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1

Successful percutaneous angioplasty after failed femorodistal bypass.  

PubMed

Although balloon angioplasty for the management of failing bypass grafts has been well documented, little mention has been made of its use in treating the occlusive lesion within the native artery after a failed bypass graft. We report our experience with five patients in whom successful balloon angioplasty was carried out subsequent to failure of a femoral popliteal bypass graft. Increasingly aggressive percutaneous therapy of arterial occlusive disease may now be expanded to include a unique group of patients with chronically failed bypass grafts and occlusive disease within the native artery conducive to percutaneous transluminal angioplasty. This group of patients would previously have been relegated to repeat bypass grafts with its inherently inferior patency and recognized added technical demands. Percutaneous balloon angioplasty appears to be a plausible alternative in selected cases for repeat lower extremity revascularization. PMID:2145958

Harris, R W; Andros, G; Oblath, R W; Salles-Cunha, S X; Dulawa, L B

1990-09-01

2

Primary percutaneous coronary intervention for refractory cardiac arrest.  

PubMed

The identification and treatment of reversible causes is paramount to the success of resuscitation in cardiac arrest, particularly when standard therapy has failed. Acute coronary occlusion is one such cause, and the introduction of primary percutaneous coronary intervention services may provide an opportunity for emergency revascularization in this setting. This article describes 2 patients with cardiac arrest as a result of coronary occlusion, in which standard therapeutic measures proved futile. The first patient had refractory ventricular fibrillation, and the second had an episode of ventricular fibrillation followed by true pulseless electrical activity: total cessation of ventricular activity. In both examples, external mechanical compression and primary percutaneous coronary intervention facilitated coronary revascularization and achieved return of spontaneous circulation, leading to survival to hospital discharge. PMID:24210369

Clayton, Benjamin J; Gribbin, Guy M; Taggu, Wasing

2014-08-01

3

Percutaneous coronary intervention in the Occluded Artery Trial: Procedural success, hazard, and outcomes over 5 years  

PubMed Central

Background The Occluded Artery Trial (OAT) was a 2,201-patient randomized clinical trial comparing routine stent-based percutaneous coronary intervention (PCI) versus optimal medical therapy alone in stable myocardial infarction (MI) survivors with persistent infarct-related artery occlusion identified day 3 to 28 post MI. Intent-to-treat analysis showed no difference between strategies with respect to the incidence of new class IV congestive heart failure, MI, or death. The influence of PCI failure, procedural hazard, and crossover on trial results has not been reported. Methods Study angiograms were analyzed and adjudicated centrally. Factors associated with PCI failure were examined. Time-to-event analysis using the OAT primary outcome was performed by PCI success status. Landmark analysis (up to and beyond 30 days) partitioned early hazard versus late outcome according to treatment received. Results Percutaneous coronary intervention was adjudicated successful in >87%. Percutaneous coronary intervention failure rates were similar in US and non-US sites, and did not significantly influence outcome at 60 months (hazard ratio for success vs fail 0.79, 99% CI 0.45–1.40, P = .29). Partitioning of early procedural hazard revealed no late benefit for PCI (hazard ratio for PCI success vs medical therapy alone 1.06, 99% CI 0.75–1.50, P = .66). Conclusions Percutaneous coronary intervention failure and complication rates in the OAT were low. Neither PCI failure nor early procedural hazard substantively influenced the primary trial results.

Buller, Christopher E.; Rankin, Jamie M.; Carere, Ronald G.; Buszman, Pawel E.; Pfisterer, Matthias E.; Dzavik, Vladimir; Thomas, Boban; Forman, Sandra; Ruzyllo, Witold; Mancini, G.B. John; Michalis, Lampros K.; Abreu, Pedro F.; Lamas, Gervasio A.; Hochman, Judith S.

2010-01-01

4

Early Detection of Myocardial Ischemia after Successful Percutaneous Coronary Angioplasty  

Microsoft Academic Search

We evaluated the functional significance of angiographically successful percutaneous transluminal coronary angioplasty (PTCA) in 50 patients before and after PTCA using an atrial pacing stress test. Before balloon angioplasty, 40\\/50 patients had transient ST-segment changes on the intracoronary (IC) ECG. After PTCA 14\\/50 patients continued to have ischemic changes on IC-ECG. Atrial pacing stress tests can be performed easily in

Avanindra Jain

1997-01-01

5

Successful treatment of multiple hepatocellular adenomas with percutaneous radiofrequency ablation  

PubMed Central

Hepatocellular adenoma (HCA) is one of the important complications of glycogen storage disease type?Ia (GSD-Ia) because it can be transformed into hepatocellular carcinoma. Although surgical resection is a standard treatment of choice for solitary HCA, multiple HCAs in GSD-Ia patients present as therapeutic challenges for curative treatment. Therefore, treatment strategy according to malignant potential is important in management of HCAs in GSD-Ia. The authors present a case of histologically proven multiple HCAs without ?-catenin mutations occurred in a GSD-Ia patient treated successfully with percutaneous radiofrequency ablation as a minimally invasive therapy.

Ahn, Sun Young; Park, Soo Young; Kweon, Young Oh; Tak, Won Young; Bae, Han Ik; Cho, Seung Hyun

2013-01-01

6

Successful treatment of multiple hepatocellular adenomas with percutaneous radiofrequency ablation.  

PubMed

Hepatocellular adenoma (HCA) is one of the important complications of glycogen storage disease type Ia (GSD-Ia) because it can be transformed into hepatocellular carcinoma. Although surgical resection is a standard treatment of choice for solitary HCA, multiple HCAs in GSD-Ia patients present as therapeutic challenges for curative treatment. Therefore, treatment strategy according to malignant potential is important in management of HCAs in GSD-Ia. The authors present a case of histologically proven multiple HCAs without ?-catenin mutations occurred in a GSD-Ia patient treated successfully with percutaneous radiofrequency ablation as a minimally invasive therapy. PMID:24259982

Ahn, Sun Young; Park, Soo Young; Kweon, Young Oh; Tak, Won Young; Bae, Han Ik; Cho, Seung Hyun

2013-11-14

7

Primary Percutaneous Coronary Intervention in a Patient with Haemophilia A  

PubMed Central

Haemophilia A is a rare genetic condition leading to coagulation factor VIII deficiency and thus predisposing to bleeding diathesis. Due to advances in treatment, life expectancy of haemophilia A sufferers is increasing, and the incidence and prevalence of coronary artery disease are rising. There have been many reported cases of acute myocardial infarction in such patients, who subsequently undergo elective percutaneous coronary intervention. We present the case of a 55-year-old gentleman presenting with an acute anterior full-thickness myocardial infarction who required emergency primary percutaneous coronary intervention.

Reddy, S. Ashwin; Hoole, Stephen P.; Besser, Martin W.

2013-01-01

8

Sampling variability of percutaneous liver biopsy in primary sclerosing cholangitis  

Microsoft Academic Search

AIMS--To study sampling variability of percutaneous liver biopsy in primary sclerosing cholangitis (PSC). METHODS--One hundred and twelve biopsy specimens (that is, 56 pairs) from 44 patients with PSC, confirmed by cholangiography, were evaluated blindly. Six different features, qualitative grading of four other features and staging according to Ludwig were assessed. RESULTS--Quantitative sampling variability was confined mainly to just one grade

R Olsson; I Hägerstrand; U Broomé; A Danielsson; G Järnerot; L Lööf; H Prytz; B O Rydén; S Wallerstedt

1995-01-01

9

Primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: changing patterns of vascular access, radial versus femoral artery  

Microsoft Academic Search

Objective:To examine the safety and efficacy of emergency transradial primary percutaneous coronary intervention for ST-elevation myocardial infarction.Design:Single-centre observational study with prospective data collection.Setting:A regional cardiac centre, United Kingdom.Patients:1051 consecutive patients admitted with ST-elevation myocardial infarction, without cardiogenic shock, between November 2004 and October 2008.Interventions:Percutaneous coronary interventions by radial and femoral accessMain outcome measures:The primary outcome measures were procedural success, major

S L Hetherington; Z Adam; R Morley; M A de Belder; J A Hall; D F Muir; A G C Sutton; N Swanson; R A Wright

2009-01-01

10

Early Clinical Outcomes of Primary Percutaneous Coronary Intervention in Bharatpur, Nepal  

PubMed Central

ABSTRACT Background: Primary percutaneous coronary intervention represents one of the cornerstone management modalities for patients with acute ST-elevation myocardial infarction and has undergone tremendous growth over the past two decades. This study was aimed to determine the early clinical outcomes of primary percutaneous coronary interventions in a tertiary-level teaching hospital without onsite cardiac surgery backup. Methods: This was a prospective descriptive study which included all consecutive patients who were admitted for primary percutaneous coronary interventions between March 2011 and January 2013 at the College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal. Total 68 patients underwent primary percutaneous coronary interventions as a mode of revascularization. The primary end point of the study was to identify in-hospital as well as 30-day clinical outcomes of primary percutaneous coronary interventions. Results: The mean age was 56.31 ± 11.47 years, with age range of 32 years to 91 years. Of the 68 primary percutaneous coronary interventions performed, 15 (22.05%) were carried out in women and 10 (14.70%) in patients over 75 years of age. Primary percutaneous coronary intervention for anterior wall myocardial infarction was more common than for non-anterior wall myocardial infarction (55.88% vs. 44.12%). Proximal artery stenting was performed in 38.50% and the non proximal artery stenting in 61.50%. The outcomes were mortality (5.88%), cardiogenic shock (5.88%), contrast-induced nephropathy requiring dialysis (2.94%), arrhythmias requiring treatment (4.41%), early stent thrombosis (2.94%) and minor complications (14.70%). Conclusion: Primary percutaneous coronary intervention improves the early clinical outcomes in patient with acute ST-elevation myocardial infarction. Despite having no onsite cardiac surgery backup, primary percutaneous coronary intervention was feasible with acceptable complications in a tertiary-care teaching hospital.

DUBEY, Laxman; BHATTACHARYA, Rabindra; GURUPRASAD, Sogunuu; SUBRAMANYAM, Gangapatnam

2013-01-01

11

Successful primary PCI in a patient with single coronary artery.  

PubMed

Sudden occlusion of the only patent coronary artery is usually a devastating event. We describe the case of a successful percutaneous recanalization of a single coronary artery originating at the right sinus of Valsalva. PMID:23735366

Pawlowski, Krzysztof; Dorniak, Waldemar; Klaudel, Jacek

2013-06-01

12

Primary and conversion percutaneous gastrojejunostomy under fluoroscopic guidance: 10 years of experience.  

PubMed

The objective of this study was to evaluate the safety and effectiveness of primary and conversion percutaneous radiologic gastrojejunostomy (PRGJ) under fluoroscopic guidance. Between January 1998 and July 2007, 29 patients (M/F=26:3) were enrolled. Indications for primary PRGJ (n=16) included recurrent aspiration pneumonia (n=8), prevention of gastroesophageal reflux in cases of disrupted gastrointestinal tract (n=6), or bypass of surgical anastomosis (n=1) or duodenal obstruction (n=1). Indications for conversion PRGJ (n=13) included recurrent aspiration pneumonia (n=11), malignant duodenal obstruction (n=1), or previous gastrostomy-related complication (n=1). All 29 procedures were successfully completed with 10.2-16.5-Fr feeding gastrojejunostomy tube tip located in the proximal jejunum. A single anchor was used in all patients with primary PRGJ. Clinical success was achieved in all study patients. There were no major complications. There was no evidence of gastroesophageal reflux or aspiration aggravation in any patient during the follow-up period. Four tubes were electively removed after healing of the esophageal rupture. The indwelling period was 10 to 429 days (mean, 110 days) after tube placement in the remaining 25 patients. Primary and conversion PRGJ under fluoroscopic guidance was a safe and effective procedure for enteral feeding as well as for preventing gastroesophageal reflux or aspiration pneumonia. In cases of primary gastrojejunostomy, use of single gastropexy was feasible and sufficient. PMID:18603182

Shin, Kwang-Ho; Shin, Ji Hoon; Song, Ho-Young; Yang, Zheng Qiang; Kim, Jin Hyoung; Kim, Kyung-Rae

2008-01-01

13

A case of refractory chylous ascites after nephrectomy successfully treated with percutaneous obliteration using adhesive glue.  

PubMed

Here we report a case of uncontrollable chylous ascites that developed after nephrectomy and was successfully treated with percutaneous obliteration of the lymphocele-like extravasation using ethiodized oil during lymphangiography. Under computed tomographic and fluoroscopic guidance, an N-butyl cyanoacrylate-ethiodized oil mixture was used with metallic coils to obliterate the extralymphatic leakage site. The volume of intraperitoneal drainage decreased steadily over the next 5 days, and the tube was removed. Percutaneous obliteration can be characterized as filling of the leakage site from outside the lymph vessel with no flow disruption, which contrasts with the conventional embolization approach via the cisterna chyli. PMID:23065489

Itou, Chihiro; Koizumi, Jun; Myojin, Kazunori; Yamashita, Tomohiro; Mori, Naoko; Imai, Yutaka

2013-01-01

14

Thrombus burden and myocardial damage during primary percutaneous coronary intervention.  

PubMed

Large thrombus burden (LTB) lesions in the context of primary percutaneous coronary intervention (p-PCI) have been related to unsuccessful angiographic reperfusion and unfavorable clinical outcomes. However, the hazard of LTB treatment on myocardial damage has not been evaluated. We investigated the impact of LTB on myocardial damage using contrast-enhanced cardiac magnetic resonance (CE-CMR) in the setting of p-PCI. In 327 patients, who underwent p-PCI without thrombus aspiration within 12 hours from symptom onset, we prospectively assessed the impact of LTB on infarct size and microvascular damage using CE-CMR. LTB was defined by the presence of Thrombolysis In Myocardial Infarction thrombus score ?3 in patent infarct-related artery (IRA); or by "cut-off" occlusion pattern and/or large reference vessel diameter (?3.5 mm) in occluded IRA. One hundred ninety-seven patients (60.2%) showed LTB and 130 (39.8%) did not. Distal embolization occurred in 18.8% patients with versus 6.9% without LTB (p = 0.003). At CE-CMR, patients with LTB had larger infarct size index (27.5 ± 11.1 vs 22.1 ± 17.5, p = 0.009) and more often transmural necrosis (70.5% vs 55.4%, p = 0.008) compared with patients without LTB. Excluding patients with distal embolization, patients with LTB still had larger necrosis. At multivariate analysis, occluded (IRA) at baseline, anterior infarction, and presence of LTB predicted transmural necrosis. In conclusion, LTB in the setting of p-PCI is related to larger myocardial damage as detected by CE-CMR, regardless of angiographic detectable distal embolization. PMID:24630783

Napodano, Massimo; Dariol, Gilberto; Al Mamary, Ahmed H; Marra, Martina Perazzolo; Tarantini, Giuseppe; D'Amico, Gianpiero; Frigo, Anna Chiara; Buja, Paolo; Razzolini, Renato; Iliceto, Sabino

2014-05-01

15

Early exercise stress testing is safe after primary percutaneous coronary intervention  

PubMed Central

Background: The optimal timing of exercise stress testing post primary percutaneous coronary intervention is uncertain with anecdotal evidence suggesting an increased risk of acute myocardial infarction and/or death if performed too early. This has translated into a delayed return to normal life activities following an acute myocardial infarction resulting in an increase in socio-economic burden. Aims: We hypothesize that early (within 7 days of primary percutaneous coronary intervention) exercise stress testing is safe. Methods: A prospective study of consecutive patients enrolled into the Cardiac Rehabilitation Program at a tertiary referral centre that underwent primary percutaneous coronary intervention, and who were able to perform a treadmill stress test were recruited. Timing of exercise stress testing was within 7 days post primary percutaneous coronary intervention and outcomes of death, acute myocardial infarction and other major adverse cardiac event were assessed 24 hours post exercise stress testing. Results: Recruited patients (n=230) aged between 29 and 78 (mean age 56 ± 10 years) with 191 being males (83%) and 39 being females (17%). While 28 patients had a positive stress test (12.2%), there were no deaths, acute myocardial infarction or any other major adverse cardiac event within 24 hours of performing the exercise stress testing. Mean METS achieved were 8.1 ± 2.3. Conclusions: Early exercise stress testing after primary percutaneous coronary intervention appears safe.

Tan, Timothy C; Zecchin, Robert P; Denniss, Alan Robert

2012-01-01

16

Reappraisal of percutaneous transhepatic cholangioscopic lithotomy for primary hepatolithiasis  

Microsoft Academic Search

Background: A review of the literature pertaining to percutaneous transhepatic cholangioscopic lithotomy (PTCSL) showed that more than 50% of reported patients had undergone earlier biliary surgery. Methods: A retrospective study investigated 74 patients undergoing initial PTCSL for hepatolithiasis who had undergone no prior biliary surgery or manipulation. The patients were followed for 1 to 23 years after PTCSL for effective

C.-H. Chen; M.-H. Huang; J.-C. Yang; C.-C. Yang; Y.-H. Yeh; H.-S. Wu; D.-A. Chou; S.-K. Yueh; C.-K. Nien

2005-01-01

17

38 False activation for primary percutaneous coronary intervention is not a benign phenomenon  

Microsoft Academic Search

IntroductionPrimary percutaneous coronary angioplasty (PPCI) is the preferred reperfusion strategy following an acute ST elevation myocardial infarction (STEMI). Since 2005 24\\/7 primary PCI has been the first line treatment for an acute STEMI in our centre. 93% of patients are direct access admissions by London Ambulance but a significant proportion (up to 20%) do not fulfil the diagnostic criteria for

U Chaudhry; C Mavroudis; R D Rakhit

2011-01-01

18

Independent no-reflow predictors in female patients with ST-elevation acute myocardial infarction treated with primary percutaneous coronary intervention  

Microsoft Academic Search

Independent no-reflow predictors should be evaluated in female patients with ST-segment elevation acute myocardial infarction\\u000a (STEMI) and successfully treated with primary percutaneous coronary intervention (PPCI) in the current interventional equipment\\u000a and techniques, thus to be constructed a no-reflow predicting model. In this study, 320 female patients with STEMI were successfully\\u000a treated with PPCI within 12 h after the onset of AMI

Yundai Chen; Changhua Wang; Xinchun Yang; Lefeng Wang; Zhijun Sun; Hongbin Liu; Lian Chen

19

44 Primary percutaneous intervention: have we taken our eye off the medicine ball?  

Microsoft Academic Search

IntroductionPrimary percutaneous intervention (PPCI) improves survival in patients with ST elevation myocardial infarction (STEMI). Significant resources have been directed to achieving timely reperfusion throughout the UK. However, intensive medical therapy is of equal importance, with landmark clinical trials demonstrating unequivocal morbidity and mortality benefits from ?-blockers, angiotensin-converting enzyme inhibitors (ACEI), and angiotensin II receptor blockers (ARB). All trials employed rigorous

J D Jones; E Damm; M Nijjar; S Pettit; N M Hawkins; R Perry

2011-01-01

20

Transradial access for primary percutaneous coronary intervention: the next standard of care?  

Microsoft Academic Search

ObjectivePrimary percutaneous coronary intervention (PPCI) has been acknowledged by the most recent European guidelines to be the preferred treatment for ST elevation myocardial infarction (STEMI). Patients undergoing PPCI are expected to receive a broad spectrum of anticoagulants and antiplatelet agents, which increases the risk of bleedings, in most cases, at the site of vascular access. The burden of bleeding complications

Giovanni Amoroso; Ferdinand Kiemeneij

2010-01-01

21

The importance of left ventricular function for long-term outcome after primary percutaneous coronary intervention  

Microsoft Academic Search

BACKGROUND: In the present study we sought to determine the long-term prognostic value of left ventricular ejection fraction (LVEF), assessed by planar radionuclide ventriculography (PRV), after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). METHODS: In total 925 patients underwent PRV for LVEF assessment after PPCI for myocardial infarction before discharge from the hospital. PRV was performed

Pieter A van der Vleuten; Saman Rasoul; Willem Huurnink; Riemer H. J. A. Slart; Stoffer Reiffers; Rudi A Dierckx; René A Tio; Jan Paul Ottervanger; Menko-Jan De Boer; Felix Zijlstra

2008-01-01

22

Improved myocardial function during exercise after successful percutaneous transluminal coronary angioplasty  

SciTech Connect

Fifty-nine consecutive patients with coronary-artery disease undergoing percutaneous transluminal coronary angioplasty were evaluated with radionuclide ventriculography at rest and during exercise before angioplasty (when possible) and afterward, when it was successful. Thirty-eight patients (64%) had an angiographically successful procedure. Three (5%) had coronary occlusion as a complication. Arterial stenosis was reduced from 74 +- 2% to 31 +- 3% (mean +- S.E.M.). The mean ejection fraction was 55 +- 3% during exercise before the procedure. After successful angioplasty, the ejection fraction was unchanged at rest but increased to 62 +- 2% (P < 0.001) during exercise. Regional dysfunction was present during exercise in 94% of the patients before the procedure and in only 8% after successful angioplasty. Of the 38 patients in whom the procedure was successful, 19 had sustained improvement for over six months, and eight for three to six months. Eleven patients had recurrence of symptoms; the second angioplasty was initially successful in nine. In 24 patients remaining asymptomatic for six months (19 after the first procedure and five after the second), the left ventricular ejection fraction during exercise remained stable or improved.

Kent, K.M.; Bonow. R.O.; Rosing, D.R.; Ewels, C.J.; Lipson, L.C.; McIntosh, C.L.; Bacharach, S.; Green, M.; Epstein, S.E.

1982-02-25

23

Percutaneous Ethibloc injection in the treatment of primary aneurysmal bone cysts.  

PubMed

The effects of percutaneous Ethibloc (Ethicon/Johnson & Johnson, St-Stevens-Woluwe, Belgium) injection into primary aneurysmal bone cysts were analysed. Two patients with a venous drainage after injection of a medium contrast were excluded. Twelve patients underwent at least one percutaneous injection of Ethibloc. The average follow-up period was 5.1 years. At final follow-up, six patients had complete healing of the cyst, three had partial healing and three, who had no response, were treated by curettage and bone grafting. Complete healing was observed for all the aggressive lesions. No major complications were noted. Ethibloc injection may be performed as a primary treatment of aneurysmal bone cysts if the technique is followed with precision. PMID:16093949

de Gauzy, Jérôme Sales; Abid, Abdelazis; Accadbled, Franck; Knorr, Gorka; Darodes, Philippe; Cahuzac, Jean Philippe

2005-09-01

24

Postconditioning during primary percutaneous coronary intervention: A review and meta-analysis  

Microsoft Academic Search

BackgroundMyocardial postconditioning (POC), defined as intermittent interruptions of blood flow at the onset of reperfusion after sustained ischemia, may attenuate reperfusion injury. In order to weigh the current evidence linking POC to reduction of myocardial infarct size in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), we performed a systematic review and meta-analysis of the

Peter Riis Hansen; Helene Thibault; Jawdat Abdulla

2010-01-01

25

Admission Hyperglycemia and TIMI Frame Count in Primary Percutaneous Coronary Intervention  

Microsoft Academic Search

We evaluated the relationship between admission blood glucose levels and estimated coronary flow by the thrombolysis in myocardial infarction (TIMI) frame count (TFC) method in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The TFC of 121 consecutive patients with STEMI were evaluated after pPCI. Patients with admission glucose levels >198 mg\\/dL (11 mmol\\/L) were

Ahmet Yildiz; Alev Arat-Ozkan; Cuneyt Kocas; Okay Abaci; Ugur Coskun; Cem Bostan; Ayhan Olcay; Faruk Akturk; Baris Okcun; Murat Ersanli; Tevfik Gurmen

2012-01-01

26

43 Prognosis after primary percutaneous coronary intervention for stemi: can the syntax score help?  

Microsoft Academic Search

BackgroundFactors affecting prognosis after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) include age at presentation, the presence of diabetes mellitus, left ventricular function and\\/or cardiogenic shock. Although the debate continues over a strategy of complete revascularisation (immediate or staged) vs culprit-only, little is known about the impact of the extent of coronary disease at presentation on prognosis

A J Brown; L M McCormick; N E J West

2011-01-01

27

Successful percutaneous coronary intervention during cardiac arrest with use of an automated chest compression device: a case report  

PubMed Central

Ventricular tachycardia or fibrillation (VT/VF) in patients with ST-elevation myocardial infarction (STEMI) is associated with poor prognosis. Performing manual chest compressions is a serious obstacle for treatment with percutaneous coronary intervention (PCI). Here we introduce a case with refractory VT/VF where the patient was successfully treated with an automated chest compression device, which made revascularization with PCI possible.

Libungan, Berglind; Dworeck, Christian; Omerovic, Elmir

2014-01-01

28

Successful revascularization to right coronary artery by percutaneous coronary intervention after endovascular therapy for leriche syndrome.  

PubMed

A 69-year-old man with effort angina was admitted to our institution. Echocardiography showed poor left ventricular systolic function with akinesis of the anterior wall and severe hypokinesis of the inferior wall. We performed coronary angiography, which revealed two diseased vessels including chronic total occlusion in the left anterior descending artery and severe stenosis in the right coronary artery (RCA). In addition, aortography revealed aortoiliac occlusive disease known as Leriche syndrome. As the patient's symptom was stable, we first planned to perform endovascular therapy (EVT) for Leriche syndrome to make a route for intra-aortic balloon pumping. We prepared a bi-directional approach from bi-femoral arteries and a left brachial artery. The guidewire was passed through the occlusive area using the retrograde approach. The self-expanding stents were deployed by a kissing technique. At one week after EVT, a 6Fr sheath was inserted from the right radial artery and an intra-aortic balloon pump was successfully inserted through the right femoral artery for percutaneous coronary intervention (PCI) to the RCA. Two drug-eluting stents were successfully deployed to RCA after using an atherectomy device (rotablator). We reported the case as a successfully performed PCI to the RCA after EVT for Leriche syndrome. PMID:24678244

Niizeki, Takeshi; Kaneko, Kazuyoshi; Sugawara, Shigeo; Sasaki, Toshiki; Tsunoda, Yuichi; Takeishi, Yasuchika; Kubota, Isao

2014-01-01

29

Successful Revascularization to Right Coronary Artery by Percutaneous Coronary Intervention after Endovascular Therapy for Leriche Syndrome  

PubMed Central

A 69-year-old man with effort angina was admitted to our institution. Echocardiography showed poor left ventricular systolic function with akinesis of the anterior wall and severe hypokinesis of the inferior wall. We performed coronary angiography, which revealed two diseased vessels including chronic total occlusion in the left anterior descending artery and severe stenosis in the right coronary artery (RCA). In addition, aortography revealed aortoiliac occlusive disease known as Leriche syndrome. As the patient’s symptom was stable, we first planned to perform endovascular therapy (EVT) for Leriche syndrome to make a route for intra-aortic balloon pumping. We prepared a bi-directional approach from bi-femoral arteries and a left brachial artery. The guidewire was passed through the occlusive area using the retrograde approach. The self-expanding stents were deployed by a kissing technique. At one week after EVT, a 6Fr sheath was inserted from the right radial artery and an intra-aortic balloon pump was successfully inserted through the right femoral artery for percutaneous coronary intervention (PCI) to the RCA. Two drug-eluting stents were successfully deployed to RCA after using an atherectomy device (rotablator). We reported the case as a successfully performed PCI to the RCA after EVT for Leriche syndrome.

Niizeki, Takeshi; Kaneko, Kazuyoshi; Sugawara, Shigeo; Sasaki, Toshiki; Tsunoda, Yuichi; Takeishi, Yasuchika; Kubota, Isao

2014-01-01

30

Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction without On-Site Cardiac Surgery A Single Hospital Experience in Taitung  

Microsoft Academic Search

Primary percutaneous coronary intervention (PCI) provides outcomes superior to fibrinolytic therapy in acute myocardial infarction (AMI), but no registry or study in Taiwan has demonstrated its use in hospital without on-site cardiac surgery. Objectives: To investigate the safety and outcome of primary PCI for AMI without on-site cardiac surgery. Methods: Between September 2003 and September 2005, 175 patients were diagnosed

Hsiao-Yang Cheng; Hung-I Yeh; Charies Jai-Yin Hou; Cheng-Ho Tsai; Kuangte Wang

31

Cardiac arrest during percutaneous coronary intervention in a patient 'resistant' to clopidogrel - successful 50-minute mechanical chest compression  

PubMed Central

We report a case of 72-year-old female patient with end-stage chronic kidney disease, undergoing percutaneous coronary intervention (PCI) that resulted in a cardiac arrest caused by a thrombus mediated flow limitation in the left coronary artery. With mechanical cardiopulmonary resuscitation (CPR) PCI of the left main artery was performed successfully during 50 min cardiac arrest. The patient was discharged from the hospital without compromising cardiac function and neurological deficits.

Szymkiewicz, Pawel; Sciborski, Krzysztof; Orda, Alina; Karolko, Bozena; Jonkisz, Anna; Lebioda, Arleta; Mysiak, Andrzej

2013-01-01

32

Pseudoaneurysm After Spontaneous Rupture of Renal Angiomyolipoma in Tuberous Sclerosis: Successful Treatment with Percutaneous Thrombin Injection  

SciTech Connect

We report a case of a large perinephric pseudoaneurysm due to spontaneous rupture of renal angiomyolipoma, occluded by percutaneous thrombin injection under ultrasound guidance in a young woman affected by tuberous sclerosis.

Corso, Rocco, E-mail: roccocorso@jumpy.it; Carrafiello, Gianpaolo; Rampoldi, Antonio [Niguarda 'Ca Granda' Hospital, Department of Diagnostic and Interventional Radiology (Italy); Leni, Davide [University of Milan, Institute of Radiology (Italy); Ticca, Cristiana [Niguarda 'Ca Granda' Hospital, Department of Diagnostic and Interventional Radiology (Italy); Vercelli, Ruggero [University of Milan, Institute of Radiology (Italy); Vanzulli, Angelo [Niguarda 'Ca Granda' Hospital, Department of Diagnostic and Interventional Radiology (Italy)

2005-04-15

33

Successful disintegration, dissolution and drainage of intracholedochal hematoma by percutaneous transhepatic intervention  

PubMed Central

Hemobilia is a rare biliary complication of liver transplantation. The predominant cause of hemobilia is iatrogenic, and it is often associated with traumatic operations, such as percutaneous liver intervention, endoscopic retrograde cholangiopancreatography, cholecystectomy, biliary tract surgery, and liver transplantation. Percutaneous transhepatic cholangiography and liver biopsy are two major causes of hemobilia in liver transplant recipients. Hemobilia may also be caused by coagulation defects. It can form intracholedochal hematomas, causing obstructive jaundice. Herein we describe a patient with an intracholedochal hematoma resulting in significant obstructive jaundice after liver transplantation for fulminant hepatic failure. Previous studies have shown that percutaneous transhepatic manipulation is a major cause of hemobilia after liver transplantation, but in our case, percutaneous transhepatic intervention was used to relieve the biliary obstruction and dissolve the biliary clot, with a good outcome.

Qin, Jian-Jie; Xia, Yong-Xiang; Lv, Ling; Wang, Zhao-Jing; Zhang, Feng; Wang, Xue-Hao; Sun, Bei-Cheng

2012-01-01

34

Percutaneous Treatment of a Primary Pancreatic Hydatid Cyst Using a Catheterization Technique  

PubMed Central

Primary pancreatic hydatid cysts are rare and its percutaneous treatment and catheterization technique has, to the best of our knowledge, not been published in literature. A 33-year-old male patient who presented with abdominal pain was evaluated by ultrasonography (US) and computed tomography examinations. Both examinations revealed a cyst in the neck of the pancreas. After the administration of albendazole chemoprophylaxis, the patient underwent diagnostic puncture showing high pressure spring water which harbored the scoleces and was treated percutaneously by the catheterization technique. In this technique, first the cyst was punctured, the fluid content aspirated, the radiocontrast material injected to see possible fistulisation, and then re-aspirated. The 20% hypertonic saline solution was injected and re-aspiration was performed to the best of our abilities, followed by the insertion of a catheter for drainage of the remaining non-aspiratable fluid content. At follow-up examination, the cyst was not visible on US after 6 months. There was no evidence of cyst recurrence or dissemination after 18 months at serologic and imaging follow-up.

Karaman, Bulent; Ustunsoz, Bahri; Ugurel, Mehmet Sahin

2012-01-01

35

Predictors and prognosis of early ischemic mitral regurgitation in the era of primary percutaneous coronary revascularisation  

PubMed Central

Background Studies assessing ischemic mitral regurgitation (IMR) comprised of heterogeneous population and evaluated IMR in the subacute setting. The incidence of early IMR in the setting of primary PCI, its progression and clinical impact over time is still undetermined. We sought to determine the predictors and prognosis of early IMR after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Methods Using our primary PCI database, we screened for patients who underwent ?2 transthoracic echocardiograms early (1–3 days) and late (1 year) following primary PCI. The primary outcomes were: (1) major adverse events (MACE) including death, ischemic events, repeat hospitalization, re-vascularization and mitral repair or replacement (2) changes in quantitative echocardiographic assessments. Results From January 2006 to July 2012, we included 174 patients. Post-primary PCI IMR was absent in 95 patients (55%), mild in 60 (34%), and moderate to severe in 19 (11%). Early after primary PCI, IMR was independently predicted by an ischemic time?>?540 min (OR: 2.92 [95% CI, 1.28 – 7.05]; p?=?0.01), and female gender (OR: 3.06 [95% CI, 1.42 – 6.89]; p?=?0.004). At a median follow-up of 366 days [34–582 days], IMR was documented in 44% of the entire cohort, with moderate to severe IMR accounting for 15%. During follow-up, MR regression (change???1 grade) was seen in 18% of patients. Moderate to severe IMR remained an independent predictor of MACE (HR: 2.58 [95% CI, 1.08 – 5.53]; p?=?0.04). Conclusions After primary PCI, IMR is a frequent finding. Regression of early IMR during long-term follow-up is uncommon. Since moderate to severe IMR post-primary PCI appears to be correlated with worse outcomes, close follow-up is required.

2014-01-01

36

Early Reduction of QT Dispersion after Primary Percutaneous Intervention in ST-Segment Elevation Acute Myocardial Infarction  

Microsoft Academic Search

Objectives: To determine, in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI), the mechanisms and clinical implications of the acute changes in QT dispersion (QTd). Methods: In this prospective study we included 216 patients admitted with a STEMI of <12 h of evolution. All were treated with PPCI. QTd was measured prior to PPCI

Javier Jiménez-Candil; Jesús Hernández Hernández; Víctor León Agüero; Ana Martín; Francisco Martín; José Luis Moríñigo; Cándido Martín-Luengo

2009-01-01

37

Trends and predictors of length of stay after primary percutaneous coronary intervention: A report from the cathPCI registry®  

Microsoft Academic Search

BackgroundPost-hoc analyses of clinical trials suggest that certain patients are eligible for early discharge after ST-segment elevation myocardial infarction (STEMI). The extent to which STEMI patients are discharged early after primary percutaneous coronary intervention (PPCI) in current practice is unknown.

Chee Tang Chin; William S. Weintraub; David Dai; Rajendra H. Mehta; John S. Rumsfeld; H. Vernon Anderson; John C. Messenger; Michael A. Kutcher; Eric D. Peterson; Ralph G. Brindis; Sunil V. Rao

38

Clinical Features and Outcome of Coronary Artery Aneurysm in Patients with Acute Myocardial Infarction Undergoing a Primary Percutaneous Coronary Intervention  

Microsoft Academic Search

Background: While coronary artery aneurysm is an uncommon anatomic disorder and has various forms, its clinical features and outcome and its impact on thrombus formation and the no-reflow phenomenon in the clinical setting of acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (p-PCI) have not been discussed. The purpose of this study was to evaluate whether this anatomic disorder

Hon-Kan Yip; Mien-Cheng Chen; Chiung-Jen Wu; Chi-Ling Hang; Kelvin Yuan-Kai Hsieh; Chih-Yuan Fang; Kuo-Ho Yeh; Morgan Fu

2002-01-01

39

"Tubeless" percutaneous surgery: a new advance in the technique of percutaneous renal surgery.  

PubMed

We describe our modification of the technique of traditional percutaneous renal surgery called "tubeless" percutaneous renal surgery. Fifty patients have now undergone percutaneous renal procedures without the use of a postoperative nephrostomy tube consisting of percutaneous nephrolithotripsy, percutaneous endopyelotomy, and both percutaneous stone extraction and endopyelotomy in the same setting. Our current modification of standard percutaneous surgical technique includes the placement of an internal ureteral catheter with primary closure of the access site using hemostatic skin sutures. The study group was compared to a control group of 50 patients who were age, sex and procedure matched who had undergone standard percutaneous renal procedures previously with routine placement of postoperative nephrostomy tubes. The incidence of complications, analgesia requirements, length of hospitalization, time of return to normal activities, and cost of treatment were compared between the two groups. All tubeless percutaneous procedures were successfully performed without significant complications. The initial 15 patients had postoperative renal ultrasounds demonstrating no urinoma. Hospital stay, analgesia requirements, and the patient's ability to return to normal activities were statistically significantly decreased in the patient group studied. The cost of a "tubeless" procedure was $1,638 compared with $3,750 (129% greater) for traditional percutaneous surgery (cost saving of $2,112/case). Tubeless percutaneous renal surgery is a safe procedure and offers advantages over the routine placement of a nephrostomy tube. The hospitalization period, analgesia requirements, return to normal activities, and cost are significantly less with this new technique. PMID:9170218

Candela, J; Davidoff, R; Gerspach, J; Bellman, G C

1997-01-01

40

Primary Science: An Exploration of Differential Classroom Success.  

ERIC Educational Resources Information Center

Uses data from the Performance Indicators in Primary Schools (PIPS) to compare the relative success of different classes in science in the National Curriculum. Discusses differences in terms of cognitive styles, training, and attitudes of teachers. Reports that primary teachers are considerably less confident about teaching science than about…

Tymms, Peter; Gallacher, Simon

1995-01-01

41

Factors responsible for successful primary closure in bladder exstrophy  

Microsoft Academic Search

To assess the important factors for successful primary closure in staged reconstruction of bladder exstrophy, 25 patients\\u000a (18 males, 7 females) underwent primary bladder closure during the years 1993–1997. Twenty-one were more than 72?h old; all\\u000a of these underwent bilateral posterior iliac osteotomies followed by primary bladder closure during the same anesthetic. Bladder\\u000a closure was done in a double layer.

Laxmikant S. Kasat; S. S. Borwankar

2000-01-01

42

Impact of Transfer for Primary Percutaneous Coronary Intervention on Survival and Clinical Outcomes (from the HORIZONS-AMI Trial)  

Microsoft Academic Search

Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI). We evaluated whether presentation of patients with STEMI to a noninterventional facility requiring transfer for primary PCI compared to direct admission to a PCI center has an impact on clinical outcomes. Of 3,602 patients enrolled in the multicenter, prospective HORIZONS-AMI trial, 988

Jochen Wöhrle; Martin Desaga; Chris Metzger; Kurt Huber; Harry Suryapranata; Victor Guetta; Giulio Guagliumi; Bernhard Witzenbichler; Helen Parise; Roxana Mehran; Gregg W. Stone

2010-01-01

43

Successful percutaneous epicardial ablation of an accessory pathway located at the right atrial appendage.  

PubMed

In patients with Wolff-Parkinson-White syndrome, difficulty in ablation of accessory pathways is associated with failures and recurrences. Epicardially located accessory pathways may require different management strategies when conventional ablation attempts fail. In particular, an epicardial accessory pathway communicating the right atrial appendage to the right ventricle is an extraordinary situation resulting in difficulties in ablation. Hereby, we report on a challenging case of percutaneous epicardial ablation of an epicardial accessory pathway located at right atrial appendage in a 28-year-old man with Wolff-Parkinson-White syndrome, who had a prior history of unsuccessful endocardial ablation. Percutaneous epicardial ablation may be a viable option obviating the necessity of surgical ablation procedures for difficult ablation cases with epicardial accessory pathways. PMID:21983769

Köse, Sedat; Ba?ar?c?, Ibrahim; Kabul, Kutsi Hasan; Barç?n, Cem

2011-10-01

44

Percutaneous endopyelotomy.  

PubMed

Percutaneous endopyelotomy, introduced over 15 years ago, is a well-established alternative to open operative pyeloplasty for management of ureteropelvic junction (UPJ) obstruction. Although several variations of the technique have been described, the goal in all cases is to develop a full thickness incision though the obstructing proximal uretra that extends out to the peripyeloureteral fat and heals over an internal stent. Though a percutaneous endopyelotomy can be considered for almost any patient with primary or secondary UPJ obstruction, it is particularly valuable in the setting of upper tract stones that can then be managed simultaneously. This article reviews the indications, techniques, and outcomes of percutaneous endopyelotomy. PMID:11098767

Streem, S B

2000-11-01

45

Failure and Success of Percutaneous Angioplasty in a Hypertensive Child with Bilateral Renal Artery Stenosis  

Microsoft Academic Search

We describe the clinical course of a 5-year-old girl with severe arterial hypertension that was uncontrollable with antihypertensive\\u000a medication. Renal angiography revealed bilateral renal artery stenoses. Because percutaneous transluminal renal angioplasty\\u000a (PTRA) failed to dilate the stenotic lesions, a renal artery bypass grafting in both renal arteries was performed. The patient\\u000a remained normotensive for 7 months, and after that the arterial

Constantinos Giavroglou; Ioannis Tsifountoudis; Theodoros Boutzetis; Dimitrios Kiskinis

2009-01-01

46

Equivalent success of simultaneous pancreas kidney and solitary pancreas transplantation. A prospective trial of tacrolimus immunosuppression with percutaneous biopsy.  

PubMed Central

OBJECTIVE: This study was designed to evaluate the results of solitary pancreas transplantation in a protocol that uses the new immunosuppressant tacrolimus (FK) and liberally applies ultrasound-guided percutaneous pancreas biopsy to diagnose rejection. SUMMARY BACKGROUND DATA: Pancreas graft survival in patients who simultaneously receive a kidney transplant (SPK) historically has been 75% to 90% at 1 year, approaching that of cadaveric kidney transplantations. In sharp contrast, graft survival rates in patients who receive a pancreas atone (PA) have remained static over the past decade, with approximately 50% functional at 1 year. It was hypothesized that the results of PA transplantations would improve with newer maintenance immunosuppressants and biopsy techniques. METHODS: Twenty-seven PA recipients prospectively were treated with FK-based immunosuppression (PA-FK). Percutaneous biopsy was performed for hyperamylasemia, hyperlipasemia, hypoamylasuria, or unexplained fever. One year pancreas graft survival in these patients was compared to 15 cyclosporine treated PA cases (PA-CsA) and 113 SPK recipients. RESULTS: The 1-year pancreas graft survival rate of 90.1% in technically successful PA-FK patients was significantly better than the 53.4% rate in PA-CsA recipients (p = 0.002) and no different than the 87.4% rate in SPK recipients. The only graft lost to acute rejection in the PA-FK group was because of acknowledged patient noncompliance. Percutaneous biopsy substantially improved the diagnostic certainty in cases of suspected rejection and was associated with a low complication rate (3/178 = 1.5%). CONCLUSIONS: Modern immunosuppression and biopsy techniques have improved the success of solitary pancreas transplantations to the point where outcome is now equivalent to that of SPKs.

Bartlett, S T; Schweitzer, E J; Johnson, L B; Kuo, P C; Papadimitriou, J C; Drachenberg, C B; Klassen, D K; Hoehn-Saric, E W; Weir, M R; Imbembo, A L

1996-01-01

47

Successful percutaneous stenting of a right gastroepiploic coronary bypass graft using monorail delivery system: a case report.  

PubMed

The right gastroepiploic artery (RGEA) is being successfully used as an arterial conduit in a selected group of patients undergoing coronary artery bypass graft surgery. However, myocardial ischemia may result due to spasm, occlusion, and stenosis of this graft. The anastamosis site at distal right coronary artery (RCA) or posterior descending artery (PDA) is the most common location for stenosis of an in situ gastroepiploic coronary bypass graft. Balloon angioplasty of such stenoses has been reported with optimal short-term results. Stent deployment would decrease the restenosis rate, so that repeat procedures could be minimized for these technically challenging lesions. We describe a case of successful deployment of a stent with monorail delivery system at the anastamotic site stenosis of an in situ gastroepiploic right coronary artery bypass graft. This percutaneous coronary intervention could prevent redo coronary artery bypass graft surgery. Cathet. Cardiovasc. Intervent. 49:197-199, 2000. PMID:10642773

Alam, M; Safi, A M; Mandawat, M K; Anderson, J E; Kwan, T; Feit, A; Clark, L T

2000-02-01

48

Successful percutaneous removal of a fractured stent fragment using a novel stretching method.  

PubMed

We present the case of percutaneous removal of a fractured stent fragment during cardiac catheterisation using a novel stretching method. The procedure was performed in a 9-month-old infant. The small distal fragment of a fractured stent in the aorta was stretched using a two-sided approach - that is, from the carotid and femoral artery. This manoeuvre allowed for the removal of the stretched, linear-shaped stent part through a 6 Fr sheath without any local and general complications. PMID:23841932

Dry?ek, Pawe?; Michalak, Krzysztof W; Moszura, Tomasz

2014-06-01

49

Successful Treatment of Double-Orifice Mitral Stenosis with Percutaneous Balloon Mitral Commissurotomy  

PubMed Central

Double-orifice mitral valve (DOMV) is an uncommon congenital anomaly, being present in 0.05% of the general population. The isolated occurrence of this anomaly is very rare and, to our knowledge, no data are currently available on the incidence of an isolated DOMV. A DOMV is characterized by a mitral valve with a single fibrous annulus with 2 orifices opening into the left ventricle (LV). Subvalvular structures, especially the tensor apparatus, invariably show various degrees of abnormality. It can substantially obstruct mitral valve inflow or cause mitral valve incompetence. We present a rare case of nineteen-year-old male who underwent percutaneous mitral balloon commissurotomy in stenotic DOMV.

