an appropriate option in some patients with HGD due to the presence of occult cancer in over one-third of patients. Endoscopic ablative modalities (eg, photodynamic therapy and cryoablation) and endoscopic resection techniques (eg, endoscopic mucosal resection) have demonstrated promising results. The significant morbidity and mortality of esophagectomy makes endoscopic treatment an attractive potential option.

  16. Endoscope-Assisted Transoral Fixation of Mandibular Condyle Fractures: Submandibular Versus Transoral Endoscopic Approach.

    PubMed

    Hwang, Na-Hyun; Lee, Yoon-Hwan; You, Hi-Jin; Yoon, Eul-Sik; Kim, Deok-Woo

    2016-07-01

    In recent years, endoscope-assisted transoral approach for condylar fracture treatment has attracted much attention. However, the surgical approach is technically challenging: the procedure requires specialized instruments and the surgeons experience a steep learning curve. During the transoral endoscopic (TE) approach several instruments are positioned through a narrow oral incision making endoscope maneuvering very difficult. For this reason, the authors changed the entry port of the endoscope from transoral to submandibular area through a small stab incision. The aim of this study is to assess the advantage of using the submandibular endoscopic intraoral approach (SEI).The SEI approach requires intraoral incision for fracture reduction and fixation, and 4 mm size submandibular stab incision for endoscope and traction wires. Fifteen patients with condyle neck and subcondyle fractures were operated under the submandibular approach and 15 patients with the same diagnosis were operated under the standard TE approach.The SEI approach allowed clear visualization of the posterior margin of the ramus and condyle, and the visual axis was parallel to the condyle ramus unit. The TE approach clearly shows the anterior margin of the condyle and the sigmoid notch. The surgical time of the SEI group was 128 minutes and the TE group was 120 minutes (P >0.05). All patients in the TE endoscope group were fixated with the trocar system, but only 2 lower neck fracture patients in the SEI group required a trocar. The other 13 subcondyle fractures were fixated with an angulated screw driver (P <0.05). There were no differences in complication and surgical outcomes.The submandibular endoscopic approach has an advantage of having more space with good visualization, and facilitated the use of an angulated screw driver.

  17. Updates and Critical Evaluation on Novel Biomarkers for the Malignant Progression of Intraductal Papillary Mucinous Neoplasms of the Pancreas.

    PubMed

    Moris, Demetrios; Damaskos, Christos; Spartalis, Eleftherios; Papalampros, Alexandros; Vernadakis, Spyridon; Dimitroulis, Dimitrios; Griniatsos, John; Felekouras, Evangelos; Nikiteas, Nikolaos

    2017-05-01

    Intraductal papillary mucinous neoplasms (IPMNs) are presumed to evolve from low-grade dysplasia to high-grade dysplasia to invasive carcinoma. Resection of lesions before the development of pancreatic cancer may prevent the development of an incurable process as, once IPMNs progress to invasive cancer, the prognosis may be as poor as resected conventional pancreatic ductal adenocarcinoma. Resection of IPMNs, particularly in the setting of high-grade dysplasia, is presumed to provide a survival benefit. IPMNs also present many challenges as the identification of high-grade dysplasia and early invasive carcinoma and the timing and frequency of malignant progression are not yet established. The limited predictive accuracy presents a challenge as pancreatic resection is associated with a risk of substantial morbidity and mortality; 20-30% and 2-4%, respectively. Diagnostic armamentarium contains pancreas-protocol computed tomography (CT) scan, gadolinium-enhanced magnetic resonance imaging (MRI) with or without magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS). The most promising method is endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) as this technique allows analysis of cyst fluid using biomarkers. Until now, in clinical practice, we utilize two biomarkers, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9); however, DNA analysis of pancreatic cystic fluid and genomic analysis could offer new tools to the diagnosis and administration of IPMNs. Novel genomic and serum biomarkers could play an important future role to identify those individuals who will benefit from an early operation and those who will benefit from watchful waiting approach. More prospective studies are needed. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  18. Papillary renal cell carcinoma embedded in an oncocytoma: Case report of a rare combined tumour of the kidney

    PubMed Central

    Sejben, István; Szabó, Zoltán; Lukács, Nándor; Loránd, Márta; Sükösd, Farkas; Cserni, Gábor

    2013-01-01

    An asymptomatic 1-cm large papillary renal cell carcinoma (RCC) embedded in a 3.5-cm large oncocytoma was diagnosed and removed by right nephrectomy in a 68-year-old male investigated for the abdominal symptoms associated with cholelithiasis. The papillary RCC displayed positive immunohistochemical stainings with cytokeratin 7, alpha-methylacyl-CoA racemase and vimentin and was negative for the E-cadherin and CD117 immunostains, whereas the oncocytoma part showed opposite staining patterns. No gains of chromosomes 7 and 17 or loss of chromosome Y was detected in the papillary carcinoma by fluorescent in situ hybridization with centromeric enumeration probes. This finding is in keeping with the morphologic diagnosis of type 2 papillary RCC reported to have lower rates of these characteristic chromosomal changes. The combination of papillary RCC and oncocytoma, two tumours of different postulated origin, is extremely rare. It may represent a simple coincidence, but 2 previous cases and our current one share a few features, including the intimate embedment of the papillary RCC in the oncocytoma, the small size of the RCC and the old age of the patients. This case raises the point that renal oncocytomas can contain a hidden malignant tumour. PMID:23914273

  19. Retained intraaortic balloon. Case report and review of the literature.

    PubMed Central

    Grande, A M; Martinelli, L; Graffigna, A; Viganò, M

    1995-01-01

    We report a case of intraaortic balloon entrapment in a 70-year-old man who underwent emergency triple coronary bypass. Intraaortic balloon rupture caused the formation of a clot inside the balloon that eventually was responsible for the balloon's entrapment at the aortic bifurcation. The patient had severe atherosclerosis of the aorta and iliac arteries. Balloon removal required aorto-iliac exposure and aorto-bifemoral bypass. After 16 months, he is symptom free and at home. Images PMID:8605436

  20. Low-Altitude Exploration of the Venus Atmosphere by Balloon

    NASA Technical Reports Server (NTRS)

    Landis, Geoffrey A.

    2010-01-01

    The planet Venus represents an exciting target for future exploration by spacecraft. One target of scientific interest is the lower atmosphere, which represents an environment of high temperature and moderate to high atmospheric pressure. This represents a considerable challenge to the technical art of ballooning, but one which may be amenable to solution. Several possible designs for low-altitude balloons are discussed. Conceptual design for three mission examples are analyzed: a conventional balloon operating below the cloud level at an altitude of 25 kilometers, a large rigid-envelope balloon operating near the surface at an altitude of 5 kilometers, and a small, technology demonstrator rigid-envelope balloon operating at 5 kilometers.

  1. Transvaginal endoscopic partial gastrectomy in porcine models: the role of an extra endoscope for gastric control.

    PubMed

    Nakajima, Kiyokazu; Takahashi, Tsuyoshi; Souma, Yoshihito; Shinzaki, Shinichiro; Yamada, Takuya; Yoshio, Toshiyuki; Nishida, Toshirou

    2008-12-01

    Transvaginal natural orifice translumenal endoscopic surgery (NOTES) gastrectomy is technically challenging, because wide perigastric dissection under appropriate tissue triangulation is unfeasible with current endoscopic instruments alone. The aim of this study was to investigate the feasibility of transvaginal NOTES gastrectomy with the use of an extra endoscope as a retracting device of the stomach. This acute in vivo feasibility study was performed under the approval of the Institutional Animal Care and Use Committee (IACUC). Four female 40-kg pigs received general anesthesia and underwent transvaginal endoscopic partial gastrectomy. Under laparoscopic guidance, the uterus was fixed anteriorly and transvaginal access was established in a standard fashion. The perigastric ligaments were dissected with needle knife/insulation-tipped electrosurgical knife (IT) via transvaginally placed double-channel endoscope. This step was assisted with the second, CO(2)-insufflating endoscope advanced in the stomach (i.e., so-called endoscopic gastric control). A linear stapling device with a flexible shaft was then passed transvaginally, and the anterior gastric wall was partially resected. The specimen was isolated and retrieved through the vagina. Concluding endoscopy was carried out to confirm the absence of mucosal damage due to endoscopic gastric control. This was further confirmed at necropsy immediately after sacrifice. All animals underwent successful transvaginal NOTES gastrectomy. Endoscopic gastric control greatly facilitated perigastric dissection by providing appropriate tissue countertraction on the ligaments. Use of transabdominal (laparoscopic) graspers was thus minimized. There were no intraoperative complications directly related to use of the primary (transvaginal) endoscope or the additional (gastric) endoscope. Distention of downstream bowel after gastric insufflation was minimal with CO(2). No major injuries were noted on gastric mucosa at postmortem

  2. Building an endoscopic ear surgery program.

    PubMed

    Golub, Justin S

    2016-10-01

    This article discusses background, operative details, and outcomes of endoscopic ear surgery. This information will be helpful for those establishing a new program. Endoscopic ear surgery is growing in popularity. The ideal benefit is in totally transcanal access that would otherwise require a larger incision. The endoscope carries a number of advantages over the microscope, as well as some disadvantages. Several key maneuvers can minimize disadvantages. There is a paucity of studies directly comparing outcomes between endoscopic and microscopic approaches for the same procedure. The endoscope is gaining acceptance as a tool for treating otologic diseases. For interested surgeons, this article can help bridge the transition from microscopic to totally transcanal endoscopic ear surgery for appropriate disease.

  3. Correlation between endoscopic forceps biopsies and endoscopic mucosal resection with endoscopic ultrasound in patients with Barrett's esophagus with high-grade dysplasia and early cancer.

    PubMed

    Thota, Prashanthi N; Sada, Alaa; Sanaka, Madhusudhan R; Jang, Sunguk; Lopez, Rocio; Goldblum, John R; Liu, Xiuli; Dumot, John A; Vargo, John; Zuccarro, Gregory

    2017-03-01

    Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or intramucosal cancer (IMC) on endoscopic forceps biopsies are referred to endoscopic therapy even though forceps biopsies do not reflect the disease extent accurately. Endoscopic mucosal resection (EMR) and endoscopic ultrasound (EUS) are frequently used for staging prior to endoscopic therapy. Our aims were to evaluate: (1) if endoscopic forceps biopsies correlated with EMR histology in these patients; (2) the utility of EUS compared to EMR; and (3) if accuracy of EUS varied based on grade of differentiation of tumor. This is a retrospective review of patients referred to endoscopic therapy of BE with HGD or early esophageal adenocarcinoma (EAC) who underwent EMR from 2006 to 2011. Age, race, sex, length of Barrett's segment, hiatal hernia size, number of endoscopies and biopsy results and EUS findings were abstracted. A total of 151 patients underwent EMR. In 50 % (75/151) of patients, EMR histology was consistent with endoscopic forceps biopsy findings. EMR resulted in change in diagnosis with upstaging in 21 % (32/151) and downstaging in 29 % (44/151). In patients with HGD on EMR, EUS staging was T0 in 74.1 % (23/31) but upstaged in 25.8 % (8/31). In patients with IMC on EMR, EUS findings were T1a in 23.6 % (9/38), upstaged in 18.4 % (7/38) and downstaged in 57.8 % (22/38). EUS accurately identified EMR histology in all submucosal cancers. Grade of differentiation was reported in 24 cancers on EMR histology. There was no correlation between grade and EUS staging. EUS is of limited utility in accurate staging of BE patients with HGD or early EAC. Endoscopic forceps biopsy correlated with EMR findings in only 50 % of patients. Irrespective of the endoscopic forceps biopsy results, all BE patients with visible lesions should be referred to EMR.

  4. The radiation controlled balloon (RACOON)

    NASA Astrophysics Data System (ADS)

    Lally, Vincent E.

    The RACOON concept permits the flight of large, low-cost polyethylene balloons for several weeks at stratospheric altitudes without ballast. The theory of operations is described. The RACOON balloon ascends each morning and descends at night. This movement of 15 to 20 km in altitude provides an ideal platform for vertical soundings and sampling measurements in the stratosphere. Results of a number of globe-circling flights are presented.

  5. The NASA super pressure balloon - A path to flight

    NASA Astrophysics Data System (ADS)

    Cathey, H. M.

    2009-07-01

    The National Aeronautics and Space Administration's Balloon Program Office has invested significant time and effort in extensive ground testing of model super pressure balloons. The testing path has been developed as an outgrowth of the results of the super pressure balloon test flight in 2006. Summary results of the June 2006 super pressure test flight from Kiruna, Sweden are presented including the balloon performance and "lessons learned". This balloons flight performance exceeded expectations, but did not fully deploy. The flight was safely terminated by command. The results of this test flight refocused the project's efforts toward additional ground testing and analysis; a path to flight. A series of small 4 m diameter models were made and tested to further explore the deployment and structural capabilities of the balloons and materials. A series of ˜27 m model balloons were successfully tested indoors. These balloons successfully replicated the cleft seen in the Sweden flight, explored the deployment trade space to help characterize better design approaches, and demonstrated an acceptable fix to the deployment issue. Photogrammetry was employed during these ˜27 m model tests to help characterize both the balloon and gore shape evolution under pressurization. A ˜8.5 m ground model was used to explore the design and materials performance. Results of these tests will be presented. A general overview of some of the other project advancements made related to demonstrating the strain arresting nature of the proposed design, materials and analysis work will also be presented. All of this work has prepared a clear path toward a renewed round of test flights. This paper will give an overview of the development approach pursued for this super pressure balloon development. A description of the balloon design, including the modifications made as a result of the lessons learned, is presented. A short deployment test flight of the National Aeronautics and Space

  6. Massive gross hematuria in a sickle cell trait patient with renal papillary necrosis. Conservative approach using a balloon ureteral catheter to tamponade the papilla bleeding.

    PubMed

    Herard, A; Colin, J; Youinou, Y; Drancourt, E; Brandt, B

    1998-08-01

    We report the case of a patient with heterozygous sickle cell trait presenting with massive gross hematuria. Ureteroscopy revealed bleeding from the tip of papilla of the inferior calica and allowed us to tamponade the bleeding with a balloon ureteral dilator set (Cook(R) Urology). We show the value of the endourological approach in the conservative management of these patients at high risk of recurrent hematuria.

  7. Experiments with Helium-Filled Balloons

    NASA Astrophysics Data System (ADS)

    Zable, Anthony C.

    2010-12-01

    The concepts of Newtonian mechanics, fluids, and ideal gas law physics are often treated as separate and isolated topics in the typical introductory college-level physics course, especially in the laboratory setting. To bridge these subjects, a simple experiment was developed that utilizes computer-based data acquisition sensors and a digital gram scale to estimate the molar mass of the gas in an inflated balloon. In this experiment, the comparable density of an inflated balloon to that of atmospheric air introduces a significant role for buoyancy that must be accounted for. The ideal gas law approximation is assumed for both the isolated gas mixture within the balloon and the surrounding air, which defines the relationship between the gas pressure, volume, temperature, and molar quantity. Analysis of the forces associated with the inflated balloon with the incorporation of Archimedes' principle and the ideal gas law into Newton's second law results in an experimental method for the measurement of the molar mass and mole fraction of a gas that is easy to implement yet academically challenging for students. The following narrative describes the basic setup of this experiment, along with a sample set of data as acquired and analyzed by a typical physics student from one of my classes.

  8. Sterilization of endoscopic instruments.

    PubMed

    Sabnis, Ravindra B; Bhattu, Amit; Vijaykumar, Mohankumar

    2014-03-01

    Sterilization of endoscopic instruments is an important but often ignored topic. The purpose of this article is to review the current literature on the sterilization of endoscopic instruments and elaborate on the appropriate sterilization practices. Autoclaving is an economic and excellent method of sterilizing the instruments that are not heat sensitive. Heat sensitive instruments may get damaged with hot sterilization methods. Several new endoscopic instruments such as flexible ureteroscopes, chip on tip endoscopes, are added in urologists armamentarium. Many of these instruments are heat sensitive and hence alternative efficacious methods of sterilization are necessary. Although ethylene oxide and hydrogen peroxide are excellent methods of sterilization, they have some drawbacks. Gamma irradiation is mainly for disposable items. Various chemical agents are widely used even though they achieve high-level disinfection rather than sterilization. This article reviews various methods of endoscopic instrument sterilization with their advantages and drawbacks. If appropriate sterilization methods are adopted, then it not only will protect patients from procedure-related infections but prevent hypersensitive allergic reactions. It will also protect instruments from damage and increase its longevity.

  9. [Study on the relationship between ultrasonographic features of papillary thyroid carcinoma and central cervical lymph node metastasis].

    PubMed

    Wang, X Q; Wei, W; Wei, X; Xu, Y; Wang, H L; Xing, X J; Zhang, S

    2018-03-23

    Objective: To investigate the correlation between ultrasonographic features of papillary thyroid carcinoma and central cervical lymph node metastasis. Methods: We retrospectively analyzed 486 patients with papillary thyroid carcinoma(PTC), pathologically confirmed after surgery in Tianjin Medical University Cancer Institute & Hospital. All patients were divided into central cervical lymph node metastasis group and non-metastasis group. No lateral cervical lymph node metastasis was found in preoperative ultrasonography and postoperative pathology. The characteristics of the ultrasound was observed and analyzed. Results: 297 out of 486 patients with papillary thyroid carcinomahad central metastasis, and the other 189 cases did not. Take pathology results as a standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of preoperative ultrasound diagnosis in PTC patients with central cervical lymph node metastasis were 35.3%, 88.6%, 83.2%, 47.4%, 56.6%, respectively. Univariate analysis showed that multi-focus, taller-than-wide, diameter>1 cm, located in the lower pole, ill-defined margin, hypoechogenicity, micro-calcification, capsule invasion more than 1/4 perimeter of papillary thyroid carcinoma were significantly associated with central cervical lymph node metastasis (all P <0.05). Multivariate analysis showed that diameter>1 cm, micro-calcification, capsule invasion more than 1/4 perimeter of papillary thyroid carcinoma became independent risk factors of central cervical neck lymph node metastasis (all P <0.05). Conclusions: Preoperative description of ultrasonographical features has important value to assess central cervical lymph node metastasis in patients with papillary thyroid carcinoma. More information could be provided for clinical treatment. When the papillary thyroid carcinoma presented as diameter>1 cm, micro-calcification, and capsule invasion more than 1/4 perimeter of, there will be a greater risk

  10. [The development of endoscope workstation].

    PubMed

    Qi, L; Qi, L; Qiou, Q J; Yu, Q L

    2001-01-01

    This paper introduces an endoscope workstation, which solved the weak points of multimedia endoscope database used by most hospitals. The endoscope workstation was built on pedal-switch and NTFS file system. This paper also Introduces how to make program optimal and quick inputting. The workstation has promoted the efficiency of the doctor's operation.

  11. Balloon concepts for scientific investigation of Mars and Jupiter

    NASA Technical Reports Server (NTRS)

    Ash, R. L.

    1979-01-01

    Opportunities for scientific investigation of the atmospheric planets using buoyant balloons have been explored. Mars and Jupiter were considered in this study because design requirements at those planets bracket nominally the requirements at Venus, and plans are already underway for a joint Russian-French balloon system at Venus. Viking data has provided quantitative information for definition of specific balloon systems at Mars. Free flying balloons appear capable of providing valuable scientific support for more sophisticated Martian surface probes, but tethered and powered aerostats are not attractive. The Jovian environment is so extreme, hot atmosphere balloons may be the only scientific platforms capable of extended operations there. However, the estimated system mass and thermal energy required are very large.

  12. Analysis of Flight of Near-Space Balloon

    NASA Astrophysics Data System (ADS)

    Miller, Zech; Evans, Austin; Seyfert, James; Leadlove, Kyle; Gumina, Kaitlyn; Martell, Eric

    2015-04-01

    In December 2014, the Electronics class at Millikin University launched a balloon designed to travel into the near-space region of the atmosphere. The balloon was equipped with an instrumentation package including a camera, accelerometer, barometric pressure sensor, temperature probes, as well as a system for tracking using an Automatic Packet Reporting System (APRS). The balloon was launched from Decatur, IL, and landed in Marysville, OH, nearly 320 miles away. The students then analyzed the data from the flight and compared results to expectations.

  13. Papillary Thyroid Cancer: The Good and Bad of the "Good Cancer".

    PubMed

    Randle, Reese W; Bushman, Norah M; Orne, Jason; Balentine, Courtney J; Wendt, Elizabeth; Saucke, Megan; Pitt, Susan C; Macdonald, Cameron L; Connor, Nadine P; Sippel, Rebecca S

    2017-07-01

    Papillary thyroid cancer is often described as the "good cancer" because of its treatability and relatively favorable survival rates. This study sought to characterize the thoughts of papillary thyroid cancer patients as they relate to having the "good cancer." This qualitative study included 31 papillary thyroid cancer patients enrolled in an ongoing randomized trial. Semi-structured interviews were conducted with participants at the preoperative visit and two weeks, six weeks, six months, and one year after thyroidectomy. Grounded theory was used, inductively coding the first 113 interview transcripts with NVivo 11. The concept of thyroid cancer as "good cancer" emerged unprompted from 94% (n = 29) of participants, mostly concentrated around the time of diagnosis. Patients encountered this perception from healthcare providers, Internet research, friends, and preconceived ideas about other cancers. While patients generally appreciated optimism, this perspective also generated negative feelings. It eased the diagnosis of cancer but created confusion when individual experiences varied from expectations. Despite initially feeling reassured, participants described feeling the "good cancer" characterization invalidated their fears of having cancer. Thyroid cancer patients expressed that they did not want to hear that it's "only thyroid cancer" and that it's "no big deal," because "cancer is cancer," and it is significant. Patients with papillary thyroid cancer commonly confront the perception that their malignancy is "good," but the favorable prognosis and treatability of the disease do not comprehensively represent their cancer fight. The "good cancer" perception is at the root of many mixed and confusing emotions. Clinicians emphasize optimistic outcomes, hoping to comfort, but they might inadvertently invalidate the impact thyroid cancer has on patients' lives.

  14. Accurate Determination of the Volume of an Irregular Helium Balloon

    ERIC Educational Resources Information Center

    Blumenthal, Jack; Bradvica, Rafaela; Karl, Katherine

    2013-01-01

    In a recent paper, Zable described an experiment with a near-spherical balloon filled with impure helium. Measuring the temperature and the pressure inside and outside the balloon, the lift of the balloon, and the mass of the balloon materials, he described how to use the ideal gas laws and Archimedes' principal to compute the average molecular…

  15. Cosmic Balloons

    ERIC Educational Resources Information Center

    El Abed, Mohamed

    2014-01-01

    A team of French high-school students sent a weather balloon into the upper atmosphere to recreate Viktor Hess's historical experiment that demonstrated the existence of ionizing radiation from the sky--later called cosmic radiation. This discovery earned him the Nobel Prize for Physics in 1936.