Patted, Suresh V.; Halkati, Prabhu C.; Ambar, Sameer S.; Sattur, Ameet G.

2012-01-01

50

Early discharge after primary percutaneous coronary intervention for ST-elevation myocardial infarction  

PubMed Central

Background: To assess safety of early discharge following primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). Methods and results: Retrospective analysis of prospectively collected data of 2448 STEMI patients treated with PPCI surviving to hospital discharge. Post-discharge all-cause mortality was reported at 1, 7, and 30 days and long-term follow up. A total of 1542 patients (63.0%) were discharged within 2 days of admission (early discharge group) and 906 patients (37.0%) after 2 days (late discharge group). In both groups, no deaths were recorded 1 day post discharge. The early and late discharge group mortality figures for 7 days were 0 and 4 patients (0.04%) and between 7 and 30 days were 11 (0.7%) and 11 patients (1.2%), respectively. During a mean follow up of 584 days, 178 patients (7.3%) died: 67 in the early discharge group (4.3%) and 111 in the late discharge group (12.3%). Conclusions: This exploratory, observational study demonstrates that discharging low-risk STEMI patients within 2 days following PPCI is safe. For providers of health care, early discharge can help to allay the cost of providing a 24-hour PPCI service and adds to the recognized benefits arising from PPCI.

Noman, Awsan; Schechter, Clyde; Balasubramaniam, Karthik; Das, Rajiv

2013-01-01

51

Combining angioplasty with percutaneous microwave ablation for treating primary Budd-Chiari syndrome associated with hepatocellular carcinoma in two patients: A case report  

PubMed Central

Percutaneous transluminal angioplasty using balloon catheters for Budd-Chiari syndrome (BCS) and transcatheter arterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC) have become increasingly accepted as alternative therapeutic modalities. However, few studies have investigated the clinical efficacy of combining percutaneous microwave ablation with angioplasty for patients with BCS complicated by HCC. In the present study, a safe and effective method for treating BCS associated with HCC is presented. Color Doppler ultrasonography, magnetic resonance imaging (MRI), computed tomography (CT), inferior venacavography, hepatic arteriogram and cytological examinations were used for the diagnosis. A KY2000 microwave system with an emission of 915 MHz was also employed for the treatment. Two patients with BCS associated with HCC that were administered different adjuvant drug treatments underwent percutaneous transluminal angioplasty and percutaneous microwave ablation successfully, with no treatment-related complications. Combining angioplasty with percutaneous microwave ablation may represent an alternative method for the treatment of BCS associated with HCC.

ZHANG, QING-QIAO; ZU, MAO-HENG; XU, HAO; GU, YU-MING; WANG, WEN-LIANG; GAO, ZHI-KANG

2013-01-01

52

Successful surgical excision of primary right atrial angiosarcoma  

PubMed Central

Primary cardiac angiosarcoma is a rare and aggressive tumor with a high incidence of metastatic spread (up to 89%) at the time of diagnosis, which restricts the indication for surgical resection to a small number of patients. We report the case of a 50-year old Caucasian woman with non-metastatic primary right atrial angiosarcoma, who underwent successful surgical excision of the tumor (with curative intent) and reconstruction of the right atrium with a porcine pericardial patch. However, after a symptom-free survival of five months the patient presented with bone and liver metastases without evidence of local tumor recurrence.

2011-01-01

53

A Unique Complication With Use of the GuideLiner Catheter in Percutaneous Coronary Interventions and its Successful Management.  

PubMed

The "GuideLiner" is an easy-to-use catheter designed for deep seating in coronary arteries. The GuideLiner can be used to provide extra guidance support for equipment delivery during difficult coronary interventions or for coaxial alignment in tortuous vessels. There are a few GuideLiner-related complications reported in the literature, which include stent damage on advancement or on withdrawal, dissection, pressure dampening and ischemia, kinking of the balloon, and displacement of the GuideLiner catheter distal marker. We report another unique and previously unreported GuideLiner-related complication and its successful management. In our case, we experienced dislodgment of the distal cylinder of the GuideLiner from the push rod into the aortic root. The embolized cylinder was removed percutaneously using a novel approach without any complications. PMID:24717280

Bhat, Tariq; Baydoun, Hassan; Tamburino, Frank

2014-04-01

54

Results of primary percutaneous coronary intervention in patients ?75 years treated by the transradial approach.  

PubMed

Previous trials in elderly patients with ST-elevation myocardial infarction (STEMI) have not shown a definitive benefit of primary percutaneous coronary intervention (PPCI) by transfemoral approach over thrombolysis. The transradial approach (TRA) is associated with a significant decrease in mortality, MACE (Major Adverse Cardiac Event), and serious access site complications compared with the transfemoral approach. We have evaluated clinical outcomes in a cohort of real-life unselected ?75-year-old patients with STEMI treated by TRA-PPCI. This is a single-center prospective, observational registry of consecutive patients with STEMI who underwent PPCI between February 2007 and February 2013. MACE was defined as death, reinfarction, or stroke. A total of 307 patients were treated by PPCI, 293 (95.1%) with TRA-PPCI (mean age 80 ± 2 years, 42% women). Patients had high co-morbidity levels (cardiogenic shock on admission 8.5%, previous myocardial infarction 11.6%, diabetes 30.4%, previous renal failure 25.6%, previous PCI 9.6%, and peripheral arterial disease 14.3%); IIbIIIa inhibitors were used in 45.1% of patients. Severe bleeding and need for transfusion were recorded for 6.5% and 9.9% of patients, respectively. In-hospital mortality, 1-year mortality, and 1-year MACE were 11.9%, 17.4%, and 22.2%, respectively. Excluding 25 patients with cardiogenic shock on admission, the in-hospital mortality, 1-year mortality, and 1-year MACE were 7.8%, 13.1%, and 17.9%, respectively. In conclusion, TRA-PPCI was feasible in the vast majority of elderly patients with STEMI. In-hospital mortality, 1-year mortality, and 1-year MACE were lower than reported for transfemoral access, suggesting a benefit of the TRA in these patients. PMID:24315363

Rodriguez-Leor, Oriol; Fernandez-Nofrerias, Eduard; Carrillo, Xavier; Mauri, Josepa; Labata, Carlos; Oliete, Carolina; Rivas, Maria del Carmen; Bayes-Genis, Antoni

2014-02-01

55

Catheter Aspiration after Every Stage during Primary Percutaneous Angioplasty; ADMIT Trial.  

PubMed

We assess the epicardial and microcirculation flow characteristics, and clinical outcome by using catheter aspiration after each stage of primary percutaneous coronary intervention (PPCI). Conflicting data are reported regarding early and late benefit of using aspiration catheter in the initial phase PPCI. A total of 100 patients with ST-segment elevation acute myocardial infarction (STEMI) were included: 51 underwent PPCI without using an aspiration device (SA group) and 49 underwent PPCI by activating an aspiration catheter after each stage of procedure; wiring, ballooning and stenting, respectively (MA group). Thrombolysis in myocardial infarction (TIMI) flow grade, TIMI frame counts and myocardial blush grade (MBG) were evaluated in each group during every stage of procedure. Major adverse cardiac events were evaluated in the index hospitalization and during 30 and 180 days of follow-up. A TIMI flow grade 2-3 was more prevalent in the MA group compared with the SA group only after wiring: 65.9 versus 39.1% (p?=?0.01), but TIMI frame counts were lower in the MA versus SA group throughout all procedural steps. MBG 2-3 was statistically higher in the MA group compared with the SA group mainly after wiring. After stenting there were no significant changes in both epicardial and microcirculation flow parameters. There were no significant differences between the groups in early and late clinical outcomes. Improved flow parameters were noticed in the MA group only by activating the aspiration device after wiring. This early advantage disappeared after stenting. The initial better flow characteristic in the MA group was not translated into a better early or late clinical outcome. PMID:24627615

Turgeman, Yoav; Bushari, Limor Ilan; Antonelli, Dante; Feldman, Alexander; Yahalom, Malka; Bloch, Lev; Suleiman, Khalid

2014-03-01

56

Comparison of the angiographic and scintigraphic evaluation of the success of percutaneous transluminal coronary angioplasty  

SciTech Connect

The hemodynamic effects of percutaneous transluminal coronary angioplasty (PTCA) are difficult to assess as the change in the degree of arterial stenosis (AS) or transluminal pressure gradients (TPG) do not portray the functional result of this procedure. Diminished maximal hyperemic blood flow (MHBF) characterizes a functionally significant coronary lesion and the ratio of MHBF to basal coronary blood flow: the coronary flow reserve (CFR), which now can be estimated at the time of coronary angiography (CA), is an alternative approach to determining the physiologic significance of a lesion. CFR was obtained in 5 patients with single vessel coronary artery disease (CAD) and compared to stress Thallium-201 myocardial scintigraphy (T1), ejection fraction (EF) and ventricular wall motion (WM) by radionuclide ventriculography (RNV) and the results of CA (AS and TPG) before and after PTCA. Despite the persistence of moderate AS and/or a TPG, T1 and WM returned to normal when CFR was normalized. Thus, T1 and RNV are reliable, noninvasive indicators of the functional results of PTCA and can be used to assess its hemodynamic effects.

Le Grand, V.; Wueron, F.; O'Neil, W.W.; Juni, J.; Gross, M.D.; Vogel, R.

1984-01-01

57

Successful Percutaneous Coil Embolization of a Ruptured Internal Iliac Artery Aneurysm Remnant after Abdominal Aortic Aneurysm Repair via the Deep Iliac Circumflex Artery  

PubMed Central

Here, we describe a case of an 83-year-old man treated with percutaneous IIA coil embolization for an enlarging remnant IIA aneurysm. CT scans revealed a contained rupture and persistent flow in the right IIA with the enlargement. We selected percutaneous embolization via the deep iliac circumflex artery, that was communicating with the superior gluteal artery and the IIA. Coil embolization of the arteries supplying the IIA aneurysm was successfully performed with 12 embolization coils placed in the IIA and its branches. The absence of blood flow and shrinkage of the aneurysm were confirmed by CT three months after embolization.

2014-01-01

58

Factors involved in successful psychotherapy referral in rural primary care.  

PubMed

Many primary care patients are identified as needing psychotherapy. Often family physicians choose to refer these patients for comprehensive treatment, yet psychotherapy referrals are traditionally difficult to transact successfully in comparison with referrals for other biomedical complaints. Previous reports have been published on the beliefs held by family physicians and psychologists regarding factors that affect the success of a referral. This follow-up study reviewed 138 referrals from rural family physicians to psychotherapists. Fifty-nine percent of the referrals were considered successful by the family physicians and 73% by the patients. Successful psychotherapy referral, as evaluated by physicians, was related to psychotherapist-initiated post-referral communication with the referring physician. There was no relationship between success of referral outcome and the number of preparatory (or follow-up) visits with the physician, physician's knowledge about the psychotherapy process, patient economic status, or insurance coverage. However, attending more than one therapy session was associated with the number of physician visits prior to referral, distance to the therapist's office, and referral by a physician who included counseling in his or her practice. Findings indicate that when physicians are kept informed about patients' treatment, they are more likely to evaluate the treatments as beneficial. PMID:1936734

Rosenthal, T C; Shiffner, J M; Lucas, C; DeMaggio, M

1991-01-01

59

Successful percutaneous mitral valve repair with the MitraClip system of acute mitral regurgitation due to papillary muscle rupture as complication of acute myocardial infarction.  

PubMed

Percutaneous mitral valve repair with the MitraClip is a new promising therapeutic option for symptomatic severe mitral regurgitation (MR). Acute myocardial infarction (MI) is a well recognized cause of papillary muscle rupture (PMR). If PMR is untreated, the prognosis is poor and the mortality could be as high as 80% during the first week of post MI. For patients with PMR, the standard therapy for MR is open surgical repair or replacement. However, in our case, percutaneous mitral valve repair with the MitraClip was chosen technique because of the metastatic colon cancer. We report the case of a 60-year-old woman who underwent successful percutaneous mitral valve repair with the MitraClip system for the treatment of acute MI complicated by PMR. PMID:23592592

Bilge, Mehmet; Alemdar, Recai; Yasar, Ayse Saatci

2014-01-01

60

Percutaneous Nephrolithotomy  

Microsoft Academic Search

In 1976, Fernstrom and Johansson reported the first successful percutaneous nephrolithotomy (PNL) in three patients (1). Since then, advances in the design of nephroscopes and new methods to fragment large calculi have increased the safety and\\u000a efficacy of this operation. PNL is an integral part of modern urological training (2) and is widely performed in both academic and community settings

Sangtae Park; Maxwell V. Meng; Marshall L. Stoller

61

Reperfusion therapy for STEMI: is there still a role for thrombolysis in the era of primary percutaneous coronary intervention?  

PubMed

In the past ten years, primary percutaneous coronary intervention (PCI) has replaced thrombolysis as the revascularisation strategy for many patients presenting with ST-segment elevation myocardial infarction (STEMI). However, delivery of primary PCI within evidence-based timeframes is challenging, and health-care provision varies substantially worldwide. Consequently, even with the ideal circumstances of rapid initial diagnosis, long transfer delays to the catheter laboratory can occur. These delays are detrimental to outcomes for patients and can be exaggerated by variations in timing of patients' presentation and diagnosis. In this Series paper we summarise the value of immediate out-of-hospital thrombolysis for STEMI, and reconsider the potential therapeutic interface with a contemporary service for primary PCI. We review recent trial data, and explore opportunities for optimisation of STEMI outcomes with a pharmacoinvasive approach. PMID:23953386

Gershlick, Anthony H; Banning, Adrian P; Myat, Aung; Verheugt, Freek W A; Gersh, Bernard J

2013-08-17

62

Nonculprit lesion progression in patients with ST elevation myocardial infarction after primary percutaneous coronary intervention.  

PubMed

The majority of cardiovascular events in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PPCI) arise from the progression of nonculprit lesions (NCL) during the long-term follow-up period. However, the clinical and angiographic factors related to the progression of nonculprit lesions are unknown.The purpose of the study was to investigate the clinical and angiographic factors related to the progression of nonculprit lesions of patients with STEMI undergoing PPCI.A total of 492 patients with STEMI who underwent PPCI from January 2006 to December 2009 were enrolled. All patients underwent PPCI as a treatment for the culprit lesion. The clinical and angiographic follow-up was performed at 12 months. Primary endpoint: Clinically driven nonculprit lesion PCI. The levels of serum catecholamines [epinephrine (E), norepinephrine (NE)] and C-reactive protein (CRP) were assayed, and the clinical and angiographic features were also analyzed.The clinical and angiographic follow-up was performed in 492 patients, and 45 patients underwent clinically driven nonculprit lesions PCI (study group). A total of 447 patients were free of additional PCI (control group). There were significant differences in the level of catecholamines (E (621.48 ± 79.31) pg/mL versus (268.14 ± 73.26) pg/mL, P < 0.0001), NE (6212.43 ± 822.41) pg/mL versus (3218.34 ± 614.16) pg/mL, P < 0.0001), CRP (3.29 ± 1.31) mg/dL versus (2.51 ± 1.14) mg/dL, P < 0.0001, cTnI peak value (27.27 ± 4.02) ng/mL versus (16.12 ± 3.23) ng/mL, P < 0.0001), thrombotic lesion rate ((62.22% versus 23.04%), P < 0.0001), ? 2 vessel lesions rate (80.00% versus 46.09%), P < 0.0001), culprit lesion length ((33.2 ± 2.9 versus 28.1 ± 3.1), P = 0.013), and complex lesion rate ((57.78% versus 36.02%), P = 0.006) between the two groups. Correlation analysis between nonculprit lesion stenosis degree and serum E, serum NE, serum CRP, cTnI peak value, thrombotic lesion rate, ? 2 vessel lesions rate, culprit lesion length, and complex lesion rate showed that there were significant correlations between serum E, serum NE, serum CRP, cTnI peak value, thrombotic lesion rate, ? 2 vessel lesions rate, culprit lesion length, complex lesion rate, and nonculprit lesion stenosis degree. The correlation coefficients were 0.95, 0.97, 0.83, 0.90, 0.81, 0.84, 0.95, and 0.96, respectively, and P < 0.0001, P < 0.0001, P = 0.01, P = 0.01, P = 0.01, P = 0.01, P < 0.0001, and P < 0.0001, respectively.Recurrent PCI was mainly due to nonculprit lesion progression in patients with STEMI after primary PCI. Complex nonculprit lesions may be prone to for additional PCI. Chronic inflammation and sustained stress may be involved in the progression of nonculprit lesions in patients with STEMI. PMID:24463926

Wang, Jian; Liu, Jing-hua; Zhu, Xiao-ling; Zhang, Ming; Wang, Shao-ping; Zheng, Ze

2014-01-01

63

Percutaneous lithotripsy.  

PubMed

We have performed percutaneous extractions of renal pelvic stones in 194 patients via the Wolf percutaneous universal nephroscope. At 1 session, with the patient under general anesthesia, a percutaneous tract is dilated to 24F and the stone is removed immediately. We have removed 185 stones successfully by ultrasonic lithotripsy, basket retrieval and/or use of forceps. Average operating time was 54 minutes and mean hospitalization was 5 days. The advantages of this technique are that a skin incision of only 1 cm. is required to remove the stone, hospital days are fewer than with open procedures and postoperative morbidity is minimal. In selected situations this method represents a significant advance over standard open surgical procedures for removal of renal pelvic stones. PMID:6644881

Segura, J W; Patterson, D E; LeRoy, A J; May, G R; Smith, L H

1983-12-01

64

Dangerous liaison: successful percutaneous edge-to-edge mitral valve repair in patients with end-stage systolic heart failure can cause left ventricular thrombus formation.  

PubMed

Aims: To evaluate the characteristics and clinical outcome of patients with new formation of left ventricular (LV) thrombus after percutaneous edge-to-edge mitral valve repair. Methods and results: Between 2009 and 2012 we intended to treat 150 patients with severe mitral regurgitation (MR) with percutaneous edge-to-edge mitral valve repair in our centre. Post-procedural transthoracic echocardiographic examinations scheduled during the hospital stay revealed the new formation of LV thrombi in three out of 150 patients. All three patients suffered from end-stage systolic heart failure with a LV ejection fraction (LVEF) below 20% and were successfully treated in terms of MR reduction (reduction of at least two MR grades). No thrombus formation was observed in patients with a LVEF >20% treated in our centre (a total of 136 patients). The frequency of new LV thrombus formation in the cohort of patients with a LVEF ?20% treated in our centre was 21% (three out of 14 patients). Conclusions: New formation of LV thrombus was detected in patients with severely depressed LVEF (?20%) after successful reduction of MR following percutaneous edge-to-edge mitral valve repair. This phenomenon could be a play of chance, but percutaneous edge-to-edge mitral valve repair using the MitraClip¨ system is a new procedure. Special care is needed when performing new procedures, and the unexpected post-procedural finding of LV thrombus formation in approximately 20% in this cohort is worth reporting. PMID:24168894

Orban, Martin; Braun, Daniel; Sonne, Carolin; Orban, Mathias; Thaler, Raffael; Grebmer, Christian; Lesevic, Hasema; Schömig, Albert; Mehilli, Julinda; Massberg, Steffen; Hausleiter, Jörg

2014-06-20

65

Population dynamics along a primary succession gradient: do alpine species fit into demographic succession theory?  

PubMed Central

Background and Aims Understanding processes and mechanisms governing changes in plant species along primary successions has been of major importance in ecology. However, to date hardly any studies have focused on the complete life cycle of species along a successional gradient, comparing pioneer, early and late-successional species. In this study it is hypothesized that pioneer species should initially have a population growth rate, ?, greater than one with high fecundity rates, and declining growth rates when they are replaced by late-successional species. Populations of late-successional species should also start, at the mid-successional stage (when pioneer species are declining), with growth rates greater than one and arrive at rates equal to one at the late successional stage, mainly due to higher survival rates that allow these species to persist for a long time. Methods The demography of pioneer- (Saxifraga aizoides), early (Artemisia genipi) and late-successional species (Anthyllis vulneraria ssp. alpicola) was investigated together with that of a ubiquitous species (Poa alpina) along the Rotmoos glacier foreland (2300–2400 m a.s.l., Central Alps, Austria) over 3 years. A matrix modelling approach was used to compare the main demographic parameters. Elasticity values were plotted in a demographic triangle using fecundity, individual growth and survival as vital rates contributing to the population growth rates. Key Results The results largely confirmed the predictions for population growth rates during succession. However, high survival rates of larger adults characterized all species, regardless of where they were growing along the succession. At the pioneer site, high mortality rates of seedlings, plantlets and young individuals were recorded. Fecundity was found to be of minor relevance everywhere, but it was nevertheless sufficient to increase or maintain the population sizes. Conclusions Demographically, all the species over all sites behaved like late-successional or climax species in secondary successions, mainly relying on survival of adult individuals. Survival serves as a buffer against temporal variation right from the beginning of the primary succession, indicating a major difference between primary and secondary succession.

Marcante, Silvia; Winkler, Eckart; Erschbamer, Brigitta

2009-01-01

66

Successful percutaneous treatment for massive hemorrhage due to infectious pseudoaneurysm in the abdominal wall after percutaneous endoscopic gastrostomy: a case report  

PubMed Central

Background Percutaneous endoscopic gastrostomy (PEG) is often performed for alimentation and to prevent weight loss in patients with feeding problems due to central neurologic diseases such as cerebral infarction or intracranial hemorrhage. Although infection at the skin site after PEG placement is a typical late complication of PEG, a ruptured infectious pseudoaneurysm caused massive bleeding adjacent to the tract is rare. Prompt treatment is required to avoid the hemorrhage shock, however surgical ligation is difficult to obtain the arrest of bleeding in damaged skin due to the infection. Case presentation A 70-year-old male was bedridden due a cerebral infarction suffered 1 year previously. APEG was placed because of feeding problems, and a push-type, 20-Fr gastrostomy tube was inserted through the anterior abdominal wall. On day 16 after PEG placement, the patient had massive bleeding from the PEG site due to the rupture of infectious pseudoaneurysm and developed a decreased level of consciousness and hypotension. Treatment by percutaneous direct injection of a mixture of n-butyl-cyanoacrylate (NBCA)-lipiodol was performed and achieved good hemostasis is obtained. Conclusions A rare case of an infectious pseudoaneurysm that developed in the abdominal wall and caused massive bleeding at a PEG placement site was described. Percutaneous injection of a mixture of n-butyl-cyanoacrylate (NBCA)-lipiodol under ultrasound guidance is an effective treatment in this case.

2014-01-01

67

Local Ablative Therapies in HCC: Percutaneous Ethanol Injection and Radiofrequency Ablation  

Microsoft Academic Search

Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy. Surgery and transarterial chemoembolization have for many years dominated the local treatment of HCC. The introduction of image-guided percutaneous techniques for local tumor ablation changed the treatment of liver cancer. Percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) have both successfully been employed in the treatment of HCC. In current

Andreas H. Mahnken; Philipp Bruners; Rolf W. Günther

2009-01-01

68

A case of percutaneous coronary intervention procedure successfully bailed out from multiple complications in hemodialysis patient.  

PubMed

A 73 year-old male who underwent coronary artery bypass surgery (CABG) 8 years ago had PCI performed on him for a diffuse calcified stenotic lesion in the right coronary artery (RCA). Following 2.5 mm non-compliant balloon dilatation supported with a child catheter (Dio from Goodman), we implanted a stent to the distal RCA through this catheter. However, because the tip of Dio was trapped by the implanted stent, it was stretched and almost ruptured by pulling it. Next, we tried to implant a stent for mid RCA with buddy wire technique, but we could not deploy it because of calcification. When we tried to withdraw this stent system, the stent was accidentally dislodged from the balloon. We could withdraw the stent with twisting two wires. However, because one of these wires had crossed a small artery in the distal RCA at twisting, a tip of this wire was fractured when the stent was removed. We could remove this wire with gooseneck snare. Finally, we successfully implanted stents in the mid RCA with balloon anchor technique and to the proximal RCA. PMID:22810922

Kawamura, Yota; Nagaoka, Masakazu; Ito, Daiki; Iseki, Harukazu; Ikari, Yuji

2013-01-01

69

45 Should primary percutaneous coronary intervention be the routine reperfusion strategy in octogenarians and non-agenarians presenting with ST elevation myocardial infarction?  

Microsoft Academic Search

IntroductionPrimary percutaneous coronary intervention (PPCI) has been established as standard therapy for ST elevation myocardial infarction (STEMI). Very few trials have looked at the outcome of PPCI in elderly patients. Even in trials which claimed to have looked at PPCI in elderly patients such as SENIOR PAMI (Grines, 2005) and TRIANA (Bueno, 2009) the minimum age for inclusion was 70

R Showkathali; E Boston-Griffiths; J Davies; G Clesham; J Sayer; P Kelly; R Aggarwal

2011-01-01

70

The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction  

Microsoft Academic Search

IntroductionThe Tpeak-Tend interval (TpTe) has been linked to increased arrhythmic risk. TpTe was investigated before and after primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI).

Christian Haarmark; Peter R. Hansen; Esben Vedel-Larsen; Sune Haahr Pedersen; Claus Graff; Mads P. Andersen; Egon Toft; Fan Wang; Johannes J. Struijk; Jørgen K. Kanters

2009-01-01

71

30 Comparison of bivalirudin vs abciximab vs “unfractionated heparin only” for primary percutaneous coronary intervention in a high-volume centre  

Microsoft Academic Search

IntroductionPrimary percutaneous coronary intervention (PPCI) has been established as a standard therapy for ST elevation myocardial infarction (STEMI). In addition to thrombectomy and unfractionated heparin (UFH), thrombus burden in STEMI may require use of more potent antithrombotic agents. Bivalirudin is shown to be superior to abciximab in reducing the net adverse clinical events and major bleeding in STEMI in the

R Showkathali; J Davies; N Malik; W Taggu; J Sayer; R Aggarwal; P Kelly

2011-01-01

72

Early abciximab administration before primary percutaneous coronary intervention improves clinical outcome in elderly patients transferred with ST-elevation myocardial infarction  

Microsoft Academic Search

BackgroundLimited data are available concerning benefits and risks of early abciximab (EA) administration before primary percutaneous coronary intervention (PPCI) in elderly ST-segment elevation myocardial infarction (STEMI) patients. The objective of the study was to assess the impact of EA before PPCI in elderly (?65 years) patients.

Artur Dziewierz; Zbigniew Siudak; Tomasz Rakowski; Micha? Chyrchel; Waldemar Mielecki; Magnus Janzon; Ralf Birkemeyer; Ilkka Tierala; Roman M. Wojdy?a; Jacek S. Dubiel; Dariusz Dudek

2010-01-01

73

Thrombolytic therapy vs primary percutaneous intervention after ventricular fibrillation cardiac arrest due to acute ST-segment elevation myocardial infarction and its effect on outcome  

Microsoft Academic Search

The aim of this study was to evaluate the effect of thrombolytic therapy on neurologic outcome and mortality in patients after cardiac arrest due to acute ST-elevation myocardial infarction and to compare this with those in patients treated with primary percutaneous coronary intervention (PCI). We retrospectively examined patients after they had ventricular fibrillation cardiac arrests. To assess the effect of

Nina Richling; Harald Herkner; Michael Holzer; Eva Riedmueller; Fritz Sterz; Wolfgang Schreiber

74

Percutaneous endopyelotomy  

Microsoft Academic Search

Objectives. During the past 10 years, numerous reports around the world have documented the safety and success rate of antegrade endopyelotomy. We describe the classic endopyelotomy in conjunction with some new alternatives for making the incision.Technical Considerations. Antegrade endopyelotomy is performed through the 0.5-in. incision of the percutaneous nephrostomy created by way of an upper or middle calix. Using the

Norberto O Bernardo; Arthur D Smith

2000-01-01

75

Effect of peripheral arterial disease on in-hospital outcomes after primary percutaneous coronary intervention for acute myocardial infarction.  

PubMed

The presence of peripheral arterial disease (PAD) in patients with stable coronary artery disease is associated with an increased long-term risk of death, myocardial infarction, and stroke. However, the effect of PAD on short-term outcomes in patients with acute myocardial infarction is less well understood. A total of 9,015 consecutive patients with acute myocardial infarction from the New York State Coronary Angioplasty Reporting System database, all of whom had undergone primary percutaneous coronary intervention in 1998 and 1999, were analyzed. The diagnosis of PAD was determined by a history of aortoiliac, femoral-popliteal, or carotid disease. A logistic regression model was used to determine the relation between PAD and in-hospital death and major adverse cardiovascular events, which included a composite of death, recurrent myocardial infarction, stroke, acute vessel occlusion, stent thrombosis, emergency coronary artery bypass surgery, and vascular injury. PAD had been diagnosed in 529 (5.9%) of the 9,015 patients. Patients with PAD had greater rates of diabetes mellitus, hypertension, and chronic kidney disease and were significantly more likely to develop heart failure, cardiogenic shock, and hemodynamic instability. The incidence of major adverse cardiovascular events was significantly greater in patients with PAD than in patients without PAD (20.4% vs 7.0%, p <0.001). Similarly, the in-hospital mortality rate was significantly greater among the patients with PAD (13% vs 3.8%, p <0.001). After adjusting for the baseline and procedural characteristics, PAD remained an independent predictor of in-hospital mortality (odds ratio 2.2, 95% confidence interval 1.7 to 3.0, p <0.001). In conclusion, PAD was independently associated with a doubling of the in-hospital mortality risk among patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. PMID:20403477

Jeremias, Allen; Gruberg, Luis; Patel, Jignesh; Connors, Gerard; Brown, David L

2010-05-01

76

A survey of primary percutaneous coronary intervention for patients with ST segment elevation myocardial infarction in Canadian hospitals  

PubMed Central

BACKGROUND: Historically, access to primary percutaneous coronary intervention (PCI) for the treatment of patients with ST segment elevation myocardial infarction (STEMI) has been limited in Canada. Recent studies have identified innovative strategies to improve timely access and reduce reperfusion time. Accordingly, the contemporary use of primary PCI treatment in Canada was ascertained. METHODS: A cross-sectional survey of all 38 Canadian hospitals that were capable of performing PCI procedures was conducted from June 2007 to November 2007. The survey focused on the practice of primary PCI for patients with STEMI and whether the hospitals had implemented internal strategies to reduce ‘door-to-balloon’ times. Analyses were performed at the level of geographical regions. RESULTS: Overall, 71% of PCI hospitals (27 of 38) provided around-the-clock primary PCI for patients with STEMI, but the proportion of PCI hospitals offering this service varied widely, from 33% to 100% across regions. All Canadian PCI hospitals provided around-the-clock rescue PCI treatment to STEMI patients who had failed fibrinolytic therapy. In terms of strategies that are associated with reduced reperfusion time, it was observed that only 42% of PCI hospitals (16 of 38) provided feedback on door-to-balloon time to the emergency department and to the cardiac catheterization laboratories within one week of the primary PCI procedure. Overall, 24% of the hospitals had not adopted any of the four identified strategies to improve door-to-balloon time. CONCLUSION: Although the majority of Canadian hospitals with PCI capability provide around-the-clock primary PCI for patients with STEMI, significant variations in this practice exist across the country. Canadian PCI hospitals have not consistently adopted strategies that are associated with improved door-to-balloon time.

Ko, Dennis T; Donovan, Linda R; Huynh, Thao; Rinfret, Stephane; So, Derek Y; Love, Michael P; Galbraith, Diane; Tu, Jack V

2008-01-01

77

Clinical Lipid Control Success Rate Before and After Percutaneous Coronary Intervention in Iran; a Single Center Study  

PubMed Central

Background High cholesterol levels have long been considered an independent risk factor for cardiovascular disease (CVD). Objective Controlling risk factors such as dyslipidemia in patients with coronary artery disease is necessary. We aimed to evaluate the success rate of lipid control, during 9 months follow-up after percutaneous coronary intervention (PCI). Patients and Methods A total of 195 patients (67.7% men, mean age = 57.8 ± 9.4 years) who underwent PCI in Tehran Heart Center were included. Serum lipid profiles were measured in all the patients before PCI and at 9-month follow-up. Dyslipidemia was defined as serum levels of LDL-C ? 100 or TG ? 150 or TC ? 200 or HDL-C ? 40 mg/dl in the men and ? 50 mg/dl or less in the women, or non-HDL-C ? 130 mg/dl with or without the consumption of lipid-lowering agents. During follow up, all patients were given atorvastatin 20-40 mg/day. Results Overall, 26.2% had diabetes mellitus, 42.6% had hypertension, and 34.9% were smokers. Dyslipidemia was more common in the women. At 9-month follow-up, there was no significant changes in terms of the prevalence of high HDL-C or low TG in patients; however, a significant increase was seen in the prevalence low TC in patients (63.6% vs. 80.5%; p value < 0.001), LDL-C (47.2% vs. 65.6%; p value < 0.001), and non-HDL-C (40.0% vs. 63.1%; p value < 0.001). Conclusions Although by current treatments, the prevalence of patients with low TC, LDL-C and non-HDL-C has significantly increased; dyslipidemia persisted in a considerable proportion of patients. These results necessitate further investigations into the relationship between high serum lipids and long-term outcome of patients after PCI as well as further evaluations of the dyslipidemia treatment strategies.

Hosseini, Seyed Kianoosh; Tahvildari, Maryam; Alemzadeh Ansari, Mohammad Javad; Nakhjavani, Manouchehr; Esteghamati, Alireza; Lotfi Tokaldany, Masoumeh

2013-01-01

78

Percutaneous Nephroscopic Surgery  

PubMed Central

With the development of techniques for percutaneous access and equipment to disintegrate calculi, percutaneous nephroscopic surgery is currently used by many urologists and is the procedure of choice for the removal of large renal calculi and the management of diverticula, intrarenal strictures, and urothelial cancer. Although it is more invasive than shock wave lithotripsy and retrograde ureteroscopic surgery, percutaneous nephroscopic surgery has been successfully performed with high efficiency and low morbidity in difficult renal anatomies and patient conditions. These advantages of minimal invasiveness were rapidly perceived and applied to the management of ureteropelvic junction obstruction, calyceal diverticulum, infundibular stenosis, and urothelial cancer. The basic principle of endopyelotomy is a full-thickness incision of the narrow segment followed by prolonged stenting and drainage to allow regeneration of an adequate caliber ureter. The preferred technique for a calyceal diverticulum continues to be debated. Excellent long-term success has been reported with percutaneous, ureteroscopic, and laparoscopic techniques. Each approach is based on the location and size of the diverticulum. So far, percutaneous ablation of the calyceal diverticulum is the most established minimally invasive technique. Infundibular stenosis is an acquired condition usually associated with inflammation or stones. Reported series of percutaneously treated infundibular stenosis are few. In contrast with a calyceal diverticulum, infundibular stenosis is a more difficult entity to treat with only a 50-76% success rate by percutaneous techniques. Currently, percutaneous nephroscopic resection of transitional cell carcinoma in the renal calyx can be applied in indicated cases.

2010-01-01

79

Fibrinolytic Therapy Versus Primary Percutaneous Coronary Interventions for ST-Segment Elevation Myocardial Infarction in Kentucky: Time to Establish Systems of Care?  

PubMed Central

Background Fibrinolytic therapy is recommended for ST-segment myocardial infarctions (STEMI) when primary percutaneous coronary intervention (PPCI) is not available or cannot be performed in a timely manner. Despite this recommendation, patients often are transferred to PPCI centers with prolonged transfer times, leading to delayed reperfusion. Regional approaches have been developed with success and we sought to increase guideline compliance in Kentucky. Methods A total of 191 consecutive STEMI patients presented to the University of Kentucky (UK) Chandler Medical Center between July 1, 2009 and June 30, 2011. The primary outcome was in-hospital mortality and the secondary outcomes were major adverse cardiovascular events, extent of myocardial injury, bleeding, and 4) length of stay. Patients were analyzed by presenting facility—the UK hospital versus an outside hospital (OSH)—and treatment strategy (PPCI vs fibrinolytic therapy). Further analyses assessed primary and secondary outcomes by treatment strategy within transfer distance and compliance with American Heart Association guidelines. Results Patients presenting directly to the UK hospital had significantly shorter door-to-balloon times than those presenting to an OSH (83 vs 170 minutes; P < 0.001). This did not affect short-term mortality or secondary outcomes. By comparison, OSH patients treated with fibrinolytic therapy had a numeric reduction in mortality (4.0% vs 12.3%; P = 0.45). Overall, only 20% of OSH patients received timely reperfusion, 13% PPCI, and 42% fibrinolytics. In a multivariable model, delayed reperfusion significantly predicted major adverse cardiovascular events (odds ratio 3.87, 95% confidence interval 1.15–13.0; P = 0.02), whereas the presenting institution did not. Conclusions In contemporary treatment of STEMI in Kentucky, ongoing delays to reperfusion therapy remain regardless of treatment strategy. For further improvement in care, acceptance of transfer delays is necessary and institutions should adopt standardized protocols in association with a regional system of care.

Wallace, Eric L.; Kotter, John R.; Charnigo, Richard; Kuvlieva, Liliana B.; Smyth, Susan S.; Ziada, Khaled M.; Campbell, Charles L.

2013-01-01

80

[Upstream administration of oral antiplatelet agents in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention].  

PubMed

Current guidelines for the management of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) recommend the administration of dual antiplatelet therapy with aspirin and an ADP receptor blocker "as early as possible" before angiography (upstream), though this suggestion is not based on the results of randomized clinical trials designed to investigate pre-hospital rather than in-hospital drug administration. The present review analyzed randomized clinical trials, registries and observational studies that assessed clopidogrel, prasugrel and ticagrelor administration in STEMI patients undergoing primary PCI to evaluate if their upstream use may be justified in clinical practice. A significant difference favoring early clopidogrel administration has been demonstrated in observational studies. No evidence is available for prasugrel and ticagrelor; however, the initial delay of their antiplatelet effect in STEMI patients could support an upstream strategy to obtain complete platelet inhibition in the first hours after PCI and prevent major adverse events (e.g., stent thrombosis) despite an increased risk of major bleeding, particularly in case of urgent bypass surgery. Data from specifically designed randomized clinical trials are warranted to establish whether early administration of prasugrel and ticagrelor may favor reperfusion and improve clinical outcome with an acceptable risk-benefit ratio. PMID:24625848

Ferlini, Marco; Mafrici, Antonio; Marzegalli, Maurizio; Piccaluga, Emanuela; Sponzilli, Carlo; Bramucci, Ezio; Visconti, Luigi Oltrona

2014-02-01

81

Percutaneous bone lesion ablation.  

PubMed

Benign tumors and metastatic bone lesions can be treated by ablation techniques performed either alone or in combination with other percutaneous techniques. Ablation techniques include ethanol or acetic acid injection and thermal ablation by means of energy deposition [including laser, radiofrequency, microwave, cryoablation, radiofrequency ionization and magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU)]. Goal definition of the therapy is crucial: ablation techniques can be proposed as curative treatments in benign bone tumors or oligometastatic disease (<3 lesions). Alternatively, these techniques can be proposed as palliative treatments aiming at reduction of pain, local control of the disease and tumor decompression. Depending on the lesion's location ablation can be combined with cementation with or without further metallic augmentation; local tumor control can be enhanced by combining ablation with transarterial bland embolization or chemoembolization. Thermal ablation of bone and soft tissues is characterized by high success and relatively low rates of potential complications, mainly iatrogenic thermal damage of surrounding sensitive structures. Successful thermal ablation requires a sufficient ablation volume and thermal protection of the surrounding vulnerable structures. This article will describe the general principles governing ablation and the mechanism of action for each technique and in addition will review the literature about safety and effectiveness of percutaneous imaging-guided ablation for benign and malignant (primary and metastatic) lesions. PMID:24894924

Filippiadis, Dimitrios K; Tutton, Sean; Kelekis, Alexis

2014-07-01

82

Successful Percutaneous Retrieval of an Inferior Vena Cava Filter Migrating to the Right Ventricle in a Bariatric Patient  

SciTech Connect

The use of an inferior vena cava filter has an important role in the management of patients who are at high risk for development of pulmonary embolism. Migration is a rare but known complication of inferior vena cava filter placement. We herein describe a case of a prophylactic retrievable vena cava filter migrating to the right ventricle in a bariatric patient. The filter was retrieved percutaneously by transjugular approach and the patient did well postoperatively. A review of the current literature is given.

Veerapong, Jula [University of Chicago Hospitals, Department of General Surgery (United States); Wahlgren, Carl Magnus, E-mail: carl.wahlgren@karolinska.s [University of Chicago Hospitals, Section of Vascular Surgery, Department of Surgery (United States); Jolly, Neeraj [University of Chicago Hospitals, Section of Interventional Cardiology, Department of Medicine (United States); Bassiouny, Hisham [University of Chicago Hospitals, Section of Vascular Surgery, Department of Surgery (United States)

2008-07-15

83

Serial Plasma Levels of Angiogenic Factors in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention  

PubMed Central

Background and Objectives Patients with acute myocardial infarction show varying degrees of collateral development. However, the relationships between angiogenic factors and degree of collaterals are not well known. Subjects and Methods Fifty-nine patients (mean age, 59±10 years) with ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PCI). Patients were divided into one of 2 groups: group I (Rentrop collateral grade 0/1, n=34) or group II (grade 2/3, n=25). Plasma levels of vascular endothelial growth factor (VEGF), soluble VEGF receptor (sFlt-1), angiopoietin (Ang)-2, and soluble Tie-2 at baseline, 24 and 48 hours after PCI were measured. Results There were fewer diabetic patients and higher incidence of previous angina and multi-vessel disease in group II. Group II had a lower left ventricular ejection fraction and a trend toward longer pain-to-balloon time. Plasma levels of Ang-2, sFlt-1 were elevated prior to primary PCI and decreased after PCI, whereas plasma level of VEGF was relatively low initially, however rose after PCI. sTie-2 levels showed no significant interval change in group I, but decreased over time in group II. VEGF, sFlt-1, and Tie-2 levels did not differ between the groups at each time point. However, plasma levels of Ang-2 were higher in group I than in group II at baseline and at 48 hours. Conclusion Presence of collaterals in STEMI patients undergoing primary PCI was associated with lesser rise in Ang-2 plasma level. VEGF showed a delayed response to acute ischemia compared to Ang-2. Clinical implications of our findings need to be investigated in further studies.

Kim, Bo Hyun; Her, Ae-Young; Kim, Jung-Sun; Hwang, Ki-Chul; Shin, Dong-Ho; Kim, Byeong-Keuk; Choi, Donghoon; Ha, Jong-Won; Hong, Myeong-Ki; Jang, Yangsoo

2012-01-01

84

Primary Students' Success on the Structured Number Line  

ERIC Educational Resources Information Center

Number lines are part of people's everyday life and are frequently used in primary mathematics as instructional aids, in texts, and for assessment purposes on mathematics tests. There are two types of number lines; (1) structured number lines, which are the focus of this paper; and (2) empty number lines. Structured number lines represent…

Diezmann, Carmel M.; Lowrie, Tom; Sugars, Lindy A.

2010-01-01

85

Shared Learning for Primary Health Care Teams: A Success Story.  

ERIC Educational Resources Information Center

A simulated learning exercise based on genograms was used with professionals in multidisciplinary primary health-care teams. Evaluation supported the importance of a positive learning environment, constructive use of personal and professional experiences, learner control, intellectual challenge and relevance, and reflection and debriefing. (SK)

Howkins, Elizabeth; Allison, Althea

1997-01-01

86

Association of diabetes with increased all-cause mortality following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in the contemporary era  

Microsoft Academic Search

Background: We investigated the association between diabetes mellitus (DM) and all-cause mortality in a large cohort of consecutive patients treated with primary percutaneous coronary intervention (PPCI) in the contemporary era.Methods: We conducted a retrospective analysis of a single-centre registry of patients undergoing PPCI for ST-segment elevation myocardial infarction (STEMI) at a large regional PCI centre between 2005 and 2009. All-cause

Matthew B Kahn; Richard M Cubbon; Ben Mercer; Alison CG Wheatcroft; Guy Gherardi; Amir Aziz; Vivek Baliga; Jonathan M Blaxill; Jim M McLenachan; Daniel J Blackman; John P Greenwood; Stephen B Wheatcroft

2012-01-01

87

Treating ST elevation myocardial infarction by primary percutaneous coronary intervention, in-hospital thrombolysis and prehospital thrombolysis. An observational study of timelines and outcomes in 625 patients  

Microsoft Academic Search

ObjectiveTo describe the effects of implementing of a percutaneous coronary intervention (PPCI) service and compare the distribution of reperfusion therapies 12 months pre and post introduction of PPCI.DesignObservational study with data collected 12 months pre and post-availability of Primary PCI as routine treatment.SettingLothian region in South-East Scotland.Patients625 Patients who received reperfusion treatment between December 2005 and November 2007.ResultsPHT was given

S. McLean; S. Wild; P. Connor; A. D. Flapan

2010-01-01

88

Grade 3 ischemia on admission electrocardiogram and chest pain duration predict failure of ST-segment resolution after primary percutaneous coronary intervention for acute myocardial infarction  

Microsoft Academic Search

ObjectivesST resolution (STR) is a surrogate marker of myocardial tissue reperfusion and a predictor of outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI). Terminal QRS distortion (grade 3 ischemia) has been shown to predict failure of STR after thrombolysis for STEMI, but the ability of grade 3 ischemia to predict STR with pPCI is unclear.