  16. Endoscopic resection of subepithelial tumors

    PubMed Central

    Schmidt, Arthur; Bauder, Markus; Riecken, Bettina; Caca, Karel

    2014-01-01

    Management of subepithelial tumors (SETs) remains challenging. Endoscopic ultrasound (EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection of SET arising from deeper layers of the gastrointestinal wall requires advanced endoscopic methods and harbours the risk of perforation. Innovative techniques such as submucosal tunneling and full thickness resection have expanded the frontiers of endoscopic therapy in the past years. This review will give an overview about endoscopic resection techniques of SET with a focus on novel methods. PMID:25512768

  17. Endoscopic resection of subepithelial tumors.

    PubMed

    Schmidt, Arthur; Bauder, Markus; Riecken, Bettina; Caca, Karel

    2014-12-16

    Management of subepithelial tumors (SETs) remains challenging. Endoscopic ultrasound (EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection of SET arising from deeper layers of the gastrointestinal wall requires advanced endoscopic methods and harbours the risk of perforation. Innovative techniques such as submucosal tunneling and full thickness resection have expanded the frontiers of endoscopic therapy in the past years. This review will give an overview about endoscopic resection techniques of SET with a focus on novel methods.

  18. A Survey of Titan Balloon Concepts and Technology Status

    NASA Technical Reports Server (NTRS)

    Hall, Jeffery L.

    2011-01-01

    This paper surveys the options for, and technology status of, balloon vehicles to explore Saturn's moon Titan. A significant amount of Titan balloon concept thinking and technology development has been performed in recent years, particularly following the spectacular results from the descent and landing of the Huygens probe and remote sensing observations by the Cassini spacecraft. There is widespread recognition that a balloon vehicle on the next Titan mission could provide an outstanding and unmatched capability for in situ exploration on a global scale. The rich variety of revealed science targets has combined with a highly favorable Titan flight environment to yield a wide diversity of proposed balloon concepts. The paper presents a conceptual framework for thinking about balloon vehicle design choices and uses it to analyze various Titan options. The result is a list of recommended Titan balloon vehicle concepts that could perform a variety of science missions, along with their projected performance metrics. Recent technology developments for these balloon concepts are discussed to provide context for an assessment of outstanding risk areas and technological maturity. The paper concludes with suggestions for technology investments needed to achieve flight readiness.

  19. Cryo-balloon catheter localization in fluoroscopic images

    NASA Astrophysics Data System (ADS)

    Kurzendorfer, Tanja; Brost, Alexander; Jakob, Carolin; Mewes, Philip W.; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

    2013-03-01

    Minimally invasive catheter ablation has become the preferred treatment option for atrial fibrillation. Although the standard ablation procedure involves ablation points set by radio-frequency catheters, cryo-balloon catheters have even been reported to be more advantageous in certain cases. As electro-anatomical mapping systems do not support cryo-balloon ablation procedures, X-ray guidance is needed. However, current methods to provide support for cryo-balloon catheters in fluoroscopically guided ablation procedures rely heavily on manual user interaction. To improve this, we propose a first method for automatic cryo-balloon catheter localization in fluoroscopic images based on a blob detection algorithm. Our method is evaluated on 24 clinical images from 17 patients. The method successfully detected the cryoballoon in 22 out of 24 images, yielding a success rate of 91.6 %. The successful localization achieved an accuracy of 1.00 mm +/- 0.44 mm. Even though our methods currently fails in 8.4 % of the images available, it still offers a significant improvement over manual methods. Furthermore, detecting a landmark point along the cryo-balloon catheter can be a very important step for additional post-processing operations.

  20. Risk of invasive breast cancer and ductal carcinoma in situ in women with atypical papillary lesions of the breast.

    PubMed

    Cuneo, Kyle C; Dash, Rajesh C; Wilke, Lee G; Horton, Janet K; Koontz, Bridget F

    2012-09-01

    Benign papillary lesions of the breast include papilloma and papillomatosis. A retrospective analysis of patients with a papillary breast lesion diagnosed between October 1992 and December 2009 was performed. Patients were excluded if they had a previous or concurrent diagnosis of invasive or in situ cancer or less than 6 months of follow-up. The Kaplan-Meier method was used to determine the risk of developing subsequent malignancy. The log rank test was used to compare groups of patients. Median follow-up for the 167 patients included in the study was 4.6 years. Fifty-one patients had a papillary lesion with atypia and 116 patients had a papillary lesion without atypia. Patients with a papillary lesion with atypia were more likely to develop invasive or in situ breast cancer with a 5 year risk of 13.0% versus 4.6% in patients with no atypia (p = 0.03). © 2012 Wiley Periodicals, Inc.

  1. Introduction (Special Issue on Scientific Balloon Capabilities and Instrumentation)

    NASA Technical Reports Server (NTRS)

    Gaskin, Jessica A.; Smith, I. S.; Jones, W. V.

    2014-01-01

    In 1783, the Montgolfier brothers ushered in a new era of transportation and exploration when they used hot air to drive an un-tethered balloon to an altitude of 2 km. Made of sackcloth and held together with cords, this balloon challenged the way we thought about human travel, and it has since evolved into a robust platform for performing novel science and testing new technologies. Today, high-altitude balloons regularly reach altitudes of 40 km, and they can support payloads that weigh more than 3,000 kg. Long-duration balloons can currently support mission durations lasting 55 days, and developing balloon technologies (i.e. Super-Pressure Balloons) are expected to extend that duration to 100 days or longer; competing with satellite payloads. This relatively inexpensive platform supports a broad range of science payloads, spanning multiple disciplines (astrophysics, heliophysics, planetary and earth science.) Applications extending beyond traditional science include testing new technologies for eventual space-based application and stratospheric airships for planetary applications.

  2. Interdental papillary house: a new concept and guide for clinicians.

    PubMed

    Gonzalez, Marly Kimie Sonohara; Almeida, Ana Lucia Pompeia Fraga; Greghi, Sebastiao Luiz Aguiar; Pegoraro, Luiz Fernando; Mondelli, Jose; Moreno, Tatiana

    2011-01-01

    Surgical and nonsurgical techniques have been proposed to regenerate interdental papillae. The results are influenced by the morphology of the interdental space, which is the housing for the papilla. The concept of the interdental papillary "house" has been established not only to allow diagnosis of the causes of papillary loss, but also to manage and predict reconstruction of the interdental gingival tissue. The adjacent teeth in contact, involving the proximal contact, contour and shape of the teeth, course of the cementoenamel junction, interdental distance, and underlying bone crest, determine the outline of the house. Since the components are combined, an understanding of each allows adequate treatment planning involving interdisciplinary procedures. This new concept serves as a guide and teaching aid for the practitioner.

  3. Surgical management of intraductal papillary mucinous neoplasm with main duct involvement: an international expert survey and case-vignette study.

    PubMed

    Scholten, Lianne; van Huijgevoort, Nadine C M; Bruno, Marco J; Fernandez-Del Castillo, Carlos; Satoi, Sohei; Sauvanet, Alain; Wolfgang, Christopher; Fockens, Paul; Chari, Suresh T; Del Chiaro, Marco; van Hooft, Jeanin E; Besselink, Marc G

    2018-05-16

    The risk of invasive cancer in resected intraductal papillary mucinous neoplasm with main pancreatic duct involvement is 33%-60%. Most guidelines, therefore, advise resection of main duct intraductal papillary mucinous neoplasm and mixed type intraductal papillary mucinous neoplasm in surgically fit patients, although advice on the surgical strategy (partial or total pancreatectomy) differs. We performed a survey amongst international experts to guide the design of future studies and help to prepare for a single international set of guidelines. An online survey including case vignettes was sent to 221 international experts who had published on main duct/mixed type intraductal papillary mucinous neoplasm in the previous decade and to all surgeon and gastroenterologist members of the pancreatic cyst guideline committees of the European Study Group and the International Association of Pancreatology. Overall, 97 experts (67 surgeons, 30 gastroenterologists) from 19 countries replied (44% response rate). Most (93%) worked in an academic hospital, with a median of 15 years' experience with intraductal papillary mucinous neoplasm treatment. In main duct/mixed type intraductal papillary mucinous neoplasm patients with pancreatic duct dilation (>5 mm) in the entire pancreas, 41% (n = 37) advised nonoperative surveillance every 3-6 months, whereas 59% (n = 54) advised operative intervention. Of those who advised operative intervention, 46% (n = 25) would perform a total pancreatectomy and 31% (n = 17) pancreatoduodenectomy with follow-up. No structural differences in advice were seen between surgeons and gastroenterologists, between continents where the respondents lived, and based on years of experience. This international survey identified a clinically relevant lack of consensus in the treatment strategy in main duct/mixed type intraductal papillary mucinous neoplasm among experts. Studies with long-term follow-up including quality of life after partial and

  4. Taking the Hot Air Out of Balloons.

    ERIC Educational Resources Information Center

    Brinks, Virgil L.; Brinks, Robyn L.

    1994-01-01

    Describes how a teacher can give their students the challenge of designing and building model balloons or blimps. The project helps students learn the basics of balloon flight and what it really means to be "lighter than air." (PR)

  5. Surgical relocation of the papillary muscles in functional ischemic mitral regurgitation: what are the forces of the relocation stitches acting on the myocardium?

    PubMed

    Jensen, Henrik; Jensen, Morten O; Vind-Kezunovic, Stefan; Vestergaard, Rikke; Ringgaard, Steffen; Smerup, Morten H; Hønge, Jesper L; Hasenkam, J Michael; Nielsen, Sten L

    2013-07-01

    In patients with chronic functional ischemic mitral regurgitation (FIMR), papillary muscle relocation has the potential to induce reverse left ventricular remodeling. However, in order to optimize function and durability, the forces imposed on the left ventricular myocardium by papillary muscle relocation should be assessed. Eight pigs with FIMR were subjected to down-sized ring annuloplasty in combination with relocation of the anterior (5 mm) and posterior (15 mm) papillary muscles towards the respective trigone. Papillary muscle relocation was obtained by a 2-0 expanded polytetrafluoroethylene stitch fixed to the trigone, exteriorized through the myocardium overlying the papillary muscle, and fixed to an epicardial disc. Tension in these stitches was measured at a systolic blood pressure > 80 mmHg using a custom-made sliding caliper with a strain gauge mounted in line. This allowed assessment of the cyclic change from minimal diastolic to maximum systolic papillary muscle relocation stitch tension. Maximum cyclic change in the posterior papillary muscle (PPM) stitch tension was 1.1 N at 15 mm relocation. In comparison, the anterior papillary muscle (APM) tension was increased to a maximum of 1.4 N with only 5 mm relocation. Surprisingly, during each step of isolated PPM relocation, the APM stitch tension increased concomitantly, but in contrast APM relocation did not influence the magnitude of PPM stitch tension. There was no statistically significant difference between cyclic changes in APM and PPM stitch tension at any step of relocation. Papillary muscle relocation using stitches attached between epicardial discs and respective trigones induced a cyclic change in papillary muscle relocation stitch tension of 1.1-1.4 N. These values were in the range of normal tension in the mitral valve apparatus, and equivalent to only 19-24% of the total papillary muscle forces. Therefore, this technique does not appear to induce a non-physiologically high cyclic load on

  6. Endovascular balloon-assisted embolization of high-flow peripheral vascular lesions using dual-lumen coaxial balloon microcatheter and Onyx: initial experience.

    PubMed

    Jagadeesan, Bharathi D; Mortazavi, Shabnam; Hunter, David W; Duran-Castro, Olga L; Snyder, Gregory B; Siedel, Glen F; Golzarian, Jafar

    2014-04-01

    Balloon-assisted embolization performed by delivering Onyx ethylene vinyl alcohol copolymer through a dual-lumen coaxial balloon microcatheter is a new technique for the management of peripheral vascular lesions. This technique does not require an initial reflux of Onyx to form around the tip of the microcatheter before antegrade flow of Onyx can commence. In a series of four patients who were treated with the use of this technique, the absence of significant reflux of Onyx was noted, as were excellent navigability and easy retrieval of the balloon microcatheter. However, in one patient, there was inadvertent adverse embolization of a digital artery, which was not caused by reflux of Onyx but could still be related to balloon inflation. © 2013 SIR Published by SIR All rights reserved.

  7. Hurricane Balloon Observations in the Hurricane Inflow Layer

    NASA Astrophysics Data System (ADS)

    Businger, S.; Johnson, R.; Ellis, R.; Talbot, R.

    2005-12-01

    Four autonomous NOAA smart balloons have been prepared at NOAA's Air Resources Lab Field Research Division. The balloons will be released from the northwest corner of Puerto Rico during August and September 2005 into the inflow of tropical cyclones passing just to the north or south of the island. Ballast control allows the balloons to be positioned low in the atmosphere in the inflow of the storms. Observations will include aspirated temperature and humidity, barometric pressure, GPS position, rain rate, ozone, downward IR temperature, and solar radiation. The observations will be transmitted in real time via satellite cellular telephone and posted to the web. Preliminary results of the analysis of the balloon data sets will be presented, including energy content of the inflow air, estimates of surface fluxes, and evidence of organized eddies. Solar cells will help prolong battery life. If a balloon survives an eye-wall penetration, data on the energy content and ozone concentrations of the boundary layer air in the eye will be presented.

  8. Balloons on Ice: NASA Launches Antarctica Scientific Balloon Campaign

    NASA Image and Video Library

    2017-12-08

    Cosmic rays and the chemicals and atoms that make up the interstellar space between stars are the focus of this year’s NASA Antarctica Long Duration Balloon Flight Campaign, which kicked into high gear with the launch of the Boron And Carbon Cosmic rays in the Upper Stratosphere (BACCUS) payload Nov. 28. The University of Maryland’s BACCUS mission is the first of three payloads taking flight from a balloon launch site on Antarctica’s Ross Ice Shelf near McMurdo Station with support from the National Science Foundation’s United States Antarctic Program. Read more: go.nasa.gov/2gCMtyP NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

  9. Controlled weather balloon ascents and descents for atmospheric research and climate monitoring

    PubMed Central

    Kräuchi, Andreas; Philipona, Rolf; Romanens, Gonzague; Hurst, Dale F.; Hall, Emrys G.; Jordan, Allen F.

    2017-01-01

    In situ upper-air measurements are often made with instruments attached to weather balloons launched at the surface and lifted into the stratosphere. Present-day balloon-borne sensors allow near-continuous measurements from the Earth’s surface to about 35 km (3–5 hPa), where the balloons burst and their instrument payloads descend with parachutes. It has been demonstrated that ascending weather balloons can perturb the air measured by very sensitive humidity and temperature sensors trailing behind them, particularly in the upper troposphere and lower stratosphere (UTLS). The use of controlled balloon descent for such measurements has therefore been investigated and is described here. We distinguish between the single balloon technique that uses a simple automatic valve system to release helium from the balloon at a preset ambient pressure, and the double balloon technique that uses a carrier balloon to lift the payload and a parachute balloon to control the descent of instruments after the carrier balloon is released at preset altitude. The automatic valve technique has been used for several decades for water vapor soundings with frost point hygrometers, whereas the double balloon technique has recently been re-established and deployed to measure radiation and temperature profiles through the atmosphere. Double balloon soundings also strongly reduce pendulum motion of the payload, stabilizing radiation instruments during ascent. We present the flight characteristics of these two ballooning techniques and compare the quality of temperature and humidity measurements made during ascent and descent. PMID:29263765

  10. Controlled weather balloon ascents and descents for atmospheric research and climate monitoring.

    PubMed

    Kräuchi, Andreas; Philipona, Rolf; Romanens, Gonzague; Hurst, Dale F; Hall, Emrys G; Jordan, Allen F

    2016-01-01

    In situ upper-air measurements are often made with instruments attached to weather balloons launched at the surface and lifted into the stratosphere. Present-day balloon-borne sensors allow near-continuous measurements from the Earth's surface to about 35 km (3-5 hPa), where the balloons burst and their instrument payloads descend with parachutes. It has been demonstrated that ascending weather balloons can perturb the air measured by very sensitive humidity and temperature sensors trailing behind them, particularly in the upper troposphere and lower stratosphere (UTLS). The use of controlled balloon descent for such measurements has therefore been investigated and is described here. We distinguish between the single balloon technique that uses a simple automatic valve system to release helium from the balloon at a preset ambient pressure, and the double balloon technique that uses a carrier balloon to lift the payload and a parachute balloon to control the descent of instruments after the carrier balloon is released at preset altitude. The automatic valve technique has been used for several decades for water vapor soundings with frost point hygrometers, whereas the double balloon technique has recently been re-established and deployed to measure radiation and temperature profiles through the atmosphere. Double balloon soundings also strongly reduce pendulum motion of the payload, stabilizing radiation instruments during ascent. We present the flight characteristics of these two ballooning techniques and compare the quality of temperature and humidity measurements made during ascent and descent.

  11. Submucosal tunnel endoscopy: Peroral endoscopic myotomy and peroral endoscopic tumor resection

    PubMed Central

    Eleftheriadis, Nikolas; Inoue, Haruhiro; Ikeda, Haruo; Onimaru, Manabu; Maselli, Roberta; Santi, Grace

    2016-01-01

    Peroral endoscopic myotomy (POEM) is an innovative, minimally invasive, endoscopic treatment for esophageal achalasia and other esophageal motility disorders, emerged from the natural orifice transluminal endoscopic surgery procedures, and since the first human case performed by Inoue in 2008, showed exciting results in international level, with more than 4000 cases globally up to now. POEM showed superior characteristics than the standard 100-year-old surgical or laparoscopic Heller myotomy (LHM), not only for all types of esophageal achalasia [classical (I), vigorous (II), spastic (III), Chicago Classification], but also for advanced sigmoid type achalasia (S1 and S2), failed LHM, or other esophageal motility disorders (diffuse esophageal spasm, nutcracker esophagus or Jackhammer esophagus). POEM starts with a mucosal incision, followed by submucosal tunnel creation crossing the esophagogastric junction (EGJ) and myotomy. Finally the mucosal entry is closed with endoscopic clip placement. POEM permitted relatively free choice of myotomy length and localization. Although it is technically demanding procedure, POEM can be performed safely and achieves very good control of dysphagia and chest pain. Gastroesophageal reflux is the most common troublesome side effect, and is well controllable with proton pump inhibitors. Furthermore, POEM opened the era of submucosal tunnel endoscopy, with many other applications. Based on the same principles with POEM, in combination with new technological developments, such as endoscopic suturing, peroral endoscopic tumor resection (POET), is safely and effectively applied for challenging submucosal esophageal, EGJ and gastric cardia tumors (submucosal tumors), emerged from muscularis propria. POET showed up to know promising results, however, it is restricted to specialized centers. The present article reviews the recent data of POEM and POET and discussed controversial issues that need further study and future perspectives. PMID

  12. Stratospheric Balloon Platforms for Near Space Access

    NASA Astrophysics Data System (ADS)

    Dewey, R. G.

    2012-12-01

    For over five decades, high altitude aerospace balloon platforms have provided a unique vantage point for space and geophysical research by exposing scientific instrument packages and experiments to space-like conditions above 99% of Earth's atmosphere. Reaching altitudes in excess of 30 km for durations ranging from hours to weeks, high altitude balloons offer longer flight durations than both traditional sounding rockets and emerging suborbital reusable launch vehicles. For instruments and experiments requiring access to high altitudes, engineered balloon systems provide a timely, responsive, flexible, and cost-effective vehicle for reaching near space conditions. Moreover, high altitude balloon platforms serve as an early means of testing and validating hardware bound for suborbital or orbital space without imposing space vehicle qualifications and certification requirements on hardware in development. From float altitudes above 30 km visible obscuration of the sky is greatly reduced and telescopes and other sensors function in an orbit-like environment, but in 1g. Down-facing sensors can take long-exposure atmospheric measurements and images of Earth's surface from oblique and nadir perspectives. Payload support subsystems such as telemetry equipment and command, control, and communication (C3) interfaces can also be tested and operationally verified in this space-analog environment. For scientific payloads requiring over-flight of specific areas of interests, such as an active volcano or forest region, advanced mission planning software allows flight trajectories to be accurately modeled. Using both line-of-sight and satellite-based communication systems, payloads can be tracked and controlled throughout the entire mission duration. Under NASA's Flight Opportunities Program, NSC can provide a range of high altitude flight options to support space and geophysical research: High Altitude Shuttle System (HASS) - A balloon-borne semi-autonomous glider carries

  13. New concepts for interplanetary balloons and blimps, particularly for Titan

    NASA Astrophysics Data System (ADS)

    Nott, J.

    This paper proposes novel approaches for balloons for planets Titan BALLUTE A balloon or blimp arriving at a planet or moon with an atmosphere might inflate falling under a parachute or after landing Neither is ideal In both cases the envelope must include qualities needed for inflation as well as those for flight A ballute BALLoon parachUTE could be used thus a ballute is like a hot air balloon with a large mouth Initially it fills by ram pressure descending through an atmosphere As proposed it would then be heated by solid propellant It would stop descending and float level with hot air lift It is now a perfect location for inflation without wind or movement through the atmosphere and away from the uncertainties of the surface A ballute could be used over several bodies in the solar system BALLOONS FOR LOW TEMPERATURES Flight in very low temperatures is also discussed Conditions are so different that it is useful to examine basic factors These apply for any planet with low temperature and weather calm enough for balloons or blimps First for terrestrial hot air balloons thermal radiation is usually the dominant way heat is lost But radiation rises with the 4th power of absolute temperature At Titan radiation will be one or two orders of magnitude smaller Also the dense atmosphere allows small balloons small temperature differences So convection is small It appears a hot air balloon can easily be heated by a radioactive source likely carried to make electricity Pinholes are not important in such a balloon

  14. Reduction of prostate intrafraction motion using gas-release rectal balloons

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Su Zhong; Zhao Tianyu; Li Zuofeng

    2012-10-15

    Purpose: To analyze prostate intrafraction motion using both non-gas-release (NGR) and gas-release (GR) rectal balloons and to evaluate the ability of GR rectal balloons to reduce prostate intrafraction motion. Methods: Twenty-nine patients with NGR rectal balloons and 29 patients with GR balloons were randomly selected from prostate patients treated with proton therapy at University of Florida Proton Therapy Institute (Jacksonville, FL). Their pretreatment and post-treatment orthogonal radiographs were analyzed, and both pretreatment setup residual error and intrafraction-motion data were obtained. Population histograms of intrafraction motion were plotted for both types of balloons. Population planning target-volume (PTV) margins were calculated withmore » the van Herk formula of 2.5{Sigma}+ 0.7{sigma} to account for setup residual errors and intrafraction motion errors. Results: Pretreatment and post-treatment radiographs indicated that the use of gas-release rectal balloons reduced prostate intrafraction motion along superior-inferior (SI) and anterior-posterior (AP) directions. Similar patient setup residual errors were exhibited for both types of balloons. Gas-release rectal balloons resulted in PTV margin reductions from 3.9 to 2.8 mm in the SI direction, 3.1 to 1.8 mm in the AP direction, and an increase from 1.9 to 2.1 mm in the left-right direction. Conclusions: Prostate intrafraction motion is an important uncertainty source in radiotherapy after image-guided patient setup with online corrections. Compared to non-gas-release rectal balloons, gas-release balloons can reduce prostate intrafraction motion in the SI and AP directions caused by gas buildup.« less