Jarrett T. McGehee; Umamahesh C. Rangasetty; Shaul Atar; Nestor N. Barbagelata; Barry F. Uretsky; Yochai Birnbaum

2007-01-01

89

Relation Between Hospital Specialization With Primary Percutaneous Coronary Intervention and Clinical Outcomes in ST-Segment Elevation Myocardial Infarction National Registry of Myocardial Infarction4 Analysis  

Microsoft Academic Search

Background—Hospitals with primary percutaneous coronary intervention (PPCI) capability may choose to predominately offer PPCI to their patients with ST-segment elevation myocardial infarction (STEMI), or they may selectively offer PPCI or fibrinolytic therapy based on patient and hospital-level factors. Whether a greater level of hospital specialization with PPCI is associated with better quality of care is unknown. Methods and Results—We analyzed

Brahmajee K. Nallamothu; Yongfei Wang; David J. Magid; Robert L. McNamara; Jeph Herrin; Elizabeth H. Bradley; Eric R. Bates; Charles V. Pollack; Harlan M. Krumholz

2010-01-01

90

Early Administration of Small-Molecule Glycoprotein IIb\\/IIIa Inhibitors Before Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: Insights From Randomized Clinical Trials  

Microsoft Academic Search

Background: Current guidelines recommend abciximab (ReoPro) as an adjunctive pharmacologic agent to primary percutaneous coronary intervention (PPCI) for patients with ST-segment elevation myocardial infarction (STEMI). However, small-molecule glycoprotein IIb\\/IIIa receptor inhibitors (smGPIs), such as tirofiban (aggrastat) and eptifibatide (integrilin), are more commonly used in clinical practice. Method and Result: We performed a meta-analysis to compare the safety and efficacy of

Lili Dong; Feng Zhang; Xianhong Shu

2010-01-01

91

[Optical coherence tomography, delayed stent implantation and primary percutaneous coronary intervention in patients with myocardial infarction and ST segment elevation].  

PubMed

Primary percutaneous coronary intervention (PCI) is an effective treatment for myocardial infarction with ST-segment elevation. However, the stent may slow (slow-flow) or even interrupt the flow (no-reflow) in the infarct-related artery with an increase in short-term and long-term mortality. Due to these limitations there is an effort to search for alternative methods or certain modifications of existing PCI. Present article introduces a modified PCI and results of trombo-aspiration technique by optical coherence tomography (OCT). The article presents the results of our clinical study and brief case report. Our pilot project involved 100 patients with STEMI in 2011-2012. 20 patients (20%) were initially treated only with trombo-aspiration without stent implantation, based on OCT. Control angiography and OCT done 9 months after event have revealed insignificant stenosis in all patients. It is plausible that universal medical procedure with stenting is not suitable for all patients with STEMI and especially patients with large thrombus may benefit from the alternative procedure performed by manually trombo-aspiration technique with intensive anticoagulant/antiaggregant therapy. Nevertheless, only randomized trials with sufficiently follow-up may confirm this hypothesis. PMID:24985987

Cervinka, Pavel

2014-04-01

92

Hypercoagulation Assessed by Thromboelastography is Neither Related to Infarct Size nor to Clinical Outcome After Primary Percutaneous Coronary Intervention.  

PubMed

Objectives: We investigated the relationship between coagulation assessed by thromboelastography (TEG) and myocardial damage in ST-segment elevation myocardial infarction (STEMI). Methods: We measured platelet activity with TEG-maximum amplitude (TEG-MA) in 233 patients undergoing urgent percutaneous coronary intervention (PCI). Infarct size and myocardial salvage index were evaluated using cardiac magnetic resonance, and the relation of these parameters to posttreatment coagulation was examined retrospectively. Adverse events were adjudicated and related to the coagulation status during the index event. Results: Hypercoagulation was found in 82 (35.2%) patients and was neither correlated to infarct size nor correlated to myocardial salvage index (P = .28 and .65, respectively) or clinical adverse events. Patients who experienced an adverse event during follow-up had a slightly higher TEG-MA value than patients with an event-free follow-up, but this was not statistically significant (68.1 vs 67.3, P = .44). Conclusions: The TEG-MA does not appear to be a sensitive predictor of reperfusion success and prognosis in urgent PCI for STEMI. PMID:23613040

Paarup Dridi, Nadia; Lønborg, Jacob T; Radu, Maria D; Clemmensen, Peter; Engstrøm, Thomas; Kelbæk, Henning; Jørgensen, Erik; Helqvist, Steffen; Saunamäki, Kari; Christensen, Troels H; Baeres, Florian M M; Johansson, Pär I; Holmvang, Lene

2013-05-01

93

Successful percutaneous coronary intervention of chronic total occlusion of the right coronary artery using "bidirectional kissing-balloon" technique.  

PubMed

We report on a 74-year-old man with chronic total occlusion (CTO) of the right coronary artery treated with percutaneous coronary intervention using the bidirectional kissing-balloon technique. When an antegrade approach fails, a retrograde approach to recanalize a CTO is reasonable. However, when the exit of the CTO is bifurcated and a protection wire does not advance antegrade into the side branch after wire externalization, loss of blood flow after ballooning or stenting may result. We report on the usefulness of the bidirectional kissing-balloon technique for a retrograde approach to chronically totally occluded coronary arterial bifurcation lesions. PMID:24907092

Numasawa, Yohei; Hamazaki, Yuji; Takahashi, Toshiyuki

2014-06-01

94

Primary Care Clinic-Based Chronic Disease Care: Features of Successful Programs  

Microsoft Academic Search

Objective: To identify common features of primary care clinics that have successfully achieved improvement in chronic disease care. Methods: We analyzed seven primary care practices that have achieved significant improvement in chronic disease care provided to adults with diabetes mellitus, hypertension, lipid disorders, or heart disease. Strategies used to improve care were mapped across categories of the Enhanced Primary Care

Patrick J. OConnor; JoAnn M. Sperl-Hillen; Nicolaas P. Pronk; Terry Murray

2001-01-01

95

Ectomycorrhizal networks and seedling establishment during early primary succession.  

PubMed

Ectomycorrhizal (ECM) fungal mycelia are the main organs for nutrient uptake in many woody plants, and often connect seedlings to mature trees. While it is known that resources are shared among connected plants via common mycorrhizal networks (CMNs), the net effects of CMNs on seedling performance in the field are almost unknown. CMNs of individual ECM fungal species were produced in an early succession volcanic desert by transplanting current-year seedlings of Salix reinii with ECM mother trees that had been inoculated with one of 11 dominant ECM fungal species. Most seedlings were connected to individual CMNs without being infected by other ECM fungi. Although control seedlings showed poor growth under severe nutrient competition with larger nonmycorrhizal mother trees, nutrient acquisition and growth of seedlings connected to CMNs were improved with most fungal species. The positive effects of CMNs on seedling performance were significantly different among ECM fungal species; for example, the maximum difference in seedling nitrogen acquisition was 1 : 5.9. The net effects of individual CMNs in the field and interspecific variation among ECM fungal species are shown. PMID:16390428

Nara, Kazuhide

2006-01-01

96

Antiplatelet effect of thienopyridine (clopidogrel or prasugrel) pretreatment in patients undergoing primary percutaneous intervention for ST elevation myocardial infarction.  

PubMed

Although previous retrospective studies have suggested the clinical benefits of clopidogrel pretreatment in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI), the antiplatelet effect of thienopyridines during a narrow door-to-balloon time frame has not been evaluated. Seventy-nine consecutive patients with STEMI were treated with either 600 mg of clopidogrel (n = 49) or 60 mg of prasugrel (n = 30) loading on admission. All patients underwent PPCI with a door-to-balloon time of 48 ± 20 minutes. Adenosine diphosphate (ADP)-induced platelet aggregation (PA) was determined by light transmission aggregometry before thienopyridine loading, at PPCI, and after 72 hours. Baseline ADP-induced PA was comparable in clopidogrel- and prasugrel-treated patients (79 ± 10% vs 76 ± 9%, p = 0.2). Although ADP-induced PA was reduced significantly in both clopidogrel- and prasugrel-treated patients (p <0.01 for both), it was significantly lesser in prasugrel-treated patients (63 ± 18% vs 74 ± 12%, p = 0.002). Yet, <50% of the prasugrel-treated patients achieved adequate platelet inhibition (ADP-induced PA <70%) at PPCI. Prasugrel-treated patients, compared with clopidogrel-treated patients, were more likely to have Thrombolysis In Myocardial Infarction myocardial perfusion grade of ?2 (79% vs 49%, p = 0.01), lower Thrombolysis In Myocardial Infarction frame count (10.2 ± 5.7 vs 13.6 ± 7.2, p = 0.03), and a numerically greater incidence of early ST-segment resolution >50% (26 of 30 [87%] vs 35 of 49 [71%], p = 0.1), suggesting better myocardial reperfusion. In conclusion, overall, prasugrel compared with clopidogrel pretreatment resulted in greater platelet inhibition at PPCI, but even with prasugrel, only <50% of the patients achieved early adequate platelet response. PMID:23972349

Beigel, Roy; Fefer, Paul; Rosenberg, Nurit; Novikov, Ilia; Elian, Dan; Fink, Noam; Segev, Amit; Guetta, Victor; Hod, Hanoch; Matetzky, Shlomi

2013-11-15

97

Corrected thrombolysis in myocardial infarction frame count and ejection fraction in patients undergoing primary percutaneous coronary intervention for myocardial infarction  

PubMed Central

BACKGROUND This study aimed to assess the associations between corrected thrombolysis in myocardial infarction frame count (CTFC) of the infarct-related artery (IRA) and ejection fraction (EF) after three-six months in patients who underwent primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI). METHODS CTFC was determined by a digital system for 78 patients. EF was measured through Simpson’s method upon discharge and three-six months later. The subjects were divided into two groups of CTFC ? 20 (n = 54) and CTFC > 20 (n = 24). Association between CTFC and EF were then specified. RESULTS CTFC ? 20 and CTFC > 20 were present in 69.2% and 30.8% of the patients, respectively. There was no significant difference between the two groups regarding baseline characteristics. EF at the time of discharge was 42.1% ± 10.2% and 43.5% ± 11.4% in groups with CTFC ? 20 and > 20, respectively. There was no significant association between EF at discharge and CTFC (P = 0.611). After three months, EF changed to 49.6% ± 8.7% and 41.6 ± 12.4% in the groups with CTFC ? 20 and CTFC > 20, respectively. Three months after PPCI, EF and CTFC had a significant relation (P = 0.007). Cumulative number and percentage of shock and death were 3 (3.8%) and 2 (2.6%), respectively. CONCLUSION Lower CTFC of the infarct-related artery in patients undergoing PPCI for STEMI was associated with higher left ventricular ejection fraction after three months.

Vakili, Hossein; Sadeghi, Roxana; Tabkhi, Mahdiyeh; Safi, Morteza

2013-01-01

98

Electrocardiographic P-wave Indices as a Useful Tool to Predict Successful Percutaneous Balloon Mitral Valvotomy in Patients with Mitral Stenosis.  

PubMed

Introduction : Patients with hemodynamically significant mitral stenosis (MS) have prolonged P-wave duration and increased P-wave dispersion (PWD) that decrease after successful percutaneous balloon mitral valvotomy (PBMV). The purpose of this study was to investigate if the changes in these indices may predict a successful procedure. Methods : Fifty two patients with MS in sinus rhythm underwent PBMV (90.4% female; mean age 38±10 years). Mitral valve area (MVA), valve score, mean diastolic mitral gradient (mMVG), mitral regurgitation severity, and systolic pulmonary artery pressure (sPAP) were evaluated by echocardiography before PBMV and repeated after one month. P-wave duration (Pmax /Pmin) and PWD were measured before and immediately after PBMV, at discharge, and at the end of the first month after discharge. Results : Among all procedures, 38 (73.1%) were defined as successful. Mean age, valve score, mMVG, and MVA before PBMV were similar for both groups. MVA was significantly greater in the successful PBMV group (1.65±0.27 vs. 1.41±0.22; P= 0.003). sPAP was reduced after PBMV in all patients and there were no significant differences in the mean sPAP before and after PBMV in both successful and unsuccessful groups. Pmax and PWD were significantly decreased immediately after the procedure (P= 0.035), the next day (P= 0.005) and at one month (P= 0.002) only in patients with successful PBMV. Pmin did not change significantly in either group. Conclusion : Only is successful PBMV associated with a decrease in Pmax and PWD. These simple electrocardiographic indices may predict the success of the procedure immediately after PBMV. PMID:24753825

Kazemi, Babak; Rostami, Ali; Aslanabadi, Naser; Ghaffari, Samad

2014-01-01

99

Electrocardiographic P-wave Indices as a Useful Tool to Predict Successful Percutaneous Balloon Mitral Valvotomy in Patients with Mitral Stenosis  

PubMed Central

Introduction: Patients with hemodynamically significant mitral stenosis (MS) have prolonged P-wave duration and increased P-wave dispersion (PWD) that decrease after successful percutaneous balloon mitral valvotomy (PBMV). The purpose of this study was to investigate if the changes in these indices may predict a successful procedure. Methods: Fifty two patients with MS in sinus rhythm underwent PBMV (90.4% female; mean age 38±10 years). Mitral valve area (MVA), valve score, mean diastolic mitral gradient (mMVG), mitral regurgitation severity, and systolic pulmonary artery pressure (sPAP) were evaluated by echocardiography before PBMV and repeated after one month. P-wave duration (Pmax /Pmin) and PWD were measured before and immediately after PBMV, at discharge, and at the end of the first month after discharge. Results: Among all procedures, 38 (73.1%) were defined as successful. Mean age, valve score, mMVG, and MVA before PBMV were similar for both groups. MVA was significantly greater in the successful PBMV group (1.65±0.27 vs. 1.41±0.22; P= 0.003). sPAP was reduced after PBMV in all patients and there were no significant differences in the mean sPAP before and after PBMV in both successful and unsuccessful groups. Pmax and PWD were significantly decreased immediately after the procedure (P= 0.035), the next day (P= 0.005) and at one month (P= 0.002) only in patients with successful PBMV. Pmin did not change significantly in either group. Conclusion: Only is successful PBMV associated with a decrease in Pmax and PWD. These simple electrocardiographic indices may predict the success of the procedure immediately after PBMV.

Kazemi, Babak; Rostami, Ali; Aslanabadi, Naser; Ghaffari, Samad

2014-01-01

100

Successful Percutaneous Renal Artery Angioplasty and Stenting for Acute Oliguric Renal Failure in a Solitary Functioning Kidney Caused by Takayasu's Arteritis  

PubMed Central

Takayasu's arteritis (TA) is a nonspecific, chronic and stenotic panarteritis which usually involves the aorta and its major branches. Corticosteroid and immunosuppressants are recommended to manage the acute inflammatory phase, but their long term benefits are uncertain. Blood pressure (BP) control during the chronic phase of TA is essential to preserve renal function, which is associated with the patient's long-term prognosis and survival. Revascularization in organ damaging arterial stenosis with percutaneous angioplasty (PTA)/stenting or bypass surgery have been accepted as established treatment options in chronic complicated phase of TA. We present a case of a 31-year-old female patient with a two-day history of sudden onset oliguria and generalized edema whose acute oliguric renal failure was successfully reversed following PTA and stenting in a solitary functioning kidney with critical renal artery stenosis (RAS) caused by TA.

Yoo, Suk-Hee; Kim, Gi-Hyun; Lee, Won-Ick; Kwon, Soon-Kil; Lee, Sang Yeub; Hwang, Kyung-Kuk; Kim, Dong-Woon; Cho, Myeong-Chan

2010-01-01

101

The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention  

PubMed Central

Purpose It has been known that inflammatory mechanisms play an important role in the coronary artery disease. Our aim in this study was to investigate the relationship between the neutrophil/lymphocyte (N/L) ratio and coronary flow velocity after primary percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI). Methods Two hundred and ten patients who had undergone primary PCI were included. The coronary flow velocities were evaluated using the recorded PCI procedures by Thrombolysis in Myocardial Infarction (TIMI) flow grades and corrected TIMI frame counts (cTFC) values. A value of >40 for the final cTFC was accepted as an index of insufficient coronary blood flow. The white blood cell subtypes and counts were determined in the blood samples obtained at the clinics. Results In 165 (78%) of the investigated patients, reperfusion was found to be sufficient (Group I) while in 45 (22%) of them (Group II) insufficient reperfusion was observed (Group II). In-hospital mortality was 7.2% (n=12) in Group I, whereas it was 17.7% (n=8) in Group II (P=0.033). Similarly, one-year mortality was higher in Group II (26.6%, n=12) than in Group I (13.3%, n=22) (P=0.031). N/L ratio was determined to be higher in Group I than in Group II (8.3±6.1 vs. 6.2±5.0; P=0.034). Also, N/L ratio was found as an independent predictor of severe no-reflow development (TIMI 0-1) and of one-year mortality (P=0.01 and P=0.047, respectively). Conclusions N/L ratio has been found to be an independent indicator for no-reflow development in patients who have undergone PCI for acute STEMI. This simple and low-cost parameter can provide useful information for the relevant risk evaluation in these patients.

Yuksel, Serkan; Gulel, Okan; Erbay, Ali Riza; Meric, Murat; Zengin, Halit; Museyibov, Muhtar; Yasar, Erdogan; Demircan, Sabri

2013-01-01

102

Endoscopic and percutaneous approaches to the treatment of biliary tract and primary liver tumors: controversies and advances.  

PubMed

Advances in percutaneous and endoscopic techniques have improved preoperative selection and optimization in patients with biliary and liver tumors, but are not without their own controversies. Selective rather than routine preoperative biliary drainage (PBD) should be employed, as PBD may be associated with increased infectious complications. Endoscopic ampullectomy (EA) offers advantages in morbidity and mortality over surgical approaches and should be the first line therapy for benign ampullary lesions. Ampullary cancers require pancreaticoduodenectomy. Effectiveness of percutaneous ablative techniques is dependent on tumor size and can be used as palliative therapy, as a bridge to transplantation, or, in select situations, as definitive therapy. PMID:24560107

Shah, Kevin N; Clary, Bryan M

2014-04-01

103

Usefulness of adiponectin as a predictor of all cause mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.  

PubMed

Substantial evidence points to a protective role of adiponectin against atherosclerosis and cardiovascular (CV) disease. However, in the setting of an acute myocardial infarction (AMI), the role of adiponectin has not previously been studied. Consequently, the aim of this study was to investigate the prognostic role of adiponectin after AMI in a large population of patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. A total of 735 consecutive patients with ST-segment elevation myocardial infarction admitted to a single high-volume invasive heart center and treated with primary percutaneous coronary intervention from September 2006 to December 2008 were included. Blood samples were drawn immediately before the invasive procedure. Plasma adiponectin was measured using a validated immunoassay. End points were all-cause mortality, CV mortality, and admission for new AMI or heart failure. The median follow-up time was 27 months (interquartile range 22 to 33). Patients with high adiponectin (quartile 4) had increased mortality compared to patients with low adiponectin (quartiles 1 to 3) (log-rank p <0.001). After adjustment for conventional risk factors (age, gender, smoking, hypertension, hypercholesterolemia, diabetes, body mass index, C-reactive protein, peak troponin I, creatinine, estimated glomerular filtration rate, previous AMI, multivessel disease, complex lesions, left anterior descending coronary artery lesion, and symptom-to-balloon time) by Cox regression analysis, high adiponectin remained an independent predictor of all-cause mortality (hazard ratio 2.1, 95% confidence interval 1.3 to 3.2, p = 0.001) and CV mortality (hazard ratio 2.6, 95% confidence interval 1.5 to 4.5, p = 0.001). In conclusion, increased plasma adiponectin independently predicts all-cause and CV mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. PMID:22105783

Lindberg, Søren; Pedersen, Sune H; Møgelvang, Rasmus; Bjerre, Mette; Frystyk, Jan; Flyvbjerg, Allan; Galatius, Søren; Jensen, Jan Skov

2012-02-15

104

Angiographic and Clinical Impact of Successful Manual Thrombus Aspiration in Diabetic Patients Undergoing Primary PCI  

PubMed Central

Background. Diabetes mellitus is associated with worse angiographic and clinical outcomes after percutaneous coronary intervention (PCI). Aim. To investigate the impact of manual thrombus aspiration on in-stent restenosis (ISR) and clinical outcome in patients treated by bare-metal stent (BMS) implantation for ST-segment elevation myocardial infarction (STEMI). Methods. 100 diabetic patients were prospectively enrolled. They were randomly assigned to undergo either standard primary PCI (group A, 50 patients) or PCI with thrombus aspiration using Export catheter (group B, 50 patients). The primary endpoint was the rate of eight-month ISR. The secondary endpoint included follow-up for major adverse cardiac events (MACE). Results. Mean age of the study cohort was 59.86 ± 8.3 years, with 64 (64%) being males. Baseline characteristics did not differ between both groups. Eight-month angiogram showed that group B patients had significantly less late lumen loss (0.17 ± 0.35 versus 0.60 ± 0.42?mm, P < 0.001), with lower incidence of ISR (4% versus 16.6%, P < 0.001). There was a trend towards lower rate of MACE in the same group of patients. Conclusion. In diabetic patients undergoing primary PCI, manual thrombus aspiration (compared with standard PCI) was associated with better ISR rate after BMS implantation.

2014-01-01

105

Strategies for and Successes with Promoting Social Integration in Primary Schools in Canada and China  

ERIC Educational Resources Information Center

This study examined social integration in 11 primary schools in Canada and 19 primary schools in China as reported by teachers in terms of the strategies employed to promote social integration and success in achieving social integration. Structured interviews were conducted with 64 Canadian and 52 Chinese general education teachers. The results…

Dyson, Lily

2012-01-01

106

Modern Languages in the Primary Curriculum: Are We Creating Conditions for Success?  

ERIC Educational Resources Information Center

As the 2010 deadline for implementation of the National Languages Strategy in primary schools approaches, how effective is the current national strategy likely to be in embedding modern languages successfully into the primary curriculum? Have lessons been learnt from the last--and ultimately failed--attempt to introduce languages into the…

McLachlan, Angela

2009-01-01

107

The Relationship between Eighth Grade Primary School Students' Proportional Reasoning Skills and Success in Solving Equations  

ERIC Educational Resources Information Center

This study investigates the relationship between eighth grade primary school students' success levels in solving equations and proportional reasoning skills. 344 eighth grade students, who were registered at various primary schools in the central districts of Konya in the 2007-2008 educational year, participated in the research. The study had a…

Cetin, Hatice; Ertekin, Erhan

2011-01-01

108

Cardiac troponin I for the prediction of functional recovery and left ventricular remodelling following primary percutaneous coronary intervention for ST-elevation myocardial infarction  

Microsoft Academic Search

ObjectiveTo investigate the ability of cardiac troponin I (cTnI) to predict functional recovery and left ventricular remodelling following primary percutaneous coronary intervention (pPCI) in ST-elevation myocardial infarction (STEMI).DesignPost hoc study extending from randomised controlled trial.Patients132 patients with STEMI receiving pPCI.Main outcome measuresLeft ventricular ejection fraction (LVEF), end-diastolic and end-systolic volume index (EDVI and ESVI) and changes in these parameters from

Jonas Hallén; Jesper K Jensen; Morten W Fagerland; Allan S Jaffe; Dan Atar

2010-01-01

109

Rationale and design of EXPLORE: a randomized, prospective, multicenter trial investigating the impact of recanalization of a chronic total occlusion on left ventricular function in patients after primary percutaneous coronary intervention for acute ST-elevation myocardial infarction  

PubMed Central

Background In the setting of primary percutaneous coronary intervention, patients with a chronic total occlusion in a non-infarct related artery were recently identified as a high-risk subgroup. It is unclear whether ST-elevation myocardial infarction patients with a chronic total occlusion in a non-infarct related artery should undergo additional percutaneous coronary intervention of the chronic total occlusion on top of optimal medical therapy shortly after primary percutaneous coronary intervention. Possible beneficial effects include reduction in adverse left ventricular remodeling and preservation of global left ventricular function and improved clinical outcome during future coronary events. Methods/Design The Evaluating Xience V and left ventricular function in Percutaneous coronary intervention on occLusiOns afteR ST-Elevation myocardial infarction (EXPLORE) trial is a randomized, prospective, multicenter, two-arm trial with blinded evaluation of endpoints. Three hundred patients after primary percutaneous coronary intervention for ST-elevation myocardial infarction with a chronic total occlusion in a non-infarct related artery are randomized to either elective percutaneous coronary intervention of the chronic total occlusion within seven days or standard medical treatment. When assigned to the invasive arm, an everolimus-eluting coronary stent is used. Primary endpoints are left ventricular ejection fraction and left ventricular end-diastolic volume assessed by cardiac Magnetic Resonance Imaging at four months. Clinical follow-up will continue until five years. Discussion The ongoing EXPLORE trial is the first randomized clinical trial powered to investigate whether recanalization of a chronic total occlusion in a non-infarct related artery after primary percutaneous coronary intervention for ST-elevation myocardial infarction results in a better preserved residual left ventricular ejection fraction, reduced end-diastolic volume and enhanced clinical outcome. Trial registration trialregister.nl NTR1108.

2010-01-01

110

Direct Primary or Secondary Percutaneous Ureteral Stenting: What Is the Most Compliant Option in Patients with Malignant Ureteral Obstructions?  

SciTech Connect

The objective of this study was to analyze three ureteral stenting techniques in patients with malignant ureteral obstructions, considering the indications, techniques, procedural costs, and complications. In the period between June 2003 and June 2006, 45 patients with bilateral malignant ureteral obstructions were evaluated (24 males, 21 females; average age, 68.3; range, 42-87). All of the patients were treated with ureteral stenting: 30 (mild strictures) with direct stenting (insertion of the stent without predilation), 30 (moderate/severe strictures) with primary stenting (insertion of the stent after predilation in a one-stage procedure), and 30 (mild/moderate/severe strictures with infection) with secondary stenting (insertion of the stent after predilation and 2-3 days after nephrostomy). The incidence of complications and procedural costs were compared by a statistical analysis. The primary technical success rate was 98.89%. We did not observe any major complications. The minor complication rate was 11.1%. The incidence of complications for the various techniques was not statistically significantly. The statistical analysis of costs demonstrated that the average cost of secondary stenting ( Euro 637; SD, Euro 115) was significantly higher than that of procedures which involved direct or primary stenting ( Euro 560; SD, Euro 108). We conclude that one-step stenting (direct or primary) is a valid option to secondary stenting in correctly selected patients, owing to the fact that when the procedure is performed by expert interventional radiologists there are high technical success rates, low complication rates, and a reduction in costs.

Carrafiello, Gianpaolo, E-mail: gcarraf@tin.it; Lagana, Domenico; Lumia, Domenico; Giorgianni, Andrea; Mangini, Monica; Santoro, Domenico [University of Insubria, Radiology Department (Italy); Cuffari, Salvatore [University of Insubria, Anesthesia Department (Italy); Marconi, Alberto [University of Insubria, Urology Department (Italy); Novario, Raffaele [University of Insubria, Physical Medicine Department (Italy); Fugazzola, Carlo [University of Insubria, Radiology Department (Italy)

2007-09-15

111

Relative efficacy of bivalirudin versus heparin monotherapy in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a network meta-analysis  

PubMed Central

In the absence of head-to-head clinical data, the objective of this study was to indirectly compare the efficacy and safety of a bivalirudin-based anticoagulation strategy with that of heparin monotherapy in patients with ST-elevation myocardial infarction (STEMI) intended for primary percutaneous coronary intervention. A systematic literature review was performed to identify randomized controlled trials to build a network of bivalirudin and heparin monotherapy strategies in STEMI patients using heparin, with glycoprotein IIb/IIIa inhibitor as a common reference strategy. At 30 days, the bivalirudin-based strategy was expected to result in lower mortality rates than heparin monotherapy (odds ratio [OR], 0.55; credible limit [CrL], 0.32–0.95). This relationship was sustained at 1 year. At 30 days, the risk for stroke (OR, 0.88; CrL, 0.37–2.13), myocardial infarction (OR, 0.79; CrL, 0.40–1.55), and thrombolysis in myocardial infarction major and minor bleedings (OR, 0.66; CrL, 0.45–0.98) tended to be numerically reduced with bivalirudin in comparison with heparin monotherapy. For patients with STEMI intended for primary percutaneous coronary intervention, bivalirudin is associated with lower mortality rates in comparison with heparin monotherapy. This study suggests that bivalirudin is more effective and safer than heparin monotherapy and should therefore be preferred over heparin monotherapy.

Kinnaird, Tim; Medic, Goran; Casella, Gianni; Schiele, Francois; Kaul, Upendra; Radke, Peter W; Eijgelshoven, Indra; Bergman, Gert; Chew, Derek P

2013-01-01

112

Causes and Consequences of Herbivory on Prairie Lupine ( Lupinus lepidus ) in Early Primary Succession  

Microsoft Academic Search

Primary succession, the formation and change of ecological communities in locations initially lacking organisms or other biological\\u000a materials, has been an important research focus for at least a century (Cowles 1899; Griggs 1933; Eggler 1941; Crocker and\\u000a Major 1955; Eggler 1959; Miles and Walton 1993; Walker and del Moral 2003). At approximately 60 km2, primary successional surfaces at Mount St.

John G. Bishop; William F. Fagan; John D. Schade; Charles M. Crisafulli

113

Simplified approach to percutaneous endopyelotomy.  

PubMed

The purpose of this report was to describe a safe, simple, and rapid approach to percutaneous antegrade endopyelotomy. In contrast to standard percutaneous endopyelotomy techniques, in this procedure, the endopyelotomy stent is placed at the outset. The endopyelotomy incision is then made with an acorn-tipped Bugbee electrode directly down onto the stent, in a manner analogous to a ureteral meatotomy in the bladder. The advantage of this approach is twofold. Primary placement of the stent helps to define the appropriate site and direction for the endopyelotomy incision, allowing marsupialization of the proximal ureter into the renal pelvis. Use of this technique also obviates the need to pass a large-caliber stent after the endopyelotomy incision has been made, thereby avoiding a potential risk of ureteropelvic junction disruption. Clinical and radiographic follow-up was available in 29 (76%) of 38 patients who underwent this procedure. Success, defined as a resolution of symptoms and decrease in calicectasis, was achieved in 24 (83%) of the 29 patients. We have found primary placement of an endopyelotomy stent and use of electrocautery as a cutting mode safely facilitates a precise endopyelotomy incision. PMID:11068315

Savage, S J; Streem, S B

2000-11-01

114

Efficacy of Early Intensive Rosuvastatin Therapy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (ROSEMARY Study).  

PubMed

The purpose of the study was to investigate whether early high-dose potent statin therapy in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention can reduce infarct size compared with conventional low-dose statin therapy. In a randomized placebo-controlled multicenter trial, 185 patients were assigned either to an early high-dose rosuvastatin group (n = 92, rosuvastatin 40 mg before treatment plus maintenance for 7 days) or to a conventional low-dose rosuvastatin group (n = 93, placebo before treatment plus rosuvastatin 10-mg maintenance for 7 days). Serial cardiac magnetic resonance imaging (MRI) was performed during the acute (3 to 7 days) and chronic (3 months) phases. The primary end point was relative infarct volume assessed by MRI at 3 months. Baseline characteristics were similar between the 2 groups, except hypertension, which was more prevalent in the high-dose group. Serial MRI data were available for 121 patients (high-dose group n = 54 and low-dose group n = 67). The relative infarct volumes in the acute (23.0 ± 9.5% vs 20.5 ± 11.7%, p = 0.208) and chronic (15.9 ± 8.3% vs 15.8 ± 9.7%, p = 0.943) phases were not different between the groups. No differences between groups were observed for periprocedural microvascular circulation evaluated by Thrombolysis In Myocardial Infarction flow grade, myocardial blush grade, ST-segment resolution, microvascular obstruction on cardiac MRI, or clinical outcomes. In conclusion, early high-dose rosuvastatin therapy in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention did not improve periprocedural myocardial perfusion or reduce infarct volume measured by MRI compared with the conventional low-dose rosuvastatin regimen. PMID:24831577

Ko, Young-Guk; Won, Hoyoun; Shin, Dong-Ho; Kim, Jung-Sun; Kim, Byeong-Keuk; Choi, Donghoon; Hong, Myeong-Ki; Bae, Jang-Ho; Lee, Sahng; Lim, Do-Sun; Jang, Yangsoo

2014-07-01

115

Successful ?en bloc resection of primary hepatocellular carcinoma directly invading the stomach and pancreas  

Microsoft Academic Search

Multivisceral surgical resection for cure was success- fully performed in a 70-year-old man suffering from a primary hepatocellular carcinoma (HCC) associated with direct invasion to the stomach and pancreas. The patient presented with gastric outlet obstruction, upper abdominal pain and a history of chronic liver disease due to hepatitis B virus (HBV) infection. Upper gastro- intestinal (GI) endoscopy revealed an

Dimitris P Korkolis; Chrysanthi Aggeli; George D; George D Plataniotis; Emmanuel Gontikakis; Helen Zerbinis; Nikitas Papantoniou; Dimitris Xinopoulos; Nikiforos Apostolikas; Perikles P Vassilopoulos

2009-01-01

116

Synthesized Comprehension Instruction in Primary Classrooms: A Story of Successes and Challenges  

ERIC Educational Resources Information Center

This 8-month qualitative study investigated 3 primary classrooms' implementation of a synthesized approach to comprehension instruction that incorporated vocabulary development, cognitive strategies, and responsive engagement. Three themes emerged, including successes and challenges in (a) the implementation of the separate components of the…

Dougherty Stahl, Katherine A.

2009-01-01

117

Successful percutaneous coronary intervention in a patient with combined deficiency of FV and FVIII due to novel compound heterozygous mutations in LMAN1.  

PubMed

Percutaneous coronary intervention (PCI) in patients with congenital coagulation factor deficiencies presents a unique challenge. They are not only at increased risk of perioperative bleeding but can also suffer thrombosis of the stent as preventive anticoagulation and antiplatelet therapy is difficult. Several cases of successful PCI have been described in patients with haemophilia A and B, but there are no reports in patients with combined coagulation factor deficiencies. We used PCI to treat the coronary artery disease in a patient with the combined deficiency of factor V and factor VIII (F5F8D) and analysed the molecular basis of the disorder for this patient. A 68-year-old patient was admitted for urgent PCI with bare metal stent placement after the diagnosis of the F5F8D. Peripheral blood DNA was extracted for the sequence analysis of LMAN1 and MCFD2 genes. Mutations in LMAN1 was confirmed by molecular cloning of the PCR product and resequencing of the resulting clones. The patient underwent successful PCI with good long-term outcome. Our patient tolerated anticoagulation therapy well, with unfractionated heparin, and double antiplatelet therapy while he was initially supported with fresh frozen plasma and recombinant FVIII. Molecular analysis revealed that the patient carries unusual compound heterozygous frameshift mutations on the same microsatellite repeat region in exon 8 of LMAN1, one of which is a novel mutation (c.912delA). Our results suggest that patients with F5F8D can safely undergo PCI for coronary artery disease, with the treatment individualized to the specific patient. PMID:23557496

Patel, A J; Liu, H-H; Lager, R A; Malkovska, V; Zhang, B

2013-07-01

118

Endothelial progenitor cells, microvascular obstruction, and left ventricular remodeling in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.  

PubMed

Endothelial progenitor cells (EPCs) are released from the bone marrow during cardiac ischemic events, potentially influencing vascular and myocardial repair. We assessed the clinical and angiographic correlates of EPC mobilization at the time of primary percutaneous coronary intervention in 78 patients with ST elevation myocardial infarction and the impact of both baseline and follow-up EPC levels on left ventricular (LV) remodeling. Blood samples were drawn from the aorta and the culprit coronary artery for cytofluorimetric EPC detection (CD34+CD45dimKDR+ cells, in percentage of cytofluorimetric counts). Area at risk was assessed by Bypass Angioplasty Revascularization Investigation myocardial jeopardy index, thrombotic burden as thrombus score and microvascular obstruction (MVO) as a combination of ST segment resolution and myocardial blush grade. Echocardiographic evaluation of LV remodeling was performed at 1-year follow-up in 54 patients, whereas peripheral EPC levels were reassessed in 40 patients. EPC levels during primary percutaneous coronary intervention were significantly higher in intracoronary than in aortic blood (0.043% vs 0.0006%, p <0.001). Both intracoronary and aortic EPC were related to area at risk extent, to intracoronary thrombus score (p <0.001), and inversely to MVO (p = 0.001). Peripheral EPC levels at 1-year follow-up were lower in patients with LV remodeling than in those without (0.001% [0.001 to 0.002] vs 0.003% [0.002 to 0.010]; p = 0.01) and independently predicted absence of remodeling at multivariate analysis. In conclusion, a rapid intracoronary EPC recruitment takes place in the early phases of ST elevation myocardial infarction, possibly reflecting an attempted reparative response. The extent of this mobilization seems to be correlated to the area at risk and to the amount of MVO. Persistently low levels of EPC are associated to LV remodeling. PMID:23746481

Porto, Italo; De Maria, Giovanni Luigi; Leone, Antonio Maria; Dato, Ilaria; D'Amario, Domenico; Burzotta, Francesco; Niccoli, Giampaolo; Trani, Carlo; Biasucci, Luigi Marzio; Bolognese, Leonardo; Crea, Filippo

2013-09-15

119

Potential significance of spontaneous and interventional ST-changes in patients transferred for primary percutaneous coronary intervention: observations from the ST-MONitoring in Acute Myocardial Infarction study (The MONAMI study)  

Microsoft Academic Search

Aims In patients with ST-elevation myocardial infarction (STEMI) scheduled for primary percutaneous coronary intervention (primary PCI), acute risk-assessment may be valuable for tailoring of adjunctive therapy at the time of coronary intervention. The present study was designed to quantify pre-, per-, and post-interventional ST-changes, to evaluate whether a pre-specified continuous ST-monitoring classifi- cation provides potential prognostic information in the pre-

Christian Juhl Terkelsen; Bjarne Linde Nørgaard; Jens Flensted Lassen; Steen Hvitfeldt Poulsen; Jens Christian Gerdes; Erik Sloth; Liv Bjørn-Hansen Gøtzsche; Frode Kirketerp Rømer; Leif Thuesen; Torsten Toftegaard Nielsen; Henning Rud Andersen

120

ST-segment resolution assessed immediately after primary percutaneous coronary intervention correlates with infarct size and left ventricular function in cardiac magnetic resonance at 1-year follow-up  

Microsoft Academic Search

BackgroundLittle is known about the predictive value of electrocardiographic ST-segment resolution (STR) assessed immediately after primary percutaneous coronary intervention (PCI). The aim of the study was to analyze the value of STR and maximum single-lead ST-segment elevation assessed immediately after primary PCI in prediction of infarct size and left ventricular function in cardiac magnetic resonance (CMR) at 1-year follow-up.

Tomasz Rakowski; Artur Dziewierz; Zbigniew Siudak; Waldemar Mielecki; Agata Brzozowska-Czarnek; Jacek Legutko; Lukasz Rzeszutko; Andrzej Urbanik; Jacek S. Dubiel; Dariusz Dudek

2009-01-01

121

Evaluation of the Restoration Success of Endodontic Therapy of the Primary Molars  

PubMed Central

Objectives: The aim of this study was to evaluate the clinical and radiographic success rates of pulpotomized primary molar teeth restored with a compomer material with using United States Public Health Service (USPHS) criteria. Methods: In 173 primary molars of 156 child patients, aged within 4–9 years (mean age: 6.1±1.4 years), conventional pulpotomy treatment were performed. The teeth treated using calcium hydroxide, formocresol or ferric sulphate. After pulpotomy procedure, teeth were restored with compomer material. The teeth were evaluated as clinically and radiographically during a period of 12–24 months. Both of success of pulpotomy treatment and also restorative material (compomer material) were evaluated during follow-up period. The data were assessed with chi-square test. Results: At the end of the first year, 45% of initial treated teeth were checked, but only 18% were checked at the end of the second year. The first year success rates in the groups treated with CH, FC, and FS were 87.5%, 95%, and 79%, respectively, and, as the number of controllable patients was lower, the success rates on available teeth were determined to be 88.3% and 80%, respectively, according to the materials at the end of the second year. Restorations having been made, they were analyzed in accordance with USPHS criteria. Conclusions: At the end of the first year, 67.5% of compomer restorations were detected to be original and healthy and at the end of the second year, 57% were deemed healthy. No statistically significant relationships were found between marginal adaptation, secondary caries and pulpotomy success (chi-square test, P>.05). Among the three groups, there is no significant difference in terms of success. The least successful age group was defined as 4–6 years.

Kirzioglu, Zuhal; Gungor, Ozge Erken; Ciftci, Z. Zahit

2011-01-01

122

[A case of primary erythromelalgia successfully treated with high-dose intravenous immunoglobulin therapy].  

PubMed

Erythromelalgia is a rare condition characterized by constant or paroxysmal burning pain, erythema, and the elevation of skin temperature in the extremities. Recently, the impairment of C-fiber function due to autoimmune system involvement is considered as the primary cause of erythromelalgia. However, a successful treatment has yet not been established. We report a case of a 39-year-old woman with primary erythromelalgia accompanied by high cerebrospinal fluid protein concentration and axonal neuropathy. She received various antiepileptic and anti-inflammatory drugs, but failed to improve. She finally underwent high-dose intravenous immunoglobulin therapy, which dramatically improved her symptoms and normalized cerebrospinal fluid protein concentration. This result demonstrates the effectiveness of high-dose intravenous immunoglobulin therapy for the treatment of primary erythromelalgia and the possibility of autoimmune system involvement. PMID:24523317

Kuroda, Takeshi; Sugimoto, Azusa; Ishigaki, Seiichirou; Murakami, Hidetomo; Kawamura, Mitsuru

2014-02-01

123

A Retrospective Assessment of Zinc Oxide-Eugenol Pulpectomies in Vital Maxillary Primary Incisors Successfully Restored With Composite Resin Crowns  

Microsoft Academic Search

Purpose: The purpose of this retrospective study was to evaluate, via clinical and radio- graphic assessments, the treatment outcome of zinc oxide-eugenol (ZOE) pulpectomies performed in vital maxillary primary incisors successfully restored with composite resin crowns. Methods: Pulpectomized vital primary incisors were treated by a uniformed technique, filled with ZOE paste, and successfully restored with composite resin crowns. Those that

Robert E. Primosch; Anissa Ahmadi; Barry Setzer

2005-01-01

124

Comparison between Intracoronary Abciximab and Intravenous Eptifibatide Administration during Primary Percutaneous Coronary Intervention of Acute ST-Segment Elevation Myocardial Infarction  

PubMed Central

Background: Administration of glycoprotein IIb/IIIa inhibitors is an effective adjunctive treatment strategy during primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). Recent data suggest that an intracoronary administration of these drugs can increase the efficacy of PPCI. This study was done to find any potential difference in terms of efficacy of administering intracoronary Abciximab vs. intravenous Eptifibatide in primary PPCI. Methods: A total of 40 STEMI patients who underwent PPCI within 12 hours of symptom onset were randomized to either an intracoronary Abciximab (0.25 ?g/kg) bolus or two boluses of intravenous Eptifibatide (0.180 ?g/kg) each 10 minutes. The primary end points were enzymatic infarct size, myocardial reperfusion measured as ST-segment resolution (STR), and post-procedural thrombolysis in myocardial infarction (TIMI) grade flow of the infarct-related artery. The secondary end points were intra-procedural adverse effect (arrhythmia) and no-reflow phenomenon, in-hospital mortality, reinfarction, hemorrhage, and post-procedural global systolic function. Results: Post-procedural TIMI grade 3 flow was achieved in 95% and 90% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively (p value = 0.61). The infarct size, as assessed by the area under the curve of creatine phosphokinase-MB in the first 48 hours after PPCI (?mol/L/hr), was similar between the intracoronary Abciximab and intravenous Eptifibatide groups: 6591 (interquartile range [IQR], 3006.0 to 11112.0) versus 7,294 (IQR, 3795.5 to 11803.5); p value = 0.59. Complete STR was achieved in 55% and 45% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively (p value = 0.87). No deaths, urgent revascularizations, reinfarctions, or TIMI major bleeding events were observed in either group. Conclusion: The intracoronary administration of Abciximab was not superior to the intravenous administration of Eptifibatide in the STEMI patients who underwent primary PCI.

Namazi, Mohammad Hasan; Safi, Morteza; Vakili, Hosein; Saadat, Habibollah; Karimi, Esfandiar; Bagheri, Ramin Khameneh

2013-01-01

125

Prognostic impact of chronic kidney disease and anemia at admission on in-hospital outcomes after primary percutaneous coronary intervention for acute myocardial infarction.  