  15. Properties of nylon 12 balloons after thermal and liquid carbon dioxide treatments.

    PubMed

    Ro, Andrew J; Davé, Vipul

    2013-03-01

    Critical design attributes of angioplasty balloons include the following: tear resistance, high burst pressures, controlled compliance, and high fatigue. Balloons must have tear resistance and high burst pressures because a calcified stenosis can be hard and nominal pressures of up to 16 atm can be used to expand the balloon. The inflated balloon diameter must be a function of the inflation pressure, thus compliance is predictable and controlled. Reliable compliance is necessary to prevent damage to vessel walls, which may be caused by over-inflation. Balloons are often inflated multiple times in a clinical setting and they must be highly resistant to fatigue. These design attributes are dependent on the mechanical properties and polymer morphology of the balloon. The effects of residual stresses on shrinkage, crystallite orientation, balloon compliance, and mechanical properties were studied for angioplasty nylon 12 balloons. Residual stresses of these balloons were relieved by oven heat treatment and liquid CO2 exposure. Residual stresses were measured by quantifying shrinkage at 80 °C of excised balloon samples using a dynamic mechanical analyzer. Shrinkage was lower after oven heat treatment and liquid CO2 exposure compared to the as-received balloons, in the axial and radial directions. As-received, oven heat treated, and liquid CO2-exposed balloon samples exhibited similar thermal properties (T(g), T(m), X(t)). Crystallite orientation was not observed in the balloon cylindrical body using X-ray scattering and polarized light microscopy, which may be due to balloon fabrication conditions. Significant differences were not observed between the stress-strain curves, balloon compliance, and average burst pressures of the as-received, oven heat treated, and liquid CO2-exposed balloons. Copyright © 2012 Elsevier B.V. All rights reserved.

  16. Endoscopic techniques in aesthetic plastic surgery.

    PubMed

    McCain, L A; Jones, G

    1995-01-01

    There has been an explosive interest in endoscopic techniques by plastic surgeons over the past two years. Procedures such as facial rejuvenation, breast augmentation and abdominoplasty are being performed with endoscopic assistance. Endoscopic operations require a complex setup with components such as video camera, light sources, cables and hard instruments. The Hopkins Rod Lens system consists of optical fibers for illumination, an objective lens, an image retrieval system, a series of rods and lenses, and an eyepiece for image collection. Good illumination of the body cavity is essential for endoscopic procedures. Placement of the video camera on the eyepiece of the endoscope gives a clear, brightly illuminated large image on the monitor. The video monitor provides the surgical team with the endoscopic image. It is important to become familiar with the equipment before actually doing cases. Several options exist for staff education. In the operating room the endoscopic cart needs to be positioned to allow a clear unrestricted view of the video monitor by the surgeon and the operating team. Fogging of the endoscope may be prevented during induction by using FREDD (a fog reduction/elimination device) or a warm bath. The camera needs to be white balanced. During the procedure, the nurse monitors the level of dissection and assesses for clogging of the suction.

  17. Evaluation of diagnostic cytology via endoscopic naso-pancreatic drainage for pancreatic tumor

    PubMed Central

    Iwata, Tomoyuki; Kitamura, Katsuya; Yamamiya, Akira; Ishii, Yu; Sato, Yoshiki; Nomoto, Tomohiro; Ikegami, Akitoshi; Yoshida, Hitoshi

    2014-01-01

    AIM: To evaluate the usefulness of cytology of the pancreatic juice obtained via the endoscopic naso-pancreatic drainage tube (ENPD-C). METHODS: ENPD was performed in cases where a diagnosis could not be made other than by using endoscopic retrograde cholangiopancreatography and in cases of pancreatic neoplasms or cystic tumors, including intraductal papillary mucinous neoplasm (IPMN) suspected to have malignant potential. 35 patients (21 males and 14 females) underwent ENPD between January 2007 and June 2013. The pancreatic duct was imaged and the procedure continued in one of ENPD-C or ENPD-C plus brush cytology (ENPD-BC). We checked the cytology result and the final diagnosis. RESULTS: The mean patient age was 69 years (range, 48-86 years). ENPD-C was performed in 24 cases and ENPD-C plus brush cytology (ENPD-BC) in 11 cases. The ENPD tube was inserted for an average of 3.5 d. The final diagnosis was confirmed on the basis of the resected specimen in 18 cases and of follow-up findings at least 6 mo after ENPD in the 18 inoperable cases. Malignancy was diagnosed in 21 cases and 14 patients were diagnosed as having a benign condition. The ratios of class V/IV:III:II/I findings were 7:7:7 in malignant cases and 0:3:11 in benign cases. The sensitivity and specificity for all patients were 33.3% and 100%, respectively. The cytology-positive rate was 37.5% (6/16) for pancreatic cancer. For IPMN cases, the sensitivity and specificity were 33% and 100%, respectively. CONCLUSION: Sensitivity may be further increased by adding brush cytology. Although we can diagnosis cancer in cases of a positive result, the accuracy of ENPD-C remains unsatisfactory. PMID:25132920

  18. Comparison of Complications Rates in Endoscopic Surgery Performed by a Clinical Assistant vs. An Experienced Endoscopic Surgeon

    PubMed Central

    Singhi, Aditi

    2009-01-01

    Study Objectives: (a) To find out the actual incidence of complications during endoscopic surgeries. (b) Comparison of complication rate between an experienced laparoscopic surgeon (> 10 years of experience in endoscopic surgery) and a clinical assistant (> 3 years of experience in endoscopic surgery). (c) How to manage complications in endoscopic surgery. (d) Concrete suggestions to reduce the complication rate. Design: Retrospective study (Canadian Task Force classification ii-2). Setting: Tertiary gynecologic endoscopic unit. Patients: A total of 3204 cases of gynecologic endoscopic surgery out of which 2001 were laparoscopic and 1203 were hysteroscopic surgeries. Interventions: Laparoscopic and hysteroscopic gynecologic surgeries in indicated cases. Measurements and Main Results: The study was carried out between April 2003 and October 2007 at a referral center for endoscopic surgery. A total of 3204 cases of gynecologic endoscopic surgery were studied. There were five significant complications in laparoscopic surgeries and four significant complications in hysteroscopic surgeries seen in four years and six months. All the complications could be managed with no mortality. Conversion to laparotomy was needed in eight cases of laparoscopic surgeries and none in hysteroscopic surgeries. Conclusion: The risk of complication reduces with the experience in endoscopic surgery. However, the proper grooming of a novice in experienced hands, for a sufficient period of time, can minimize the complication rate in the initial learning phase. The complication may be utilized as a stepping-stone to overcome any given situation without panic, but with adequate safety. PMID:22442510

  19. [Papillary cystadenoma of the epididymis: a report of 2 cases and review of the literature].

    PubMed

    Zhang, Wei; Tu, Pin; Wang, Jian-jun; He, Yan; Yu, Bo; Wang, Hai; Shi, Qun-li

    2015-02-01

    To study the clinicopathological characteristics of papillary cystadenoma of the epididymis. Using routine pathology and immunohistochemistry, we observed the surgically obtained samples from 2 cases of papillary cystadenoma of the epididymis, analyzed their pathological features and clinical presentations, and reviewed the related literature. The 2 patients were both adult males. The tumors typically manifested as painless swelling in the epididymis, with occasionally dull pain and tenesmus in 1 of the cases. Pathologically, the lesions exhibited three morphological features, i. e., dilated ducts and small cysts surrounded by fibrous connective tissue, adenoid papillary hyperplasia into the cysts embraced by fibrovascular stroma, and acidophil substance present in the cysts. Immunohistochemistry showed that the tumors were strongly positive for CK8/18, CK7, and EMA, but negative for CK20, CEA, MC, Calretenin, P53, P63, SMA, VHL, and CD10, with the positive rate of Ki-67 <1%. Follow-up visits revealed good prognosis in both cases. Papillary cystadenoma of the epididymis is a rare benign tumor in the male urogenital system, which may be accompanied by the VHL syndrome. Surgery is the first choice for its treatment.

  20. Static and quasi-static analysis of lobed-pumpkin balloon

    NASA Astrophysics Data System (ADS)

    Nakashino, Kyoichi; Sasaki, Makoto; Hashimoto, Satoshi; Saito, Yoshitaka; Izutsu, Naoki

    The present study is motivated by the need to improve design methodology for super pressure balloon with 3D gore design concept, currently being developed at the Scientific Balloon Center of ISAS/JAXA. The distinctive feature of the 3-D gore design is that the balloon film has excess materials not only in the circumferential direction but also in the meridional direction; the meridional excess is gained by attaching the film boundaries to the corresponding tendons of a shorter length with a controlled shortening rate. The resulting balloon shape is a pumpkin-like shape with large bulges formed between adjacent tendons. The balloon film, when fully inflated, develops wrinkles in the circumferential direction over its entire region, so that the stresses in the film are limited to a small amount of uniaxial tension in the circumferential direction while the high meridional loads are carried by re-enforced tendons. Naturally, the amount of wrinkling in the film is dominated by the shortening rate between the film boundaries and the tendon curve. In the 3-D gore design, as a consequence, the shortening rate becomes a fundamental design parameter along with the geometric parameters of the gore. In view of this, we have carried out a series of numerical study of the lobed-pumpkin balloon with varying gore geometry as well as with varying shortening rate. The numerical simula-tions were carried out with a nonlinear finite element code incorporating the wrinkling effect. Numerical results show that there is a threshold value for the shortening rate beyond which the stresses in the balloon film increases disproportionately. We have also carried out quasi-static simulations of the inflation process of the lobed-pumpkin balloon, and have obtained asymmetric deformations when the balloon films are in uniaxial tension state.

  1. 14 CFR 101.39 - Balloon position reports.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Balloon position reports. 101.39 Section 101.39 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES MOORED BALLOONS, KITES, AMATEUR ROCKETS AND UNMANNED FREE...

  2. 14 CFR 101.39 - Balloon position reports.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false Balloon position reports. 101.39 Section 101.39 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES MOORED BALLOONS, KITES, AMATEUR ROCKETS AND UNMANNED FREE...

  3. 14 CFR 101.39 - Balloon position reports.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Balloon position reports. 101.39 Section 101.39 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES MOORED BALLOONS, KITES, AMATEUR ROCKETS AND UNMANNED FREE...

  4. 14 CFR 101.39 - Balloon position reports.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Balloon position reports. 101.39 Section 101.39 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES MOORED BALLOONS, KITES, AMATEUR ROCKETS AND UNMANNED FREE...

  5. 14 CFR 101.39 - Balloon position reports.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Balloon position reports. 101.39 Section 101.39 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES MOORED BALLOONS, KITES, AMATEUR ROCKETS AND UNMANNED FREE...

  6. [Endoscopic extraction of gallbladder calculi].

    PubMed

    Kühner, W; Frimberger, E; Ottenjann, R

    1984-06-29

    Endoscopic extraction of gallbladder stones were performed, as far as we know for the first time, in three patients with combined choledochocystolithiasis. Following endoscopic papillotomy (EPT) and subsequent mechanical lithotripsy of multiple choledochal concrements measuring up to 3 cm the gallbladder stones were successfully extracted with a Dormia basket through the cystic duct. The patients have remained free of complications after the endoscopic intervention.

  7. The balloon and the airship technological heritage

    NASA Technical Reports Server (NTRS)

    Mayer, N. J.

    1981-01-01

    The balloon and the airship are discussed with emphasis on the identification of commonalities and distinctions. The aerostat technology behind the shape and structure of the vehicles is reviewed, including a discussion of structural weight, internal pressure, buckling, and the development of a stable tethered balloon system. Proper materials for the envelope are considered, taking elongation and stress into account, and flight operation and future developments are reviewed. Airships and tethered balloons which are designed to carry high operating pressure with low gas loss characteristics are found to share similar problems in low speed flight operations, while possessing interchangeable technologies.

  8. Development of a super-pressure balloon with a diamond-shaped net

    NASA Astrophysics Data System (ADS)

    Saito, Y.; Iijima, I.; Matsuzaka, Y.; Matsushima, K.; Tanaka, S.; Kajiwara, K.; Shimadu, S.

    2014-10-01

    The essential reason of the lobed-pumpkin shaped super-pressure balloon to withstand against the high pressure is that the local curvature of the balloon film is kept small. Recently, it has been found that the small local curvature can also be obtained if the balloon is covered by a diamond-shaped net with a vertically elongated shape. The development of the super-pressure balloon using this method was started from a 3-m balloon with a polyethylene film covered by a net using Kevlar ropes. The ground inflation test showed the expected high burst pressure. Then, a 6-m and a 12-m balloon using a polyethylene film and a net using the Vectran were developed and stable deployment was checked through the ground inflation tests. The flight test of a 3000 m3 balloon was performed in 2013 and shown to resist a pressure of at least 400 Pa. In the future, after testing a new design to relax a possible stress concentration around the polar area, test flights of scaled balloons will be performed gradually enlarging their size. The goal is to launch a 300,000 m3 super-pressure balloon.

  9. Unusual presentation of Warthin variant of Papillary thyroid carcinoma with lymph nodal metastases in a patient of Graves' disease.

    PubMed

    Padma, Subramanyam; Sundaram, Palaniswamy Shanmuga; Arun, B R

    2015-01-01

    Warthin-like Papillary thyroid carcinoma (WPTC) is a rare variant of papillary carcinoma of thyroid, PTC which derives its name by closely resembling Warthin's tumor of salivary gland. Hallmark histological feature of this variant is papillary folding lined by oncocytic neoplastic cells with clear nuclei and nuclear pseudoinclusions, accompanied by prominent lymphocytic infiltrate in the papillary stalks. It is thought to be one of those differentiated thyroid cancers with favorable prognosis. We report a case of Graves' disease with a cold nodule harboring WPTC with initial presentation of lymph nodal metastases. It is important to identify this peculiar variant of PTC as 5 to 10% of them undergo dedifferentiation and 30% have the lymph nodal metastases and extra thyroidal extension.

  10. Balloon-Inflated Catheters for Enteral Feeding: a Word of Caution.

    PubMed

    Dash, Nihar Ranjan; Singh, Anand Narayan; Kilambi, Ragini

    2018-02-01

    Catheters with inflatable balloons such as a Foley catheter may be used for feeding gastrostomy/jejunostomy. The incorrect or improper use of these catheters can have serious consequences. We report 13 cases of feeding jejunostomy with balloon-inflated catheter's malfunction, some referred to our centre and others operated here over a period of 8 years. The most dramatic consequence of such improper use led to rupture of the small intestine due to inadvertent over-inflation (over 100 ml) of the balloon of the catheter during a contrast study. The patient required a laparotomy with resection and anastomosis of the bowel. Three other patients had similar over-inflation of the balloon leading to severe pain and discomfort. In all three patients, timely deflation of the balloon was sufficient to relieve the symptoms. One patient had intussusception with the inflated balloon acting as a lead point. The patient underwent resection of the small bowel with end jejunostomy and distal mucous fistula. All other patients presented with abdominal pain and distension and intestinal obstruction and were managed non-operatively with deflation of balloon either by aspiration, cutting the balloon port or ultrasound-guided puncture of balloon. Healthcare personnel dealing with patients with indwelling catheters must be educated to suspect, detect and manage such problems. The best measure for such unusual complications of otherwise safe devices would be prevention by training and generation of awareness.

  11. Development of a Compact Captive Balloon and Its Level Supporting

    NASA Astrophysics Data System (ADS)

    Nakao, Tatsuya; Fujiwara, Kazuhito; Furukawa, Motoyasu; Hiroe, Tetsuyuki

    Many kinds of observation techniques have been developed to obtain the properties of atmospheric conditions. The advanced observation techniques of the flow in relatively large scale are remote sensing by satellite facilities, long range observations by radar or Doppler Sodar, etc., while data from conventional climometers set at fixed places are merely limited information about local scale flow. Captive balloons are also available and feasible for the observation of local flows if their standing mechanics are robust against the strong wind and the motion of balloon are stable for all wind direction and the change of wind direction. In this paper, a compact captive balloon (about 2m diam.) for flow measurement is proposed and the preservation of balloon height level and the stabilization of its motion are challenged by using a kite. The relation between force balances acted on the balloon and the balloon height or position was estimated and confirmed in experiments. Although the lift force of single kite worked successfully, it is found that the performance of plural kites is less in the traction of balloon since the interaction of their tensions. The compact balloon supported by the kite enabled the over 300m floating by virtue of the small size causing only low air resistance.

  12. Papillary Thyroid Microcarcinoma Arising Within a Mature Ovarian Teratoma: Case Report and Review of the Literature.

    PubMed

    Pineyro, Maria M; Pereda, Jimena; Schou, Pamela; de Los Santos, Karina; de la Peña, Soledad; Caserta, Benedicta; Pisabarro, Raul

    2017-01-01

    Mature cystic teratoma is the most common kind of ovarian germ cell tumor. Malignant transformation is uncommon, with thyroid cancer rarely found. Papillary thyroid microcarcinoma has rarely been described as associated with ovarian teratomas. We report a case of a 34-year-old woman who presented with abdominal pain and an ovarian mass. After surgery, the patient was diagnosed with a follicular variant papillary thyroid microcarcinoma that arose within a mature cystic ovarian teratoma. Based on the small size of the primary lesion and patient preferences, no further treatment was performed. To our knowledge, this is the third reported case of papillary thyroid microcarcinoma arising within a mature ovarian teratoma without struma ovarii. There is no consensus on the surgical approach and postoperative management of this condition. Whether further therapy with total thyroidectomy and radioiodine ablation may be beneficial is unknown. In conclusion, papillary thyroid microcarcinoma can also arise within mature ovarian teratomas. Although a favorable prognosis is anticipated, there is limited information about its history or prognosis.

  13. Papillary Thyroid Microcarcinoma Arising Within a Mature Ovarian Teratoma: Case Report and Review of the Literature

    PubMed Central

    Pineyro, Maria M; Pereda, Jimena; Schou, Pamela; de los Santos, Karina; de la Peña, Soledad; Caserta, Benedicta; Pisabarro, Raul

    2017-01-01

    Mature cystic teratoma is the most common kind of ovarian germ cell tumor. Malignant transformation is uncommon, with thyroid cancer rarely found. Papillary thyroid microcarcinoma has rarely been described as associated with ovarian teratomas. We report a case of a 34-year-old woman who presented with abdominal pain and an ovarian mass. After surgery, the patient was diagnosed with a follicular variant papillary thyroid microcarcinoma that arose within a mature cystic ovarian teratoma. Based on the small size of the primary lesion and patient preferences, no further treatment was performed. To our knowledge, this is the third reported case of papillary thyroid microcarcinoma arising within a mature ovarian teratoma without struma ovarii. There is no consensus on the surgical approach and postoperative management of this condition. Whether further therapy with total thyroidectomy and radioiodine ablation may be beneficial is unknown. In conclusion, papillary thyroid microcarcinoma can also arise within mature ovarian teratomas. Although a favorable prognosis is anticipated, there is limited information about its history or prognosis. PMID:28615984

  14. Subcentimeter noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).

    PubMed

    Rosario, Pedro Weslley

    2018-05-23

    Recently, it was proposed that the noninvasive encapsulated follicular variant of papillary thyroid carcinoma (noninvasive E-FVPTC) start to be called "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP). 1 As the original cohort of 109 patients with NIFTP studied by the consensus conference included only tumors which were equal or more than 1 cm in size, the consensus diagnostic criteria of NIFTP did not explicitly address subcentimeter lesions. 1,2 In fact, in a recent review published in this journal, Hung & Barletta recognize that there are a few published subcentimetre NIFTP in the literature. 3 This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  15. Endoscopic findings following retroperitoneal pancreas transplantation.

    PubMed

    Pinchuk, Alexey V; Dmitriev, Ilya V; Shmarina, Nonna V; Teterin, Yury S; Balkarov, Aslan G; Storozhev, Roman V; Anisimov, Yuri A; Gasanov, Ali M

    2017-07-01

    An evaluation of the efficacy of endoscopic methods for the diagnosis and correction of surgical and immunological complications after retroperitoneal pancreas transplantation. From October 2011 to March 2015, 27 patients underwent simultaneous retroperitoneal pancreas-kidney transplantation (SPKT). Diagnostic oesophagogastroduodenoscopy (EGD) with protocol biopsy of the donor and recipient duodenal mucosa and endoscopic retrograde pancreatography (ERP) were performed to detect possible complications. Endoscopic stenting of the main pancreatic duct with plastic stents and three-stage endoscopic hemostasis were conducted to correct the identified complications. Endoscopic methods showed high efficiency in the timely diagnosis and adequate correction of complications after retroperitoneal pancreas transplantation. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. False coronary dissection with the new Monorail angioplasty balloon catheter.

    PubMed

    Esplugas, E; Cequier, A R; Sabaté, X; Jara, F

    1990-01-01

    During percutaneous transluminal coronary angioplasty, the appearance of persistent staining in the vessel by contrast media suggests coronary dissection. We report seven patients in whom a false image of severe coronary dissection was observed during angioplasty performed with the new Monorail balloon catheter. This image emerges at the moment of balloon inflation, is distally located to the balloon, and disappears with balloon catheter deflation. No complications were associated with the appearance of this image.

  17. Sounding rocket and balloon flight safety philosophy and methodologies

    NASA Technical Reports Server (NTRS)

    Beyma, R. J.

    1986-01-01

    NASA's sounding rocket and balloon goal is to successfully and safely perform scientific research. This is reflected in the design, planning, and conduct of sounding rocket and balloon operations. The purpose of this paper is to acquaint the sounding rocket and balloon scientific community with flight safety philosophy and methodologies, and how range safety affects their programs. This paper presents the flight safety philosophy for protecting the public against the risk created by the conduct of sounding rocket and balloon operations. The flight safety criteria used to implement this philosophy are defined and the methodologies used to calculate mission risk are described.

  18. BRAF mutation status in papillary thyroid carcinoma: significance for surgical strategy.

    PubMed

    Miccoli, P; Basolo, F

    2014-02-01

    BRAF mutation is probably the only molecular marker acting as a risk factor that is available before surgery: for this reason, soon after it became quite widespread, it seemed an important tool as a guide towards an individualized surgical therapy in papillary thyroid carcinoma. Capsule invasion, multifocality, and lymph node involvement are the most important parameters influencing the choice of surgical strategy in front of small papillary cancers and, in more detail, of micro papillary carcinomas. The relationship between these parameters and the BRAF mutation are closely examined through the more recent literature. Capsular invasion seems to show the strongest correlation with the mutation and this has important correlations, thus suggesting that a more aggressive local surgery might be advisable, whereas the correlation between the mutation and lymph node involvement would be weaker, at least according to the most recent studies. The personalization of surgical therapy, today, seems easier to achieve thanks to molecular testing. In particular, an important result could be in the short term reduction in the number of completion thyroidectomies following simple lobectomies. Also, post operative radioactivated iodine therapies should be more carefully evaluated and tailored according to BRAF status. A possible flow chart for the decision of the therapeutic approach is proposed in accordance to the results of the literature.