PubMed

Cardiorenal anemia syndrome has recently been receiving greater attention; however, data regarding the relationship between chronic kidney disease (CKD)/anemia on presentation and in-hospital outcome in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) are still limited in Japan.A total of 1,447 primary PCI-treated AMI patients were classified into 4 groups according to the presence of CKD and/or anemia on hospital admission (with CKD/with anemia n = 222, with CKD/without anemia n = 299, without CKD/with anemia n = 151, without CKD/without anemia n = 775). Angiographic acute results of primary PCI were similar among the 4 groups. The patients with CKD had a significantly higher in-hospital overall mortality rate than the patients without CKD, and in the presence or absence of CKD, patients with anemia tended to have a higher in-hospital mortality rate than the patients without anemia. According to a multivariate analysis, anemia on admission was found to be an independent predictor of in-hospital mortality, whereas admission CKD and admission eGFR were statistically not independent predictors. Moreover, the multivariable adjusted odds ratio of in-hospital death in AMI patients with CKD alone was 1.855 (95% CI 0.929-3.706), and that in AMI patients with CKD/with anemia was 3.384 (95% CI 1.697-6.748).These results suggest that among real-world, unselected Japanese AMI patients undergoing primary PCI, the combination of CKD and anemia on admission confers significant adverse effects on in-hospital mortality. PMID:24881584

Shiraishi, Jun; Kohno, Yoshio; Nakamura, Takeshi; Yanagiuchi, Takashi; Hashimoto, Sho; Ito, Daisuke; Kimura, Masayoshi; Matsui, Akihiro; Yokoi, Hirokazu; Arihara, Masayasu; Hyogo, Masayuki; Shima, Takatomo; Sawada, Takahisa; Matoba, Satoaki; Yamada, Hiroyuki; Matsumuro, Akiyoshi; Shirayama, Takeshi; Kitamura, Makoto; Furukawa, Keizo

2014-07-10

126

Fibro-Fatty Component is Important for the Long-Term Clinical Events in Patients Who Have Undergone Primary Percutaneous Coronary Intervention  

PubMed Central

Background and Objectives We evaluated which plaque components are associated with long-term clinical events in patients who underwent primary percutaneous coronary intervention (PCI). Subjects and Methods The study subjects consisted of 57 consecutive patients (mean age, 58.5±14.5 years; 45 males) who underwent primary PCI and a virtual histology-intravascular ultrasound examination. Major adverse cardiac events (MACEs) including death, acute myocardial infarction, stroke, and revascularization were evaluated during the mean 28 month follow-up period. Results Patients with high fibro-fatty volume (FFV >13.4 mm3, n=29; mean age, 61.3 years) had a lower ejection fraction (52.7% vs. 59.4%, p=0.022), a higher incidence of multi-vessel disease (69.0% vs. 28.6%, p=0.002), larger plaque area (25.7 mm2 vs. 15.9 mm2, p<0.001), and larger plaque volume (315 mm3 vs. 142 mm3, p<0.001) than those with a low FFV (?13.4 mm3, n=28; mean age, 55.6 years). Patients with high FFV had a significantly higher incidence (32.1% vs. 8.3%, p=0.036) of MACE than those with low FFV. When we divided the study population according to the necrotic core volume (NCV), fibrous volume, or dense calcified volume, no significant findings in terms of demographics and MACE rates were observed. A Cox regression analysis revealed that the independent factor for MACE was FFV (hazard ratio, 6.748; 95% confidence interval, 1.168-38.971, p=0.033) in this study population. Conclusion The coronary plaque component, particularly FFV, but not NCV, was important in long-term clinical outcomes in patients who underwent primary PCI.

Kim, Wan Ho; Park, Hyun Woong; Kim, Ki Hong; Song, In Girl; Yang, Dong Ju; Lee, Chung Seop; Seo, Young Hoon; Kwon, Taek Geun

2012-01-01

127

Comparison of Left Ventricular Function Following First ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention in Men Versus Women.  

PubMed

Previous data reported worse outcomes in female patients after acute ST elevation myocardial infarction (STEMI), related at least in part to less aggressive and nonparallel treatment. We investigated the presence of gender differences in left ventricular (LV) systolic and diastolic function in patients presenting with first STEMI, treated with primary percutaneous coronary intervention (PCI). Study population included 187 consecutive patients (81% men) presenting with STEMI and treated by primary PCI and guideline-based medications. Their mean age was 58 ± 10 years. All patients underwent a comprehensive echocardiographic evaluation within 3 days of admission. Female patients were older (62 ± 11 vs 59 ± 10 years, p = 0.006), with more co-morbidities and longer symptom duration (490 ± 436 vs 365 ± 437 minutes, p = 0.013). Echocardiography demonstrated that female patients had significantly lower LV systolic function (47 ± 8% vs 45 ± 8%, p = 0.03), lower septal and lateral e' velocities, higher average E/e' ratio (all p <0.001), elevated systolic pulmonary artery pressure (p = 0.03), and worse diastolic dysfunction (p = 0.007). No significant changes were present in left atrial volumes. In a logistic multivariate analysis model, female gender emerged as an independent predictor of septal e' <8 cm/s (odds ratio 10.11, 95% confidence interval 1.23 to 82.32, p = 0.002) and E/average e' ratio >15 (odds ratio 6.47, 95% confidence interval 1.63 to 25.61, p = 0.008). In conclusion, female patients undergoing primary PCI for first STEMI demonstrated worse systolic and diastolic LV function, despite receiving similar treatment as male patients. PMID:24795168

Shacham, Yacov; Topilsky, Yan; Leshem-Rubinow, Eran; Laufer-Perl, Michal; Keren, Gad; Roth, Arie; Steinvil, Arie; Arbel, Yaron

2014-06-15

128

Transfer Times and Outcomes in ST-Elevations Myocardial Infarction Patients Undergoing Inter-Hospital Transfer for Primary Percutaneous Coronary Intervention: APEX-AMI Insights  

PubMed Central

Background Transfer delays for primary percutaneous coronary intervention (PPCI) may increase mortality in patients with ST-segment elevation myocardial infarction (STEMI). We examined the association between door 1 to door 2 (D1D2) time, a measure capturing the entire transfer process, and outcomes in patients undergoing inter-hospital transfer for primary PCI. Methods and Results We evaluated the relationship between D1D2 time and the 90 day incidence of death, shock, and heart failure in the sub-set of 2075 (36.1%) of 5745 patients who underwent inter-hospital transfer for PPCI in the APEX-AMI trial. There was no significant difference in the 90 day incidence of death, shock, and heart failure between the transferred and the non-transferred groups (10.3% vs 10.2%, p=0.89). The median difference in symptom to balloon time between the two groups was 45 minutes (229 vs 184, p<0.001). The primary outcome per 30 minute delay was higher for patients with a D1D2 time ? 150 minutes (HR 1.19: 95% Confidence Interval [CI], 1.06 to 1.33 p=0.004) but not for D1D2 times > 150 minutes (HR, 0.99: 95% CI, 0.96 to 1.02; p=0.496). The association between longer D1D2 time and worsening outcome was no longer statistically significant after multivariable adjustment. Conclusion Longer transfer times were associated with higher rate of death, shock, and heart failure among patients undergoing inter-hospital transfer from PPCI, although this difference did not persist after adjusting for baseline characteristics. Clinical Trial Registration Information URL: www.clincaltrials.gov, Unique Identifier: NCT00091637

van Diepen, Sean; Widimsky, Petr; Lopes, Renato D.; White, Kyle R; Weaver, W. Douglas; Van de Werf, Frans; Ardissino, Diego; van't Hof, Arnoud W. J.; Armstrong, Paul W.; Granger, Christopher B.

2012-01-01

129

Clinical Outcome, and Survival Between Primary Percutaneous Coronary Intervention Versus Fibrinolysis in Patients Older Than 60 Years with Acute Myocardial Infarction  

PubMed Central

Objective: The aim of the present study was to compare the short-term and 6-month clinical outcome, and survival in patients older than 60 years with ST-elevation myocardial infarction randomized to either primary percutaneous coronary intervention (PPCI) or thrombolysis. Materials and Methods: 82 patients with STEMI older than 60 years were randomized to either primary PCI or thrombolysis from September 2006 to August 2008. Angiograms were reviewed by two interventionalists not involved in the study. Patients randomized to primary PCI received Aspirin and 600 mg Clopidogrel. Heparin was administered in conjunction with PCI. Patients randomized to thrombolysis received Aspirin followed by streptokinase infusion for one hour. Rescue PCI was considered if there was ongoing pain and ST-segment resolution was <50% at 90 min. after initiation of thrombolysis or chest pain recurred with ST-segment elevation within 24 hours. All patients were followed up for 6 months. End points were reinfarction and cardiac death using competing-risks regression estimation. Results: The mean time from hospital admission to start of streptokinase infusion was 31 ± 15 min and door to balloon time was 70 ± 25 min. There was no significant difference between the groups in the number of deaths and reinfarctions at 6 months. As expected, the fibrinolysis group had a higher rate of revascularization and heart failure. Conclusion: The higher rates of heart failure and need for revascularization in the fibrinolysis group reinforces benefits of PPCI in patients older than 60 years. PPCI in those who are 60 years and above with AMI is safe and cost effective.

Falsoleiman, H.; Fatehi, G. H.; Dehghani, M; Shakeri, M. T.; Bayani, Baktash; Ahmadi, Mostafa; Rohani, Atoosheh

2012-01-01

130

Interhospital transfer due to failed prehospital diagnosis for primary percutaneous coronary intervention: an observational study on incidence, predictors, and clinical impact  

PubMed Central

Background: For patients with ST-elevation myocardial infarction (STEMI), guidelines recommend prehospital triage and direct referral to a percutaneous coronary intervention (PCI)-capable centre in order to minimize ischemic time. However, few have studied failed prehospital diagnosis. We assessed the incidence, predictors, and clinical impact of interhospital transfer for primary PCI after initial referral to a non-PCI-capable centre due to a failed prehospital STEMI diagnosis. Methods: We studied 846 consecutive STEMI patients undergoing primary PCI between January 2008 and January 2010. Results: We found that 609 patients (72%) were directly admitted through prehospital triage and 127 patients (15%) required interhospital transfer after failed prehospital diagnosis. Median first medical contact to treatment time was 88 min in the prehospital diagnosis group and 155 min in the interhospital transfer group (p<0.001). In the interhospital transfer group, the first available electrocardiogram was diagnostic for STEMI in 77% of cases. Predictors of interhospital transfer were female gender, diabetes, prior myocardial infarction, and greater event location to PCI-capable centre distance. Interhospital transfer independently accounted for a 47% increase in ischemic time (95% CI 33 to 63%; p<0.001). One-year mortality was higher in the interhospital transfer group (10 vs. 5.3%; p=0.030). Conclusions: Despite an often-diagnostic electrocardiogram, interhospital transfer after failed prehospital diagnosis occurred in 15% of STEMI patients undergoing primary PCI. Interhospital transfer was a major predictor of ischemic time and 1-year mortality was significantly higher. Continuing efforts to optimize prehospital triage are warranted, especially among patients at higher risk of failed prehospital diagnosis.

Gu, Youlan L; Nijsten, Maarten W; de Vos, Ronald; Nieuwland, Wybe; Zijlstra, Felix; Hillege, Hans L; van der Horst, Iwan C; de Smet, Bart JGL

2013-01-01

131

Successful Triple Immuno - Enzymatic Method Employing Primary Antibodies from Same Species and Same Immunoglobulin Subclass  

PubMed Central

Protocols for immunohistochemical (IHC) detection of multiple antigens in the same tissue sections have been developed using primary antibodies directly conjugated to different enzymes or fluorochromes, or ones that have been raised in different species, or from different immunoglobulin (Ig) classes or subclasses. For antibodies lacking such dissimilarities, very few proposals have been published with varying degrees of generalizability. In this report we present a successful triple IHC protocol engaging three unconjugated monoclonal primary antibodies raised in the same species and of the same Ig subclass. Compared to other methods, our results showed that denaturation of the preceding reaction complex by microwave heating, combined with additional suppression of enzyme activity, enabled the detection of all three reactions by using the same detection system, with no cross reaction observed. Moreover, expression patterns of each of the three antigens in the triple stained sections, was found to be similar to the pattern observed when single staining was performed. Unlike previous reports, no damage of targeted antigens or tissues did occur following this protocol. Furthermore, the contrast of the colors employed was investigated by computerized color deconvolution, and the three reactions products were successfully separated into three individual images that could be used for further objective quantification.

Osman, T.A.; ?ijordsbakken, G.; Costea, D.E.; Johannessen, A.C.

2013-01-01

132

Intracoronary Compared to Intravenous Abciximab in Patients with ST Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention Reduces Mortality, Target Vessel Revascularization and Reinfarction after 1 Year  

Microsoft Academic Search

Objectives: Administration of the glycoprotein IIb\\/IIIa inhibitor abciximab to patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) improves outcome. Data have suggested that an intracoronary (IC) bolus might be superior to the standard intravenous (IV) administration. We have previously reported reduced short-term mortality and need for target vessel revascularization (TVR) with the IC route.

Allan Zeeberg Iversen; Soeren Galatius; Ulrik Abildgaard; Anders Galloe; Peter Riis Hansen; Sune Pedersen; Thomas Engstroem; Jan Skov Jensen

2011-01-01

133

Mean platelet volume predicts patency of the infarct-related artery before mechanical reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention  

Microsoft Academic Search

Background and aimsPatency of infarct-related artery (IRA) before mechanical reperfusion with primary percutaneous coronary intervention (PPCI) has been associated with better prognosis in patients with ST-Elevation myocardial infarction (STEMI). Mean platelet volume (MPV) increases in STEMI patients and may be associated with increased thrombotic potential. In STEMI patients scheduled for PPCI we sought to assess whether mean platelet volume (MPV),

Rodrigo Estévez-Loureiro; Jorge Salgado-Fernández; Raquel Marzoa-Rivas; Eduardo Barge-Caballero; Alberto Pérez-Pérez; Victor Noriega-Concepción; Ramón Calviño-Santos; José Manuel Vázquez-Rodríguez; Nicolás Vázquez-González; Alfonso Castro-Beiras; Juan Carlos Kaski

2009-01-01

134

Intracoronary versus intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: 6-month effects on infarct size and left ventricular function  

Microsoft Academic Search

Background  Administration of abciximab during primary percutaneous coronary intervention (PCI) reduces major adverse cardiac events (MACE)\\u000a in patients with ST-elevation myocardial infarction (STEMI). Intracoronary (IC) abciximab bolus application during PCI results\\u000a in high local drug concentration, improved perfusion, reduction of infarct size, and less microvascular obstruction early\\u000a after infarction. Aim of this study was to investigate whether the early benefits of

Ingo Eitel; Josef Friedenberger; Georg Fuernau; Annett Dumjahn; Steffen Desch; Gerhard Schuler; Holger Thiele

2011-01-01

135

Impact of admission blood glucose levels on prognosis of elderly patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention  

PubMed Central

Objective Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events. We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients (> 65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction. Methods We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ± 5.4). Patients were divided into two groups according to admission blood glucose levels. Group 1: low glucose group (LLG), glucose < 168 mg/dL; and Group 2: high glucose group (HGG), glucose > 168 mg/dL. Results In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P < 0.001). Multivariate regression analysis showed: Killip > 1, post-thrombolysis in MI < 3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P < 0.001). Conclusions Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality.

Ekmekci, Ahmet; Uluganyan, Mahmut; Tufan, Fatif; Uyarel, Huseyin; Karaca, Gurkan; Kul, Seref; Gungor, Bar?s; Ertas, Gokhan; Erer, Betul; Sayar, Nurten; Gul, Mehmet; Eren, Mehmet

2013-01-01

136

Bryophyte-Cyanobacteria Associations during Primary Succession in Recently Deglaciated Areas of Tierra del Fuego (Chile)  

PubMed Central

Bryophyte establishment represents a positive feedback process that enhances soil development in newly exposed terrain. Further, biological nitrogen (N) fixation by cyanobacteria in association with mosses can be an important supply of N to terrestrial ecosystems, however the role of these associations during post-glacial primary succession is not yet fully understood. Here, we analyzed chronosequences in front of two receding glaciers with contrasting climatic conditions (wetter vs drier) at Cordillera Darwin (Tierra del Fuego) and found that most mosses had the capacity to support an epiphytic flora of cyanobacteria and exhibited high rates of N2 fixation. Pioneer moss-cyanobacteria associations showed the highest N2 fixation rates (4.60 and 4.96 µg N g?1 bryo. d?1) very early after glacier retreat (4 and 7 years) which may help accelerate soil development under wetter conditions. In drier climate, N2 fixation on bryophyte-cyanobacteria associations was also high (0.94 and 1.42 µg N g?1 bryo. d?1) but peaked at intermediate-aged sites (26 and 66 years). N2 fixation capacity on bryophytes was primarily driven by epiphytic cyanobacteria abundance rather than community composition. Most liverworts showed low colonization and N2 fixation rates, and mosses did not exhibit consistent differences across life forms and habitat (saxicolous vs terricolous). We also found a clear relationship between cyanobacteria genera and the stages of ecological succession, but no relationship was found with host species identity. Glacier forelands in Tierra del Fuego show fast rates of soil transformation which imply large quantities of N inputs. Our results highlight the potential contribution of bryophyte-cyanobacteria associations to N accumulation during post-glacial primary succession and further describe the factors that drive N2-fixation rates in post-glacial areas with very low N deposition.

Arroniz-Crespo, Maria; Perez-Ortega, Sergio; De los Rios, Asuncion; Green, T. G. Allan; Ochoa-Hueso, Raul; Casermeiro, Miguel Angel; de la Cruz, Maria Teresa; Pintado, Ana; Palacios, David; Rozzi, Ricardo; Tysklind, Niklas; Sancho, Leopoldo G.

2014-01-01

137

Resource use efficiency and community effects of invasive Hypochaeris radicata (Asteraceae) during primary succession.  

PubMed

• Premise of the study: We sought to better understand the impacts and mechanisms underpinning a successful invasion of resource-poor sites by a nonnative plant on Mount St. Helens volcano (MSH). • Methods: We investigated the short-term effects of the nonnative plant Hypochaeris radicata on growth of native species colonizing drought-prone primary successional surfaces under N-limited and N-augmented conditions. To understand the success of H. radicata, we compared its resource use efficiency to that of a closely related native colonist, Hieracium albiflorum, under the same conditions. • Key results: Removing H. radicata did not affect growth of the most common colonists, but N addition demonstrated strong N limitation to growth in H. albiflorum, H. radicata, and Agrostis spp. Nonnative H. radicata exhibited lower water-use efficiency than H. albiflorum but did not differ in efficiency of N use. H. radicata biomass increased faster in response to an N pulse than did the native H. albiflorum, as did the pool of N held in H. radicata tissues. • Conclusions: Our findings contrast with results from Hawaiian volcanic sites, where higher short-term resource use efficiency was reported for invasive species, including H. radicata. Our results suggest that at MSH, the success of H. radicata relies on rapid uptake and utilization of N rather than on higher efficiency. This strategy is especially advantageous at MSH because N pulses commonly occur as a consequence of herbivore-induced mortality of Lupinus lepidus (Fabaceae). PMID:21616816

Schoenfelder, Anna C; Bishop, John G; Martinson, Holly M; Fagan, William F

2010-11-01

138

Effects of atorvastatin loading prior to primary percutaneous coronary intervention on endothelial function and inflammatory factors in patients with ST-segment elevation myocardial infarction  

PubMed Central

Previous studies have demonstrated the beneficial effect of statin loading prior to elective and early percutaneous coronary intervention (PCI), in which the ‘pleiotropic effects’ of statins may contribute to these clinical benefits. The aim of the present study was to examine the potential effects of atorvastatin loading prior to primary PCI on coronary endothelial function and inflammatory factors in patients with acute ST-segment elevation myocardial infarction (STEMI). A total of 60 patients with STEMI were randomized into three groups: Loading dose (80 mg atorvastatin prior to PCI; n=20), regular dose (20 mg atorvastatin prior to PCI; n=20) and control (without atorvastatin prior to PCI; n=20). The plasma samples were collected prior to, and immediately, 6 and 24 h after PCI in all the patients. The plasma concentrations of endothelial nitric oxide synthase (eNOS), nitric oxide (NO), interleukin-6 (IL-6), tumor necrosis factor-? (TNF-?) and intercellular adhesion molecule-1 (ICAM-1) were examined using ELISA. The plasma eNOS levels immediately and 24 h after PCI were significantly higher in the regular dose group compared with the other groups. However, there were no significant differences in the plasma eNOS concentration prior to and 6 h after PCI, or in the plasma NO concentration at any of the time-points among the three groups. The plasma IL-6 levels prior to PCI were significantly lower in the loading dose group compared with the other groups; however, there were no significant differences in the plasma concentration of IL-6 following PCI or in the concentrations of TNF-? and ICAM-1 at any of the time-points among the three groups. In conclusion, atorvastatin loading in patients with STEMI undergoing primary PCI may not have protective effects on endothelial function and the inflammatory reaction.

YONG, HUIJUAN; WANG, XIN; MI, LIN; GUO, LIJUN; GAO, WEI; ZHANG, YONGZHEN; CUI, MING

2014-01-01

139

Clopidogrel pretreatment in primary percutaneous coronary intervention: prevalence of high on-treatment platelet reactivity and impact on preprocedural patency of the infarct-related artery.  

PubMed

To date, there is limited data on levels of platelet inhibition achieved in patients with ST-elevation myocardial infarction (STEMI) who are loaded with clopidogrel and aspirin (ASA) prior to undergoing primary percutaneous coronary intervention (P-PCI). The aim of this investigation was to evaluate the percentage of STEMI patients with high on-treatment platelet reactivity (HPR) to clopidogrel at the time of initiating P-PCI and its association with the initial patency of the infarct-related artery (IRA). This prospective pharmacodynamic study included 50 STEMI patients, previously naïve to oral antiplatelet agents, who received 500-mg ASA and 600-mg clopidogrel loading doses prior to P-PCI. Platelet function assessment was performed at the beginning of the procedure using various assays, including VerifyNow™ system (primary endpoint), light transmission aggregometry and multiple electrode aggregometry. The percentage of patients with suboptimal response to clopidogrel and ASA assessed with the VerifyNow™ system was 88.0% and 28.6%, respectively. Similar results were obtained with the other assays used. A higher percentage of patients with initial patency of the IRA was observed among those patients without HPR compared with those with HPR to clopidogrel (66.7% vs 15.9%; p=0.013), while no differences were observed regarding postprocedural angiographic or electrocardiographic outcomes. In conclusion, this study shows that a high percentage of STEMI patients have inadequate levels of clopidogrel-induced and, to a lesser extent, aspirin-mediated platelet inhibition when starting a P-PCI procedure, and suggests that a poor response to clopidogrel might be associated with impaired initial TIMI flow in the IRA. PMID:23615769

Ferreiro, José Luis; Homs, Sílvia; Berdejo, Javier; Roura, Gerard; Gómez-Lara, Josep; Romaguera, Rafael; Teruel, Luis; Sánchez-Elvira, Guillermo; Marcano, Ana Lucrecia; Gómez-Hospital, Joan Antoni; Angiolillo, Dominick J; Cequier, Ángel

2013-07-01

140

Ultrasound-guided percutaneous renal biopsy-induced accessory renal artery bleeding in an amyloidosis patient  

PubMed Central

Abstract Ultrasound-guided percutaneous renal biopsy is an important technique for diagnosis of glomerular diseases, and the biopsy-induced life-threatening bleeding rarely happens. Primary systemic amyloidosis is a rare disease which may lead to organ dysfunction including arterial stiffness. The accessory renal artery is a kind of renal vascular variation which goes into the renal parenchyma directly or via the renal hilum. Here we reported a rare case of percutaneous renal biopsy-induced accessory renal artery life-threatening bleeding in a renal amyloidosis patient, and our experience of successful rescue in this patient. Virtual Slides http://www.diagnosticpathology.diagnomx.eu/vs/1524207344817819

2012-01-01

141

Idiopathic primary chylopericardium with associated chylothorax following coronary artery surgery--successful conservative treatment.  

PubMed

A 58-year-old Asian male underwent an uneventful triple coronary bypass that included a pedicled left internal mammary artery (LIMA) graft. On the third postoperative day, following resumption of full oral intake he developed a high output left-sided chylothorax. Initial therapy with a medium chain trigylceride diet and intercostal drainage showed no improvement. CT scan demonstrated a chylopericardium that was drained percutaneously. Complete resolution occurred 2 weeks later with adequate drainage and institution of total parenteral nutrition avoiding further surgery. We discuss the etiology and management of this rare complication following coronary surgery. PMID:18435645

Sachithanandan, Anand; Nanjaiah, Prakash; Rooney, Stephen J; Rajesh, Pala B

2008-01-01

142

Impact of renal insufficiency on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention  

PubMed Central

Background Chronic kidney disease is associated with increased risk of mortality. We examined the impact of moderate and severe renal insufficiency (RI) on short- and long-term mortality among unselected patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods From January 1, 2002 to December 31, 2010 all patients with STEMI treated with primary PCI were identified. The hazard ratio (HR) for death was estimated using a Cox regression model, controlling for potential confounders. RI was defined as creatinine clearance (CrCl)?primary PCI, moderate and severe RI were associated with increased risk of mortality.

2014-01-01

143

Incidence, determinants, and prognostic value of reverse left ventricular remodelling after primary percutaneous coronary intervention: results of the Acute Myocardial Infarction Contrast Imaging (AMICI) multicenter study  

PubMed Central

Aims Few data are available on the extent and prognostic value of reverse left ventricular remodelling (r-LVR) after ST-elevation acute myocardial infarction (STEMI). We sought to evaluate incidence, major determinants, and long-term clinical significance of r-LVR in a group of STEMI patients treated with primary percutaneous coronary intervention (PPCI). In particular, the role of preserved microvascular flow within the infarct zone in inducing r-LVR has been investigated. Methods and results Serial echocardiograms (2DE) and myocardial contrast study were obtained within 24 h of coronary recanalization (T1) and at pre-discharge (T2) in 110 reperfused STEMI patients. Follow-up 2DE was scheduled after 6 months (T3). Two-year clinical follow-up was obtained. Reverse remodelling was defined as a reduction >10% in LV end-systolic volume (LVESV) at 6 months follow-up. r-LVR occurred in 39% of study population. At multivariable analysis, independent predictors of r-LVR were an effective microvascular reflow within the infarct zone, the in-hospital improvement of myocardial perfusion, an initial large LVESV, and a short time to reperfusion. Cox analysis identified r-LVR as the only independent predictor of 2-year event-free survival. Combined events rate was significantly higher among patients without compared to those with r-LVR (log-rank test P < 0.05). Conclusion r-LVR frequently occurs in STEMI patients treated with PPCI and it is an important predictor of favourable long-term outcome. A preserved microvascular perfusion within the infarct zone is the major determinant of r-LVR.

Funaro, Stefania; La Torre, Giuseppe; Madonna, Mariapina; Galiuto, Leonarda; Scara, Antonio; Labbadia, Alessandra; Canali, Emanuele; Mattatelli, Antonella; Fedele, Francesco; Alessandrini, Francesco; Crea, Filippo; Agati, Luciano

2009-01-01

144

Patients with microvascular obstruction after primary percutaneous coronary intervention show a gp91phox (NOX2) mediated persistent oxidative stress after reperfusion  

PubMed Central

Background: Persistent oxidative stress may play a key role in microvascular obstruction (MVO). We aimed at assessing the role of platelet gp91phox (NOX2), the catalytic subunit of NADPH oxidase in MVO. Methods: We enrolled 40 patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention within 12 h from symptoms onset, either with angiographic MVO (n=20) or good angiographic myocardial reperfusion (MR) (n=20). Angiographic MVO was defined as a final thrombolysis in myocardial infarction (TIMI) flow ?2 or TIMI flow of 3 with myocardial blush grade <2. NOX2 and isoprostanes (8-iso-PGF2?) levels, as assessed by enzyme-linked immunoadsorbent assay (ELISA) or by an enzyme immunoassays, respectively, were measured on admission, at 24 h and pre-discharge. Results: NOX2 levels increased from baseline to pre-discharge in patients with angiographic MVO (20.25 (15–24.75) pg/ml vs 25.50 (17–29.25) pg/ml, p=0.02), but not in MR patients (p=0.45), with a significant interaction between baseline and pre-discharge levels among the two groups (p=0.04). The levels of 8-iso-PGF2? showed a trend to increase from baseline to pre-discharge in angiographic MVO patients (295 (183.50–389.25) pmol/l vs 322 (206–370) pmol/l, p=0.06), but not in patients with MR (p=0.56), with a trend for interaction between baseline and pre-discharge levels among the two groups (p=0.09). Conclusion: Patients with MVO, but not those with myocardial reperfusion, have a sustained increase of NOX2 and 8-iso-PGF2?. Therapies targeting NOX2 or high dosage antioxidants should be tested for MVO prevention and treatment.

Celestini, Andrea; Calvieri, Camilla; Cosentino, Nicola; Falcioni, Elena; Carnevale, Roberto; Nocella, Cristina; Fracassi, Francesco; Roberto, Marco; Antonazzo, Roberta P; Pignatelli, Pasquale; Crea, Filippo; Violi, Francesco

2013-01-01

145

Usefulness of the Platelet-to-Lymphocyte Ratio in Predicting Angiographic Reflow After Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction.  

PubMed

Impaired coronary flow after primary percutaneous coronary intervention (PPCI) is associated with short- and long-term morbidity and mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Recent studies have demonstrated that platelet-to-lymphocyte ratio (PLR) is associated with adverse cardiovascular outcomes. The aim of this study was to assess the relation between admission PLR and angiographic reflow after PPCI. A total of 520 patients with acute STEMI (age 60 ± 13 years; 74% men) occurring within 12 hours of the onset of symptoms who underwent PPCI were enrolled. The PLR and other laboratory parameters were measured before PPCI. The patients were divided into 2 groups based on the postintervention Thrombolysis in Myocardial Infarction (TIMI) flow grade: normal-reflow group (defined as postintervention TIMI grade 3 flow) and none-reflow group (consisted of both patients with angiographic no-reflow defined as postintervention TIMI grades 0 to 1 flow and slow flow defined as postintervention TIMI grade 2 flow). There were 117 patients (22.5%) in the none-reflow group (age 68 ± 13 years and 77% men) and 403 patients in the normal-reflow group (age 58 ± 12 years and 63% men). The none-reflow group had significantly higher PLR compared with the normal-reflow group (219 ± 79 vs 115 ± 59, p <0.001). In logistic regression analysis, PLR (odds ratio 1.818, 95% confidence interval 1.713 to 1.980, p <0.001) and total stent length (OR 1.052, confidence interval 1.019 to 1.086, p = 0.002) were independent predictors of none-reflow after PPCI. In conclusion, preintervention PLR is a strong and independent predictor of slow flow/no-reflow after PPCI in patients with acute STEMI. PMID:24948493

Kurtul, Alparslan; Yarlioglues, Mikail; Murat, Sani Namik; Ergun, Gokhan; Duran, Mustafa; Kasapkara, Haci Ahmet; Demircelik, Muhammed Bora; Cetin, Mustafa; Ocek, Adil Hakan

2014-08-01

146

Dexmedetomidine as a Procedural Sedative for Percutaneous Tracheotomy: Case Report and Systematic Literature Review  

PubMed Central

Purpose. To describe the successful use of dexmedetomidine as the primary procedural sedative for a percutaneous tracheotomy procedure and to systematically present the supporting literature. Materials and Methods. A Case report of our experience and systematic literature search. PubMed, Embase, and Google Scholar were searched without restriction using the key words dexmedetomidine, percutaneous tracheotomy, and tracheotomy procedure. All relevant published references were retrieved irrespective of their methodological quality. Results. In total, only 3 relevant references were found. These include one small placebo controlled randomized trial and 2 case reports. The randomized, placebo controlled trial enrolled patients already sedated on midazolam and included 64 total patients. The 2 other case reports both described the use of dexmedetomidine as the primary procedural sedative. All of the cases reported the successful completion of the percutaneous tracheotomy without any major complication, but none reported the subjective patient experience. Conclusion. Based on the available published literature and our experience, we suggest that dexmedetomidine be considered for use as the primary procedural sedative for percutaneous tracheotomy procedure. Dexmedetomidine's ability to provide adequate sedation and amnesia, without blunting the respiratory drive and protective reflexes of the patient, may make it an optimal agent in specific cases.

Perrott, Jerrold L.; Co, Michelle T.; Reynolds, Steven C.; Gunning, Derek J. R.

2012-01-01

147

Out-of-hours primary percutaneous coronary intervention for ST-elevation myocardial infarction is not associated with excess mortality: a study of 3347 patients treated in an integrated cardiac network  

PubMed Central

Objectives Timely delivery of primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-segment elevation myocardial infarction (STEMI). Optimum delivery of PPCI requires an integrated network of hospitals, following a multidisciplinary, consultant-led, protocol-driven approach. We investigated whether such a strategy was effective in providing equally effective in-hospital and long-term outcomes for STEMI patients treated by PPCI within normal working hours compared with those treated out-of-hours (OOHs). Design Observational study. Setting Large PPCI centre in London. Participants 3347 STEMI patients were treated with PPCI between 2004 and 2012. The follow-up median was 3.3?years (IQR: 1.2–4.6?years). Primary and secondary outcome measures The primary endpoint was long-term major adverse cardiac events (MACE) with all-cause mortality a secondary endpoint. Results Of the 3347 STEMI patients, 1299 patients (38.8%) underwent PPCI during a weekday between 08:00 and 18:00 (routine-hours group) and 2048 (61.2%) underwent PPCI on a weekday between 18:00 and 08:00 or a weekend (OOHs group). There were no differences in baseline characteristics between the two groups with comparable door-to-balloon times (in-hours (IHs) 67.8?min vs OOHs 69.6?min, p=0.709), call-to-balloon times (IHs 116.63 vs OOHs 127.15?min, p=0.60) and procedural success. In hospital mortality rates were comparable between the two groups (IHs 3.6% vs OOHs 3.2%) with timing of presentation not predictive of outcome (HR 1.25 (95% CI 0.74 to 2.11). Over the follow-up period there were no significant differences in rates of mortality (IHs 7.4% vs OFHs 7.2%, p=0.442) or MACE (IHs 15.4% vs OFHs 14.1%, p=0.192) between the two groups. After adjustment for confounding variables using multivariate analysis, timing of presentation was not an independent predictor of mortality (HR 1.04 95% CI 0.78 to 1.39). Conclusions This large registry study demonstrates that the delivery of PPCI with a multidisciplinary, consultant-led, protocol-driven approach provides safe and effective treatment for patients regardless of the time of presentation.

Rathod, Krishnaraj S; Jones, Daniel A; Gallagher, Sean M; Bromage, Daniel I; Whitbread, Mark; Archbold, Andrew R; Jain, Ajay K; Mathur, Anthony; Wragg, Andrew; Knight, Charles J

2013-01-01

148

Development of a primary-care tool to assess treatment success in COPD: consensus report from a closed meeting of respiratory and primary-care specialists  

Microsoft Academic Search

A 1-day meeting, attended by invited respiratory and primary-care specialists all of whom had an international profile and a specific interest in Chronic Obstructive Pulmonary Disease (COPD), considered specific research recommendations from the Global Initiative in Obstructive Lung Disease (GOLD) workshop report. Attendees discussed developing a tool to complement spirometry and help primary-care physicians assess treatment success in patients with

Jim Reid; David Price; Thys van der Molen; Bruno Housset; José Jardim; Paul Jones; Peter Kardos; Jean-François Muir; Pierluigi Paggiaro; Stephen Rennard; Emiel Wouters

2004-01-01

149

Contemporary analysis of incidence and outcomes of stent thrombosis presenting as ST elevation myocardial infarction in a primary percutaneous coronary intervention cohort.  

PubMed

There are limited data about the effectiveness of primary percutaneous coronary intervention (PPCI) for stent thrombosis treatment. We aimed to evaluate the prevalence and outcomes of PPCI in patients with ST elevation acute myocardial infarction (STEMI) due to stent thrombosis, and comparing the outcomes with patients treated for de novo coronary thrombosis. This was an observational cohort study of 2,935 patients who underwent PPCI from 2003 to 2011 with follow-up for a median of 3.0 years (interquartile range 1.2 to 4.6). The primary end point was the first major adverse cardiac event (MACE) defined as death, nonfatal myocardial infarction, stroke, or target vessel revascularization. Stent thrombosis overall accounted for 6.6% (194 of 2,935) of all STEMIs with a proportion that increased over time (3.3% in 2004 to 9.4% in 2011). A total of 34.5% were early, 30.9% late stent thrombosis, and 34.5% were very late stent thrombosis. Indications for the original intervention were elective in 27.8%, after acute coronary syndrome (non-STEMI or unstable angina) in 21.1%, and after PPCI in 51.1%. Patients with stent thrombosis had higher rates of hypertension, hypercholesterolemia, diabetes, renal dysfunction, and previous myocardial infarction or coronary artery bypass surgery compared with patients with native artery occlusion. MACE rates were higher in patients with stent thrombosis compared with patients with native artery occlusions (40.9%, 95% confidence interval [CI] 31.1 to 50.6 vs 15.1%, 95% CI 12.5 to 18.3; p <0.0001). The poor outcome of stent thrombosis was particularly associated with early and late stent thromboses. Very late stent thrombosis appears to be a relatively less serious event, with similar outcomes to native vessel thromboses (MACE very late stent thrombosis 16.5%, 95% CI 8.2 to 28.6 vs native 15.1%, 95% CI 12.5 to 18.3, p = 0.245). In conclusion, stent thrombosis accounts for an increasing proportion of STEMI and is associated with worse outcomes compared with native artery occlusion. PMID:24012030

Jones, Daniel A; Gallagher, Sean; Rathod, Krishnaraj S; Akhtar, Mohammed; Knight, Charles J; Rothman, Martin T; Kapur, Akhil; Mathur, Anthony; Jain, Ajay K; Timmis, Adam D; Smith, Elliot J; Wragg, Andrew

2013-11-01

150

'Sax-sess'-- genetics of primary succession in a pioneer species on two parallel glacier forelands.  

PubMed

The primary succession on glacier forelands is characterized by a sequence of early and late successional species, but whether there is also a chronosequence at the intraspecific, genetic level is a matter of debate. Two opposing hypotheses differ in their prediction of genetic diversity in colonizing populations due to founder effects and postcolonization gene immigration. The development of genetic diversity in the pioneer Saxifraga aizoides was investigated along a successional gradient on two parallel glacier forelands, in order to test whether populations from older successional stages were less genetically diverse than populations from younger successional stages, and to locate the sources of the propagules that originally colonized new glacier foreland. Genetic diversity was determined with amplified fragment length polymorphisms, and potential sources of colonizing propagules were assessed via assignment tests. Our results indicate considerable postcolonization gene flow among populations on glacier forelands, since population differentiation was low and genetic diversity within populations was significantly higher. Molecular diversity and differentiation of populations did not develop linearly. Dispersal events within the glacier foreland, from the adjacent valley slopes, and from parallel glacier valleys were identified. In summary, it seems that the colonization of glacier forelands in the European Alps is highly dynamic and stochastic. PMID:16842417

Raffl, C; Schönswetter, P; Erschbamer, B

2006-08-01

151

Percutaneous Ablation of Adrenal Tumors  

PubMed Central

Adrenal tumors comprise a broad spectrum of benign and malignant neoplasms, and include functional adrenal adenomas, pheochromocytomas, primary adrenocortical carcinoma and adrenal metastases. Percutaneous ablative approaches that have been described and used in the treatment of adrenal tumors include percutaneous radiofrequency ablation (RFA), cryoablation, microwave ablation and chemical ablation. Local tumor ablation in the adrenal gland presents unique challenges, secondary to the adrenal gland’s unique anatomic and physiologic features. The results of clinical series employing percutaneous ablative techniques in the treatment of adrenal tumors are reviewed in this article. Clinical and technical considerations unique to ablation in the adrenal gland are presented, including approaches commonly used in our practices, and risks and potential complications are discussed.

Venkatesan, Aradhana M.; Locklin, Julia; Dupuy, Damian E.; Wood, Bradford J.

2010-01-01

152

The Role of Percutaneous Endopyelotomy for Ureteropelvic Junction Obstruction  

PubMed Central

INTRODUCTION Over the last 20 years, the surgical management of ureteropelvic junction obstruction (UPJO) has been revolutionised by the development of endourological instrumentation and several minimally invasive procedures including: antegrade or retrograde endopyelotomy, retrograde balloon dilatation, and laparoscopic pyeloplasty. Currently, in our department, we offer percutaneous antegrade endopyelotomy (PAE) as primary treatment of UPJO in adults, believing it offers less morbidity, better cosmetic results, and quicker operating time compared with open pyeloplasty. PATIENTS AND METHODS We performed a retrospective audit of our results for the 14 patients who underwent percutaneous antegrade endopyelotomy between January 2000 and May 2004. RESULTS Mean operative time was 53 min (range, 30–80 min), mean in-patient stay was 3.8 days (range, 2–7 days), and there were no major postoperative complications for this series with mean follow-up of 31.8 months (range, 12–52 months). Eleven out of the 14 patients (79%) showed radiological improvement on their 3-month MAG 3 (mercaptoacetyl-triglycyl) renogram, and 13 out of the 14 (93%) patients reported significant reduction or resolution of pain, compared with their preoperative state. CONCLUSIONS The majority of urologists still offer open pyeloplasty as primary treatment for UPJO with laparoscopic pyeloplasty currently an evolving procedure in the UK. Our series reports comparable success rates for PAE compared to other series. Despite these results, we feel that the future role of percutaneous endopyelotomy will be as a salvage procedure following failed open or laparoscopic surgery. However, in patients with concurrent stone disease or requiring antegrade ureteric access, percutaneous endopyelotomy would be suitable as a primary treatment option.

Rukin, NJ; Ashdown, DA; Patel, P; Liu, S

2007-01-01

153

Intracoronary fixed dose of nitroprusside via thrombus aspiration catheter for the prevention of the no-reflow phenomenon following primary percutaneous coronary intervention in acute myocardial infarction  

PubMed Central

Previous studies have shown that intracoronary (IC) nitroprusside (NTP) injection is a safe and effective strategy for the treatment of no-reflow (NR) during percutaneous coronary intervention (PCI). The present study tested the hypothesis that, on the basis of thrombus aspiration for the treatment of ST-segment elevation myocardial infarction (STEMI), the selective IC administration of a fixed dose of NTP (100 ?g) plus tirofiban is a safe and superior treatment method compared with the IC administration of tirofiban alone for the prevention of NR during primary PCI. A total of 162 consecutive patients with STEMI, who underwent primary PCI within 12 h of onset, were randomly assigned to two groups: Group A, IC administration of a fixed dose of NTP (100 ?g) plus tirofiban (10 ?g/kg) and group B, IC administration of tirofiban (10 ?g/kg) alone (n=80 and n=82, respectively). The drugs were selectively injected into the infarct-related artery (IRA) via a thrombus aspiration catheter advanced into the IRA. The primary end-point was post-procedural corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC). The proportion of complete (>70%) ST-segment resolution (STR); the TIMI myocardial perfusion grade (TMPG) 2–3 ratio following PCI; the peak value of creatine kinase (CK)-MB; the TIMI flow grade; the incidence of major adverse cardiac events (MACEs) and the left ventricular ejection fraction (LVEF) after 6 months of follow-up were observed as the secondary end-points. There were no significant differences in the baseline clinical and angiographic characteristics between the two groups. Compared with group B, group A had i) a lower CTFC (23±7 versus 29±11, P=0.000); ii) a higher proportion of complete STR (72.5 versus 55.9%, P=0.040); iii) an enhanced TMPG 2–3 ratio (71.3 versus 53.7%, P=0.030) and iv) a lower peak CK-MB value (170±56 versus 210±48 U/l, P=0.010). There were no statistically significant differences in the final TIMI grade-3 flow between the two groups (92.5 versus 91.5% for groups A and B, respectively; P=0.956). The LVEF at 6 months was higher in group A than group B (63±9 versus 53±11%, respectively; P=0.001); however, the incidence of MACEs was not statistically different between the two groups, although there was a trend indicating improvement in group A (log rank ?2=0.953, P=0.489). The selective IC administration of a fixed dose of NTP (100 ?g) plus tirofiban via a thrombus aspiration catheter advanced into the IRA is a safe and superior treatment method compared with tirofiban alone in patients with STEMI undergoing primary PCI. This novel therapeutic strategy improves the myocardial level perfusion, in addition to reducing the infarct size. Furthermore, it may improve the postoperative clinical prognosis following PCI.

ZHAO, YU-JUN; FU, XIANG-HUA; MA, XIAO-XIAO; WANG, DONG-YING; DONG, QIU-LI; WANG, YAN-BO; LI, WEI; XING, KUN; GU, XIN-SHUN; JIANG, YUN-FA

2013-01-01

154

Impact of initial platelet count on baseline angiographic finding and end-points in ST-elevation myocardial infarction referred for primary percutaneous coronary intervention  

PubMed Central

The baseline platelet count (BPC) in patients with acute ST elevation myocardial infarction (STEMI) may reflect the baseline anjiografic finding and may also predic long-term outcomes after primary percutaneous coronary intervention (PPCI). Available data for the value of BPC in patients with STEMI treated with PPCI are still questionable. Therefore, we sought to determine the prognostic value of BPC for baseline angiographic finding and the impact of BPC on clinical outcomes of patients treating with PPCI. Blood sample for BPC was obtained on admission in 140 consecutive patients undergoing PPCI. Patients were divided 2 groups that group-1 (104 patients): TIMI flow-grade 0 and group-2 (36 patients): TIMI flow-grade 1-3. Follow-up was performed at 1-9 months. Baseline demographics were comparable, but, BPC was significantly higher in group-1 comparing 2 (293.7±59.8x109/L vs. 237.7±50.9x109/L, p<0.0001), pre-procedural lesion length longer in group-1 comparing 2 (13.6±3.6 mm vs. 11.4±3.9 mm, p:0.003). Distal embolization (19.0% vs. 0.0%, p:0.001), slow-flow (15.2% vs. 2.9%, p:0.033) were more common in group-1 and mean maximum troponin-I level (9.1±4.2 ?g/L vs. 5.1±3.9 ?g/L, p<0.0001) and mean maximum creatinin kinase (2077.6±1378.4 U/L vs. 1163.4±869.7 U/L, p:<0.0001) were higher in group-1. In-hospital and 30-days major cardiac adverse events (MACEs) (16.5% vs. 5.7%), p:0.14) were similarly in both groups, but, at 6-months target vessel revascularization (13.9% vs. 0.0%, p:0.017) and MACEs significantly higher in the group-1 (24.1% vs. 2.9%, p:0.013). Conclusion: A higher BPC without any antithrombotic agent is a strongly predictor of total occlusion of IRA in STEMI treated with PPCI. And a higher BPC associated with poor clinical outcomes at 9-months. Apart from prognostic value, measuring of a BPC on admission may also provide further practical and therapeutic profits.

Kaplan, Sahin; Kaplan, Safiye Tuba; Kiris, Abdulkadir; Gedikli, Omer

2014-01-01

155

Percutaneous Image-guided cryoablation for localized bone plasmacytoma treatment.  

PubMed

Bone plasmacytoma (BP) occurs in most patients with multiple myeloma and is highly disabling. Radiotherapy is the primary treatment modality for BP and, although local control rates are excellent, several weeks are needed before the treatment is completed and for patients to note significant pain relief. Over the past decade, percutaneous image-guided cryoablation has emerged as a safe and effective alternative in the management of localized bone metastasis in solid tumours. In this report the author's show that a localized BP was successfully treated using this procedure. Furthermore, some of the most relevant potential advantages that makes this procedure more attractive than other alternative techniques are highlighted. PMID:22621822

Duarte, R; Pereira, T; Pinto, P; Coelho, H

2012-05-21

156

Effect of 5E Instructional Model in Student Success in Primary School 6th Year Circulatory System Topic  

ERIC Educational Resources Information Center

The aim of this study is to research the effect of the 5E instructional model on primary (sixth grade) student success during the circulatory system unit. This study was conducted with 38 students in two different classes by the same researcher in 2006-2007. One of the classes was assigned as the control group and the other as the experimental…

Cardak, Osman; Dikmenli, Musa; Saritas, Ozge

2008-01-01

157

Successful surgical treatment of a primary liver gastrinoma during pregnancy: a case report.  

PubMed

Primary neuroendocrine tumors of the liver, particularly gastrinomas, are exceptionally rare. We present a case of a sporadic primary liver gastrinoma in a young woman in whom the definitive diagnosis was reached, and surgical therapy was performed during pregnancy. PMID:15547548

Delgado, Jorge; Delgado, Bertha; Sperber, Ami D; Fich, Alex

2004-11-01

158

Prospective evaluation of complications using the modified Clavien grading system, and of success rates of percutaneous nephrolithotomy using Guy's Stone Score: A single-center experience  

PubMed Central

Introduction and Objectives: To prospectively document the perioperative complications of percutaneous nephrolithotomy (PCNL) using the modified Clavien grading system. Evaluation of complications and clearance rates according to stone complexity using the validated Guy's Stone Score (GSS) was also done. Materials and Methods: A total of 221 renal units underwent 278 PCNL procedures at a urology resident training center between September 2010 and September 2011 and data were recorded prospectively in our registry. Patients with co-morbidities like diabetes, renal failure, hypertension and cardiopulmonary diseases were excluded. Stone complexity was classified according to the GSS while peri-operative complications were recorded using the modified Clavien grading system. Results: Two hundred and forty-five complications were encountered in 278 PCNL procedures involving 116 renal units (41.72%). Complications of Grades 1, 2, 3a, 3b, 4a, 4b and 5 were seen in 52 (18.7%), 122 (43.8%), 42 (15.1%), 18 (6.4%), 6 (2.1%), 4 (1.4%) and 1 (0.3%) renal units respectively. There were 68, 98, 50 and 5 renal units in GSS I, II, III and IV groups, respectively. All grades of complications were more common in GSS III and IV (P<0.05). For GSS I, II, III and IV 100%, 74%, 56% and 0% of renal units, respectively, were stone-free after one session and 0%, 24%, 44% and 60% respectively needed two sessions to be stone-free. Conclusion: Although the complication rates were higher most were of low grade and self-limiting. Complications were significantly more common with higher GSS and the GSS effectively predicted stone-free rates.

Mandal, Swarnendu; Goel, Apul; Kathpalia, Rohit; Sankhwar, Satyanarayan; Singh, Vishwajeet; Sinha, Rahul J.; Singh, Bhupender P.; Dalela, Divakar

2012-01-01

159

Sequential thallium-201 myocardial perfusion studies after successful percutaneous transluminal coronary artery angioplasty: delayed resolution of exercise-induced scintigraphic abnormalities  

SciTech Connect

To characterize the sequential changes of myocardial perfusion scintigraphy in patients with coronary artery disease (CAD) after complete revascularization, 43 patients underwent exercise thallium-201 (/sup 201/Tl) myocardial perfusion scintigraphy before and at 9 +/- 5 days, 3.3 +/- 0.6, and 6.8 +/- 1.2 months after percutaneous transluminal coronary angioplasty (PTCA). Only patients with single-vessel CAD, without previous myocardial infarction, and without evidence of restenosis at 6 to 9 months after PTCA were included. Perfusion scans were analyzed blindly with the use of a new quantitative method to define regional myocardial perfusion in the topographic distribution of each coronary artery, which was shown to be reproducible (r = .94 or higher and SEE of 7% or less, between repeated measures by one and two operators). At 4 to 18 days after PTCA, the mean treadmill walking time increased by 123 +/- 42 sec, mean exercise-induced ST segment depression decreased by 0.6 +/- 0.3 mm, group maximal heart rate increased by 20 +/- 9 beats/min, and group systolic blood pressure at peak exercise increased by 24 +/- 10 mm Hg, compared with pre-PTCA values (p less than .001). However, no group differences were noted in these variables between the three post-PTCA stages. Myocardial perfusion in the distribution of the affected (dilated) coronary artery, on the other hand, improved progressively. In the 45 degree left anterior oblique view for instance, myocardial perfusion increased at 9 days after PTCA (from 68 +/- 24% before PTCA to 91 +/- 9%, p less than .001) and at 3.3 months after PTCA (101 +/- 8%, p less than .05 vs 9 days after PTCA), but no further significant changes were seen at 6.8 months after PTCA (102 +/- 8%). Similar changes were noted in the other two views. No relationship between minor complications during PTCA and delayed improvement on the /sup 201/Tl was observed.

Manyari, D.E.; Knudtson, M.; Kloiber, R.; Roth, D.

1988-01-01

160

Organizational Culture in a Successful Primary School: An Ethnographic Case Study  

ERIC Educational Resources Information Center

Even though they are perceived similar from outside, all schools have distinct characteristics and a culture that differ them from other schools. School culture, is one of the important factors that play role in school efficiency and success. The purpose of this study was to examine the culture of a successful school profoundly. This study was a…

Negis-Isik, Ayse; Gursel, Musa

2013-01-01

161

A Case of Primary Subglottic Malignant Melanoma with a Successful Surgical Treatment  

PubMed Central

Primary subglottic malignant melanoma is a very rare and underdiagnosed neoplasm. We are reporting a case of primary malignant melanoma of subglottic mucosa in a 78-year-old woman who presented to our hospital with shortness of breath and hoarseness of voice. Laryngoscopy and excisional biopsy along with immunoreactivity to S-100 and human melanoma black-45 (HMB-45) confirmed the diagnosis. The patient was treated with laryngectomy followed by radiotherapy. Five years following surgical treatment, she continues to be asymptomatic. To our knowledge, there is only one reported case of primary malignant melanoma of subglottic mucosa in the medical literatures.

Goldblatt, Curtis; Stark, Owen; Masciotra, Nicholas

2014-01-01

162

Different Impact of Diabetes Mellitus on In-Hospital and 1-Year Mortality in Patients with Acute Myocardial Infarction Who Underwent Successful Percutaneous Coronary Intervention: Results from the Korean Acute Myocardial Infarction Registry  

PubMed Central

Background/Aims The aim of this study was to evaluate the impact of diabetes mellitus (DM) on in-hospital and 1-year mortality in patients who suffered acute myocardial infarction (AMI) and underwent successful percutaneous coronary intervention (PCI). Methods Among 5,074 consecutive patients from the Korea AMI Registry with successful revascularization between November 2005 and June 2007, 1,412 patients had a history of DM. Results The DM group had a higher mean age prevalence of history of hypertension, dyslipidemia, ischemic heart disease, high Killip class, and diagnoses as non-ST elevation MI than the non-DM group. Left ventricular ejection fraction (LVEF) and creatinine clearance were lower in the DM group, which also had a significantly higher incidence of in-hospital and 1-year mortality of hospital survivors (4.6% vs. 2.8%, p = 0.002; 5.0% vs. 2.5%, p < 0.001). A multivariate analysis revealed that independent predictors of in-hospital mortality were Killip class IV or III at admission, use of angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers, LVEF, creatinine clearance, and a diagnosis of ST-elevated MI but not DM. However, a multivariate Cox regression analysis showed that DM was an independent predictor of 1-year mortality (hazard ratio, 1.504; 95% confidence interval, 1.032 to 2.191). Conclusions DM has a higher association with 1-year mortality than in-hospital mortality in patients with AMI who underwent successful PCI. Therefore, even when patients with AMI and DM undergo successful PCI, they may require further intensive treatment and continuous attention.

Park, Keun-Ho; Jeong, Myung Ho; Chae, Shung Chull; Hur, Seung Ho; Kim, Young Jo; Seong, In Whan; Chae, Jei Keon; Hong, Taek Jong; Cho, Myeong Chan; Bae, Jang Ho; Rha, Seung Woon; Jang, Yang Soo

2012-01-01

163

Primary bone marrow B-cell non-Hodgkin's lymphoma successfully treated with R-CHOP.  

PubMed

Primary isolated bone marrow disease as a presenting feature of lymphoma is very rare. We describe the case of a Chinese with isolated bone marrow small B-cell lymphoma as a first manifestation. A 55-year old woman was admitted to our hospital with fever. Her peripheral blood smear and laboratory findings were suggestive of bicytopenia. Bone marrow specimen showed diffusely distributed small-sized lymphocytes. Combined with immunophenotypic and chromosomal analysis, a diagnosis of primary bone marrow B-cell non-Hodgkin's lymphoma was made. The patient was treated with R-CHOP (rituximab and cyclophosphamide, epirubicin, vindesine, and prednisone) regimen for six cycles. She had complete remission and is still alive without relapse. We concluded that primary bone marrow mature small B-cell lymphoma is a rare but distinctive subtype of lymphoma. The prognosis for this entity is poor but rituximab-based treatment is promising for improving its outcomes. PMID:24171336

Qian, Liren; Zhang, Zhi; Shen, Jianliang; Liu, Yi

2013-01-01

164

Central Die-back of Monoclonal Stands of Reynoutria japonica in an Early Stage of Primary Succession on Mount Fuji  

Microsoft Academic Search

Reynoutria japonicais a common perennial pioneer species on Japanese volcanoes. In a volcanic desert (1500m above sea level) on Mount Fuji (3776m), central Japan, this species forms circular stands (patches). As a patch develops, shoot density decreases in its centre (‘central die-back’). The central die-back has been considered a key process in the early stages of primary succession, though its

NAOKI ADACHI; ICHIRO TERASHIMA; MASAYUKI TAKAHASHI

1996-01-01

165

A Case of Successful Remission of Extensive Primary Gastric Diffuse Large B Cell Lymphoma: Radiologic, Endoscopic and Pathologic Evidence  

PubMed Central

Though rare amongst stomach neoplasms, primary gastric diffuse large B cell lymphoma is one of the commonest extranodal non-Hodgkin lymphomas. If left untreated, it can have a devastating progression and life-threatening consequences. We present the case of a successfully treated large antral ulcer confirmed to be large B cell lymphoma as evidenced by radiologic, endoscopic and histopathologic findings. A brief discussion about the types of gastric lymphoma, their Helicobacter pylori relation and therapeutic modalities follows.

Bismar, Mike M.; Alasadi, Mazen; Hendawy, Bassem S.; Waness, Abdelkarim

2014-01-01

166

Accumulation of nitrogen and organic matter during primary succession of Leymus arenarius dunes on the volcanic island Surtsey, Iceland  

NASA Astrophysics Data System (ADS)

The volcanic island of Surtsey has been a natural laboratory where the primary succession of flora and fauna has been monitored, since it emerged from the N-Atlantic Ocean in 1963. We quantified the accumulation rates of nitrogen (N) and soil organic matter (SOM) in a 37 year long chronosequence of Leymus arenarius dunes in order to illuminate the spatiotemporal patterns in their build-up in primary succession. The Leymus dune area, volume and height grew exponentially over time. Aboveground plant biomass, cover or number of shoots per unit area did not change significantly with time, but root biomass accumulated with time, giving a root-shoot ratio of 19. The dunes accumulated on average 6.6 kg N ha-1 year-1, which was 3.5 times more than is received annually by atmospheric deposition. The extensive root system of Leymus seems to effectively retain and accumulate large part of the annual N deposition, not only deposition directly on the dunes but also from the adjacent unvegetated areas. SOM per unit area increased exponentially with dune age, but the accumulation of roots, aboveground biomass and SOM was more strongly linked to soil N than time: 1 g m-2 increase in soil N led on the average to 6 kg C m-2 increase in biomass and SOM. The Leymus dunes, where most of the N has been accumulated, will therefore probably act as hot-spots for further primary succession of flora and fauna on the tephra sands of Surtsey.

Stefansdottir, G.; Aradottir, A. L.; Sigurdsson, B. D.

2014-05-01

167

Myocardial viability assessed by Dobutamine echocardiography in acute myocardial infarction after successful primary coronary angioplasty  

Microsoft Academic Search

Dobutamine echocardiography (5 and 10 ?g\\/kg\\/ min) was performed in 40 patients 4 ± 1 days after acute myocardial infarction reperfused by primary coronary angioplasty. The left ventricle was divided into 11 segments. Reversible myocardial dysfunction was indicated by a decrease in at least 2 grades in the total segmental score. Follow-up echocardiography was performed 2 months later. Contractile reserve

Florence Leclercq; Patrick Messner-Pellenc; Christophe Moragues; François Rivalland; Denis Carabasse; Jean-Marc Davy; Robert Grolleau-Raoux

1997-01-01

168

Using Literacy Booster Groups To Maintain and Extend Reading Recovery Success in the Primary Grades.  

ERIC Educational Resources Information Center

Describes a comprehensive school literacy program for primary students and looks specifically at one component, Literacy Booster Groups. Notes that in Booster Groups, former Reading Recovery students receive extra support to maintain and extend literacy progress. Concludes that students who were once functioning at the bottom of their class are…

MacKenzie, Karla K.

2001-01-01

169

CT-Guided Percutaneous Cryoablation for Osteoid Osteoma: Initial Experience in Adults.  

PubMed

OBJECTIVE. The purpose of this study was to investigate the safety and efficacy of CT-guided percutaneous cryoablation for the treatment of osteoid osteoma in adults. MATERIALS AND METHODS. A retrospective case series over a 30-month period involved 10 consecutive adult patients (nine male and one female patients; mean age, 27.9 years; age range, 16-49 years) who underwent CT-guided percutaneous cryoablation for management of osteoid osteoma. Clinical and technical success was evaluated with postprocedure MRI at 4-5 weeks and with digital numeric pain scores taken before and immediately after the procedure, as well as at primary follow-up (4-10 weeks; average, 5 weeks) and secondary follow-up (23-29 weeks; average, 24 weeks). RESULTS. Clinical and technical success rates were 100%. Average digital numeric pain scores were 7.4 before the procedure, 1.5 after procedure, 0.5 at the primary follow-up, and 0.3 at secondary follow-up. No minor or major complications were noted during the procedure, recovery period, primary follow-up, or secondary follow-up. CONCLUSION. CT-guided percutaneous cryoablation is safe and effective in the treatment of osteoid osteoma in adults. PMID:24758671

Coupal, Tyler M; Mallinson, Paul I; Munk, Peter L; Liu, David; Clarkson, Paul; Ouellette, Hugue

2014-05-01

170

Facilitating Primary Head Teacher Succession in England: The Role of the School Business Manager  

ERIC Educational Resources Information Center

School leadership is significant for student learning, but increased workload and complexity are believed to be in part responsible for the difficulties internationally in managing succession, with experienced leaders leaving the profession prematurely and potential future leaders reluctant to take on the role. This article draws on a national…

Woods, Charlotte; Armstrong, Paul; Pearson, Diana

2012-01-01

171

Predicting Success on a Bachelor of Arts Primary Education Degree Course  

ERIC Educational Resources Information Center

Background: Successfully selecting students for undergraduate courses and for teaching is notoriously difficult. Traditionally, in England, A level grades and interviews have been used in conjunction with a variety of other approaches. Purpose: This paper examines the predictive validity of students' A level grades and of scores from a structured…

Barmby, Patrick; Bolden, David; Higgins, Steve; Tymms, Peter

2012-01-01

172

Planning for Leadership Succession: Creating a Talent Pool in Primary Schools  

ERIC Educational Resources Information Center

This article reports on a study that was funded by the National College for School Leadership in order to explore practices, drivers and barriers to leadership talent identification, leadership development, leadership succession planning and leadership retention within a group of contextually different schools. The article offers two narratives…

Brundrett, Mark; Rhodes, Christopher; Gkolia, Chrysanthi

2006-01-01

173

Supine percutaneous nephrolithotomy: con.  

PubMed

Advocates of supine percutaneous nephrolithotomy (PCNL) consider several theoretical advantages for this procedure. Despite the potential advantages of the supine PCNL, the majority of urologists have remained reluctant to perform this technique. This reluctance may be related to successful outcomes of prone PCNL and technical difficulties associated with supine PCNL. Feasibility of supine PCNL has been shown in different series and the current evidence, although limited and not fully organized, implies the application of this technique for patients with simple stones who are at high anesthesiological risk. However, there is no convincing evidence to support performing supine PCNL in morbidly obese patients and those with complex and multiple stones. Further randomized clinical trials of large sample size and high methodological quality are required to recommend extensive application of supine PCNL as an alternative to prone PCNL. PMID:22090043

Lashay, Alireza; Amini, Erfan; Ahanian, Ali; Ozhand, Ardalan; Nikkar, Mohammad Masoud; Sharifi, Seyed Hossein Hosseini

2011-01-01

174

Percutaneous nephrostomy by direct puncture technique: An observational study  

PubMed Central

Percutaneous nephrostomy is the procedure of establishing a temporary drainage tract of the renal pelvi-calyceal system through the skin. This study aims to find out whether low cost trocar catheter can be a suitable substitute for the relatively high cost fluoroscopy/ultrasonography guided tract dilatation and tube insertion procedure. Percutaneous nephrostomy by the trocar catheter was performed in 126 patients. Under local anesthesia, a stab wound deep enough to traverse the muscle layer was made through which the trocar - catheter drainage set was inserted under ultrasonography guidance. About 179 procedures were performed in 126 patients. Primary technical success rate was 94%, major complication rate 1.6%, minor complication rate 11% and catheter related complications like catheter blockage or dislodgement were 13%. There was no procedure related mortality in our series. The ultrasonography-guided trocar, catheter nephrostomy, is a quick, safe and low cost procedure in selected cases of upper urinary tract obstruction. The primary technical success and complication rates are comparable to any other reported procedure and its low cost is particularly suitable for developing countries like India.

Karim, R.; Sengupta, S.; Samanta, S.; Aich, R. K.; Das, U.; Deb, P.

2010-01-01

175

Salvage of Immature Arteriovenous Fistulas with Percutaneous Transluminal Angioplasty  

SciTech Connect

The purpose of this study was to assess the value of percutaneous transluminal angioplasty (PTA) for the salvage of arteriovenous fistulas (AVFs) that fail to mature. From November 1998 to February 2003, 19 patients who were treated with PTA due to immature forearm AVFs were selected. Fistulography and PTA were performed via a retrograde transvenous approach after direct puncture of the fistular vein. Technical success was defined as less than a 30% residual stenosis, whereas clinical success was defined as the ability to perform at least one session of normal hemodialysis after PTA. Findings of fistulograms, success rates of PTA, and patency rates were evaluated. On initial fistulograms, stenoses were observed in all cases and 68% (13/19) of the stenoses were located in the perianastomotic area of these immature AVFs. The initial technical success rate was 84% (16/19). Technical failures comprised two patients with diffuse narrowing and segmental thrombosis of the cephalic veins and one case of elastic recoil of the anastomotic site stenosis after PTA. Two patients were immediately lost on follow-up. The remaining 14 cases underwent successful hemodialysis 0 to 33 (mean = 15) days after PTA, showing 74% (14/19) clinical success. Although accessory branch veins were noted in most cases (74%, 14/19), leaving them alone did not affect the maturation of AVFs following PTA. There was no significant procedural or late complication. Primary and secondary patency rates at 1 year were 61 and 82%, respectively. For those AVFs that failed to mature, there were stenoses along their vascular courses as underlying causes. For the percutaneous procedure, the retrograde transvenous approach was a reasonable one. As PTA is effective and quick for the salvation of immature AVFs, it can be considered a primary method for salvaging these immature AVFs.

Shin, Sung Wook; Do, Young Soo, E-mail: ysdo@smc.samsung.co.kr; Choo, Sung Wook; Lieu, Wei Chiang; Choo, In-Wook [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiology (Korea, Republic of)

2005-05-15

176

Space Shuttle Program Primary Avionics Software System (PASS) Success Legacy - Quality and Reliability Date  

NASA Technical Reports Server (NTRS)

Thsi slide presentation reviews the avionics software system on board the space shuttle, with particular emphasis on the quality and reliability. The Primary Avionics Software System (PASS) provides automatic and fly-by-wire control of critical shuttle systems which executes in redundant computers. Charts given show the number of space shuttle flights vs time, PASS's development history, and other charts that point to the reliability of the system's development. The reliability of the system is also compared to predicted reliability.

Orr, James K.; Peltier, Daryl

2010-01-01

177

Successful treatment of primary fetal hydrothorax with a double basket catheter.  

PubMed

Fetal pleural effusions can sometimes be detected before birth with ultrasonography. Intervention may be warranted when there is a condition that results in hydroplastic lung and/or fetal hydrops. A 22-week-old fetus with a severe pleural effusion and hydrops was successfully treated by long-term pleural drainage with a double basket catheter from 22 to 39 weeks of gestation. PMID:12541212

Sase, Masakatsu; Miwa, Ichiro; Hasegawa, Keiko; Sumie, Masahiro; Nakata, Masahiko; Kato, Hiroshi

2002-11-01

178

Percutaneous Management of High-Output Chylothorax: Case Reviews  

SciTech Connect

Chylothorax carries significant mortality and morbidity. Patients with high-output chylothorax have traditionally been managed by surgical treatment if nonoperative management has proved unsuccessful. Newer, more recent percutaneous techniques used to treat chylothorax are safer and less invasive than surgery. We present three cases that have been successfully managed using these percutaneous techniques.

Choo, Joseph C., E-mail: joseph_choo@hotmail.com; Foley, Peter T. [Alfred, Department of Radiology (Australia); Lyon, Stuart M. [Alfred, Vascular and Interventional Radiology, Department of Radiology (Australia)

2009-07-15

179

Management of postoperative chylothorax utilizing percutaneous CT-guided drainage.  

PubMed

This case presentation describes a patient who developed postoperative chylothorax after transhiatal esophagectomy for achalasia that was successfully managed by percutaneous drainage. A review of chylothorax causes and treatment options are presented. The effectiveness of percutaneous drainage for treatment of chylothorax is discussed. This minimally invasive method is a valuable alternative to open surgical or thoracoscopic drainage. PMID:18828464

Barnidge, Michael; Vea, Romulo; Rau, Brian; Chu, Quyen; Behm, William; D'Agostino, Horacio

2008-01-01

180

Percutaneous Cyanoacrylate Glue Injection into the Renal Pseudoaneurysm to Control Intractable Hematuria After Percutaneous Nephrolithotomy  

SciTech Connect

We report a case of a 43-year-old man who developed intractable hematuria after percutaneous nephrolithotomy. Angiography detected a pseudoaneurysm arising from the lower polar artery; however, embolization could not be performed because of unfavorable vascular anatomy. A percutaneous thrombin injection under ultrasound guidance initially controlled the bleeding, but hematuria subsequently recurred as a result of recanalization of the aneurysm. The case was successfully managed with ultrasound- and fluoroscopic-guided direct injection of cyanoacrylate glue into the pseudoaneurysm.

Lal, Anupam, E-mail: dralal@rediffmail.com; Kumar, Ajay; Prakash, Mahesh; Singhal, Manphool [Post Graduate Institute of Medical Education and Research (PGIMER), Department of Radiodiagnosis and Imaging (India); Agarwal, Mayank Mohan; Sarkar, Debansu [Post Graduate Institute of Medical Education and Research (PGIMER), Department of Urology (India); Khandelwal, Niranjan [Post Graduate Institute of Medical Education and Research (PGIMER), Department of Radiodiagnosis and Imaging (India)

2009-07-15

181

Safety and Efficacy of the Prostar XL Vascular Closing Device for Percutaneous Closure of Large Arterial Access Sites  

PubMed Central

Purpose. The purpose of this study is to retrospectively evaluate the efficacy and safety of the Prostar XL device for percutaneous large access site closure in an unselected patient and operator collective. Materials and Methods. All patients (n = 50) who had received percutaneous vascular closing with the Prostar XL device in our institution with follow-up data of at least 6 months were retrospectively included. Primary (freedom from surgical conversion) and continued (freedom from groin surgery in further course) technical success and major (deviations from expected outcome requiring surgery) and minor (other deviations from expected outcome) complications were assessed. Success and complications rates were correlated with delivery system size (Mann-Whitney Rank Sum Tests) and operator experience (paired samples t-test). Results. Rates of primary and continued technical success as well as major and minor complications were 93.6%, 89.7%, 10.3%, and 10.3% (groin based) and 90.0%, 84.0%, 16.0%, and 16.0% (patient based), respectively. No correlation of success and complications rate was found with delivery system sizes and operator experience. Conclusions. Application of the Prostar XL device for percutaneous closure of large arterial access sites is safe with a relatively high rate of technical success and low rate of major complications. Sizes of the delivery systems and the experience of the operator did not influence the results.

Thomas, Christoph; Steger, Volker; Heller, Stefan; Heuschmid, Martin; Ketelsen, Dominik; Claussen, Claus D.; Brechtel, Klaus

2013-01-01

182

[The successes and failures in the primary prevention of coronary disease].  

PubMed

The modification of major behavioural and environmental risk factors has helped reduce coronary heart disease. It seems, however, that prevention results were not so good as expected. It is assumed that the major cause of this apparent unsuccessful data is basically due to world population ageing, as it is known that coronary heart disease is much more frequent in older people. Therefore the current life expectancy shows that the preventive measures have indeed been successful. From the analysis and discussion of the preventive epidemiological recommendations and the identification of new risk factors, the Authors suggest new strategies for health promotion and particularly for coronary heart disease reduction. PMID:10466374

Clara, J G; de Pádua, F

1999-01-01

183

Successful treatment of a primary cutaneous zygomycosis caused by Absidia corymbifera in a premature newborn.  

PubMed

Mucormycosis (zygomycosis) normally occurs among individuals with predisposing factors such as prematurity, use of broad spectrum antibiotics, metabolic acidosis or advanced stages of immunosuppression. There have been reports of sporadic cases of cutaneous mucormycosis related to predisposing skin lesions and contact with contaminated material such as adhesive bandages and tongue depressors placed close to intravenous catheter insertion sites. We report successful treatment of a case of Absidia corymbifera infection with the combination of amphotericin B and surgical debridement of the affected area. PMID:15131477

Morales-Aguirre, José Juan; Agüero-Echeverría, Wilson Martín; Ornelas-Carsolio, María Elena; Reséndiz-Sánchez, Jesús; Gómez-Barreto, Demóstenes; Cashat-Cruz, Miguel

2004-05-01

184

Association between intraprocedural thrombotic events and adverse outcomes after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (a Harmonizing Outcomes With RevasculariZatiON and Stents in Acute Myocardial Infarction [HORIZONS-AMI] Substudy).  

PubMed

The present study sought to determine the extent to which adverse angiographic events encountered during percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) are associated with adverse clinical outcomes. Patients with STEMI represent a cohort at particularly high risk of intraprocedural thrombotic events (IPTEs). The overall frequency and implications of IPTEs occurring in patients with STEMI have not been systematically quantified in previous studies. A total of 3,163 patients undergoing primary percutaneous coronary intervention with stent implantation for STEMI in the Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial underwent detailed frame-by-frame core laboratory angiographic analysis to assess IPTEs. The clinical outcomes at 30 days were compared between the patients with and without IPTEs. IPTEs, defined as the development of new or increasing thrombus, abrupt vessel closure, no reflow, slow reflow, and distal embolization at any point during the procedure, occurred in 386 patients (12.2%). The independent predictors of IPTE were thrombus at baseline, lesion length, and randomization to bivalirudin; the patients with IPTEs were also more likely to receive bailout glycoprotein IIb/IIIa inhibitors and unplanned thrombectomy. Compared with patients without IPTEs, the patients with IPTEs had higher 30-day rates of composite major adverse cardiovascular events (death, myocardial infarction, ischemic target vessel revascularization, and stroke; 7.8% vs 4.2%, p = 0.002), major bleeding not related to coronary artery bypass grafting (11.8% vs 6.5%, p <0.001), and all-cause death (4.2% vs 1.8%, p = 0.002). On multivariate analysis, IPTEs were independently associated with 30-day major adverse cardiovascular events, major bleeding, and death. In conclusion, the development of IPTEs in patients undergoing primary percutaneous coronary intervention for STEMI was associated with subsequent adverse outcomes, including major adverse cardiovascular events, major bleeding, and death. Additional studies of strategies to decrease the occurrence of IPTEs are warranted. PMID:24169019

Kirtane, Ajay J; Sandhu, Prabhdeep; Mehran, Roxana; McEntegart, Margaret; Cristea, Ecaterina; Brener, Sorin J; Xu, Ke; Fahy, Martin; Généreux, Philippe; Wessler, Jeffrey D; Stone, Gregg W

2014-01-01

185

Primary small cell carcinoma of the stomach successfully treated with cisplatin and etoposide.  

PubMed

We report a 44-year-old man with primary gastric small cell carcinoma who showed a remarkable response to chemotherapy specific for pulmonary small cell carcinoma. The patient had been admitted to another local hospital because of intermittent epigastralgia. An upper gastrointestinal examination there revealed an ulcerative tumor, 5 cm in diameter, on the lesser curvature side of the cardia, and endoscopic biopsy reported adenocarcinoma. Computed tomography revealed a mass over the lesser curvature of the stomach and some enlarged regional lymph nodes. Radical total gastrectomy, lymph node dissection, Roux-en-Y esophagojejunostomy and splenectomy were performed at our hospital. Pathology revealed gastric mucosa infiltrated by small-sized tumor cells with scanty cytoplasm and hyperchromatic nuclei. Immunohistochemically, the tumor cells were positive for synaptophysin, chromogranin A, and CD56. Primary gastric small cell carcinoma was diagnosed. The postoperative course, complicated by shock due to bleeding, wound infection and intra-abdominal abscess, took more than 2 months to resolve. Follow-up computed tomography showed tumor recurrence with multiple enlarged lymph nodes in the aortocaval region and hepatic hilum. The patient received palliative chemotherapy consisting of cisplatin 80 mg/m(2) on day 1 and etoposide 80 mg/m(2) on days 1-3 every 28 days, and had partial response to the chemotherapy, with a progression-free survival of 10 months. Chemotherapy with cisplatin and etoposide used for small cell carcinoma of the lung is a good treatment for gastric small cell carcinoma. PMID:19948438

Kuo, Shu-Chen; Chao, Yee; Luo, Jiing-Chyuan; Lee, Kuei-Chuan; Wu, Chew-Wun; Li, Anna Fen-Yau; Lee, Rheun-Chuan; Li, Chung-Pin

2009-11-01

186

Relation between white blood cell count and final infarct size in patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention (from the INFUSE AMI trial).  

PubMed

Although it has been shown that elevated white blood cell count (WBCc) on presentation is associated with an increased risk of cardiac mortality in patients with ST-segment elevation myocardial infarction (STEMI), the responsible mechanisms are unknown. We therefore sought to investigate whether elevated WBCc is associated with increased infarct size measured with cardiac magnetic resonance imaging 30 days after primary percutaneous coronary intervention in the Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction trial. INFUSE AMI randomized patients with STEMI and proximal or mid-left anterior descending coronary artery occlusion to bolus intracoronary abciximab versus no abciximab and to manual aspiration versus no aspiration. WBCc at hospital admission was available in 407 of 452 randomized patients. Patients were stratified according to tertiles of WBCc. At 30 days, a significant stepwise increase in infarct size (percentage of total left ventricular mass) was apparent across tertiles of increasing WBCc (median [interquartile range] for tertiles I vs II vs III = 11.2% [3.8% to 19.6%] vs 17.5% [0.5% to 22.9%] vs 19.1% [13.7 to 26.0], respectively, p <0.0001). Absolute infarct mass in grams and abnormal wall motion score were also significantly increased across tertiles of WBC. By multivariate linear regression analysis, WBCc was an independent predictor of infarct size along with intracoronary abciximab randomization, age, time from symptom onset to first device, proximal left anterior descending location, and baseline TIMI flow of 0/1. In conclusion, in patients with anterior wall STEMI, an elevated admission WBCc is a powerful independent predictor of infarct size measured with cardiac magnetic resonance imaging 30 days after primary percutaneous coronary intervention. PMID:24063843

Palmerini, Tullio; Brener, Sorin J; Genereux, Philippe; Maehara, Akiko; Della Riva, Diego; Mariani, Andrea; Witzenbichler, Bernhard; Godlewski, Jacek; Parise, Helen; Dambrink, Jan-Henk E; Ochala, Andrzej; Fahy, Martin; Xu, Ke; Gibson, C Michael; Stone, Gregg W

2013-12-15

187

Percutaneous Ablation of Hepatic Tumors  

PubMed Central

The liver is a common site of both primary and secondary malignancy resulting in significant morbidity and mortality. Careful patient evaluation and triage allows for optimal utilization of all oncologic therapies, including radiation, systemic chemotherapy, surgery, transarterial therapies, and ablation. Although the role of interventional oncologists in the management of hepatic malignancies continues to evolve, the use of percutaneous ablation therapies has proven to be an effective and minimally invasive modality for treatment. Percutaneous ablation therapies have diversified from direct ethanol injection to multiple modalities including radiofrequency ablation (RFA), cryoablation, acetic acid injection, laser ablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation. RFA is the most commonly utilized modality for hepatic interventions and has proven efficacy in both hepatocellular carcinoma and colorectal carcinoma metastases. Although tumor size remains a challenge, combination therapies and new device innovations continue to allow for improved ablation zones and more durable results.

McCarley, James R.; Soulen, Michael C.

2010-01-01

188

A "low and slow" approach to successful medical treatment of primary cardiac lymphoma  

PubMed Central

Primary cardiac lymphomas (PCL) are very rare lymphoid malignancies that originate in the heart or pericardium. Their clinical diagnosis is often difficult, as they infrequently present with signs and symptoms consistent with cardiopulmonary conditions. Typically when B symptoms develop, (fever, weight loss, fatigue common in lymphoid malignancies), progressive heart failure will ensue. Antineoplastic treatment of PCL carries the risk of rapid tumor destruction, causing significant cardiovascular complications including life threatening arrhythmias, pericardial effusion or ventricular septal rupture. While chemotherapy is recommended to treat PCL, prognosis and response to therapy are impacted by the cardiovascular complications. In this instance, a low intensity initiation of chemotherapy followed by the standard full-dose regimen was able to achieve complete remission without cardiovascular complications. Patient monitoring in the Cardiac Intensive Care Unit (CICU) while undergoing initial cycles of chemotherapy may further offer the opportunity to institute lifesaving treatment when encountering the aforementioned cardiovascular complications.

Shah, Khanjan

2014-01-01

189

Nephrotic syndrome due to primary systemic AL amyloidosis, successfully treated with VAD (vincristine, doxorubicin and dexamethasone) alone.  

PubMed

We report 3 patients with nephrotic syndrome ascribed to primary systemic AL amyloidosis that were successfully treated with VAD (vincristine, doxorubicin and dexamethasone) alone. M-protein in serum disappeared soon after VAD, and nephrotic syndrome gradually improved in parallel with a decrease in daily protein excretion in urine. Long-term follow-up of these patients showed neither relapse of nephrotic syndrome nor reappearance of M-protein. High-dose melphalan followed by autologous stem cell support is a standard therapy for primary systemic AL amyloidosis, but in high-risk cases for this treatment, such as elderly patients and those with multiple organ involvement, VAD might be a therapeutic option. PMID:18344643

Matsuda, Masayuki; Gono, Takahisa; Katoh, Nagaaki; Yoshida, Takuhiro; Tazawa, Ko-Ichi; Shimojima, Yasuhiro; Ishii, Wataru; Fushimi, Tomohisa; Ikeda, Shu-Ichi

2008-01-01

190

Primary Care and Public Health Activities in Select US Health Centers: Documenting Successes, Barriers, and Lessons Learned  

PubMed Central

Objectives. We examined primary care and public health activities among federally funded health centers, to better understand their successes, the barriers encountered, and the lessons learned. Methods. We used qualitative and quantitative methods to collect data from 9 health centers, stratified by administrative division, urban–rural location, and race/ethnicity of patients served. Descriptive data on patient and institutional characteristics came from the Uniform Data System, which collects data from all health centers annually. We administered questionnaires and conducted phone interviews with key informants. Results. Health centers performed well on primary care coordination and community orientation scales and reported conducting many essential public health activities. We identified specific needs for integrating primary care and public health: (1) more funding for collaborations and for addressing the social determinants of health, (2) strong leadership to champion collaborations, (3) trust building among partners, with shared missions and clear expectations of responsibilities, and (4) alignment and standardization of data collection, analysis, and exchange. Conclusions. Lessons learned from health centers should inform strategies to better integrate public health with primary care.

Shi, Leiyu; Chowdhury, Joya; Sripipatana, Alek; Zhu, Jinsheng; Sharma, Ravi; Hayashi, A. Seiji; Daly, Charles A.; Tomoyasu, Naomi; Nair, Suma; Ngo-Metzger, Quyen

2012-01-01

191

Percutaneous Intervention in Axillary Loop-Configured Arteriovenous Grafts for Chronic Hemodialysis Patients  

PubMed Central

Objective The purpose of this study was to evaluate the fistulographic features of malfunctioning axillary loop-configured arteriovenous grafts and the efficacy of percutaneous interventions in failed axillary loop-configured arteriovenous grafts. Materials and Methods Ten patients with axillary loop-configured arteriovenous grafts were referred for evaluation of graft patency or upper arm swelling. Fistulography and percutaneous intervention, including thrombolysis, percutaneous transluminal angioplasty and stent placement, were performed. Statistical analysis of the procedure success rate and the primary and secondary patency rates was done. Results Four patients had graft related and subclavian venous stenosis, two patients had graft related stenosis and another four patients had subclavian venous stenosis only. Sixteen sessions of interventional procedures were performed in eight patients (average: 2 sessions / patient) until the end of follow-up. An interventional procedure was not done in two patients with central venous stenosis. The overall procedure success rate was 69% (11 of 16 sessions). The post-intervention primary and secondary patency rates were 50% and 63% at three months, 38% and 63% at six months and 25% and 63% at one year, respectively. Conclusion Dysfunctional axillary loop-configured arteriovenous grafts almost always had subclavian venous and graft-related stenosis. Interventional treatments are helpful to overcome this and these treatments are expected to play a major role in restoring and maintaining the axillary loop-configured arteriovenous loop grafts.

Park, Beom Jin; Chung, Hwan Hoon; Sung, Deuk Jae; Park, Sang Joon; Son, Ho Sung; Jo, Sang Kyung; Kim, Yun Hwan; Cho, Sung Bum

2010-01-01

192

Percutaneous balloon angioplasty of inferior vena cava in Budd-Chiari syndrome-R1.  

PubMed

This study was to evaluate the clinical effects of percutaneous balloon angioplasty of Budd-Chiari syndrome (BCS) caused by inferior vena cava (IVC) obstruction. Between 1993 and 1999, 28 men and 14 women with mean age of 44+/-12 years underwent percutaneous balloon angioplasty for primary BCS. Color Doppler ultrasound and venography showed membranous and segmental obstruction of IVC in 29 and 13 patients, respectively. Fourteen patients also had left- and/or mid-hepatic vein obstruction. Angioplasty of IVC was successful in 41 patients (97.6%), resulting in a reduction of pressure gradient between IVC and the right atrium from 15.0+/-2.5 to 5.5+/-0.8 mmHg (P<0.01). A stent was placed in the site of obstruction in the patient with unsuccessful balloon angioplasty. Patients with successful angioplasty or stent placement had significant improvement in clinical symptoms indicated by a reduction in hepatomegaly and the degree of ascites. No specific attempt was made to treat the occluded left- and/or mid-hepatic vein due to the presence of potent right hepatic vein. Over the follow-up period of 32+/-12 months, restenosis of IVC occurred in only one patient (2.4%), which was redilated successfully. Percutaneous balloon angioplasty is a safe and effective therapy for Budd-Chiari syndrome caused by IVC obstruction, therefore should be the first choice of treatment for this condition. PMID:12007692

Wu, Tongguo; Wang, Lexin; Xiao, Qiang; Wang, Bosong; Li, Shanying; Li, Xiurong; Zhang, Jinying

2002-05-01

193

Successful combination chemotherapy with irinotecan hydrochloride and cisplatin for primary gastric small cell carcinoma: report of a case  

PubMed Central

Primary gastric small cell carcinoma is a rare and aggressive malignant disease with a poor prognosis that was first reported in 1976 by Matsusaka et al. The incidence is very low and the clinicopathological features are similar to those of small cell lung carcinoma. We herein report a case of successful treatment by combination chemotherapy consisting of irinotecan hydrochloride and cisplatin for primary gastric small cell carcinoma. The patient was a 71-year-old male who was admitted to a local hospital with anemia. Gastrointestinal endoscopy revealed the presence of advanced gastric carcinoma at the upper region of the stomach. The patient underwent surgery, and the pathological diagnosis was small cell carcinoma due to the presence of the typical features of small round cells with scant cytoplasm that were positive for synaptophysin and chromogranin A in the resected specimen. The patient underwent subsequent combination chemotherapy, which provided him with over 1 year of survival and a good quality of life. We also present a review of the literature regarding chemotherapy for primary gastric small cell carcinoma.

2013-01-01

194

Carotid artery stenting by direct percutaneous puncture.  

PubMed

Carotid artery stenting is usually performed by a femoral approach. When the patient's anatomy forbids this or other distal access to the carotids, a direct access by percutaneous puncture may be used. We present two cases in which a successful stenting of the carotids with the use of a cerebral protection device was performed. PMID:21315547

Guimaraens, Leopoldo; Theron, Jacques; Casasco, Alfredo; Cuellar, Hugo

2011-07-01

195

Microcatheter Use for Difficult Percutaneous Biliary Procedures  

SciTech Connect

Percutaneous biliary drainage procedures in patients with nondilated ducts are demanding, resulting in lower success rates than in patients with bile duct dilatation. Pertinent clinical settings include patients with iatrogenic bile leaks, diffuse cholangiocarcinomas, and sclerosing cholangitis. We describe a method to facilitate these procedures with the combined use of a 2.7-Fr microcatheter and a 0.018-in. hydrophilic wire.

Brountzos, Elias N., E-mail: ebrountz@med.uoa.gr; Kelekis, Alexis D.; Ptohis, Nikolaos; Kotsioumba, Ioanna [Athens University Medical School, Attikon University Hospital, Second Department of Radiology (Greece); Misiakos, Evangelos [Athens University, Medical School, Attikon University Hospital, Third Department of Surgery (Greece); Perros, George [Athens University, Medical School, Attikon University Hospital, Fourth Department of Surgery (Greece); Gouliamos, Athanasios D. [Athens University Medical School, Attikon University Hospital, Second Department of Radiology (Greece)

2008-09-15

196

Percutaneous balloon valvotomy in tricuspid stenosis.  

PubMed Central

This report describes the first successful treatment of tricuspid stenosis by percutaneous double balloon valvotomy. There was a dramatic reduction of the tricuspid valve gradient, with an increase in calculated valve area, together with an increase in resting cardiac output and symptomatic relief. The feasibility of the non-surgical treatment of severe tricuspid stenosis was demonstrated unequivocally. Images Fig 1 Fig 2

Al Zaibag, M; Ribeiro, P; Al Kasab, S

1987-01-01

197

Mirizzi syndrome treated by percutaneous stone removal  

Microsoft Academic Search

We report a case of Mirizzi syndrome due to a cystic duct stone occurring in a 66-year-old man in the presence of multiple debilitating medical conditions which precluded surgery. The patient was successfully treated by percutaneous stone removal and made a swift and uneventful recovery. This is the first report of Mirizzi syndrome due to a ductal stone being treated

John William Oxtoby; Chee Chew Yeong; David John West

1994-01-01

198

Percutaneous Nephrostomy: Technical Aspects and Indications  

PubMed Central

First described in 1955 by Goodwin et al as a minimally invasive treatment for urinary obstruction causing marked hydronephrosis, percutaneous nephrostomy (PCN) placement quickly found use in a wide variety of clinical indications in both dilated and nondilated systems. Although the advancement of modern endourological techniques has led to a decline in the indications for primary nephrostomy placement, PCNs still play an important role in the treatment of multiple urologic conditions. In this article, the indications, placement, and postprocedure management of percutaneous nephrostomy drainage are described.

Dagli, Mandeep; Ramchandani, Parvati

2011-01-01

199

Percutaneous nephrostomy: technical aspects and indications.  

PubMed

First described in 1955 by Goodwin et al as a minimally invasive treatment for urinary obstruction causing marked hydronephrosis, percutaneous nephrostomy (PCN) placement quickly found use in a wide variety of clinical indications in both dilated and nondilated systems. Although the advancement of modern endourological techniques has led to a decline in the indications for primary nephrostomy placement, PCNs still play an important role in the treatment of multiple urologic conditions. In this article, the indications, placement, and postprocedure management of percutaneous nephrostomy drainage are described. PMID:23204641

Dagli, Mandeep; Ramchandani, Parvati

2011-12-01

200

Participation in the SUCCESS-A Trial Improves Intensity and Quality of Care for Patients with Primary Breast Cancer  

PubMed Central

The SUCCESS-A trial is a prospective, multicenter, phase III clinical trial for high-risk primary breast cancer. It compares disease-free survival after randomization in patients treated with fluorouracil, epirubicin and cyclophosphamide followed by 3 cycles of docetaxel (FEC-D) with that of patients treated with 3 cycles of FEC followed by 3 cycles of gemcitabine and docetaxel (FEC-DG). After a second randomization patients were treated with zoledronate for 2 or 5 years. A total of 251 centers took part in the trial and 3754 patients were recruited over a period of 18 months which ended in March 2007. In a questionnaire-based survey we investigated the impact of enrollment in the trial on patient care, the choice of chemotherapy protocol and access to current oncologic information as well as overall satisfaction in the respective centers. Analysis of the 78 questionnaires returned showed that 40?% of the centers had never previously enrolled patients with these indications in clinical studies. Prior to participating in the study, 4?% of the centers prescribed CMF or other protocols in patients with high-primary breast cancer risk, 46?% administered anthracycline-based chemotherapy and 50?% gave taxane-based chemotherapy. Around half of the participating centers noted that intensity of care and overall quality of care became even better and that access to breast cancer-specific information improved through participation in the trial. After their experience with the SUCCESS-A trial, all of the centers stated that they were prepared to enroll patients in clinical phase III trials again in the future. These data indicate that both patients and physicians benefit from clinical trials, as enrollment improves treatment strategies and individual patient care, irrespective of study endpoints.