  19. Endoscopic submucosal dissection using flexknife.

    PubMed

    Kodashima, Shinya; Fujishiro, Mitsuhiro; Yahagi, Naohisa; Kakushima, Naomi; Omata, Masao

    2006-01-01

    Although the standard treatment for early-stage gastrointestinal tumors is still surgical resection, endoscopic resection has been accepted for some of these lesions, especially in Japan. However, the indication was limited until recently to achieve en bloc resection and prevent local recurrence. To overcome the disadvantage of endoscopic resection with conventional endoscopic mucosal resection (EMR), several investigators, including us, have developed a new endoscopic resection technique: endoscopic submucosal dissection (ESD). ESD is a remarkable technique that enables to remove the lesions en bloc regardless of size, shape, coexisting ulcer, and location. Nowadays, several knives are available for ESD, such as the needle knife, insulation-tipped (IT) knife, Hookknife, triangle-tipped (TT) knife, and Flexknife. Each of them has some merits and demerits, and the ways to use the knives are different. We summarize here how to use the Flexknife, which we made ourselves in cooperation with the Olympus Company, and how we use the technique in our hospital.

  20. Balloon Sculpture

    ERIC Educational Resources Information Center

    Warwick, James F.

    1976-01-01

    For the adventurous teacher and student there is an alternative to the often messy mixing, pouring, casting, cutting, scoring and sanding of plaster of Paris for casting or sculptural projects. Balloon sculpture, devised, designed and shown here by a sculptor/teacher, is an eye appealing sculptural form and holds a strong interest for students.…

  1. Diffuse lipomatosis of the thyroid gland with papillary microcarcinoma: Report of a rare entity.

    PubMed

    Nandyala, Hariharanadha Sarma; Madapuram, Srinivasulu; Yadav, Megha; Katamala, Sudheer Kumar

    2015-01-01

    Presence of lobules of adipose tissue either focally or diffusely is very rare in the thyroid gland. Fat accumulation can be macroscopic or microscopic. Focal infiltrates of fat have been reported in conditions such as adenolipoma, intrathyroid lipoma, and encapsulated papillary carcinoma. Diffuse lipomatosis has been reported in conditions such as amyloid goitre, heterotopic fat nests, thyrolipoma and liposarcoma. The exact mechanism of fat accumulation is not known although there are many theories postulated. Investigations such as ultrasound, computed tomography scan, and magnetic resonance imaging can detect the presence of macroscopic fat in the thyroid gland. Accurate diagnosis of the type of fat accumulation is necessary because tumorous and nontumorous conditions fall into the differential diagnosis. Only nine cases of papillary carcinoma associated with lipomatosis of thyroid are reported so far. We report possibly the first case of diffuse lipomatosis of the thyroid gland with a focus of papillary microcarcinoma.

  2. Skin metastasis on the neck: an unusual presentation of recurrence of papillary thyroid carcinoma

    PubMed Central

    Soylu, Selen; Teksoz, Serkan; Ozcan, Murat; Bukey, Yusuf

    2017-01-01

    Skin metastasis of papillary thyroid carcinoma (PTC) is rare. Here, two cases of skin metastases of PTC are presented. Both of the patients were females, one is 83 and the other is 65 years old. The patients were admitted to the hospital with a movable skin lesion on anterior neck region. Free T3 and T4 levels were in normal levels and TSH levels were low in both patients. The 83-year-old patient underwent total thyroidectomy due to papillary thyroid cancer and received 131I ablation therapy and then thyroid suppression therapy. After the surgery, the patient lived without evidence of disease for 3 years and then skin metastasis occurred. The 65-year-old patient had a total thyroidectomy 5 years ago due to PTC then neck dissection due to metastasis 3 years later and then received 131I ablation therapy. Thyroid ultrasonography of both patients showed hypoechoic nodules with central vascularization. In the histological examination of both patients, cystic lesions filled with papillary structures were seen. Fine needle aspiration biopsy (FNAB) taken from both patients were papillary carcinoma with solid trabecular pattern. PTC tends to metastasize to regional lymph nodes but distant metastasis is rare. When distant metastasis develops, prognosis of the disease is poor. Therefore, skin metastasis of papillary thyroid cancer is a poor prognostic factor. If the patient does not have a thyroid malignancy history, diagnosis of PTC metastatic to the skin may be difficult since primary skin tumors such as apocrine tumors have similar histopathological features. However, in the presented cases since there was a PTC history, the diagnosis was easier with the help of histopathological examination. Skin metastasis of PTC should be kept in mind when differential diagnosis of atypical skin lesions are made especially in the patients with thyroid malignancy history. PMID:29142854

  3. Endoscopic management of pancreatic fluid collections-revisited

    PubMed Central

    Nabi, Zaheer; Basha, Jahangeer; Reddy, D Nageshwar

    2017-01-01

    The development of pancreatic fluid collections (PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has become easier. The requirement of re-intervention is less with new metal stents as compared to plastic stents. However, endoscopic drainage is not free of adverse events. Severe complications including bleeding, perforation, sepsis and embolism have been described with endoscopic approach to PFC. Therefore, the endoscopic management of PFC is a multidisciplinary affair and involves interventional radiologists as well as GI surgeons to deal with unplanned adverse events and failures. In this review we discuss the recent advances and controversies in the endoscopic management of PFC. PMID:28487603

  4. Drug-eluting balloon angioplasty versus uncoated balloon angioplasty for peripheral arterial disease of the lower limbs.

    PubMed

    Kayssi, Ahmed; Al-Atassi, Talal; Oreopoulos, George; Roche-Nagle, Graham; Tan, Kong Teng; Rajan, Dheeraj K

    2016-08-04

    Atherosclerotic peripheral arterial disease (PAD) can lead to disabling ischemia and limb loss. Treatment modalities have included risk factor optimization through life-style modifications and medications, or operative approaches using both open and minimally invasive techniques, such as balloon angioplasty. Drug-eluting balloon (DEB) angioplasty has emerged as a promising alternative to uncoated balloon angioplasty for the treatment of this difficult disease process. By ballooning and coating the inside of atherosclerotic vessels with cytotoxic agents, such as paclitaxel, cellular mechanisms responsible for atherosclerosis and neointimal hyperplasia are inhibited and its devastating complications are prevented or postponed. DEBs are considerably more expensive than uncoated balloons, and their efficacy in improving patient outcomes is unclear. To assess the efficacy of drug-eluting balloons (DEBs) compared with uncoated, nonstenting balloon angioplasty in people with symptomatic lower-limb peripheral arterial disease (PAD). The Cochrane Vascular Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched December 2015) and Cochrane Register of Studies (CRS) (2015, Issue 11). The TSC searched trial databases for details of ongoing and unpublished studies. We included all randomized controlled trials that compared DEBs with uncoated, nonstenting balloon angioplasty for intermittent claudication (IC) or critical limb ischemia (CLI). Two review authors (AK, TA) independently selected the appropriate trials and performed data extraction, assessment of trial quality, and data analysis. The senior review author (DKR) adjudicated any disagreements. Eleven trials that randomized 1838 participants met the study inclusion criteria. Seven of the trials included femoropopliteal arterial lesions, three included tibial arterial lesions, and one included both. The trials were carried out in Europe and in the USA and all used the taxane drug paclitaxel in the

  5. Cytopathology of non-invasive follicular thyroid neoplasm with papillary-like nuclear features: A comparative study with similar patterned papillary thyroid carcinoma variants.

    PubMed

    Mahajan, S; Agarwal, S; Kocheri, N; Jain, D; Mathur, S R; Iyer, V K

    2018-06-01

    Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a recently described, indolent thyroid tumor, with well-defined histopathological diagnostic criteria. Cytology features are not well documented. We reviewed cytology of histologically proven cases of NIFTP and some of its common differentials to look for salient diagnostic features. Cases reported on histopathology as follicular variant of papillary thyroid carcinoma (FVPTC), or NIFTP between July 2015 and April 2017 having available cytology smears were retrieved and reclassified as NIFTP, FVPTC, and classical papillary thyroid carcinoma with predominant follicular pattern (PTC-FP). Cytological features were assessed, classified as per The Bethesda System for Reporting Cytopathology and compared. There were 23 NIFTP cases, 18 FVPTC and 8 PTC-FP. A microfollicle-predominant pattern was seen in all. Nuclear score was 2 in most NIFTP cases (61%). Pseudoinclusions were absent. NIFTP showed features of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (III) in 61%, follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN) (IV) in 35% and suspicious for malignancy (SFM) (V) in 4%. Most of the FVPTCs were also called FN/SFN (IV) (56%) or AUS/FLUS (III) (22%). Nuclear features did not statistically differ from NIFTP. PTC-FP showed high-grade cytology in 75%, and higher nuclear score (3 in 75%) in contrast to NIFTP (P = .003). NIFTP and FVPTC show a similar distribution among the Bethesda categories hence precluding conclusive distinction on cytology. PTC-FP, in contrast, was found to have a statistically significant higher nuclear score and more commonly showed malignant cytology. © 2018 John Wiley & Sons Ltd.

  6. Solar energy collector including a weightless balloon with sun tracking means

    DOEpatents

    Hall, Frederick F.

    1978-01-01

    A solar energy collector having a weightless balloon, the balloon including a transparent polyvinylfluoride hemisphere reinforced with a mesh of ropes secured to its outside surface, and a laminated reflector hemisphere, the inner layer being clear and aluminized on its outside surface and the outer layer being opaque, the balloon being inflated with lighter-than-air gas. A heat collection probe extends into the balloon along the focus of reflection of the reflective hemisphere for conducting coolant into and out of the balloon. The probe is mounted on apparatus for keeping the probe aligned with the sun's path, the apparatus being founded in the earth for withstanding wind pressure on the balloon. The balloon is lashed to the probe by ropes adhered to the outer surface of the balloon for withstanding wind pressures of 100 miles per hour. Preferably, the coolant is liquid sodium-potassium eutectic alloy which will not normally freeze at night in the temperate zones, and when heated to 4,000.degree. R exerts a pressure of only a few atmospheres.

  7. Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures

    PubMed Central

    Mortagy, Mohamed; Mehta, Neal; Parsi, Mansour A; Abe, Seiichiro; Stevens, Tyler; Vargo, John J; Saito, Yutaka; Bhatt, Amit

    2017-01-01

    Endoscopic submucosal dissection (ESD) is a well-established, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection. Magnetic anchor guided endoscopic submucosal dissection (MAG-ESD) has potential benefits compared to other current traction methods. MAG-ESD offers dynamic tissue retraction independent of the endoscope mimicking a surgeon’s “second hand”. Two types of magnets can be used: electromagnets and permanent magnets. In this article we review the MAG-ESD technology, published work and studies of magnets in ESD. We also review the use of magnetic anchor guidance systems in natural orifice transluminal endoscopic surgery and the idea of magnetic non-contact retraction using surface ferromagentization. We discuss the current limitations, the future potential of MAG-ESD and the developments needed for adoption of this technology. PMID:28522906

  8. [Endoscopic full-thickness resection].