Andergassen, U.; Kasprowicz, N. S.; Hepp, P.; Schindlbeck, C.; Harbeck, N.; Kiechle, M.; Sommer, H.; Beckmann, M. W.; Friese, K.; Janni, W.; Rack, B.; Scholz, C.

2013-01-01

201

Successful synchronous chemotherapy and radiotherapy followed by consecutive chemotherapy without surgery for primary intracranial choriocarcinoma: A case report.  

PubMed

We experienced a rare case of primary intracranial choriocarcinoma treated successfully with synchronous chemotherapy and radiotherapy followed by three consecutive courses of chemotherapy without surgery. A 19-year-old male patient presented with a two-week history of diplopia, headache, nausea and vomiting. Neurological examination revealed visual disturbance, bilateral hearing loss, bilateral sixth nerve palsy, left skew deviation, downgaze limitation and clockwise torsional nystagmus on the left upgaze. During image evaluation, the patient suddenly presented with a confused mental status, bradycardia and decreased respiration. An emergency third ventriculostomy was conducted, followed by synchronous ifosfamide, cisplatin and etoposide chemotherapy (ICE; I, 900 mg/m(2); C, 20 mg/m(2); and E, 60 mg/m(2)) on days 1-5, and external radiotherapy (whole brain, 30 Gy/15 Fxs; local boost, 30 Gy/15 Fxs) followed again by three consecutive courses of chemotherapy. This therapy resulted in tumor regression by 63% and full improvement in the patient's neurological condition. However, it was difficult to remove the remaining tumor using a surgical approach due to the risk of postoperative hemorrhage and limited access. We planned to observe the remaining mass without surgery. This patient is now alive and the mass size has not changed for 18 months since treatment. This is the first report of the effectiveness of synchronous chemotherapy and radiotherapy followed by consecutive chemotherapy without surgery in a patient with primary intracranial choriocarcinoma. PMID:23205140

Kim, Minjin; Yun, Jina; Hur, Soon Mi; Moon, Jong Joo; Nam, Jae Hyung; Kim, Se Hyung; Kim, Hyun Jung; Kim, Chan Kyu; Park, Seong Kyu; Hong, Dae Sik

2012-12-01

202

N-P Co-Limitation of Primary Production and Response of Arthropods to N and P in Early Primary Succession on Mount St. Helens Volcano  

PubMed Central

Background The effect of low nutrient availability on plant-consumer interactions during early succession is poorly understood. The low productivity and complexity of primary successional communities are expected to limit diversity and abundance of arthropods, but few studies have examined arthropod responses to enhanced nutrient supply in this context. We investigated the effects of nitrogen (N) and phosphorus (P) addition on plant productivity and arthropod abundance on 24-yr-old soils at Mount St. Helens volcano. Methodology/Principal Findings We measured the relative abundance of eight arthropod orders and five families in plots that received N, P, or no nutrients for 3–5 years. We also measured plant % cover, leaf %N, and plant diversity. Vegetation responded rapidly to N addition but showed a lagged response to P that, combined with evidence of increased N fixation, suggested P-limitation to N availability. After 3 yrs of fertilization, orthopterans (primarily Anabrus simplex (Tettigoniidae) and Melanoplus spp (Acrididae)) showed a striking attraction to P addition plots, while no other taxa responded to fertilization. After 5 yrs of fertilization, orthopteran density in the same plots increased 80%–130% with P addition and 40% with N. Using structural equation modeling, we show that in year 3 orthopteran abundance was associated with a P-mediated increase in plant cover (or correlated increases in resource quality), whereas in year 5 orthopteran density was not related to cover, diversity or plant %N, but rather to unmeasured effects of P, such as its influence on other aspects of resource quality. Conclusions/Significance The marked surprising response to P by orthopterans, combined with a previous observation of P-limitation in lepidopteran herbivores at these sites, suggests that P-mediated effects of food quantity or quality are critical to insect herbivores in this N-P co-limited primary successional system. Our results also support a previous suggestion that the availability of N in these soils is P-limited.

Bishop, John G.; O'Hara, Niamh B.; Titus, Jonathan H.; Apple, Jennifer L.; Gill, Richard A.; Wynn, Louise

2010-01-01

203

Percutaneous removal of kidney stones. Preliminary report.  

PubMed

We have performed percutaneous extractions of renal pelvic stones in 15 patients with the use of the Wolf percutaneous universal nephroscope. At one session, with the patient under general anesthesia, a percutaneous tract is dilated to 24 F, and the stone is immediately removed. Fifteen stones have been removed successfully by ultrasonic lithotripsy, basket retrieval, use of a forceps, or a combination of these techniques. Average operating time has been 1 hour and the mean hospitalization time 4 days. The advantages of this technique are that a skin incision of only 1 to 2 cm is required to remove the stone, hospital days are fewer than with open procedures, and postoperative morbidity is minimal. In selected situations, this method represents a significant advance over standard open surgical procedures for removal of renal pelvic stones. PMID:7121066

Segura, J W; Patterson, D E; LeRoy, A J; McGough, P F; Barrett, D M

1982-10-01

204

[Permanent percutaneous electric connection. General principles].  

PubMed

The Swedes for more than twenty years, and the Germans for over five years have been able to maintain inert or active prostheses with permanent percutaneous connections, thanks to the dependable and proven material and techniques of extraoral implants. The significant improvement extra-oral implants have brought about is not only in a new therapeutic approach to the treatment of important facial defects or transmission deafness; it is also because for some twenty old years now, the few millimeter wide cylinders of Titanium, the affixed on the implants, have crossed the cutaneous barrier for extended periods without complications. The percutaneous abutment thus creates a permanent communication between the interior and the exterior of the organism. If the abutment, instead of simply carrying a Maxillo-Facial Prosthesis or an auditive prosthesis, is modified by placing an electric conductor inside it, the simple "percutaneous peg" will turn out to be, in a way, a "percutaneous electric plug". By adapting classic "mechanical" abutments and implants, authors have created a Permanent Percutaneous Electric Connection (PPEC) which has been successfully experimented on rabbits to record EEG. Clinical applications on humans would make it possible either to receive "bio-electrical information" coming from within the organism, or to send electrical energy into the organism. This last application opens vast perspectives of improvement both in diagnosis and therapy in many fields. PMID:9687654

Sabin, P; Labbé, D; Levillain, D; Cazin, L; Caston, J

1997-01-01

205

The Association Between Levels of Tissue Inhibitor of Metalloproteinase-1 with Acute Heart Failure and Left Ventricular Dysfunction in Patients with ST Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention  

PubMed Central

Aims: Tissue inhibitors of metalloproteinase (TIMPs) bind to active matrix metalloproteinase (MMPs), and thereby inhibit their proteolytic activity. We investigated the role of polymorphisms in the gene for TIMP-1 and serum levels of TIMP-1 in association with postmyocardial infarction (MI), left ventricular (LV) dysfunction, and symptoms of acute heart failure (AHF) in patients treated with primary percutaneous coronary intervention. Methods: In total, 556 patients with STEMI were evaluated. Levels of TIMP-1 were measured at admission and 24?h after MI onset. The TIMP-1 exon 5 SNP rs4898 (F124F with T>C) located at X chromosome was assayed. Results: TIMP-1 levels were higher for men with AHF as well as for men with LV dysfunction (ejection fraction [EF]<40%). According to multivariate analysis, the TIMP-1 level was a factor with an independent negative relationship to EF and AHF in men. An independent relationship between exon 5 TIMP-1 gene polymorphism and EF, AHF or TIMP-1 level was not documented. Conclusion: These results provide evidence that a higher level of circulating TIMP-1 is independently associated with worse EF and AHF.

Goldbergova, Monika Pavkova; Jarkovsky, Jiri; Kala, Petr; Poloczek, Martin; Manousek, Jan; Kluz, Krystyna; Kubkova, Lenka; Littnerova, Simona; Tesak, Martin; Toman, Ondrej; Pavek, Nikolas; Cermakova, Zdenka; Tomandl, Josef; Vasku, Anna; Spinar, Jindrich

2012-01-01

206

Percutaneous Stone Removal  

Microsoft Academic Search

In this chapter the method of percutaneous stone removal is reviewed in its entirety. The indications for percutaneous stone\\u000a removal in the age of shockwave lithotripsy and ureteroscopy are carefully reviewed: staghorn stones, obstruction and stones\\u000a (e.g., ureteropelvic junction obstruction and calyceal diverticula), renal anomalies (e.g., horseshoe kidney), stones with\\u000a difficult lower pole anatomy, and calculi that are extremely hard

Louis Eichel; Ralph V. Clayman

207

Percutaneous drainage and sclerotherapy as definitive treatment of renal lymphangiomatosis  

PubMed Central

We report the technique and outcome of percutaneous drainage and sclerotherapy as primary treatment of renal lymphangiomatosis. Between January and May 2009, two patients presenting with symptomatic renal lymphangiomatosis were treated in our department by a minimally invasive modality combining percutaneous drainage with repeated sclerotherapy. We retrospectively analysed recurrence, complications and patient satisfaction. In this limited case series, percutaneous drainage and repeated sclerotherapy proved to be safe and effective for treating renal lymphangiomatosis. This procedure provides a minimally invasive option for selected patients, potentially avoiding a surgical procedure and any risk of complications.

Valerio, Massimo; Meuwly, Jean-Yves; Tawadros, Cecile; Jichlinski, Patrice

2012-01-01

208

Percutaneous Endovascular Treatment of Chronic Iliac Artery Occlusion  

SciTech Connect

Purpose: To evaluate the clinical and radiological long-term results of recanalization of chronic occluded iliac arteries with balloon angioplasty and stent placement.Methods: Sixty-nine occluded iliac arteries (mean length 8.1 cm; range 4-16 cm) in 67 patients were treated by percutaneous transluminal angioplasty and stent placement. Evaluations included clinical assesment according to Fontaine stages, Doppler examinations with ankle-brachial index (ABI) and bilateral lower extremity arteriograms. Wallstent and Cragg vascular stents were inserted for iliac artery recanalization under local anesthesia. Follow-up lasted 1-83 months (mean 29.5 months).Results: Technical success rate was 97.1% (67 of 69). The mean ABI increased from 0.46 to 0.85 within 30 days after treatment and was 0.83 at the most recent follow-up. Mean hospitalization time was 2 days and major complications included arterial thrombosis (3%), arterial rupture (3%) and distal embolization (1%). During follow-up 6% stenosis and 9% thrombosis of the stents were observed. Clinical improvement occurred in 92% of patients. Primary and secondary patency rates were 75% and 95%, respectively.Conclusion: The long-term patency rates and clinical benefits suggest that percutaneous endovascular revascularization with metallic stents is a safe and effective treatment for patients with chronic iliac artery occlusion.

Carnevale, F. C. [Institute of Radiology, University of Sao Paulo, Department of Interventional Radiology (Brazil)], E-mail: fcarnevale@uol.com.br; De Blas, Mariano; Merino, Santiago; Egana, Jose M. [Hospital De Guipuzcoa, Department of Radiology (Spain); Caldas, Jose G.M.P. [Institute of Radiology, University of Sao Paulo, Department of Interventional Radiology (Brazil)

2004-09-15

209

Emergency percutaneous treatment of arterial iliac axis ruptures.  

PubMed

The objective of this paper is to assess the feasibility and effectiveness of emergency percutaneous treatment of ruptures of the iliac axis. In 5 years, we observed 13 patients (mean age, 62.1 years), 11 with rupture of the external iliac artery and two with rupture of the common iliac artery (six traumatic and seven iatrogenic). All patients were treated with stent grafts. A follow-up was performed with a color Doppler ultrasound at 1, 3, 6, and 12 months during the first year and then yearly. Immediate technical success was obtained in all cases. During a mean follow-up of 22.3 months, one stent-graft occlusion and one infection of a retroperitoneal hematoma occurred. The primary patency rate is 92.3%. Percutaneous treatment is a feasible and safe tool for iliac axis ruptures because it can provide a fast and definitive exclusion of bleeding with a patency rate comparable to surgery and less major morbidity and mortality. PMID:17453260

Laganà, Domenico; Carrafiello, Gianpaolo; Mangini, Monica; Giorgianni, Andrea; Lumia, Domenico; Cuffari, Salvatore; Fugazzola, Carlo

2007-07-01

210

Percutaneous coronary intervention with anomalous origin of right coronary artery: case reports and literature review  

PubMed Central

Percutaneous coronary intervention (PCI) in an anomalous right coronary artery (RCA) can be technically difficult because selective cannulation of the vessel may not be easy. We thereby present two cases with unstable angina pectoris of anomalous originated RCA. The PCI were successfully performed in two patients with a special guiding wire manipulating skill which we called “gone with the flow” combined with balloon anchoring technology, providing excellent angiographic visualization and sound guide support for stent delivery throughout the procedure without severe cardiovascular adverse effects. Our primary data suggested that PCI for geriatric patients with an anomalous origin of RCA accompanied by severe atherosclerotic lesions might also be a safe, available, and feasible strategy.

Hong, Li-Feng; Luo, Song-Hui; Li, Jian-Jun

2013-01-01

211

Percutaneous Radiofrequency Ablation of Lung Tumors in Contact with the Aorta: Dangerous and Difficult but Efficient: A Report of Two Cases  

SciTech Connect

Percutaneous imaging-guided tumor ablation is a widely accepted method for the treatment of primary and secondary lung tumors. Although it is generally feasible and effective for local tumor control, some conditions may affect its feasibility and effectiveness. Herein the authors report their experience with two patients with lung malignancies contiguous to the aorta who were successfully treated with radiofrequency ablation, even though it initially appeared highly risky due to the possible fatal complications.

Thanos, Loukas, E-mail: loutharad@yahoo.co ['Sotiria' General Hospital of Chest Diseases, Computed Tomography and Interventional Radiology Department (Greece); Mylona, Sofia; Giannoulakos, Nikolaos [Red Cross General Hospital of Athens, Radiology Department (Greece); Ptohis, Nikolaos ['Sotiria' General Hospital of Chest Diseases, Computed Tomography and Interventional Radiology Department (Greece); Galani, Panagiota; Pomoni, Maria [Red Cross General Hospital of Athens, Radiology Department (Greece)

2008-11-15

212

Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments  

PubMed Central

Background Measuring team factors in evaluations of Continuous Quality Improvement (CQI) may provide important information for enhancing CQI processes and outcomes; however, the large number of potentially relevant factors and associated measurement instruments makes inclusion of such measures challenging. This review aims to provide guidance on the selection of instruments for measuring team-level factors by systematically collating, categorizing, and reviewing quantitative self-report instruments. Methods Data sources: We searched MEDLINE, PsycINFO, and Health and Psychosocial Instruments; reference lists of systematic reviews; and citations and references of the main report of instruments. Study selection: To determine the scope of the review, we developed and used a conceptual framework designed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). We included papers reporting development or use of an instrument measuring factors relevant to teamwork. Data extracted included instrument purpose; theoretical basis, constructs measured and definitions; development methods and assessment of measurement properties. Analysis and synthesis: We used qualitative analysis of instrument content and our initial framework to develop a taxonomy for summarizing and comparing instruments. Instrument content was categorized using the taxonomy, illustrating coverage of the InQuIRe framework. Methods of development and evidence of measurement properties were reviewed for instruments with potential for use in primary care. Results We identified 192 potentially relevant instruments, 170 of which were analyzed to develop the taxonomy. Eighty-one instruments measured constructs relevant to CQI teams in primary care, with content covering teamwork context (45 instruments measured enabling conditions or attitudes to teamwork), team process (57 instruments measured teamwork behaviors), and team outcomes (59 instruments measured perceptions of the team or its effectiveness). Forty instruments were included for full review, many with a strong theoretical basis. Evidence supporting measurement properties was limited. Conclusions Existing instruments cover many of the factors hypothesized to contribute to QI success. With further testing, use of these instruments measuring team factors in evaluations could aid our understanding of the influence of teamwork on CQI outcomes. Greater consistency in the factors measured and choice of measurement instruments is required to enable synthesis of findings for informing policy and practice.

2013-01-01

213

Percutaneous Decortication of Cystic Renal Disease  

PubMed Central

Purpose To assess the efficacy of percutaneous unroofing in the treatment of simple renal cysts instead of laparoscopic decortication and open surgeries. Materials and Methods From November 2009 to October 2010 at our department, 11 patients with 12 simple cyst units were managed by percutaneous unroofing. All cysts were evaluated with ultrasonography and abdominal computed tomography. If there were no contraindications, cyst wall resection was performed. A standard transurethral resectoscope was used to resect the cyst wall, and the parenchymal portion of the cyst was subsequently cauterized. The drain was left in place for 2 days. Results At the 5-month follow-up, patients were asked about their symptoms and ultrasonography was performed. From 12 cyst units, 8 were completely resolved, 3 were reduced to less than 50%, and 1 was persistent to near its original size. Success was defined as a more than 50% reduction in cyst volume. Conclusions Simple renal cysts can be safely managed by percutaneous unroofing with a success rate of more than 90%. This technique can offer several advantages over open surgery, such as decreased length of hospital stay, improved convalescence, and reduced risk of complications. Percutaneous resection also avoids the multiple trocar sites, extensive dissection, and technical difficulty associated with laparoscopy.

Tehranchi, Ali

2011-01-01

214

Microbial Succession during a Field Evaluation of Phenol and Toluene as the Primary Substrates for Trichloroethene Cometabolism  

PubMed Central

Microbial community composition and succession were studied in an aquifer that was amended with phenol, toluene, and chlorinated aliphatic hydrocarbons to evaluate the effectiveness of these aromatic substrates for stimulating trichloroethene (TCE) bioremediation. Samples were taken after the previous year's field studies, which used phenol as the primary substrate, and after three successive monthly treatments of phenol plus 1,1-dichloroethene (1,1-DCE) plus TCE, phenol plus TCE, and toluene plus TCE. Dominant eubacteria in the community were assessed after each of the four treatments by characterizing isolates from the most dilute most-probable-number tubes and by extracting DNA from aquifer samples. The succession of dominant phenol- and toluene-degrading strains was evaluated by genomic fingerprinting, cellular fatty acid methyl ester (FAME) analysis, and amplified ribosomal DNA restriction analysis (ARDRA). 1,1-DCE was found to drastically reduce microbial growth and species richness, which corresponded to the reduction in bioremediation effectiveness noted previously for this treatment (G. D. Hopkins and P. L. McCarty, Environ. Sci. Technol. 29:1628-1637, 1995). Only a few gram-positive isolates could be obtained after treatment with 1,1-DCE, and these were not seen after any other treatments. Microbial densities returned to their original levels following the subsequent phenol-TCE treatment, but the original species richness was not restored until after the subsequent toluene-TCE treatment. Genomic fingerprinting and FAME analysis indicated that six of the seven originally dominant microbial groups were still dominant after the last treatment, indicating that the community is quite resilient to toxic disturbance by 1,1-DCE. FAME analysis indicated that six microbial taxa were dominant: three members of the (beta) subclass of the class Proteobacteria (Comamonas-Variovorax, Azoarcus, and Burkholderia) and three gram-positive groups (Bacillus, Nocardia, and an unidentified group). ARDRA revealed that the dominant community members were stable during the three nontoxic treatments and that virtually all of the bands could be accounted for by isolates from five of the dominant taxa, indicating that the isolation protocol used likely recovered most of the dominant members of this community.

Fries, M. R.; Hopkins, G. D.; Mccarty, P. L.; Forney, L. J.; Tiedje, J. M.

1997-01-01

215

Percutaneous Management of Abscess and Fistula Following Pancreaticoduodenectomy  

SciTech Connect

Purpose: To evaluate the efficacy of percutaneous drainage of fluid collections following pancreaticoduodenectomy (Whipple's procedure). Methods: We performed a retrospective review of 19 patients referred to our service with fluid collections following pancreaticoduodenectomy. The presence of associated enteric or biliary fistulas, the route(s) of access for image-guided drainage, the incidence of positive bacterial cultures, and the duration and success of percutaneous management were recorded. Results: Fistulous communication to the jejunum in the region of the pancreatico-jejunal anastomosis was demonstrable in all 19 patients by gentle contrast injection into drainage tubes. Three patients had concurrent biliary fistulas. In 18 of 19 patients, fluid samples yielded positive bacterial cultures. Successful percutaneous evacuation of fluid was achieved in 17 of 19 patients (89%). The mean duration of drainage was 31 days. Conclusion: Percutaneous drainage of abscess following pancreaticoduodenectomy is effective in virtually all patients despite the coexistence of enteric and biliary fistulas.

AAssar, O. Sami; LaBerge, Jeanne M.; Gordon, Roy L.; Wilson, Mark W.; Mulvihill, Sean J.; Way, Lawrence W.; Kerlan, Robert K. [Department of Radiology, Box 0252, UCSF Medical Center, 505 Parnassus Avenue, San Francisco CA 94143-0252 (United States)

1999-01-15

216

Frequency of Nonsystem Delays in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Implications for Door-to-Balloon Time Reporting (from the American Heart Association Mission: Lifeline Program).  

PubMed

The percentage of patients with primary percutaneous coronary intervention (PCI) with door-to-balloon (D2B) times ?90 minutes is used as a hospital performance measure for public reporting. Patients can be excluded from reporting for nonsystem-related delays. How exclusions impact D2B time reporting at the hospital level is unknown. The percentage of patients having nonsystem delays for primary PCI at the hospital level was calculated using data from the Acute Coronary Treatment Intervention Outcomes Network Registry-Get with the Guidelines Registry. Hospitals were categorized based on tertiles of percentage of excluded patients: low, ?7.1%; intermediate, >7.1% to 11.2%; and high, >11.2%. From January 1, 2007, to March 31, 2011, 43,909 patients from 294 hospitals were included. The percentage of exclusions differed substantially among hospitals (0% to 68%, median 9.2% [interquartile range 5.6% to 13.5%]). Exclusion reasons included vascular access difficulty (7.6%), cardiac arrest/intubation (38%), and PCI procedural difficulties (20%). Including patients with nonsystem delays significantly increased D2B times by ?2 minutes for each group. The effect was larger on the proportion of patients having a D2B ?90 minutes (low 83.6% to 85%, intermediate 82.9% to 86.3%, high 82% to 87.5%, p <0.001, for all). If a criterion of having ?90% of patients with D2B ?90 minutes was used, excluding patients with nonsystem delays significantly increased the proportion of patients meeting this goal for each group: low, 28% to 37%; intermediate, 17.7% to 37.5%; and high, 14% to 52% (all p <0.01). In conclusion, the proportion of patients excluded from D2B reporting varies substantially among hospitals. This has a greater impact on percentage of patients with D2B time ?90 minutes than on median D2B times. PMID:24819905

Cotoni, David A; Roe, Matthew T; Li, Shuang; Kontos, Michael C

2014-07-01

217

Successful production of the engineering development unit (EDU) primary mirror segment and flight unit tertiary mirror for JWST  

NASA Astrophysics Data System (ADS)

During 2009, Tinsley finished most of the Configuration 1 pre-cryo test Computer Controlled Optical Surfacing (CCOS) operations on the James Webb Space Telescope primary mirror segments and in mid-2009 we began the Configuration 2 post-cryo test CCOS operations. After completing the grinding and polishing operations, including final figuring to a cryo-null target, we delivered the finished Engineering Development Unit (EDU) to Ball Aerospace Technology Corporation on 4 December 2009. Achieving fabrication and metrology conditions to meet the specifications for this off-axis ~1.5 m hexagonal point-to-point segmented mirror required special methods. Achieving repeatable and accurate interferometric alignment of the off-axis aspherical mirror surface and stable thermal gradient control of the beryllium substructure during tests required rigorous component and system-level validation. Final optical wavefront measurements over the various spatial frequency ranges have demonstrated that all of the requirements are met. This success has validated our processes of fabrication and metrology and allows us to proceed with the production of the 18 flight mirror segments. The first finished flight mirror, the Tertiary Mirror, was shipped to BATC on 24 February, 2010. Performance of that mirror is reported here also.

Arneson, Andrea; Alongi, Chris; Bernier, Rob; Boese, Ed; Daniel, Jay; Dettmann, Lee; Garfield, Robert; Glatzel, Holger; Kincade, John; Johnson, Patrick; Lee, Allen; Magruder, Adam; Patel, Ankit; Seilonen, Martin; Surges, Gary; Bergeland, Mark; Brown, Robert J.; Gallagher, Benjamin; McKay, Andrew; Cohen, Lester M.

2010-07-01

218

Percutaneous diode laser disc nucleoplasty  

NASA Astrophysics Data System (ADS)

The treatment of herniated disc disease (HNP) over the years involved different miniinvasive surgical options. The classical microsurgical approach has been substituted over the years both by endoscopic approach in which is possible to practice via endoscopy a laser thermo-discoplasty, both by percutaneous laser disc nucleoplasty. In the last ten years, the percutaneous laser disc nucleoplasty have been done worldwide in more than 40000 cases of HNP. Because water is the major component of the intervertebral disc, and in HNP pain is caused by the disc protrusion pressing against the nerve root, a 980 nm Diode laser introduced via a 22G needle under X-ray guidance and local anesthesia, vaporizes a small amount of nucleous polposus with a disc shrinkage and a relief of pressure on nerve root. Most patients get off the table pain free and are back to work in 5 to 7 days. Material and method: to date, 130 patients (155 cases) suffering for relevant symptoms therapy-resistant 6 months on average before consulting our department, have been treated. Eightyfour (72%) males and 46 (28%) females had a percutaneous laser disc nucleoplasty. The average age of patients operated was 48 years (22 - 69). The level of disc removal was L3/L4 in 12 cases, L4/L5 in 87 cases and L5/S1 in 56 cases. Two different levels were treated at the same time in 25 patients. Results: the success rate at a minimum follow-up of 6 months was 88% with a complication rate of 0.5%.

Menchetti, P. P.; Longo, Leonardo

2004-09-01

219

Percutaneous Management of High-Output Chylothorax: Case Reviews  

Microsoft Academic Search

Chylothorax carries significant mortality and morbidity. Patients with high-output chylothorax have traditionally been managed\\u000a by surgical treatment if nonoperative management has proved unsuccessful. Newer, more recent percutaneous techniques used\\u000a to treat chylothorax are safer and less invasive than surgery. We present three cases that have been successfully managed\\u000a using these percutaneous techniques.

Joseph C. Choo; Peter T. Foley; Stuart M. Lyon

2009-01-01

220

Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in a Young Female with Idiopathic Thrombocytopenic Purpura: A Case Report and Review  

PubMed Central

A 23-year-old female with the diagnosis of idiopathic thrombocytopenic purpura (ITP) was admitted to our hospital with severe chest pain. The electrocardiogram (ECG) revealed acute anterior myocardial infarction. She underwent an immediate cardiac catheterization. An occluded left anterior descending (LAD) was detected by coronary angiography. Reperfusion was performed successfully by angioplasty and stenting with optimal distal flow without any complications. In this report we discussed the management strategies of acute myocardial infarction (AMI) in a patient with ITP.

Yildiz, Ahmet; Coskun, Ugur; Batukan, Ozlem Esen; Keskin, Kudret

2010-01-01

221

Myocardial viability, coronary flow reserve, and in-hospital predictors of late recovery of contractility following successful primary stenting for acute myocardial infarction  

Microsoft Academic Search

Objective: To assess the relation between myocardial viability, coronary flow reserve, and recovery of myocardial contractility after stenting for acute myocardial infarction.Design: Consecutive sample prospective study.Setting: University hospital.Patients: 41 patients with single vessel disease and successful primary stenting for a first acute myocardial infarction.Interventions:201Tl single photon emission computed tomography, contrast ventriculography, and intracoronary Doppler performed 7 (1) days after primary

F Beygui; C Le Feuvre; G Helft; C Maunoury; J P Metzger

2003-01-01

222

Total Percutaneous Aortic Repair: Midterm Outcomes  

SciTech Connect

The purpose of this study was to examine the immediate and midterm outcomes of percutaneous endovascular repair of thoracic and abdominal aortic pathology. Between December 2003 and June 2005, 21 patients (mean age: 60.4 {+-} 17.1 years; 15 males, 6 females) underwent endovascular stent-graft insertion for thoracic (n = 13) or abdominal aortic (n = 8) pathology. Preprocedural computed tomographic angiography (CTA) was performed to assess the suitability of aorto-iliac and common femoral artery (CFA) anatomy, including the degree of CFA calcification, for total percutaneous aortic stent-graft repair. Percutaneous access was used for the introduction of 18- to 26-Fr delivery devices. A 'preclose' closure technique using two Perclose suture devices (Perclose A-T; Abbott Vascular) was used in all cases. Data were prospectively collected. Each CFA puncture site was assessed via clinical examination and CTA at 1, 6, and 12 months, followed by annual review thereafter. Minimum follow-up was 36 months. Outcome measures evaluated were rates of technical success, conversion to open surgical repair, complications, and late incidence of arterial stenosis at the site of Perclose suture deployment. A total of 58 Perclose devices were used to close 29 femoral arteriotomies. Outer diameters of stent-graft delivery devices used were 18 Fr (n = 5), 20 Fr (n = 3), 22 Fr (n = 4), 24 Fr (n = 15), and 26 Fr (n = 2). Percutaneous closure was successful in 96.6% (28/29) of arteriotomies. Conversion to surgical repair was required at one access site (3.4%). Mean follow-up was 50 {+-} 8 months. No late complications were observed. By CT criteria, no patient developed a >50% reduction in CFA caliber at the site of Perclose deployment during the study period. In conclusion, percutaneous aortic stent-graft insertion can be safely performed, with a low risk of both immediate and midterm access-related complications.

Bent, Clare L., E-mail: clare.bent@bartsandthelondon.nhs.uk; Fotiadis, Nikolas; Renfrew, Ian [Barts and The London NHS Trust, Department of Diagnostic Imaging (United Kingdom); Walsh, Michael; Brohi, Karim [Barts and The London NHS Trust, Department of Vascular Surgery and Trauma Surgery (United Kingdom); Kyriakides, Constantinos [Barts and The London NHS Trust, Department of Vascular Surgery and Queen Mary's School of Medicine and Dentistry (United Kingdom); Matson, Matthew, E-mail: Matthew.matson@bartsandthelondon.nhs.u [Barts and The London NHS Trust, Department of Diagnostic Imaging (United Kingdom)

2009-05-15

223

Percutaneous Pediculoplasty for Traumatic Pedicle Fracture  

PubMed Central

Summary The objective of this case is to illustrate a technique for performing fluoroscopically guided percutaneous pediculoplasty in the setting of traumatic or non-neoplastic pedicle fractures. Pediculoplasty has been described in the literature as a complimentary technique performed during vertebroplasty. In this case, isolated pediculoplasty is demonstrated using existing vertebroplasty equipment, which may be utilized as a primary intervention for pedicle fractures in patients who are poor surgical candidates.

Singh, J.; Baker, M.D.; Morris, P.P.; Whitlow, C.T.

2012-01-01

224

Percutaneous mitral valve repair.  

PubMed

Nonsurgical treatment of clinically important mitral regurgitation (MR) has evolved tremendously over the past decade. Recent studies of percutaneous mitral valve repair procedures have shown that less invasive procedures are safe and can be effective in selected patients. MitraClip has been studied most extensively. The MitraClip is attached to the middle scallop of the mitral leaflets by a transseptal-transvascular approach. The device approximates the leaflets in an edge-to-edge percutaneous repair technique that diminishes MR, improves functional status, and improves left ventricular remodeling. The subgroup that has the most benefit includes patients with older age, poorer left ventricular function, and functional MR and is considered high risk for surgical valve replacement. Other novel percutaneous mitral valve therapies under investigation include indirect and direct annuloplasty, and ventricular remodeling devices. PMID:24281977

Young, Amelia; Feldman, Ted

2014-01-01

225

Usefulness of the RISK-PCI score to predict stent thrombosis in patients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a substudy of the RISK-PCI trial.  

PubMed

Stent thrombosis (ST) is an important cause of death after primary percutaneous coronary intervention (pPCI). This substudy aimed at evaluating the usefulness of the RISK-PCI score, originally developed for the prediction of 30-day major adverse cardiovascular events, to predict the occurrence of ST after pPCI. We analyzed 1972 consecutive patients who underwent pPCI with stent implantation between February 2007 and December 2009. Early ST (EST), late ST (LST), and cumulative 1-year ST (CST) were the predefined end points. Definite, probable, and possible ST were included. Models discrimination and calibration to predict ST was tested using receiver-operating characteristics curves and the goodness-of-fit (GoF) test. Sensitivity analyses and 1000-resample bootstrapping were used to evaluate the model's performance. The rates of EST, LST, and CST were 4.6, 1.4, and 6.0 %, respectively. Compared with controls, the cumulative ST group was associated with much higher rates of adverse clinical outcomes at 30-day follow-up (adjusted odds ratio (OR) for death 6.45, adjusted OR for major bleeding 4.41) and at 12-month follow-up (adjusted OR for death 7.35, adjusted OR for major bleeding 4.56). Internal validation confirmed a reasonably good discrimination and calibration of the RISK-PCI score for the prediction of EST (area under the curve (AUC) 0.71, GoF 0.42), LST (AUC 0.69, GoF 0.36), and CST (AUC 0.70, GoF 0.22) after pPCI. ST after pPCI is associated with adverse 30-day and 1-year clinical outcomes. We conclude that the risk of ST could be accurately assessed using the RISK-PCI score, which might help in deciding upon measures aimed at preventing adverse prognosis. PMID:22975713

Mrdovic, Igor; Savic, Lidija; Lasica, Ratko; Krljanac, Gordana; Asanin, Milika; Brdar, Natasa; Djuricic, Nemanja; Cvetinovic, Natasa; Marinkovic, Jelena; Perunicic, Jovan

2013-07-01

226

Long-term mortality after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in patients with insulin-treated versus non-insulin-treated diabetes mellitus.  

PubMed

Aims: We investigated the impact of preadmission diabetic status on long-term outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), to improve risk stratification. Methods and results: Between 1997 and 2007, 4,402 STEMI patients were admitted to our hospital and stratified as having insulin-treated diabetes mellitus (ITDM) (n=176), non-ITDM (NITDM) (n=354) and non-DM (n=3,872). Five-year mortality was significantly higher in patients with DM compared to non-DM (29% vs. 18%, p<0.01). After stratification for preadmission glucose-lowering therapy, five-year mortality was significantly higher in ITDM patients compared to NITDM (36% vs. 25%, p=0.01) and in NITDM patients compared to non-DM patients (25% vs. 18%, p<0.01). After adjustment for age and gender the mortality risk between patients with NITDM versus non-DM was comparable (HR: 1.1, 95% CI: 0.9-1.4, p=0.38), in contrast to patients with ITDM (HR: 1.9, 95% CI: 1.5-2.5, p<0.01) and ITDM versus NITDM (HR: 1.7, 95% CI: 1.2-2.4, p<0.01). After adjustment for all baseline characteristics, the results were comparable to the age and gender adjusted model. Conclusions: ITDM was a strong predictor for long-term mortality when compared to non-DM and NITDM. The mortality between patients without DM and NITDM was comparable after adjustment for age and gender. PMID:24832639

Hoebers, Loes P; Claessen, Bimmer E; Woudstra, Pier; DeVries, J Hans; Wykrzykowska, Joanna J; Vis, Marije M; Baan, Jan; Koch, Karel T; Tijssen, Jan G P; de Winter, Robbert J; Piek, Jan J; Henriques, José P S

2014-05-20

227

Themes from older men's lay definitions of successful aging as indicators of primary and secondary control beliefs over time: The Manitoba Follow-up Study.  

PubMed

Constructs of control have theoretically been equated to successful aging in the psychology literature. Hence, we used themes from lay definitions of successful aging to quantify the prevalence of primary and secondary control beliefs over time. In doing so we hoped to shed new light upon the virtually uncharted area of older men's primary and secondary control beliefs over time. Using successful aging narratives spanning a 10-year timeframe from the Manitoba Follow-up Study cohort, we mapped themes from older men's lay definitions of successful aging onto Rothbaum, Weisz, and Snyder's (1982) constructs of primary and secondary control. We then examined the prevalence of the constructs of control over 10 years and found that some men emphasized primary control, some emphasized secondary control, and others emphasized both, prospectively. Counter to what had previously been theorized, many older men continued to emphasize primary control as important well into late life. As expected, secondary control became more important with age. Furthermore, among those men who endorsed both primary and secondary control, significantly more men switched emphasis from primary to secondary control beliefs as they aged. This finding supported Rothbaum et al.'s (1982) surmise that individuals could switch from one type of control to another, presumably as life circumstances dictated. Knowing which types of control beliefs older men emphasize as they age has theoretical and practical implications. Theoretically, it sheds new light on the under-researched area of control beliefs in older men. Practically, it is informative for anyone interested in enhancing older men's perceptions of control in very late life, particularly in the face of otherwise uncontrollable age-related decline and imminent demise. PMID:24300061

Swift, Audrey U; Tate, Robert B

2013-12-01

228

Imaging in percutaneous ablation for atrial fibrillation  

Microsoft Academic Search

Percutaneous ablation for electrical disconnection of the arrhythmogenic foci using various forms of energy has become a well-established\\u000a technique for treating atrial fibrillation (AF). Success rate in preventing recurrence of AF episodes is high although associated\\u000a with a significant incidence of pulmonary vein (PV) stenosis and other rare complications. Clinical workup of AF patients\\u000a includes imaging before and after ablative

Ružica Maksimovi?; Thorsten Dill; Arsen D. Risti?; Petar M. Seferovi?

2006-01-01

229

Infraclavicular Subclavian Angiography by Percutaneous Puncture  

PubMed Central

Successful visualization of the extracranial circulation and posterior basilar-vertebral complex was accomplished with a modified technique for direct percutaneous infraclavicular puncture of the subclavian artery. The advantage of the described method over other methods relates to the simplicity and safety of the technique. The advantages outweigh the not serious complications which may be encountered. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.

Pineda, Anselmo; Gammel, Edward O.; Slater, Roger A.

1965-01-01

230

Microcatheter use for difficult percutaneous biliary procedures.  

PubMed

Percutaneous biliary drainage procedures in patients with nondilated ducts are demanding, resulting in lower success rates than in patients with bile duct dilatation. Pertinent clinical settings include patients with iatrogenic bile leaks, diffuse cholangiocarcinomas, and sclerosing cholangitis. We describe a method to facilitate these procedures with the combined use of a 2.7-Fr microcatheter and a 0.018-in. hydrophilic wire. PMID:18320271

Brountzos, Elias N; Kelekis, Alexis D; Ptohis, Nikolaos; Kotsioumba, Ioanna; Misiakos, Evangelos; Perros, George; Gouliamos, Athanasios D

2008-01-01

231

Percutaneous balloon dilatation in congenital mitral stenosis.  

PubMed Central

A three year old girl with severe congenital mitral stenosis was successfully treated by percutaneous balloon dilatation of the mitral valve. Cardiac catheterisation and cross sectional and Doppler echocardiography indicated that the orifice of the mitral valve had doubled in area. A small atrial septal defect was found at follow up cardiac catheterisation and angiography. Balloon dilatation of the mitral valve is a reasonable alternative to surgical treatment for typical congenital mitral stenosis even in young children. Images Fig 1 Fig 2

Alday, L E; Juaneda, E

1987-01-01

232

Effects of arbuscular mycorrhizal fungi and soil developmental stages on herbaceous plants growing in the early stage of primary succession on Mount Fuji  

Microsoft Academic Search

A pot culture experiment was conducted to examine the effects of arbuscular mycorrhizal (AM) fungi and soil developmental stages on the growth and nutrient absorption of pioneer plants growing in the early stage of primary succession on Mt. Fuji. Four herbaceous plants, Polygonum cuspidatum (Polygonaceae), Miscanthus oligostachyus (Gramineae), Aster ageratoides var. ovatus (Compositae), and Hedysarum vicioides (Leguminosae), were grown from

Masaaki Fujiyoshi; Atsushi Kagawa; Takayuki Nakatsubo; Takehiro Masuzawa

2006-01-01

233

The Effect of Learning Geometry Topics of 7th Grade in Primary Education with Dynamic Geometer's Sketchpad Geometry Software to Success and Retention  

ERIC Educational Resources Information Center

The aim of this study is to investigate the effect of learning geometry topics of 7th grade in primary education with dynamic geometer's sketchpad geometry software to student's success and retention. The experimental research design with The Posttest-Only Control Group was used in this study. In the experimental group, dynamic geometer's…

Kesan, Cenk; Caliskan, Sevdane

2013-01-01

234

The identification, development, succession and retention of leadership talent in contextually different primary schools: a case study located within the English West Midlands  

Microsoft Academic Search

This article explores head teacher and middle leader perceptions of leadership talent identification, development, succession and retention in 12 contextually different urban primary schools. The schools are located within a single local education authority in the English West Midlands. The study is constructed to inform the research agenda in the face of a looming leadership recruitment and retention crisis in

Christopher Rhodes; Mark Brundrett

2006-01-01

235

Effect of Family Supported Pre-Reading Training Program Given to Children in Preschool Education Period on Reading Success in Primary School  

ERIC Educational Resources Information Center

In this study, the effect of Family Supported Pre-Reading Program developed for 6 year olds attending nursery school on children's reading success in the future was examined. In order to fulfill this aim, reading skills of 25 primary school first-grade pupils who participated Family Supported Pre-Reading Program were compared with another 25…

Buyuktaskapu, Sema

2012-01-01

236

Very Late Stent Thrombosis After Primary Percutaneous Coronary Intervention With Bare-Metal and Drug-Eluting Stents for ST-Segment Elevation Myocardial Infarction  

PubMed Central

Objectives The purpose of this study was to assess the frequency of very late stent thrombosis (VLST) after stenting with bare-metal stents (BMS) and drug-eluting stents (DES) for ST-segment elevation myocardial infarction (STEMI). Background Stent thrombosis occurs more frequently after stenting for STEMI than after elective stenting, but there are little data regarding VLST. Methods Consecutive patients (n = 1,463) who underwent stenting for STEMI were prospectively enrolled in our database. BMS were implanted exclusively from 1995 to 2002, and DES and BMS were implanted from 2003 to 2009. Follow-up was obtained at 1 to 15 years. Results Bare-metal stent patients (n = 1,095) were older and had more shock, whereas DES patients (n = 368) had more diabetes and smaller vessels. Stent thrombosis occurred in 107 patients, of which 42 were VLST (>1 year). Stent thrombosis continued to increase to at least 11 years with BMS and to at least 4.5 years with DES. Stent thrombosis rates with BMS versus DES were similar at 1 year (5.1% and 4.0%, respectively) but increased more with DES after the first year (1.9%/year vs. 0.6%/year, respectively). Landmark analysis (>1 year) found DES had a higher frequency of VLST (p < 0.001) and reinfarction (p = 0.003). Drug-eluting stent was the only significant independent predictor of VLST (hazard ratio: 3.79, 95% confidence interval: 1.64 to 8.79, p = 0.002). Conclusions Very late stent thrombosis after primary PCI for STEMI occurs with relatively high frequency to at least 11 years with BMS and to at least 4.5 years with DES. Very late stent thrombosis and reinfarction (>1 year) were more frequent with DES. New strategies are needed to manage this problem.

Brodie, Bruce; Pokharel, Yashashwi; Fleishman, Nathan; Bensimhon, Adam; Kissling, Grace; Hansen, Charles; Milks, Sally; Cooper, Michael; McAlhany, Christopher; Stuckey, Tom

2011-01-01

237

Early administration of abciximab reduces mortality in female patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the EUROTRANSFER Registry).  