    PubMed

    Meier, B; Schmidt, A; Caca, K

    2016-08-01

    Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are powerful tools for the treatment of gastrointestinal (GI) neoplasms. However, those techniques are limited to the superficial layers of the GI wall (mucosa and submucosa). Lesions without lifting sign (usually arising from deeper layers) or lesions in difficult anatomic positions (appendix, diverticulum) are difficult - if not impossible - to resect using conventional techniques, due to the increased risk of complications. For larger lesions (>2 cm), ESD appears to be superior to the conventional techniques because of the en bloc resection, but the procedure is technically challenging, time consuming, and associated with complications even in experienced hands. Since the development of the over-the-scope clips (OTSC), complications like bleeding or perforation can be endoscopically better managed. In recent years, different endoscopic full-thickness resection techniques came to the focus of interventional endoscopy. Since September 2014, the full-thickness resection device (FTRD) has the CE marking in Europe for full-thickness resection in the lower GI tract. Technically the device is based on the OTSC system and combines OTSC application and snare polypectomy in one step. This study shows all full-thickness resection techniques currently available, but clearly focuses on the experience with the FTRD in the lower GI tract.

  9. Strengths of balloon films with flaws and repairs

    NASA Technical Reports Server (NTRS)

    Portanova, M. A.

    1989-01-01

    The effects of manufacture flaws and repairs in high altitude scientific balloons was examined. A right circular cylinder was used to induce a biaxial tension-tension stress field in the polyethlene film used to manufacture these balloons. A preliminary investigation of the effect that cylinder geometry has on stress rate as a function of inflation rate was conducted. The ultimate goal was to rank, by order of degrading effects, the flaws and repairs commonly found in current high altitude balloons.

  10. Endoscopic full-thickness resection: Current status

    PubMed Central

    Schmidt, Arthur; Meier, Benjamin; Caca, Karel

    2015-01-01

    Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices. PMID:26309354

  11. Endoscopic full-thickness resection: Current status.

    PubMed

    Schmidt, Arthur; Meier, Benjamin; Caca, Karel

    2015-08-21

    Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices.

  12. Innovations in Balloon Catheter Technology in Rhinology.

    PubMed

    D'Anza, Brian; Sindwani, Raj; Woodard, Troy D

    2017-06-01

    Since being introduced more than 10 years ago, balloon catheter technology (BCT) has undergone several generations of innovations. From construction to utilization, there has been a myriad of advancements in balloon technology. The ergonomics of the balloon dilation systems have improved with a focus on limiting the extra assembly. "Hybrid" BCT procedures have shown promise in mucosal preservation, including treating isolated complex frontal disease. Multiple randomized clinical trials report improved long-term outcomes in stand-alone BCT, including in-office use. The ever-expanding technological innovations ensure BCT will be a key component in the armamentarium of the modern sinus surgeon. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. NASA’s BARREL Mission Launches 20 Balloons

    NASA Image and Video Library

    2017-12-08

    Some of the BARREL balloon launches took place at the South African National Antarctic Expedition Research base, called SANAE IV, the others at Halley Research Station. This balloon is taking flight at SANAE IV. Credit: NASA --- In Antarctica in January, 2013 – the summer at the South Pole – scientists launched 20 balloons up into the air to study an enduring mystery of space weather: when the giant radiation belts surrounding Earth lose material, where do the extra particles actually go? The mission is called BARREL (Balloon Array for Radiation belt Relativistic Electron Losses) and it is led by physicist Robyn Millan of Dartmouth College in Hanover, NH. Millan provided photographs from the team’s time in Antarctica. The team launched a balloon every day or two into the circumpolar winds that circulate around the pole. Each balloon floated for anywhere from 3 to 40 days, measuring X-rays produced by fast-moving electrons high up in the atmosphere. BARREL works hand in hand with another NASA mission called the Van Allen Probes, which travels through the Van Allen radiation belts surrounding Earth. The belts wax and wane over time in response to incoming energy and material from the sun, sometimes intensifying the radiation through which satellites must travel. Scientists wish to understand this process better, and even provide forecasts of this space weather, in order to protect our spacecraft. As the Van Allen Probes were observing what was happening in the belts, BARREL tracked electrons that precipitated out of the belts and hurtled down Earth’s magnetic field lines toward the poles. By comparing data, scientists will be able to track how what’s happening in the belts correlates to the loss of particles – information that can help us understand this mysterious, dynamic region that can impact spacecraft. Having launched balloons in early 2013, the team is back at home building the next set of payloads. They will launch 20 more balloons in 2014. NASA

  14. Clinical relevance of endoscopic assessment of inflammation in ulcerative colitis: Can endoscopic evaluation predict outcomes?

    PubMed Central

    Mohammed, Noor; Subramanian, Venkataraman

    2016-01-01

    Ulcerative colitis (UC) is a chronic inflammatory bowel condition characterised by a relapsing and remitting course. Symptom control has been the traditional mainstay of medical treatment. It is well known that histological inflammatory activity persists despite adequate symptom control and absence of endoscopic inflammation. Current evidence suggests that presence of histological inflammation poses a greater risk of disease relapse and subsequent colorectal cancer risk. New endoscopic technologies hold promise for developing endoscopic markers of mucosal inflammation. Achieving endoscopic and histological remission appears be the future aim of medical treatments for UC. This review article aims to evaluate the use of endoscopy as a tool in assessment of mucosal inflammation UC and its correlation with disease outcomes. PMID:27895420

  15. Genetic Alterations in Hungarian Patients with Papillary Thyroid Cancer.

    PubMed

    Tobiás, Bálint; Halászlaki, Csaba; Balla, Bernadett; Kósa, János P; Árvai, Kristóf; Horváth, Péter; Takács, István; Nagy, Zsolt; Horváth, Evelin; Horányi, János; Járay, Balázs; Székely, Eszter; Székely, Tamás; Győri, Gabriella; Putz, Zsuzsanna; Dank, Magdolna; Valkusz, Zsuzsanna; Vasas, Béla; Iványi, Béla; Lakatos, Péter

    2016-01-01

    The incidence of thyroid cancers is increasing worldwide. Some somatic oncogene mutations (BRAF, NRAS, HRAS, KRAS) as well as gene translocations (RET/PTC, PAX8/PPAR-gamma) have been associated with the development of thyroid cancer. In our study, we analyzed these genetic alterations in 394 thyroid tissue samples (197 papillary carcinomas and 197 healthy). The somatic mutations and translocations were detected by Light Cycler melting method and Real-Time Polymerase Chain Reaction techniques, respectively. In tumorous samples, 86 BRAF (44.2%), 5 NRAS (3.1%), 2 HRAS (1.0%) and 1 KRAS (0.5%) mutations were found, as well as 9 RET/PTC1 (4.6%) and 1 RET/PTC3 (0.5%) translocations. No genetic alteration was seen in the non tumorous control thyroid tissues. No correlation was detected between the genetic variants and the pathological subtypes of papillary cancer as well as the severity of the disease. Our results are only partly concordant with the data found in the literature.

  16. Renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion: radiological findings mimicking papillary subtype.

    PubMed

    Kato, Hiroki; Kanematsu, Masayuki; Yokoi, Shigeaki; Miwa, Kousei; Horie, Kengo; Deguchi, Takashi; Hirose, Yoshinobu

    2011-01-01

    The authors describe the computed tomography (CT) and magnetic resonance imaging (MRI) findings of an 18-year-old man with renal cell carcinoma (RCC) associated with the Xp11.2 translocation/transcription factor E3 (TFE3) gene fusion (Xp11 translocation carcinoma). The lesion was hyperdense on unenhanced CT, hypovascular on contrast-enhanced studies, hypointense on T2-weighted MR images, and hemosiderin deposition was suspected on phase-shift gradient-echo MR images. Histopathological specimens revealed pathological findings resembling papillary RCC predominantly and exhibited immunoreactivity for TFE3. Because there is often considerable morphological overlap between this carcinoma and papillary RCC, the imaging findings of Xp11 translocation carcinoma may be similar to those of the papillary subtype. Therefore, Xp11 translocation carcinoma should be considered, particularly in young patients when radiologic images demonstrate a renal tumor mimicking the papillary subtype. Copyright © 2010 Wiley-Liss, Inc.

  17. Fluorescence Lyman-Alpha Stratospheric Hygrometer (FLASH): application on meteorological balloons, long duration balloons and unmanned aerial vehicles.

    NASA Astrophysics Data System (ADS)

    Lykov, Alexey; Khaykin, Sergey; Yushkov, Vladimir; Efremov, Denis; Formanyuk, Ivan; Astakhov, Valeriy

    The FLASH instrument is based on the fluorescent method, which uses H2O molecules photodissociation at a wavelength lambda=121.6 nm (Lalpha - hydrogen emission) followed by the measurement of the fluorescence of excited OH radicals. The source of Lyman-alpha radiation is a hydrogen discharge lamp while the detector of OH fluorescence at 308 -316 nm is a photomultiplier run in photon counting mode. The intensity of the fluorescent light as well as the instrument readings is directly proportional to the water vapor mixing ratio under stratospheric conditions with negligible oxygen absorption. Initially designed for rocket-borne application, FLASH has evolved into a light-weight balloon sonde (FLASH-B) for measurements in the upper troposphere and stratosphere on board meteorological and small plastic balloons. This configuration has been used in over 100 soundings at numerous tropical mid-latitude and polar locations within various international field campaigns. An airborne version of FLASH instrument is successfully utilized onboard stratospheric M55-Geophysica aircraft and tropospheric airborne laboratory YAK42-Roshydromet. The hygrometer was modified for application onboard stratospheric long-duration balloons (FLASH-LDB version). This version was successfully used onboard CNES super-pressure balloon launched from SSC Esrange in March 2007 and flown during 10 days. Special design for polar long duration balloon PoGOLite was created for testing work during polar day in June 2013. Installation and measurement peculiarities as well as observational results are presented. Observations of water vapour using FLASH-B instrument, being of high quality are rather costly as the payload recovery is often complicated and most of the time impossible. Following the goal to find a cost-efficient solution, FLASH was adapted for use onboard Unmanned Aerial Vehicles (UAV). This solution was only possible thanks to compactness and light-weight (0.5 kg) of FLASH instrument. The

  18. The Latest Developments in NASA's Long Duration Balloon Systems

    NASA Astrophysics Data System (ADS)

    Stilwell, Bryan D.

    The Latest Developments in NASA’s Long Duration Balloon Systems Bryan D. Stilwell, bryan.stilwell@csbf.nasa.gov Columbia Scientific Balloon Facility, Palestine, Texas, USA The Columbia Scientific Balloon Facility, located in Palestine, Texas offers the scientific community a high altitude balloon based communications platform. Scientific payload mass can exceed 2722 kg with balloon float altitudes on average of 40000 km and flight duration of up to 100 days. Many developments in electrical systems have occurred over the more than 25 years of long duration flights. This paper will discuss the latest developments in electronic systems related to long duration flights. Over the years, the long duration flights have increased in durations exceeding 56 days. In order to support these longer flights, the systems have had to increase in complexity and reliability. Several different systems that have been upgraded and/or enhanced will be discussed.

  19. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Neurological endoscope. 882.1480 Section 882.1480...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Diagnostic Devices § 882.1480 Neurological endoscope. (a) Identification. A neurological endoscope is an instrument with a light source used to view the inside of the...

  20. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Neurological endoscope. 882.1480 Section 882.1480...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Diagnostic Devices § 882.1480 Neurological endoscope. (a) Identification. A neurological endoscope is an instrument with a light source used to view the inside of the...