PubMed

The present study assessed the impact of early administration of abciximab in female and male patients with ST-segment elevation myocardial infarction (STEMI) transferred for primary angioplasty (PPCI). Data were gathered for 1,650 consecutive patients with STEMI transferred for PPCI from hospital networks in seven countries in Europe from November 2005 to January 2007 (the EUROTRANSFER Registry population). Among 1,086 patients who received abciximab, there were 186 women and 541 men who received abciximab early (>30 min before PPCI), and 86 women and 273 men treated with late abciximab. Female patients were high-risk individuals, with advanced age and increased rate of ischemic events. Early abciximab administration was associated with enhanced patency of the infarct-related artery before PPCI, and improved epicardial flow after PPCI in both women and men. Early abciximab in women led to the decrease in ischemic events, including 30 day (adjusted OR 0.26, 95 % CI 0.10-0.69, p = 0.007) and 1 year (adjusted OR 0.37, 95 % CI 0.16-0.84, p = 0.017) mortality reduction. In contrast, the reduction in 30 day (adjusted OR 0.69, 95 % CI 0.35-1.39, p = 0.27) and 1 year (adjusted OR 0.68, 95 % CI 0.38-1.22, p = 0.19) mortality was not significant in men. The frequency of bleeding events was similar in the early abciximab group compared to the late abciximab group in both women and men. Early administration of abciximab improved patency of the infarct-related artery before and after PPCI, and led to improved survival in female patients with STEMI. PMID:23065325

Dziewierz, Artur; Siudak, Zbigniew; Rakowski, Tomasz; Kleczy?ski, Pawe?; Dubiel, Jacek S; Dudek, Dariusz

2013-10-01

238

ASTER and Ground Observations of Vegetation Primary Succession and Habitat Development near Retreating Glaciers in Alaska and Nepal  

NASA Astrophysics Data System (ADS)

Like active volcanoes, glaciers are among the most dynamic components of the Earth's solid surface. All of the main surface processes active in these areas have an ability to suddenly remake or "resurface" the landscape, effectively wiping the land clean of vegetation and habitats, and creating new land surface and aqueous niches for life to colonize and develop anew. This biological and geomorphological resurfacing may remove the soil or replace it with inorganic debris layers. The topographical, hydrological, and particle size-frequency characteristics of resurfaced deglaciated landscapes typically create a high density of distinctive, juxtaposed niches where differing plant communities may become established over time. The result is commonly a high floral and faunal diversity and fecundity of life habitats. The new diverse landscape continues to evolve rapidly as ice-cored moraines thaw, lakes drain or fill in with sediment, as fluvial dissection erodes moraine ridges, as deltaic sedimentation shifts, and other processes (coupled with primary succession) take place in rapid sequence. In addition, climate dynamics which may have caused the glaciers to retreat may continue. We will briefly explore two distinctive glacial environments-(1) the maritime Copper River corridor through the Chugach Mountains (Alaska), Allen Glacier, and the river's delta; and (2) Nepal's alpine Khumbu valley and Imja Glacier. We will provide an example showing how ASTER multispectral and stereo-derived elevation data, with some basic field-based constraints and observations, can be used to make automatic maps of certain habitats, including that of the Tibetan snowcock. We will examine geomorphic and climatic domains where plant communities are becoming established in the decades after glacier retreat and how these link to the snowcock habitat and range. Snowcock species have previously been considered to have evolved in close association with glacial and tectonic history of South and Central Asia (B. An et al., 2009, Molecular Phylogenetics and Evolution 50: 526-533; R. Luzhang et al., 2010, Animal Biology 60: 449-465). The new maps and some observations of the snowcock's habits, ecological relationships to other species and landscapes, and physiological limitations support that basic model. Our new data and mapping carries some profound implications for past, present, and future coevolution of these birds and glaciers. Using insights derived from ASTER remote sensing based habitat mapping, we will explore some specific processes that may drive snowcock habitat, population, and genetic dynamics. Although the ecological fabric differs from one region to another, some basic insights from the Himalayan Khumbu valley may be applied to the Chugach Range.

Kargel, J. S.; Leonard, G. J.; Furfaro, R.

2011-12-01

239

Intra-Arterial Hepatic Chemotherapy: A Comparison of Percutaneous Versus Surgical Implantation of Port-Catheters  

SciTech Connect

Purpose: To compare retrospectively the safety and efficacy of percutaneous and surgical implantations of port-catheters for intra-arterial hepatic chemotherapy (IAHC). Materials and Methods: Between January 2004 and December 2008, 126 consecutive patients (mean age 58 years) suffering from liver colorectal metastases were referred for intra-arterial hepatic chemotherapy (IAHC). Port-catheters were percutaneously implanted (P) through femoral access with the patient under conscious sedation when no other surgery was planned or were surgically implanted (S) when laparotomy was performed for another purpose. We report the implantation success rate, primary functionality, functionality after revision, and complications of IAHC. Results: The success rates of implantation were 97% (n = 65 of 67) for P and 98% (n = 58 of 59) for S. One hundred eleven patients received IAHC in our institution (n = 56P and n = 55S). Primary functionality was the same for P and S (4.80 vs. 4.82 courses), but functionality after revision was significantly higher for P (9.18 vs. 5.95 courses, p = 0.004) than for S. Forty-five complications occurred during 516 courses for P and 28 complications occurred during 331 courses for S. The rates of discontinuation of IAHC linked to complications of the port-catheters were 21% (n = 12 of 56) for P and 34% (n = 19 of 55) for S. Conclusion: Overall, significantly better functionality and similar complication rates occurred after P versus S port-catheters.

Deschamps, F., E-mail: frederic.deschamps@igr.fr [Gustave Roussy Institut, Department of Interventional Radiology (France); Elias, D., E-mail: elias@igr.fr; Goere, D., E-mail: goere@igr.fr [Gustave Roussy Institut, Department of Surgery (France); Malka, D., E-mail: malka@igr.fr; Ducreux, M., E-mail: ducreux@igr.fr; Boige, V., E-mail: boige@igr.fr [Gustave Roussy Institut, Department of Medical Oncology (France); Auperin, A., E-mail: auperin@igr.fr [Gustave Roussy Institut, Department of Statistics (France); Baere, T. de, E-mail: debaere@igr.fr [Gustave Roussy Institut, Department of Interventional Radiology (France)

2011-10-15

240

A prospective comparison of a percutaneous tracheostomy technique with standard surgical tracheostomy  

Microsoft Academic Search

A prospective non-randomized study was undertaken to compare, in intensive care patients, the safety and utility of a percutaneous tracheostomy technique performed at the bedside with a surgical tracheostomy technique performed in the operating room. During a 21 month period, 153 percutaneous tracheostomies were performed. Complications occurred in 6 patients (3.9%). Secondary wound haemorrhage occurred in 4 patients and primary

W. M. Griggs; J. A. Myburgh; L. I. G. Worthley

1991-01-01

241

Percutaneous Trigeminal Tractotomy  

Microsoft Academic Search

During percutaneous trigeminal tractotomy, the obex, the floor of the 4 ventricle and the dorsum of the brain stem were satisfactorily outlined by contrast radiography in 20 patients. Emulsified Pantopaque was injected into the cisterna magna with the patient prone. The variations of the pattern of the obex seen on translateral X-ray film are described.

J. L. Fox

1974-01-01

242

Percutaneous transluminal renal angioplasty  

Microsoft Academic Search

Summary Percutaneous transluminal renal angioplasty (PTRA) is a simple, efficient procedure with a low risk\\/benefit ratio when carried out by experienced interventional radiologists. The role of radiology in the diagnosis and treatment of renovascular hypertension (RVH) is discussed, with special attention to technique. PTRA and surgical results are dependent on the etiology and location of renal artery stenosis (RAS). At

Carl Tack; Thomas A. Sos

1989-01-01

243

Percutaneous Abscess Drainage: Update  

Microsoft Academic Search

During the approximately 20 years that percutaneous abscess drainage (PAD) has been an extant procedure and as the millennium begins, PAD has become, by consensus, the treatment of choice for abscesses. Indications for PAD continue to expand, and currently almost all abscesses are considered amenable. On occasion, PAD is an adjunctive procedure that provides a beneficial temporizing effect for the

2001-01-01

244

Percutaneous cholecystolithotripsy: Lessons learned  

Microsoft Academic Search

Summary Endoscopic removal of gallbladder stones via a percutaneous transperitoneal approach appears to be an attractive alternative to surgical cholecystectomy, provided that the gallbladder is normal. Compared with ESWL and adjunctive chemolysis, this procedure offers the advantage of immediate removal of all stone material, regardless of its composition. In 20 patients subjected to this method in a 10-month period, it

M. Marberger; W. Hruby; W. Stackl; C. Armbruster

1989-01-01

245

Isolated spontaneous dissection of the common iliac artery: percutaneous stent placement in two patients.  

PubMed

Isolated spontaneous dissection of the common iliac artery (CIA) is a rare entity. Two patients with this condition were successfully treated by percutaneous stent placement. We emphasize the feasibility of nonsurgical management by percutaneous stent placement for isolated spontaneous dissection of the CIA. PMID:16328683

Kwak, Hyo-Sung; Han, Young-Min; Chung, Gyung-Ho; Yu, Hee Chul; Jeong, Yeon-Jun

2006-01-01

246

A critical evaluation of a percutaneous diagnostic and treatment strategy for chylothorax after thoracic surgery  

Microsoft Academic Search

Objective: Because chylothorax complicating thoracic surgery is difficult to diagnose and failure of nonoperative management necessitates further surgery, we critically evaluated an evolving percutaneous strategy for diagnosing and treating chylothorax. Methods: After thoracic surgery, 37 patients with a clinical diagnosis of chylothorax were referred for lymphangiography for definitive diagnosis and percutaneous treatment. Successful localization of the cisterna chyli by lymphangiogram

Daniel J. Boffa; Mark J. Sands; Thomas W. Rice; Sudish C. Murthy; David P. Mason; Michael A. Geisinger; Eugene H. Blackstone

2008-01-01

247

Isolated spontaneous dissection of the superior mesenteric artery: percutaneous stent placement in two patients.  

PubMed

Isolated spontaneous dissection of the superior mesenteric artery (SMA) is a rare cause of acute mesenteric ischemia. Two patients were successfully treated by percutaneous stent placement within the main trunk of the SMA. Emphasis is placed on the feasibility of nonsurgical management with percutaneous stent placement of isolated spontaneous dissection of the SMA. PMID:15235239

Kim, Jeong Ho; Roh, Byung-Suk; Lee, Young Hwan; Choi, See-Sung; So, Byung-Jun

2004-01-01

248

Th2 Cytokine mRNA Expression in Primary Cutaneous CD30Positive Lymphoproliferative Disorders: Successful Treatment With Recombinant Interferon-?  

Microsoft Academic Search

Primary cutaneous CD30 (Ki-1)+ large cell lymphoma (KiL) and lymphomatoid papulosis (LyP) type A are collectively termed as primary cutaneous CD30-positive lymphoproliferative disorders. We examined the cytokine profile of skin-infiltrating cells and the therapeutic efficacy of recombinant interferon-? (rIFN-?) in primary cutaneous KiL and LyP type A. By reverse transcriptase-polymerase chain reaction, mRNAs for interleukin-4 (IL-4) and IL-b were detected

Hiroaki Yagi; Yoshiki Tokura; Fukumi Furukawa; Masahiro Takigawa

1996-01-01

249

Percutaneous cecostomy in the management of organic fecal incontinence in children  

PubMed Central

AIM: To assess the effectiveness and safety of imaging-guided percutaneous cecostomy in the management of pediatric patients with organic fecal incontinence. METHODS: Twenty three cecostomies were performed on 21 children with organic fecal incontinence (13 males, 8 females), aged from 5 to 16 years (mean 9.5 years). Thirteen patients had neurogenic fecal incontinence and 8 patients had anorectal anomalies. Procedures were performed under general anesthesia and fluoroscopic guidance. Effectiveness and complication data were obtained for at least 1 year after the procedure. RESULTS: Cecostomy was successful in 20 patients (primary technical success rate 95%). Cecostomy failed in one patient due to tube breakage (secondary technical success rate 100%). The tubes were in situ for an average of 18 mo (range 12-23 mo). Eighteen patients (87%) expressed satisfaction with the procedures. Resolution of soiling was achieved in all patients with neurogenic fecal incontinence (100%) and in 5 of 8 patients with anorectal anomalies (62.5%). Eleven patients (52%) experienced minor problems. No major complications were noted. CONCLUSION: Percutaneous cecostomy improves the quality of life in children with organic fecal incontinence. A satisfactory outcome is more prevalent in patients with neurogenic fecal incontinence than anorectal anomalies.

Donkol, Ragab Hani; Al-Nammi, Ahmed

2010-01-01

250

Nephrolithotony: percutaneous removal of renal calculi.  

PubMed

The development of percutaneous nephrostomy has laid the foundation for a major advance in the treatment of urolithiasis: the percutaneous removal of renal and ureteral calculi (i.e., nephrolithotony). With the use of a variety of instruments, calculi can be either removed intact or, if too large, fragmented in situ and then extracted. The method has wide applicability; more than 90% of all upper urinary tract calculi can be successfully treated. Length of hospitalization and costs are comparable to or less than those for open surgery; however, the period of convalescence is only 2-7 days. Continued advances in fluoroscopic technology and endoscopic instrumentation will enable the urologic surgeon to treat the majority of urinary tract conditions using endourologic techniques. PMID:6740832

Clayman, R V; Castaneda-Zuniga, W

1984-01-01

251

Percutaneous Ethanol Injection  

Microsoft Academic Search

\\u000a The chapter considers the principles, the techniques, the results of PEI for treating cirrhotic patients with HCC, and its\\u000a current indications compared to those of RF, which is now considered the gold standard.\\u000a \\u000a \\u000a HCC is an organ pathology, so the first nodule detected is only a prelude to others. Therefore, hepatic resection or percutaneous\\u000a ablation therapies can offer a palliative

Tito Livraghi; Maria Franca Meloni; Anita Andreano

252

Percutaneous Intraosseous Cyst Management  

Microsoft Academic Search

\\u000a The majority of patients affected by intraosseous cysts are children or adolescents. The most commonly noted forms are vascular\\u000a anomalies (including aneurysmal bone cysts), unicameral bone cysts and histiocytosis. Percutaneous treatment of intraosseous\\u000a cysts is an alternative to surgical treatment. It minimizes the risk of bleeding, avoids immobilization and prevents disfiguration\\u000a or dysfunction particularly when the lesion is located in

Josée Dubois; Laurent Garel

253

Percutaneous penetration - methodological considerations.  

PubMed

Studies on percutaneous penetration are needed to assess the hazards after unintended occupational skin exposures to industrial products as well as the efficacy after intended consumer exposure to topically applied medicinal or cosmetic products. During recent decades, a number of methods have been developed to replace methods involving experimental animals. The results obtained from these methods are decided not only by the chemical or product tested, but to a significant degree also by the experimental set-up and decisions made by the investigator during the planning phase. The present MiniReview discusses some of the existing and well-known experimental in vitro and in vivo methods for studies of percutaneous penetration together with some more recent and promising methods. After this, some considerations and recommendations about advantages and limitations of the different methods and their relevance for the prediction of percutaneous penetration are given. Which method to prefer will depend on the product to be tested and the question asked. Regulatory guidelines exist for studies on percutaneous penetration, but researchers as well as regulatory bodies need to pay specific attention to the vehicles and solvents used in donor and sampling fluids so that it reflects in-use conditions as closely as possible. Based on available experimental data, mathematical models have been developed to aid predictions of skin penetration. The authors question the general use of the present mathematical models in hazard assessment, as they seem to ignore outliers among chemicals as well as the heterogeneity of skin barrier properties and skin conditions within the exposed populations. PMID:24373389

Holmgaard, Rikke; Benfeldt, Eva; Nielsen, Jesper B

2014-07-01

254

Central Die-back of Monoclonal Stands of Reynoutria japonica in an Early Stage of Primary Succession on Mount Fuji  

Microsoft Academic Search

Reynoutria japonica is a common perennial pioneer species on Japanese volcanoes. In a volcanic desert (1500 m above sea level) on Mount Fuji (3776 m), central Japan, this species forms circular stands (patches). As a patch develops, shoot density decreases in its centre ('central die-back'). The central die-back has been considered a key process in the early stages of primary

NAOKI A DACHI; I CHIRO; M ASAYUKI T AKAHASHI

255

Chylothorax after Primary Repair of Esophageal Atresia with Tracheo-esophageal Fistula: Successful Management by Biological Fibrin Glue.  

PubMed

A neonate, who had undergone primary repair of esophageal atresia with tracheo-esophageal fistula, developed right pleural effusion in the postoperative period. It was initially misdiagnosed as an anastomotic leak, but later confirmed to be chylothorax. Conservative treatment failed. Application of biological fibrin glue (sealant) on the mediastinum through a thoracotomy was curative. PMID:23061032

Dhua, Anjan Kumar; Ratan, Simmi K; Aggarwal, Satish K

2012-09-01

256

Chylothorax after Primary Repair of Esophageal Atresia with Tracheo-esophageal Fistula: Successful Management by Biological Fibrin Glue  

PubMed Central

A neonate, who had undergone primary repair of esophageal atresia with tracheo-esophageal fistula, developed right pleural effusion in the postoperative period. It was initially misdiagnosed as an anastomotic leak, but later confirmed to be chylothorax. Conservative treatment failed. Application of biological fibrin glue (sealant) on the mediastinum through a thoracotomy was curative.

Dhua, Anjan kumar; Ratan, Simmi K

2012-01-01

257

From the Brink of Closure to Ofsted Success: Five Years in the Life of a Primary School.  

ERIC Educational Resources Information Center

Describes efforts at St. James' C of E Primary school (Ashton-u-Lyne) that resulted in a school transformation from being under the threat of closure because of low enrollment numbers to being an oversubscribed school that is credited with promoting the highest standards of personal development and racial harmony. How this period of change was…

Carlin, Jane; Heaton, Bernard

1997-01-01

258

Bright and Beautiful: High Achieving Girls, Ambivalent Femininities, and the Feminization of Success in the Primary School  

ERIC Educational Resources Information Center

This paper refocuses attention on and problematizes girls' experiences of school achievement and the construction of schoolgirl femininities. In particular, it centres on the relatively neglected experiences and identity work of high achieving primary school girls. Drawing upon ethnographic data (observations, interviews, and pupil diaries) from a…

Renold, Emma; Allan, Alexandra

2006-01-01

259

Primary Plasma Cell Leukemia: A Case Report of Successful Responder to a Combination Chemotherapy of Vincristine, Doxorubicin and Dexamethasone  

Microsoft Academic Search

A patient with primary plasma cell leukemia is described. Immunoelectrophoresis revealed a monoclonal IgG\\/? protein and Bence Jones protein. Hematological data showed numerous immature plasma cells in peripheral blood and bone marrow. Cytogenetic study of tumor cells revealed a complex karyotypic abnormality. Subcutaneous involvement by tumor cells was found. The patient was treated with a combination of vincristine, doxorubicin, dexamethason

Mami Suzuki; Kiyotaka Kawauchi; Hajime Sugiyarna; Masako Yasuyama; Haruo Watanabe

1989-01-01

260

Bright and Beautiful: High achieving girls, ambivalent femininities, and the feminization of success in the primary school  

Microsoft Academic Search

This paper refocuses attention on and problematizes girls’ experiences of school achievement and the construction of schoolgirl femininities. In particular, it centres on the relatively neglected experiences and identity work of high achieving primary school girls. Drawing upon ethnographic data (observations, interviews, and pupil diaries) from a broader study of girls’ and boys’ perceptions and experiences of schoolwork and achievement

Emma Renold; Alexandra Allan

2006-01-01

261

Teachers' Practices, Values and Beliefs for Successful Inquiry-Based Teaching in the International Baccalaureate Primary Years Programme  

ERIC Educational Resources Information Center

Through narrative inquiry, this study investigated the role of personal and professional aspects of teaching and learning which teachers have developed and practiced, in relation to the dispositions, values, beliefs and knowledge that may assist them in successfully transforming to inquiry-based teaching, specifically in the implementation of the…

Twigg, Vani Veikoso

2010-01-01

262

Treatment of primary CNS lymphoma (PCNSL) following successful treatment of systemic non-Hodgkin's lymphoma (NHL): a case series.  

PubMed

Management of PCNSL occurring after successful treatment of systemic non-Hodgkin's lymphoma (NHL) is poorly defined. Illustrate a treatment approach for PCNSL following prior treatment of a systemic NHL. A retrospective case series of 6 patients (mean age 60 years; range 46-65) diagnosed with a diffuse large B cell lymphoma of the CNS following prior successful treatment of a systemic NHL (low-grade in 2; high-grade in 4). Mean interval to diagnosis of PCNSL after diagnosis of systemic NHL was 12 months (range 7-18). In 4/6 patients in whom genetic analysis could be performed, the PCNSL and NHL differed. Treatment utilized high-dose methotrexate and rituximab (immunochemotherapy) followed in patients with a radiographic complete response by autologous peripheral stem cell transplant (ASCT) with total body irradiation (TBI) and multi-agent conditioning chemotherapy (BEAM: carmustine, etoposide, cytarabine, melphalan). 5/6 patients had a radiographic complete response to immunochemotherapy and were treated with ASCT. 4/5 patients were free of disease following ASCT with a mean follow-up of 3 years (range 0.5-4 years). There were no toxic deaths and all patients transplanted successfully engrafted within 28 days (mean 18). Using a treatment paradigm similar to that utilized for recurrent systemic NHL (induction chemotherapy followed by ASCT) for PCNSL occurring metachronously after successful treatment of systemic NHL appears safe and effective. PMID:23456654

Chamberlain, Marc C

2013-05-01

263

Percutaneous Extracorporeal Membrane Oxygenation for Graft Dysfunction after Heart Transplantation  

PubMed Central

Background We evaluated the safety and efficacy of percutaneous extracorporeal membrane oxygenation (ECMO) in patients with primary graft dysfunction after heart transplantation. Methods Of 65 patients (44 males and 21 females) who underwent heart transplantation from January 2006 to December 2012, 13 patients (group I) needed peripheral ECMO support due to difficulty in weaning from cardiopulmonary bypass (CPB) and 52 patients (group II) were weaned from CPB without mechanical support. The mean age of the patients at the time of operation was 54.4±13.6 years. There were no differences in the preoperative characteristics of the two groups. Multivariable analysis was performed to identify the risk factors for ECMO therapy. Results All group I patients were successfully weaned from ECMO after 53±9 hours of circulatory support. Early mortality occurred in four patients (1 [7.7%] in group I and 3 [5.8%] in group II, p>0.999). There were no differences in the postoperative complications between the two groups, with the exception of reoperation for bleeding. A greater number of group I patients underwent reoperation for bleeding (5 [38.5%] in group I vs. 6 [11.5%] in group II, p=0.035). In multivariable analysis, preoperative mechanical support (ECMO and intra-aortic balloon pump) and longer CPB time were the risk factors of ECMO therapy for graft dysfunction (odds ratio, 6.377; 95% confidence interval, 1.519 to 26.77; p=0.011 and odds ratio, 1.010; 95% confidence interval, 1.001 to 1.019; p=0.033). Conclusion Percutaneous ECMO support could be a viable option for rescuing patients when graft dysfunction refractory to medical management develops after heart transplantation.

Lim, Jae Hong; Hwang, Ho Young; Yeom, Sang Yoon; Cho, Hyun-Jai; Lee, Hae-Young

2014-01-01

264

Outcomes of Surgical, Percutaneous Endoscopic, and Percutaneous Radiologic Gastrostomies  

Microsoft Academic Search

Objectives: To evaluate and compare outcomes and complications in patients having undergone gastros- tomy by surgical (SG), percutaneous endoscopic (PEG), or percutaneous radiological (PRG) procedure. Design: Retrospective analysis. Setting: University-based tertiary care center. Patients: Of 82 patients who met inclusion criteria, 14 patients (median age, 40 years) received a surgical tube placement (SG), in 24 patients (median age, 55 years)

Enrico P. Cosentini; Thomas Sautner; Michael Gnant; Friedrich Winkelbauer; Bela Teleky; Raimund Jakesz

1998-01-01

265

Primary succession of the warm-temperate broad-leaved forest on a volcanic island, Miyake-jima, Japan  

Microsoft Academic Search

The primary successional sere of a warm-temperate forest was inferred from an age sequence of four basaltic volcanic substrates\\u000a (16-, 37- and 125-yr-old lava flows, and volcanic ejecta older than 800 years) at several altitudes (ranging from 30 to 550\\u000a m) on Miyake-jima Island. The DCA analysis of species composition indicated that the vegetation is patterned by substrate\\u000a age and

Takashi Kamijo; Kanehiro Kitayama; Aya Sugawara; Shinya Urushimichi; Kanako Sasai

2002-01-01

266

Outcome of post-liver transplant ischemic and nonischemic biliary stenoses treated with percutaneous interventions: the Bologna experience.  

PubMed

In liver transplantation (LT), biliary strictures (BSs) are among the most common complications. The aim of this study was to evaluate the efficacy of percutaneous treatments in the management of post-LT BSs. Between 1999 and 2007, 48 patients underwent percutaneous treatments for posttransplant BSs. We divided the population into 2 groups according to the cause [ischemic (n = 14) or nonischemic (n = 34)] and into further subgroups according to the site [anastomotic (n = 34) or nonanastomotic (n = 14)]. All patients were treated with bilioplasty; in 9 patients who were refractory to bilioplasty, metallic stents were implanted. A technical success rate of 90% was achieved without differences between the ischemic and nonischemic groups or between the anastomotic and nonanastomotic subgroups (P = 0.10). The major complication rate was 4%. The overall 1- and 3-year primary patency rates were 94% and 45%, respectively, and better results were found for patients with nonischemic stenoses versus patients with ischemic stenoses (P = 0.032). The overall secondary patency rates were 94% and 83% at 1 and 3 years, respectively, and there were no statistical differences between the ischemic and nonischemic groups or between the anastomotic and nonanastomotic groups. In the stent subgroup, the overall primary 1- and 2-year patency rates were 100% and 71%, respectively, and the secondary patency rates were 100% and 100%, respectively. In conclusion, a percutaneous approach is highly effective for the treatment of post-LT BSs, and the best results are obtained for patients with simple, nonischemic BSs (technical success rate = 94%, 3-year primary patency rate = 81%, 3-year secondary patency rate = 75%). For patients with ischemic BSs, closer follow-up and retreatment are more frequently needed to achieve secondary patency rates comparable to (or even better than) those for patients with nonischemic stenoses. PMID:22006838

Giampalma, Emanuela; Renzulli, Matteo; Mosconi, Cristina; Ercolani, Giorgio; Pinna, Antonio Daniele; Golfieri, Rita

2012-02-01

267

Gastric perforation in an extremely low birth weight infant recovered with percutaneous peritoneal drainage.  

PubMed

Neonatal gastric perforation is an uncommon but life-threatening condition, which is mainly encountered in premature infants. Primary surgical repair is the principal mode of the treatment. Gastric perforation in neonates improving with percutaneous peritoneal drainage alone has not been described previously. Therefore, an extremely low birth weight infant is presented herein in order to emphasize that gastric perforation may improve with percutaneous peritoneal drainage alone. Isolated gastric perforations in newborn infants may be improved with percutaneous peritoneal drainage alone without need for primary surgical repair. PMID:21980855

Aydin, Mustafa; Zenciro?lu, Ay?egül; Hakan, Nilay; Erdo?an, Derya; Okumu?, Nurullah; Ipek, Mehmet Sah

2011-01-01

268

Percutaneous Endovascular Treatment of Hepatic Artery Stenosis in Adult and Pediatric Patients After Liver Transplantation  

SciTech Connect

The purpose of this study was to evaluate the efficacy of percutaneous endovascular techniques for the treatment of hepatic artery stenosis (HAS) occurring after liver transplantation (LT) in adult and pediatrics patients. From February 2003 to March 2009, 25 patients (15 adults and 10 children) whose developed HAS after LT were referred to our interventional radiology unit. Technical success was achieved in 96% (24 of 25) of patients. Percutaneous transluminal angioplasty (PTA) was performed in 13 patients (7 children), and stenting was performed in 11 patients (2 children). After the procedure, all patients were followed-up with liver function tests, Doppler ultrasound, and/or computed tomography. Mean follow-up was 15.8 months (range 5 days to 58 months). Acute hepatic artery thrombosis occurred immediately after stent deployment in 2 patients and was successfully treated with local thrombolysis. One patient developed severe HA spasm, which reverted after 24 h. After the procedure, mean trans-stenotic pressure gradient decreased from 30.5 to 6.2 mmHg. Kaplan-Meyer curve of HA primary patency was 77% at 1 and 2 years. During the follow-up period, 5 patients (20%) had recurrent stenosis, and 2 patients (8.3%) had late thrombosis. Two of 7 patients with stenosis/thrombosis underwent surgical revascularization (n = 1) and liver retransplantation (n = 1). Six (25%) patients died during follow-up, but overall mortality was not significantly different when comparing patients having patent hepatic arteries with those having recurrent stenosis/thrombosis. There were no significant differences in recurrent stenosis/thrombosis and mortality comparing patients treated by PTA versus stenting and comparing adult versus pediatric status. Percutaneous interventional treatment of HAS in LT recipients is safe and effective and decreases the need for surgical revascularization and liver retransplantation. However, the beneficial effects for survival are not clear, probably because the clinical complexity of many of these cases.

Maruzzelli, Luigi; Miraglia, Roberto, E-mail: rmiraglia@ismett.edu; Caruso, Settimo; Milazzo, Mariapina; Mamone, Giuseppe [Mediterranean Institute for Transplantation and Advanced Specialized Therapies, (ISMETT), Department of Diagnostic and Interventional Radiology (Italy); Gruttadauria, Salvatore; Spada, Marco [University of Pittsburgh Medical Center (United States); Luca, Angelo [Mediterranean Institute for Transplantation and Advanced Specialized Therapies, (ISMETT), Department of Diagnostic and Interventional Radiology (Italy); Gridelli, Bruno [University of Pittsburgh Medical Center (United States)

2010-12-15

269

Arthroscopically assisted reconstruction and percutaneous screw fixation of a Pilon tibial fracture.  

PubMed

We report a case of closed distal tibial fracture (AO 43C3), treated successfully with arthroscopically assisted minimally invasive reduction and percutaneous screw fixation. Techniques and postoperative treatment are described. PMID:12724669

Kralinger, Franz; Lutz, Martin; Wambacher, Markus; Smekal, Vinzenz; Golser, Karl

2003-01-01

270

Percutaneous Transosseous Embolization of Internal Iliac Artery Aneurysm Type II Endoleak: Report of Two Cases  

SciTech Connect

This report describes two cases of successful treatment of an internal iliac artery aneurysm (IIAA) type II endoleak utilizing a percutaneous transosseous access that could not be treated using an endovascular or standard percutaneous approach. A direct percutaneous approach through bone was chosen to avoid vital structures and the surrounding bowel. The procedure was successful and required minimal fluoroscopy time compared with other treatment options. We believe this procedure is an alternative to some of the more complex and technically challenging means of treating this lesion.

Gemmete, Joseph J., E-mail: gemmete@umich.edu; Arabi, Mohammad; Cwikiel, Wojciech B. [University of Michigan Health System, Department of Radiology (United States)

2011-02-15

271

Space Shuttle Program Primary Avionics Software System (PASS) Success Legacy - Major Accomplishments and Lessons Learned Detail Historical Timeline Analysis  

NASA Technical Reports Server (NTRS)

This presentation focuses on the Space Shuttle Primary Avionics Software System (PASS) and the people who developed and maintained this system. One theme is to provide quantitative data on software quality and reliability over a 30 year period. Consistent data relates to code break discrepancies. Requirements were supplied from external sources. Requirement inspections and measurements not implemented until later, beginning in 1985. Second theme is to focus on the people and organization of PASS. Many individuals have supported the PASS project over the entire period while transitioning from company to company and contract to contract. Major events and transitions have impacted morale (both positively and negatively) across the life of the project.

Orr, James K.

2010-01-01

272

Successful interventional management of abdominal compartment syndrome caused by blunt liver injury with hemorrhagic diathesis  

PubMed Central

We report that a case of primary abdominal compartment syndrome (ACS), caused by blunt liver injury under the oral anticoagulation therapy, was successfully treated. Transcatheter arterial embolization (TAE) was initially selected, and the bleeding point of hepatic artery was embolized with N-Butyl Cyanoacylate (NBCA). Secondary, percutaneous catheter drainage (PCD) was performed for massive hemoperitoneum. There are some reports of ACS treated with TAE. However, combination treatment of TAE with NBCA and PCD for ACS has not been reported. Even low invasive interventional procedures may improve primary ACS if the patient has hemorrhagic diathesis or coagulopathy discouraging surgeon from laparotomy.

2014-01-01

273

Ultrasonography guided percutaneous radiofrequency ablation for hepatic cavernous hemangioma  

Microsoft Academic Search

AIM: Hepatic cavernous hemangioma (HCH) is the most common benign tumor of the liver and its management is still controversial. Recent success in situ radiofrequency ablation of hepatic malignancies has led us to consider using this technique in patients with HCH. This study was to assess the efficacy, safety, and complications of percutaneous radiofrequency ablation (PRFA) under ultrasonography guidance in

Yan Cui; Li-Yan Zhou; Man-Ku Dong; Ping Wang; Min Ji; Xiao-Ou Li; Chang-Wei Chen; Zi-Pei Liu; Yong-Jie Xu; Hong-Wen Zhang

2003-01-01

274

Progressive discrete subaortic stenosis developed after successful primary repair of the supravalvular aortic stenosis in Williams syndrome.  

PubMed

Discrete subaortic stenosis is a rare, late complication of the surgical repair of congenital heart defects. Secondary subaortic stenosis late after surgical repair of supravalvular aortic stenosis in Williams syndrome has not previously been described. A 20 year-old female patient with Williams syndrome became symptomatic eight years after subaortic membrane resection. A discrete subaortic stenosis was identified by echocardiography. She was indicated for a Konno operation with a 19-mm Sorin SL valve inserted in the aortic position, along with ventricular septal defect closure with a pericardial patch. She produced a transient slight hypocalcemia after the operation. She was discharged home in a good condition on the fourth post-operative day. Intracardiac morphological and hemodynamic factors have been suggested as responsible for such a late complication. Our case study suggests the need for regular follow-up in patients with Williams syndrome, even after primary surgical repair. PMID:19653183

Yuan, Shi-Min; Kuperstein, Rafael; Lavce, Jacob

2009-01-01

275

Percutaneous needle aspiration biopsy.  

PubMed Central

This paper reviews the history, technique, applications, advantages, disadvantages and complications of percutaneous needle aspiration biopsy. This technique, particularly when performed with a time needle (21-gauge or less), is a relatively painless, inexpensive and safe method of obtaining a pathologic diagnosis, and it can often be carried out at the bedside or in the outpatient department. It complements other methods and may obviate, but never precludes, subsequent excisional biopsy. Its advantages are insufficiently recognized. Considerable expertise of the cytopathologist and close cooperation with the clinician are necessary for consistent results. Images FIG. 1

McLoughlin, M. J.; Ho, C. S.; Tao, L. C.

1978-01-01

276

Mycorrhiza-plant colonization patterns on a subalpine glacier forefront as a model system of primary succession.  

PubMed

Lyman glacier in the North Cascades Mountains of Washington has a subalpine forefront characterized by a well-developed terminal moraine, inconspicuous successional moraines, fluting, and outwash. These deposits were depleted of symbiotic fungi when first exposed but colonized by them over time after exposure. Four major groups of plant species in this system are (1) mycorrhiza-independent or facultative mycotrophic, (2) dependent on arbuscular mycorrhizae (AM) (3) dependent on ericoid mycorrhiza (ERM) or ectomycorrhizae (EM), and (4) colonized by dark-septate (DS) endophytes. We hypothesized that availability of mycorrhizal propagules was related to the success of mycorrhiza-dependent plants in colonizing new substrates in naturally evolved ecosystems. To test this hypothesis roots samples of 66 plant species were examined for mycorrhizal colonization. The plants were sampled from communities at increasing distances from the glacier terminus to compare the newest communities with successively older ones. Long established, secondary successional dry meadow communities adjacent to the glacier forefront, and nearby high alpine communities were sampled for comparison. DS were common on most plant species on the forefront. Nonmycorrhizal plants predominated in the earlier successional sites, whereas the proportion of mycorrhizal plants generally increased with age of community. AM were present, mostly at low levels, and nearly absent in two sites of the forefront. ERM were present in all species of Ericaceae sampled, and EM in all species of Pinaceae and Salicaceae. Roots of plants in the long established meadow and heath communities adjacent to the forefront and the high alpine community all had one or another of the colonization types, with DS and AM predominating. PMID:15772815

Cázares, Efrén; Trappe, James M; Jumpponen, Ari

2005-09-01

277

[Chronic urinary retention in women caused by primary bladder neck obstruction : report of two cases treated successfully with transurethral resection of bladder neck].  

PubMed

A 60-year-old female was referred to our hospital for the treatment of chronic urinary retention which had compelled her to continue clean intermittent self catheterization (CIC) for several years. After further examination including physical examinations, urodynamic study, cystography, and urethrocystoscopy, she was diagnosed with primary bladder neck obstruction (PBNO). Transurethral resection of the bladder neck (TURBN) was performed to relieve the bladder outlet obstruction and she was free from CIC thereafter. Another 61-year-old female on CIC was also referred to our hospital and diagnosed with PBNO through detailed examinations including urodynamics. She was also successfully relieved of CIC after TURBN. Primary bladder neck obstruction is a condition which can be effectively treated by a less-invasive procedure when properly diagnosed by urodynamic examination. Urologists must keep this rare condition in mind as a possible cause of chronic urinary retention in women. PMID:23412123

Momose, Hitoshi; Hoshiyama, Fumiaki; Morizawa, Yosuke; Toyoshima, Yuta; Takada, Satoshi; Fujimoto, Ken; Oyama, Nobuo; Okada, Noboru

2013-01-01

278

Successful pregnancy after the treatment of primary amenorrhea in a patient with non-classical congenital adrenal hyperplasia.  

PubMed

We describe a case of non-classical congenital adrenal hyperplasia (NCCAH) due to 21-hydroxylase deficiency in a 30-year-old Japanese woman who achieved pregnancy after treatment of primary amenorrhea. Hirsutism and clitoromegaly were present. Ultrasound examination showed polycystic appearance of the ovary. Luteinizing hormone-releasing hormone (LH-RH) test resulted in exaggerated LH response, showing a polycystic ovary syndrome (PCOS) pattern. The diagnosis was based on the elevated intial levels of 17-hydroxyprogesterone (55?ng/mL) and dihydroepiandosterone (7780?ng/mL). The first withdrawal bleeding occurred within 6?weeks after treatment with hydrocortisone (20?mg/day) combined with conjugated estrogens (1.25?mg/day) and medroxyprogesterone acetate (10?mg/day), which were continued for five courses. The bleeding remained cyclic every 28?days with maintenance doses of hydrocortisone. Subsequently, ovulation was induced using clomiphene citrate (100?mg/day). Pregnancy was achieved at the second attempt of ovulation induction and was within 10?months after initial presentation. Continuing hydrocortisone, the patient delivered a healthy baby at term. PMID:22672538

Purwana, Indri N; Kanasaki, Haruhiko; Oride, Aki; Miyazaki, Kohji

2013-01-01

279

Elective Percutaneous Coronary Intervention  

PubMed Central

Regardless of the diabetic status of patients with coronary artery disease, hyperglycemia and hypoglycemia are adversely associated with cardiovascular events. The relationship between glucose levels and increased mortality risk in acute myocardial infarction has been shown through various glucose metrics; however, there is a dearth of multivariate analysis of the relationship between elective coronary angioplasty and preprocedural blood glucose levels. We evaluated the relationship between preprocedural blood glucose levels and myocardial injury in 1,012 consecutive patients who underwent elective percutaneous coronary angioplasty. The patients were classified into 4 glycemic groups on the basis of blood glucose levels measured immediately before the procedure: hypoglycemic, euglycemic, mildly hyperglycemic, and hyperglycemic. Samples for troponin I and creatine kinase–MB fraction were collected before each procedure and at 8, 16, and 24 hours after each procedure. Bivariate analysis revealed that postprocedural troponin I levels were significantly higher in the hyperglycemic group (P=0.027). Although postprocedural levels of creatine kinase–MB fraction rose insignificantly in the hypoglycemic patients, our results showed that these patients were more likely to have postprocedural levels 2 to 5 times the upper limit of normal (P=0.013). We tentatively conclude that abnormally low preprocedural plasma glucose levels—together with a recent history of smoking—are associated with an increased incidence of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention.

Madani, Mohsen; Alizadeh, Keivan; Ghazaee, Sepideh Parchami; Zavarehee, Abbas; Abdi, Seifollah; Shakerian, Farshad; Salehi, Negar; Firouzi, Ata

2013-01-01

280

[Percutaneous thrombus aspiration in renal artery stenosis after renal transplantation].  

PubMed

We describe the case of a patient with chronic renal failure under hemodialysis for five years who, after renal transplantation, developed acute renal failure and hypertension refractory to medical therapy. Given the clinical and imaging (renal ultrasound and computed tomography) suspicion of renal artery graft thrombosis, invasive angiography was performed, which confirmed the diagnosis. The therapeutic approach consisted of percutaneous thrombus aspiration and subsequent balloon angioplasty of the entire artery, followed by stent implantation in a second procedure. The clinical course was uneventful with improvement of renal function and normalization of blood pressure. The case highlights the importance of percutaneous intervention in the management of patients with vascular complications after transplantation, with successful application of a procedure normally used in the setting of acute myocardial infarction - percutaneous thrombus aspiration and implantation of a drug-eluting vascular stent. PMID:23141785

Dores, Hélder; Campante Teles, Rui; Nogueira, António; Almeida, Manuel; Messias, Humberto; Barata, José Diogo; Mendes, Miguel

2012-12-01

281

Computer-assisted percutaneous scaphoid fixation: concepts and evolution.  

PubMed

Background?The treatment for undisplaced scaphoid waist fractures has evolved from conventional cast immobilization to percutaneous screw insertion. Percutaneous fixation reduces some of the risks of open surgery, but can be technically demanding and carries the risk of radiation exposure. Recently, computer-assisted percutaneous scaphoid fixation (CAPSF) has been gaining interest. Materials and Methods?Conventional percutaneous scaphoid fixation is performed under fluoroscopic guidance and involves insertion of a guide wire along the length of the scaphoid to facilitate placement of a cannulated screw. Adapting computer-assisted techniques for scaphoid fixation poses several unique challenges including patient tracking and registration. Results?To date, five groups have successfully implemented systems for CAPSF. These systems have implemented wrist immobilization strategies to resolve the issue of patient tracking and have developed unique guidance techniques incorporating 2D fluoroscope, cone-beam CT, and ultrasound, to circumvent patient-based registration. Conclusions?Computer-aided percutaneous pinning of scaphoid waist fractures can significantly reduce radiation exposure and has the potential to improve the accuracy of this procedure. This article reviews the rationale for, and the evolution of, CAPSF and describes the key principles of computer-assisted technology. PMID:24436833

Smith, Erin J; Ellis, Randy E; Pichora, David R

2013-11-01

282

Sensitivity of percutaneous endoscopy compared with ultrasonography in the detection of residue or mucosal lesions after topical gallbladder stone dissolution  

Microsoft Academic Search

Background: Early gallstone recurrence in some patients after “successfulpercutaneous topical dissolution may be due to residual debris. An endoscope small enough to be introduced without dilating the existing percutaneous track was used for gallbladder examination after stone dissolution.Methods: The sensitivity of gallbladder endoscopy was compared with ultrasonography and double-contrast cholecystography for the detection of residual debris or mucosal lesions

Salam F. Zakko; Susanna Srb; Gale R. Ramsby

1995-01-01

283

Seasonal succession of net primary productivity, particulate organic carbon export, and autotrophic community composition in the eastern Bering Sea  

NASA Astrophysics Data System (ADS)

Seasonal patterns in the partitioning of phytoplankton carbon during receding sea ice conditions in the eastern Bering Sea water column are presented using rates of 14C net primary productivity (NPP), phototrophic plankton carbon content, and POC export fluxes from shelf and slope waters in the spring (March 30-May 6) and summer (July 3-30) of 2008. At ice-covered and marginal ice zone (MIZ) stations on the inner and middle shelf in spring, NPP averaged 76±93 mmol C m-2 d-1, and in ice-free waters on the outer shelf NPP averaged 102±137 mmol C m-2 d-1. In summer, rates of NPP were more uniform across the entire shelf and averaged 43±23 mmol C m-2 d-1 over the entire shelf. A concomitant shift was observed in the phototrophic pico-, nano-, and microplankton community in the chlorophyll maximum, from a diatom dominated system (80±12% autotrophic C) in ice covered and MIZ waters in spring, to a microflagellate dominated system (71±31% autotrophic C) in summer. Sediment trap POC fluxes near the 1% PAR depth in ice-free slope waters increased by 70% from spring to summer, from 10±7 mmol C m-2 d-1 to 17±5 mmol C m-2 d-1, respectively. Over the shelf, under-ice trap fluxes at 20 m were higher, averaging 43±17 mmol C m-2 d-1. POC export over the shelf and slope estimated from 234Th deficits averaged 11±5 mmol C m-2 d-1 in spring and 10±2 mmol C m-2 d-1 in summer. Average e-ratios calculated on a station-by-station basis decreased by ˜30% from spring to summer, from 0.46±0.48 in ice-covered and MIZ waters, to 0.33±0.26 in summer, though the high uncertainty prevents a statistical differentiation of these data.

Moran, S. B.; Lomas, M. W.; Kelly, R. P.; Gradinger, R.; Iken, K.; Mathis, J. T.

2012-06-01

284

Continental Collision Zones are Primary Sites of net Continental Crustal Growth: Evidence From the Linzizong Volcanic Succession in Southern Tibet  

NASA Astrophysics Data System (ADS)

The Linzizong volcanics (ca. 65-45Ma) and the coeval batholiths (ca. 60-40Ma) of andesitic-to-rhyolitic composition are magmatic response to the India-Asia continental collision that began at ca. 70-65Ma and ended at ca. 45-40Ma with convergence continuing to present [1,2]. These syncollisional magmatic rocks are widely distributed along much of the >1500km long Gangdese Belt immediately north of the India-Asia suture (Yarlung-Zangbo) in southern Tibet [2-6]. Our study of the Linzizong volcanics from the Linzhou Basin (near Lhasa) encourages the proposal that syncollisional granitoid magmatism may in fact account for much of the net contribution to continental crust growth. The Linzizong volcanics in the Linzhou Basin show a first-order temporal change from the lower andesitic formation (64.4-60.6Ma), to the middle dacitic formation (ca. 54Ma), and to the upper rhyolitic formation (48.7-43.9Ma). The three formations show no systematic but overlapping Nd-Sr isotope variations. The isotopically depleted samples with ?Nd(t)>0 (up to + 8) indicate that their primary sources are of mantle origin. The best source candidate in the broad context of Tethyan ocean closing and India- Asia collision is the remaining part of the Tethyan ocean crust [6]. This ocean crust melts when reaching its hydrous solidus during and soon after the collision in the amphibolite facies, producing andesitic melts parental to the Linzizong volcanics (also the coeval batholiths) with inherited mantle isotopic signatures [6]. Ilmenite is abundant in amphibolite [7], and partial melting of amphibolite with ilmenite as a residual phase accounts for the depletion of Nb, Ta and Ti in the melt. The effect of ocean crust alteration plus involvement of mature crustal materials (e.g., recycled terrigeneous sediments) enhances the elevated abundances of Ba, Rb, Th, U, K and Pb in the melt [8,9]. These give the syncolissional Linzizong volcanics characteristic "arc-like" geochemical signature. Residual amphibole that possesses super-chondritic Nb/Ta ratio explains the sub-chondritic Nb/Ta ratio in the melt, typical of continental crust [10]. These observations and reasoning plus the remarkable compositional similarity between the lower andesitic formation and the model bulk continental crust [11] corroborates our proposal [6] that continental collision zones are sites of net crustal growth (juvenile crust) through process of syncollisional granitoid magmatism. While these interpretations are reasonable in terms of petrology, geochemistry and tectonics, they require further testing through detailed studies of samples with a greater spatial coverage along the entire Gangdese belt, which are currently underway. References: [1] Yin, Harrison, Ann. Rev. Earth Planet. Sci., 28, 211-280, 2000; [2] Mo et al., Earth Sci. Front., 10, 135-148, 2003; [3] Mo et al., Acta Geol. Sinica, 79, 66-76, 2005; [4] Mo et al., Geol. Soc. Am. Spec. Pap., 409, 507-530, 2006; [5] Mo, Hou, Niu et al., Lithos, 96, 225-242, 2007; [6] Mo, Niu, Dong et al., Chem. Geol. (submitted); [7] Niu, Lesher, Econ. Geol., 86, 983-1001, 1991; [8] Plank, Langmuir, Chem. Geol., 145, 325-394, 1998; [9] Elliot, Geophys. Monogr., 138, 23-46, 2003; [10] Foley et al., Nature, 417, 837- 840, 2002; [11] Rudnick & Gao, Treatise on Geochemistry, 3, 1-64, 2003.

Niu, Y.; Mo, X.; Dong, G.; Zhao, Z.; Hou, Z.; Zhou, S.; Ke, S.

2007-12-01

285

A Survival Analysis of Patients with Malignant Biliary Strictures Treated by Percutaneous Metallic Stenting  

SciTech Connect

Background. Percutaneous metal stenting is an accepted palliative treatment for malignant biliary obstruction. Nevertheless, factors predicting survival are not known. Methods. Seventy-six patients with inoperable malignant biliary obstruction were treated with percutaneous placement of metallic stents. Twenty patients had non-hilar lesions. Fifty-six patients had hilar lesions classified as Bismuth type I (n = 15 patients), type II (n = 26), type III (n = 12), or type IV (n = 3 patients). Technical and clinical success rates, complications, and long-term outcome were recorded. Clinical success rates, patency, and survival rates were compared in patients treated with complete (n = 41) versus partial (n = 35) liver parenchyma drainage. Survival was calculated and analyzed for potential predictors such as the tumor type, the extent of the disease, the level of obstruction, and the post-intervention bilirubin levels. Results. Stenting was technically successful in all patients (unilateral drainage in 70 patients, bilateral drainage in 6 patients) with an overall significant reduction of the post-intervention bilirubin levels (p < 0.001), resulting in a clinical success rate of 97.3%. Clinical success rates were similar in patients treated with whole-liver drainage versus partial liver drainage. Minor and major complications occurred in 8% and 15% of patients, respectively. Mean overall primary stent patency was 120 days, while the restenosis rate was 12%. Mean overall secondary stent patency was 242.2 days. Patency rates were similar in patients with complete versus partial liver drainage. Mean overall survival was 142.3 days. Survival was similar in the complete and partial drainage groups. The post-intervention serum bilirubin level was an independent predictor of survival (p < 0.001). A cut-off point in post-stenting bilirubin levels of 4 mg/dl dichotomized patients with good versus poor prognosis. Patient age and Bismuth IV lesions were also independent predictors of survival. Conclusions. Percutaneous metallic biliary stenting provides good palliation of malignant jaundice. Partial liver drainage achieved results as good as those after complete liver drainage. A serum bilirubin level of less than 4 mg/dl after stenting is the most important independent predictor of survival, while increasing age and Bismuth IV lesions represent dismal prognostic factors.

Brountzos, Elias N., E-mail: ebrountz@cc.uoa.gr; Ptochis, Nikolaos; Panagiotou, Irene; Malagari, Katerina [Athens University School of Medicine, Attikon University Hospital, 2nd Department of Radiology (Greece); Tzavara, Chara [Athens University School of Medicine, Department of Hygiene and Epidemiology (Greece); Kelekis, Dimitrios [Athens University School of Medicine, Attikon University Hospital, 2nd Department of Radiology (Greece)

2007-02-15

286

Percutaneous lumboperitoneal shunt. Technical note.  

PubMed

The authors describe a new catheter for use in percutaneous lumboperitoneal shunting, designed to overcome the problem of kinking. They present their experience with the catheter in 14 patients. PMID:1194948

Spetzler, R F; Wilson, C B; Grollmus, J M

1975-12-01

287

Percutaneous Pulmonary Valve Implantation  

PubMed Central

Pulmonary regurgitation (PR) is a frequent sequelae after repair of tetralogy of Fallot, pulmonary atresia, truncus arteriosus, Rastelli and Ross operation. Due to patient growth and conduit degeneration, these conduits have to be changed frequently due to regurgitation or stenosis. However, morbidity is significant in these repeated operations. To prolong conduit longevity, bare-metal stenting in the right ventricular outflow tract (RVOT) obstruction has been performed. Stenting the RVOT can reduce the right ventricular pressure and symptomatic improvement, but it causes PR with detrimental effects on the right ventricle function and risks of arrhythmia. Percutaneous pulmonary valve implantation has been shown to be a safe and effective treatment for patients with pulmonary valve insufficiency, or stenotic RVOTs.

Lee, Hyoung-Doo

2012-01-01

288

Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization  

SciTech Connect

Purpose: To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach. Methods: The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated. Results: Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 days (range 26-313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40-659 days). Conclusion: This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.

Pabon-Ramos, Waleska M., E-mail: waly.pr@duke.edu [Duke University Hospital, Department of Radiology (United States); Niemeyer, Matthew M. [Washington University Medical Center, Mallinckrodt Institute of Radiology (United States)] [Washington University Medical Center, Mallinckrodt Institute of Radiology (United States); Dasika, Narasimham L., E-mail: narasimh@med.umich.edu [University of Michigan Health System, Department of Radiology (United States)

2013-10-15

289

Primary Self-Expandable Nitinol Stent Placement in Focal Lesions of Infrarenal Abdominal Aorta: Long Term Results  

SciTech Connect

Purpose. To evaluate the technical and clinical success, safety and long term results of percutaneous transluminal angioplasty/self-expandable nitinol stent placement of infrarenal abdominal aorta focal lesions. Materials and Methods. Eighteen patients underwent PTA of focal atherosclerotic occlusive disease of distal abdominal aorta. Two symptomatic occlusions and 16 stenoses in 10 male and 8 female patients (mean age 68.2 years) were treated with primary self-expandable nitinol stent placement. Results. Primary self-expandable nitinol stent placement was technically successful in all 18 procedures; clinical success was achieved in 100% of patients. No complications associated with the procedure occurred. During the 49.4 months of mean follow up (range 3-96, 4 months) all treated aortic segments remained patent. Conclusions. Endovascular treatment (primary self-expandable nitinol stent placement) of focal atherosclerotic lesions of distal abdominal aorta is a safe method with excellent primary technical and clinical success rates and favourable Long term results.

Lastovickova, Jarmila, E-mail: jala@medicon.cz; Peregrin, Jan H. [Institute for Clinical and Experimental Medicine, Department of Diagnostic and Interventional Radiology (Czech Republic)

2008-01-15

290

Percutaneous Management of Occlusive Arterial Disease Associated with Vasculitis: A Single Center Experience  

SciTech Connect

The purpose of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty for occlusive arterial disease associated with vasculitis. Eleven patients(10 women, 1 man; ages 35-82 years) with the diagnosis of vasculitis of the large vessels underwent interventional treatment during intraarterial angiography. The causes included giant cell arteritis(n = 8) and Takayasu arteritis (n = 3).Thirty-three occlusive lesions (including brachiocephalic and renalarteries, and arteries of upper and lower extremities) were treated with balloon angioplasty and/or stent placement. Follow-up included clinical examination, angiography, and color duplex ultrasound.Technical success was 100% (25/25) for stenoses and 50% (4/8) for occlusive lesions, representing all lesions combined from different anatomic locations. Dissection (n = 3) and arterial rupture with retroperitoneal hematoma (n = 1) was found in three patients. During follow-up (mean 12 months), restenoses(n = 8) and re-restenoses (n = 1)occurred in 8 vascular areas. Three of these lesions were treated with repeated PTA (n = 4). The cumulative primary clinical success rate was 67.6%, cumulative secondary success rate 74.4%, and cumulative tertiary success rate 75.9%. Interventional therapy in systemic vasculitis provides promising results in technical success rates and followup. Angioplasty may result in arterial injury, but the rate of complications is low.

Both, M.; Jahnke, T. [Department of Radiology, Christian-Albrechts-University of Kiel, Kiel(Germany); Reinhold-Keller, E. [Department of Rheumatology, University of Luebeck, Rheumaklinik Bad Bramstedt (Germany); Reuter, M.; Grimm, J.; Biederer, J.; Brossmann, J. [Department of Radiology, Christian-Albrechts-University of Kiel, Kiel (Germany); Gross, W.L. [Department of Rheumatology, University of Luebeck, Rheumaklinik Bad Bramstedt (Germany); Heller, M.; Mueller-Huelsbeck, S. [Department of Radiology, Christian-Albrechts-University of Kiel, Kiel (Germany)

2003-02-15

291

Image-Guided Percutaneous Ablation of Bone and Soft Tissue Tumors  

PubMed Central

Image-guided percutaneous ablation of bone and soft tissue tumors is an effective minimally invasive alternative to conventional therapies, such as surgery and external beam radiotherapy. Proven applications include treatment of benign primary bone tumors, particularly osteoid osteoma, as well as palliation of painful bone metastases. Use of percutaneous ablation in combination with cementoplasty can provide stabilization of metastases at risk for fracture. Local control of oligometastatic disease and treatment of desmoid tumors are emerging applications.

Kurup, A. Nicholas; Callstrom, Matthew R.

2010-01-01

292

Totally percutaneous rendezvous techniques for the treatment of bile strictures and leakages.  

PubMed

Some challenging pathologic conditions of the biliary tract cannot be treated with endoscopy alone, and a combined approach with rendezvous techniques is frequently needed. Three different totally percutaneous rendezvous techniques were successfully applied in three cases. The rendezvous techniques were performed either with bilateral catheterization of bile ducts to treat a challenging type IV biliary stenosis and iatrogenic biliary damage or with biliary catheterization and percutaneous puncture of the anastomotic loop to treat a biliodigestive anastomosis failure with bile leakage. PMID:24674222

De Robertis, Riccardo; Contro, Alberto; Zamboni, Giulia; Mansueto, Giancarlo

2014-04-01

293

Percutaneous endovascular management of atherosclerotic axillary artery stenosis: Report of 2 cases and review of literature  

PubMed Central

With recent advancement in percutaneous endovascular management, most atherosclerotic peripheral arterial diseases are amenable for intervention. However, there is limited published literature about atherosclerotic axillary artery involvement and its endovascular management. We report two cases of atherosclerotic axillary artery stenosis, which were successfully managed with stent angioplasty using self expanding nitinol stents. The associated coronary artery disease was treated by percutaneous angioplasty and stenting. The long term follow-up revealed patent axillary stents in both cases.

Vijayvergiya, Rajesh; Yadav, Mukesh; Grover, Anil

2011-01-01

294

Retrograde percutaneous closure of a ventricular septal defect after myectomy for hypertrophic obstructive cardiomyopathy.  

PubMed

In patients with hypertrophic obstructive cardiomyopathy, hemodynamically significant ventricular septal defect after septal myectomy is a rare sequela that warrants closure. Percutaneous closure provides a safer alternative to repeated sternotomy, which is associated with significant morbidity and mortality rates. We report a possibly unique case of successful retrograde percutaneous closure, with an AMPLATZER Muscular VSD Occluder, of an iatrogenic ventricular septal defect consequent to surgical therapy for hypertrophic obstructive cardiomyopathy. PMID:24082382

Singh, Vikas; Badheka, Apurva O; Bokhari, Syed S; Ghersin, Eduard; Clark, Pedro Martinez; O'Neill, William W

2013-01-01

295

Temporal-Spatial Variation and Controls of Soil Respiration in Different Primary Succession Stages on Glacier Forehead in Gongga Mountain, China  

PubMed Central

Soil respiration (SR) is an important process in the global carbon cycle. It is difficult to estimate SR emission accurately because of its temporal and spatial variability. Primary forest succession on Glacier forehead provides the ideal environment for examining the temporal-spatial variation and controlling factors of SR. However, relevant studies on SR are relatively scarce, and variations, as well as controlling factors, remain uncertain in this kind of region. In this study, we used a static chamber system to measure SR in six sites which represent different stages of forest succession on forehead of a temperate glacier in Gongga Mountain, China. Our results showed that there was substantial temporal (coefficient of variation (CV) ranged from 39.3% to 73.9%) and spatial (CV ranged from 12.3% to 88.6%) variation in SR. Soil temperature (ST) at 5 cm depth was the major controlling factor of temporal variation in all six sites. Spatial variation in SR was mainly caused by differences in plant biomass and Total N among the six sites. Moreover, soil moisture (SM), microbial biomass carbon (MBC), soil organic carbon (SOC), pH and bulk density could influence SR by directly or indirectly affecting plant biomass and Total N. Q10 values (ranged from 2.1 to 4.7) increased along the forest succession, and the mean value (3.3) was larger than that of temperate ecosystems, which indicated a general tendency towards higher-Q10 in colder ecosystems than in warmer ecosystems. Our findings provided valuable information for understanding temporal-spatial variation and controlling factors of SR.

Luo, Ji; Chen, Youchao; Wu, Yanhong; Shi, Peili; She, Jia; Zhou, Peng

2012-01-01

296

Effects of seabird nitrogen input on biomass and carbon accumulation after 50 years of primary succession on a young volcanic island, Surtsey  

NASA Astrophysics Data System (ADS)

What happens during primary succession after the first colonizers have occupied a pristine surface largely depends on how they ameliorate living conditions for other species. For vascular plants the onset of soil development and associated increase in nutrient (mainly nitrogen, N) and water availability is especially important. Here, we report the relation between N accumulation and biomass- and ecosystem carbon (C) stocks in a 50 year old volcanic island, Surtsey, in Iceland, where N stocks are still exceptionally low. However, 27 year old seagull colony on the island provided nutrient-enriched areas, which enabled us to assess the relationship between N stock and biomass- and ecosystem C stocks across a much larger range in N stock. Further, we compared areas on shallow and deep tephra sands as we expected that deep-rooted systems would be more efficient in retaining N. The sparsely vegetated area outside the colony was more efficient in N retention than we expected and had accumulated 0.7 kg N ha-1 yr-1, which was ca. 60% of the estimated N input rate from wet deposition. The seagulls have added, on average, 47 kg N ha-1 yr-1, which induced a shift from belowground to aboveground in ecosystem N and C stocks and doubled the ecosystem "N use efficiency", determined as the ratio of biomass and C storage per unit N input. Soil depth did not significantly affect total N stocks, which suggests a high N retention potential. Both total ecosystem biomass and C stocks were strongly correlated with N stock inside the colony, which indicated the important role of N during the first steps of primary succession. Inside the colony, the ecosystem biomass C stocks (17-27 kg C ha-1) had reached normal values for grasslands, while the soil organic carbon stocks (SOC; 4-10 kg C ha-1) were only a fraction of normal grassland values. Thus, it will take a long time until the SOC stock reaches equilibrium with the current primary production; during which conditions for new colonists may change.

Leblans, N. I. W.; Sigurdsson, B. D.; Roefs, P.; Thuys, R.; Magnússon, B.; Janssens, I. A.

2014-05-01

297

Percutaneous balloon pulmonary valvuloplasty.  

PubMed

Percutaneous balloon pulmonary valvuloplasty (BPV) was performed in 18 consecutive patients with valvular pulmonary stenosis (PS) with no associated cardiac defects. The patients were 11 months to 19 years of age. The balloon was positioned across the pulmonary valve and inflated to pressures of 80, 100, and 120 pounds/square inch (psi). Each inflation lasted approximately 10 seconds. Peak systolic pulmonary valve gradient (delta P) and cardiac output were measured before and 15 minutes after BPV. There was no change in cardiac output, but all patients had an improved delta P. The prevalvuloplasty delta P was 81 +/- 31 mm Hg, decreasing to 23 +/- 11 mm Hg after BPV (p less than 0.01). The right ventricular peak systolic pressure decreased from 106 +/- 31 to 50 +/- 12 mm Hg (p less than 0.01). No pulmonary regurgitation was noted after BPV. The balloons were 12 or 15 mm in diameter, chosen according to the diameter of the pulmonary valve anulus. Pressures of 100 to 120 psi were required to achieve full inflation of the balloons. BPV also was performed in a patient with tetralogy of Fallot. Subsequent total repair provided an opportunity to observe the mechanism of the dilatation. Evidence of a small tear alongside the anterior valve raphe was noted. BPV induced a significant decrease in delta P and may offer an alternative method for treating PS. PMID:6225329

Lababidi, Z; Wu, J R

1983-09-01

298

Percutaneous transhepatic dissolution of gallbladder stones.  

PubMed

The method of percutaneous transhepatic dissolution with methyl tert-butyl ether (MTBE) has been used at the Zagreb Clinical Hospital Department of Medicine since 1989. From December 1989 until December 1991, 69 patients, 51 (74%) females and 18 (26%) males, with symptomatic and cholesterol gallbladder stones were hospitalised at the Department. All patients preferred percutaneous transhepatic dissolution to surgical treatment of gallbladder stones. The gallbladder was successfully punctured and the catheter placed into the gallbladder lumen in 63 (91%) patients, whereas complete dissolution was achieved in 59 (85.5%) patients. In 21 (33.9%) of these 59 patients, after completed dissolution computer-processed roentgenograms and ultrasonic scan of the gallbladder revealed residual particles of debris sized up to 2 mm. Six patients in whom puncture, i.e. the placement of the catheter into the lumen was unsuccessful, were electively operated on the following day without any complications. The mean duration of hospitalisation for 63 patients was 4.5 days. PMID:1509785

Salamon, V; Simunic, S; Radanovic, B

1992-07-01

299

Outpatient percutaneous and endoscopic surgery in interventional pain management.  

PubMed

The evolution of interventional pain management from inception through the present is examined. Increasing demand from patients, referring physicians and third party payors for proven interventions which provide long-term functional relief of symptoms or primary correction of common spinal pain syndromes is discussed. The role of current palliative therapy as compared to the proven clinical validity of outpatient percutaneous and endoscopic spinal surgical techniques is reviewed. Practitioners are encouraged to transition from the use of spinal injections and narcotics of unproven benefit to percutaneous and endoscopic spinal intervention as primary therapy of herniated lumbar disc, discogenic spinal pain, and lumbar spinal stenosis in appropriately selected patients. SD, Expenditures and health status among adults with back and neck problems. PMID:23256229

McMillan, Marion R

2011-12-01

300

Pseudoaneurysm after Ponseti percutaneous Achilles tenotomy: a case report.  

PubMed

The Ponseti method has become a popular technique to treat idiopathic clubfoot. In most cases, a percutaneous Achilles tenotomy is required to correct residual equinus contracture. Bleeding has been reported as a complication of percutaneous tenotomy. We present a case of a baby who developed a pseudoaneurysm after undergoing an appropriate Ponseti percutaneous Achilles tenotomy at the age of 8 weeks. The diagnosis of pseudoaneurysm was confirmed by color ultrasonography, which showed active flow in the base of the mass. This complication has not been previously described after Ponseti percutaneous Achilles tenotomy. The large pseudoaneurysm mass together with an incomplete correction made bracing with straight last shoes and Denis Browne bar impossible, and the patient developed an immediate relapse of the clubfoot deformity. The relapsed deformity was successfully treated with 4 weeks of additional Ponseti casting, with an emphasis on applying pressure over the pseudoaneurysm by molding the cast. Repeat ultrasonogram at that time showed that the pseudoaneurysm completely resolved, making invasive treatment of the pseudoaneurysm unnecessary. Physicians should be aware that vascular injury could lead to pseudoaneurysm after performing this otherwise simple office procedure. PMID:18362805

Burghardt, Rolf D; Herzenberg, John E; Ranade, Ashish

2008-01-01

301

Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter  

SciTech Connect

Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6-20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6-38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5-14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10-58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites.

Oh, Jung Suk, E-mail: oj-cumc@daum.net; Lee, Hae Giu, E-mail: hgleehfh@catholic.ac.kr; Chun, Ho Jong; Choi, Byung Gil [Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)] [Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of); Lee, Sang Hoon; Hahn, Seong Tai [Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)] [Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of); Ohm, Joon Young [Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)] [Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)

2013-10-15

302

Congenital Splenic Cyst Treated with Percutaneous Sclerosis Using Alcohol  

Microsoft Academic Search

We report a case of successful percutaneous treatment of a congenital splenic cyst using alcohol as the sclerosing agent.\\u000a A 14-year-old female adolescent presented with a nonsymptomatic cystic mass located in the spleen that was believed to be\\u000a congenital. After ultrasonography, a drainage catheter was placed in the cavity. About 250 ml of serous liquid was extracted\\u000a and sent for

Ramon Añon; Jorge Guijarro; Cirilo Amoros; Joaquin Gil; Marta M. Bosca; Julio Palmero; Adolfo Benages

2006-01-01

303

Percutaneous treatment of hepatic cysts by aspiration and sclerotherapy  

Microsoft Academic Search

We treated 35 patients who had hepatic cysts (30 congenital cysts, 5 hydatid cysts) with percutaneous puncture and sclerotherapy.\\u000a After puncture and drainage of the cyst, a 95% alcohol solution was instilled as sclerosing agent into the cystic cavity.\\u000a In all the patients, cyst puncture and drainage was successful. Follow-up in all cases was at least 12 months. In three

Giovanni Simonetti; Stefano Profili; Gian Luigi Sergiacomi; Giovanni Battista Meloni; Antonio Orlacchio

1993-01-01

304

Lasers in percutaneous renal procedures  

Microsoft Academic Search

Introduction  Since the invention of lasers in 1960, they have been increasingly used in medicine. In this review paper, the types of lasers\\u000a used in urology, in addition to their applications to percutaneous renal surgery will be reviewed. Specifically, use of lasers\\u000a in the percutaneous management of renal stones, upper tract transitional cell carcinoma and stricture will be reviewed.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and

Nadya M. Cinman; Sero Andonian; Arthur D. Smith

2010-01-01

305

Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads  

PubMed Central

Background. Widespread use of cardiovascular implantable electronic devices has inevitably increased the need for lead revision/replacement. We report our experience in percutaneous extraction of transvenous permanent pacemaker/defibrillator leads. Methods. Thirty-six patients admitted to our centre from September 2005 through October 2012 for percutaneous lead extraction were included. Lead removal was attempted using Spectranetics traction-type system (Spectranetics Corp., Colorado, CO, USA) and VascoExtor countertraction-type system (Vascomed GmbH, Weil am Rhein, Germany). Results. Lead extraction was attempted in 59 leads from 36 patients (27 men), mean ± SD age 61 ± 5 years, with permanent pacemaker (n = 25), defibrillator (n = 8), or cardiac resynchronisation therapy (n = 3) with a mean ± SD implant duration of 50 ± 23 months. The indications for lead removal included pocket infection (n = 23), endocarditis (n = 2), and ventricular (n = 10) and atrial lead dysfunction (n = 1). Traction device was used for 33 leads and countertraction device for 26 leads. Mean ± SD fluoroscopy time was 4 ± 2 minutes/lead for leads implanted <48 months (n = 38) and 7 ± 3 minutes/lead for leads implanted >48 months (n = 21), P = 0.03. Complete procedural success rate was 91.7% and clinical procedural success rate was 100%, while lead procedural success rate was 95%. Conclusions. In conclusion, percutaneous extraction of transvenous permanent pacemaker/defibrillator leads using dedicated removal tools is both feasible and safe.

Paraskevaidis, Stylianos; Mantziari, Lilian; Megarisiotou, Athanasia; Karvounis, Charalambos

2014-01-01

306

Percutaneous extraction of transvenous permanent pacemaker/defibrillator leads.  

PubMed

Background. Widespread use of cardiovascular implantable electronic devices has inevitably increased the need for lead revision/replacement. We report our experience in percutaneous extraction of transvenous permanent pacemaker/defibrillator leads. Methods. Thirty-six patients admitted to our centre from September 2005 through October 2012 for percutaneous lead extraction were included. Lead removal was attempted using Spectranetics traction-type system (Spectranetics Corp., Colorado, CO, USA) and VascoExtor countertraction-type system (Vascomed GmbH, Weil am Rhein, Germany). Results. Lead extraction was attempted in 59 leads from 36 patients (27 men), mean ± SD age 61 ± 5 years, with permanent pacemaker (n = 25), defibrillator (n = 8), or cardiac resynchronisation therapy (n = 3) with a mean ± SD implant duration of 50 ± 23 months. The indications for lead removal included pocket infection (n = 23), endocarditis (n = 2), and ventricular (n = 10) and atrial lead dysfunction (n = 1). Traction device was used for 33 leads and countertraction device for 26 leads. Mean ± SD fluoroscopy time was 4 ± 2 minutes/lead for leads implanted <48 months (n = 38) and 7 ± 3 minutes/lead for leads implanted >48 months (n = 21), P = 0.03. Complete procedural success rate was 91.7% and clinical procedural success rate was 100%, while lead procedural success rate was 95%. Conclusions. In conclusion, percutaneous extraction of transvenous permanent pacemaker/defibrillator leads using dedicated removal tools is both feasible and safe. PMID:24971363

Paraskevaidis, Stylianos; Konstantinou, Dimitrios; Vassilikos, Vassilios; Theofilogiannakos, Efstratios; Mantziari, Lilian; Megarisiotou, Athanasia; Galitsianos, Ioannis; Karvounis, Charalambos

2014-01-01

307

Percutaneous Radiologic Gastrostomy Using the One-Anchor Technique in Patients after Partial Gastrectomy  

PubMed Central

Objective The purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success. Materials and Methods Nineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success. Results Percutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011). Conclusion Percutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.

Park, Jung-Hoon; Ko, Heung Kyu; Kim, Jin Hyoung; Song, Ho-Young; Kim, Soo Hwan

2014-01-01

308

Percutaneous Biliary Drainage Using Open Cell Stents for Malignant Biliary Hilar Obstruction  

PubMed Central

Objective To evaluate the feasibility, safety and the effectiveness of the complex assembly of open cell nitinol stents for biliary hilar malignancy. Materials and Methods During the 10 month period between January and October 2007, 26 consecutive patients with malignant biliary hilar obstruction underwent percutaneous insertion of open cell design nitinol stents. Four types of stent placement methods were used according to the patients' ductal anatomy of the hilum. We evaluated the technical feasibility of stent placement, complications, patient survival, and the duration of stent patency. Results Bilobar biliary stent placement was conducted in 26 patients with malignant biliary obstruction-T (n = 9), Y (n = 7), crisscross (n = 6) and multiple intersecting types (n = 4). Primary technical success was obtained in 24 of 26 (93%) patients. The crushing of the 1st stent during insertion of the 2nd stent occurred in two cases. Major complications occurred in 2 of 26 patients (7.7%). One case of active bleeding from hepatic segmental artery and one case of sepsis after procedure occurred. Clinical success was achieved in 21 of 24 (87.5%) patients, who were followed for a mean of 141.5 days (range 25-354 days). The mean primary stent patency period was 191.8 days and the mean patient survival period was 299 days. Conclusion Applying an open cell stent in the biliary system is feasible, and can be effective, especially in multiple intersecting stent insertions in the hepatic hilum.

Ahn, Sun Jun; Han, Tae Sun; Won, Je Hwan; Kim, Ji Dae; Kwack, Kyu-Sung; Lee, Jae Hee; Kim, Young Chul

2012-01-01

309

Femoral versus Radial Access in Primary Angioplasty. Analysis of the ACCEPT Registry.  

PubMed

Background: The radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Objective: To compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route. Methods: From August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure. Results: The mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used. Conclusions: The femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques. PMID:25004418

Andrade, Pedro Beraldo de; Andrade, Mônica Vieira Athanazio de; Barbosa, Robson Alves; Labrunie, André; Hernandes, Mauro Esteves; Marino, Roberto Luiz; Precoma, Dalton Bertolim; Sá, Francisco Carleial Feijó de; Berwanger, Otávio; Mattos, Luiz Alberto Piva E

2014-07-01

310

Femoral versus Radial Access in Primary Angioplasty. Analysis of the ACCEPT Registry  

PubMed Central

Background The radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Objective To compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route. Methods From August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure. Results The mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used. Conclusions The femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques.

de Andrade, Pedro Beraldo; de Andrade, Monica Vieira Athanazio; Barbosa, Robson Alves; Labrunie, Andre; Hernandes, Mauro Esteves; Marino, Roberto Luiz; Precoma, Dalton Bertolim; de Sa, Francisco Carleial Feijo; Berwanger, Otavio; Mattos, Luiz Alberto Piva e

2014-01-01

311

Use of StarClose for brachial artery closure after percutaneous endovascular interventions.  

PubMed

The objective of this study was to evaluate a percutaneous extravascular closure device (StarClose, Abbott Vascular, Redwood City, CA) after brachial endovascular approach. From 2004 to 2006, 29 patients received StarClose for brachial closure. Primary endpoints were successful deployment and absence of procedure-related morbidity, secondary endpoints were brachial artery patency on duplex and absence of late (> 30 days) complications. The device was successfully deployed in all patients. In two patients (6.8%) local complications occurred: one patient developed a large hematoma successfully treated with prolonged compression and a second patient presented with brachial artery occlusion requiring operative intervention. After a mean follow-up of 7.5+/-7.2 months, all patients had a palpable brachial/radial pulse; none had signs of infection, distal embolization or neurological deficits. On ultrasound b-mode imaging, the clip was visible as a 4 mm echolucent area at the outer anterior wall of the artery. Based on the peak systolic velocity ratios between the site of StarClose and proximal brachial artery (mean 1.08+/-0.2), none of the studied patients had a significant stenosis at the site of closure. StarClose is safe and effective in providing hemostasis following interventional procedures through the brachial artery; further advantages include patients comfort and early discharge. PMID:18377837

Puggioni, Alessandra; Boesmans, Evelyne; Deloose, Koen; Peeters, Patrick; Bosiers, Marc

2008-01-01

312

Outpatient bilateral supracostal tubeless percutaneous nephrolithotomy for staghorn calculi  

PubMed Central

Percutaneous nephrolithotomy (PCNL) is the surgical procedure of choice to treat staghorn calculi. Most centres perform PCNL as the traditional inpatient procedure. However, outpatient PCNL has been successfully attempted and represents a feasible method of reducing hospital costs. We report the case of a 35-year-old female who underwent outpatient simultaneous PCNL for bilateral renal staghorn calculi. The patient was discharged in stable condition less than 3 hours following the procedure with minimal discomfort. To the best of our knowledge, this case report is the first to describe a successfully completed outpatient bilateral supracostal tubeless PCNL for staghorn calculi.

Kokorovic, Andrea; Wilson, James W.L.; Beiko, Darren

2014-01-01

313

Congenital Splenic Cyst Treated with Percutaneous Sclerosis Using Alcohol  

SciTech Connect

We report a case of successful percutaneous treatment of a congenital splenic cyst using alcohol as the sclerosing agent. A 14-year-old female adolescent presented with a nonsymptomatic cystic mass located in the spleen that was believed to be congenital. After ultrasonography, a drainage catheter was placed in the cavity. About 250 ml of serous liquid was extracted and sent for microbiologic and pathologic studies to rule out an infectious or malignant origin. Immediately afterwards, complete drainage and local sclerotherapy with alcohol was performed. This therapy was repeated 8 days later, after having observed 60 ml of fluid in the drainage bag. One year after treatment the cyst has practically disappeared. We believe that treatment of splenic cyst with percutaneous puncture, ethanolization, and drainage is a valid option and it does not rule out surgery if the conservative treatment fails.

Anon, Ramon [Clinical University Hospital, University of Valencia, Department of Gastroenterology (Spain)], E-mail: ranon@comv.es; Guijarro, Jorge [Clinical University Hospital, University of Valencia, Department of Interventional Radiology (Spain); Amoros, Cirilo [Clinical University Hospital, University of Valencia, Department of Gastroenterology (Spain); Gil, Joaquin [Clinical University Hospital, University of Valencia, Department of Interventional Radiology (Spain); Bosca, Marta M. [Clinical University Hospital, University of Valencia, Department of Gastroenterology (Spain); Palmero, Julio [Clinical University Hospital, University of Valencia, Department of Interventional Radiology (Spain); Benages, Adolfo [Clinical University Hospital, University of Valencia, Department of Gastroenterology (Spain)

2006-08-15

314

Percutaneous Transsplenic Access to the Portal Vein for Management of Vascular Complication in Patients with Chronic Liver Disease  

SciTech Connect

Purpose: To evaluate the safety and feasibility of percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver diseases. Methods: Between Sept 2009 and April 2011, percutaneous transsplenic access to the portal vein was attempted in nine patients with chronic liver disease. Splenic vein puncture was performed under ultrasonographic guidance with a Chiba needle, followed by introduction of a 4 to 9F sheath. Four patients with hematemesis or hematochezia underwent variceal embolization. Another two patients underwent portosystemic shunt embolization in order to improve portal venous blood flow. Portal vein recanalization was attempted in three patients with a transplanted liver. The percutaneous transsplenic access site was closed using coils and glue. Results: Percutaneous transsplenic splenic vein catheterization was performed successfully in all patients. Gastric or jejunal varix embolization with glue and lipiodol mixture was performed successfully in four patients. In two patients with a massive portosystemic shunt, embolization of the shunting vessel with a vascular plug, microcoils, glue, and lipiodol mixture was achieved successfully. Portal vein recanalization was attempted in three patients with a transplanted liver; however, only one patient was treated successfully. Complete closure of the percutaneous transsplenic tract was achieved using coils and glue without bleeding complication in all patients. Conclusion: Percutaneous transsplenic access to the portal vein can be an alternative route for portography and further endovascular management in patients for whom conventional approaches are difficult or impossible.

Chu, Hee Ho; Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Jae, Hwan Jun [Seoul National University College of Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, Department of Radiology, Institute of Radiation Medicine, Clinical Research Institute (Korea, Republic of); Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk [Seoul National University College of Medicine and Seoul National University Hospital, Department of Surgery (Korea, Republic of); Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, Department of Radiology, Institute of Radiation Medicine, Clinical Research Institute (Korea, Republic of)

2012-12-15

315

Preliminary clinical trial in percutaneous nephrolithotomy using a real-time navigation system for percutaneous kidney access  

NASA Astrophysics Data System (ADS)

Background: Precise needle puncture of renal calyces is a challenging and essential step for successful percutaneous nephrolithotomy. This work tests and evaluates, through a clinical trial, a real-time navigation system to plan and guide percutaneous kidney puncture. Methods: A novel system, entitled i3DPuncture, was developed to aid surgeons in establishing the desired puncture site and the best virtual puncture trajectory, by gathering and processing data from a tracked needle with optical passive markers. In order to navigate and superimpose the needle to a preoperative volume, the patient, 3D image data and tracker system were previously registered intraoperatively using seven points that were strategically chosen based on rigid bone structures and nearby kidney area. In addition, relevant anatomical structures for surgical navigation were automatically segmented using a multi-organ segmentation algorithm that clusters volumes based on statistical properties and minimum description length criterion. For each cluster, a rendering transfer function enhanced the visualization of different organs and surrounding tissues. Results: One puncture attempt was sufficient to achieve a successful kidney puncture. The puncture took 265 seconds, and 32 seconds were necessary to plan the puncture trajectory. The virtual puncture path was followed correctively until the needle tip reached the desired kidney calyceal. Conclusions: This new solution provided spatial information regarding the needle inside the body and the possibility to visualize surrounding organs. It may offer a promising and innovative solution for percutaneous punctures.

Rodrigues, Pedro L.; Moreira, António H. J.; Rodrigues, Nuno F.; Pinho, A. C. M.; Fonseca, Jaime C.; Lima, Estevão.; Vilaça, João. L.

2014-03-01

316

One size does not fit all: case report of two percutaneous closures of aortic pseudoaneurysm and review of the literature.  

PubMed

Aortic pseudoaneurysms (PSAs) are common complications following cardiac surgery, and carry significant morbidity and mortality. Surgical management of aortic PSAs is associated with high mortality, however there are emerging reports of transcatheter techniques for closure of aortic PSAs. We present two cases of ascending aorta PSA which developed following cardiac surgery and were treated percutaneously with novel closure devices. We also describe a comprehensive review of the literature of all published cases of ascending aorta PSA which have been closed percutaneously, and report on the success rate and available devices for percutaneous closure. PMID:24630705

Patel, Amit Vipin; Gupta, Sameer; Laffin, Luke Joseph; Retzer, Elizabeth Marie; Dill, Karin Evelyn; Shah, Atman Prabodh

2014-04-01

317

Percutaneous Transumbilical Portal Vein Embolization in a Patient with a Ruptured Hepatocellular Carcinoma Supplied by the Portal Vein  

SciTech Connect

We describe a case of a ruptured hepatocellular carcinoma supplied by the portal vein that was successfully treated with portal vein embolization via a percutaneous transumbilical approach. A contrast material-enhanced computed tomographic (CT) scan showed the presence of a large hypervascular tumor on portal venous phase as well as right hepatic vein thrombosis and hemoperitoneum that prevented portal vein embolization by the use of the percutaneous and transjugular transhepatic approach. The use of percutaneous transumbilical portal vein embolization can be an alternative option in this situation.

Kim, Soo Chin; Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University College of Medicine, Department of Radiology (Korea, Republic of)

2011-02-15

318

Spinal extradural arachnoid cyst following percutaneous vertebroplasty  

Microsoft Academic Search

We report a rare complication of extradural arachnoid cyst following percutaneous vertebroplasty in a spinal metastasis patient.\\u000a Percutaneous vertebroplasty has been established as a safe and effective treatment for osteoporotic vertebral fractures and\\u000a vertebral metastatic lesions. To our knowledge, extradural arachnoid cyst following vertebroplasty has not been reported in\\u000a literature. A 48-year-old woman diagnosed with adenocarcinoma underwent percutaneous vertebroplasty at

Hai-Qing Mao; Hui-Lin Yang; De-Chun Geng; Zhao-Hua Bao; Tian-Si Tang

2011-01-01

319

New instrumentation in percutaneous nephrolithotomy  

PubMed Central

Percutaneous nephrolithotomy (PCNL) is the procedure of choice for removing large, complex, and/or multiple renal calculi. Since its first description in 1976, PCNL techniques and equipment have evolved to maximize procedural efficacy, safety, and reproducibility. We reviewed current literature from January 2004 to November 2009 using Medline search regarding PCNL instrumentation and technology. Additional equipment discovered during the review process without published Medline evidence was summarized from manufacturer brochures and data. Included in this review are summaries of intracorporeal lithotriptors and accessory equipment, stone manipulation devices, PCNL tract sealants, and a digital rigid nephroscope. The evolution of these devices from their predecessors has increased the instrumentation options for the treating urologist and may represent more effective technology for the percutaneous treatment of large renal stones.

Pugh, Joseph W.; Canales, Benjamin K.

2010-01-01

320

Percutaneous Ablation in the Kidney  

PubMed Central

Percutaneous ablation in the kidney is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection. Its increasing use has been largely prompted by the rising incidental detection of renal cell carcinomas with cross-sectional imaging and the need to preserve renal function in patients with comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. Clinical studies to date indicate that radiofrequency ablation and cryoablation are effective therapies with acceptable short- to intermediate-term outcomes and with a low risk in the appropriate setting, with attention to pre-, peri-, and postprocedural detail. The results following percutaneous radiofrequency ablation and cryoablation in the treatment of renal cell carcinoma are reviewed in this article, including those of several larger scale studies of ablation of T1a tumors. Clinical and technical considerations unique to ablation in the kidney are presented, and potential complications are discussed. © RSNA, 2011

Wood, Bradford J.; Gervais, Debra A.

2011-01-01

321

Successful Pregnancy in Stage IE Primary Non-Hodgkin’s Lymphoma of Uterine Cervix Treated with Neoadjuvant Chemotherapy and Conservative Surgery  

Microsoft Academic Search

Background: Primary non-Hodgkin’s lymphoma involving the uterine cervix is extremely rare with a frequency of 0.008% of all cervical tumors. No standard treatment has been defined for this disease. Case: A 29-year-old Caucasian woman with primary non-Hodgkin stage IE lymphoma of the uterine cervix was treated with neoadjuvant chemotherapy and conservative surgery. Three years after completion of primary treatment, she

D. Lorusso; G. Ferrandina; L. Pagano; M. L. Gagliardi; G. Scambia

2007-01-01

322

Percutaneous treatment of pediatric thrombosis.  

PubMed

While rare, thrombosis in the pediatric population can result serious sequelae including death. The best treatment options have not yet been firmly established for this age group. During childhood, there are age-related changes in components of the coagulation system that can affect treatment choices. This review article gives an overview of pediatric coagulation and describes the current state of percutaneous treatment options including local thrombolysis and thrombectomy. PMID:15607849

Temple, Michael; Williams, Suzan; John, Philip; Chait, Peter; Connolly, Bairbre

2005-01-01

323

Percutaneous closure of complex paravalvular aortic root pseudoaneurysm and aorta-cavitary fistulas.  

PubMed

Native aortic valve or its prosthetic valve endocarditis can extend to the adjacent periannular areas and erode into nearby cardiac chambers, leading to pseudoaneurysm and aorta-cavitary fistulas respectively. The later usually leads to acute cardiac failure and hemodynamic instability requiring an urgent surgical intervention. However rarely this might pass unnoticed and the patient might present later with cardiac murmur. Percutaneous device closure of aortic pseudoaneurysm, ruptured sinus of Valsalva aneurysm, aorta-pulmonary window, paravalvular leaks, and aorta-cavitary fistula have been reported. We present a 59-year-old female who developed a large aortic root pseudoaneurysm with biventricular communication aorta-cavitary fistulas presenting late following aortic prosthetic valve endocarditis. She underwent successful percutaneous device closure of her pseudoaneurysm and aorta-cavitary fistulas using two Amplatzer Duct Occluders. This case illustrates a challenging combination of aortic root pseudoaneurysm and biventricular aorta-cavitary fistulas that was successfully treated with percutaneous procedure. PMID:24973845

Al-Maskari, Salim; Panduranga, Prashanth; Al-Farqani, Abdullah; Thomas, Eapen; Velliath, John

2014-01-01

324

[A case of percutaneous coronary intervention after transfemoral implantation of a medtronic CoreValve System].  

PubMed

The association between aortic valve disease and coronary atherosclerosis is common. In the recent era of transcatheter aortic valve implantation there is little experience with coronary artery intervention after valve implantation. We report a case of a 80-year-old male who underwent successful coronary artery intervention few months after a Medtronic CoreValve System percutaneous implantation for severe aortic valve stenosis. Verification of the position of the used wires (crossing from inside the self expanding frame) is of utmost importance before proceeding to coronary intervention. In this case, crossing the aortic valve, coronary angiography and percutaneous coronary intervention were successfully performed. In conclusion, percutaneous coronary intervention in patients with previous Medtronic CoreValve System implantation is feasible and safe. PMID:22567737

Corcione, Nicola; Ferraro, Paolo; Polimeno, Michele; Messina, Stefano; de Rosa, Vincenzo; Giordano, Arturo

2011-12-01

325

Use of the Collings knife electrode for percutaneous access in difficult endourology cases.  

PubMed

Percutaneous endourological techniques for the removal of upper urinary tract calculi and for the closed treatment of ureteropelvic junction obstruction are well described. These techniques are dependent on satisfactory percutaneous access and nephrostomy tract dilation. We used the Collings knife electrode for the creation of a nephrostomy tract in 17 patients (19 renal units) with difficult percutaneous access due to scarification, or the inability to advance a guide wire sufficiently for stabilization and dilation by conventional means. A nephrostomy tract was established successfully in all 19 procedures requiring an average of 12 minutes. Two major complications occurred that required blood transfusion and an open operation. Endourological treatment was successful in the remaining 17 cases. We believe that this technique provides an alternative to an open operation when standard access and dilation methods for endourological procedures are unsuccessful. PMID:1988714

Davis, B E; Noble, M J; Mebust, W K

1991-02-01

326

First in human percutaneous implantation of a balloon expandable transcatheter heart valve in a severely stenosed native mitral valve.  

PubMed

Transcatheter implantation of a balloon expandable valve in calcified severely stenosed native mitral valves has recently been described. The two cases reported so far utilized the surgical transapical approach generally used for transapical transcatheter aortic valve replacement. A percutaneous approach has not been published. We report the first successful percutaneous implantation of a balloon expandable transcatheter valve in the native mitral valve without a surgical incision. © 2014 Wiley Periodicals, Inc. PMID:24532349

Guerrero, Mayra; Greenbaum, Adam; O'Neill, William

2014-06-01

327

Rapidly Aggravated Dissecting Flap by Angiography during Percutaneous Stent Placement for Acute Isolated Superior Mesenteric Artery Dissection  

PubMed Central

Acutely aggravated dissecting flap and consequent occlusion of the superior mesenteric artery (SMA) by simple contrast passage during initial angiography for percutaneous stent placement is a uncommon event, which usually is not reported. After analysis of many factors that underlie development of such complications, we present herein one case of successful treatment of isolated SMA dissection and its complications with favorable outcomes during 25 months follow-up after percutaneous stent placement.

Yang, Hye Jin; Son, Tae Jun; Jung, Yoon Young; Choi, Seung A; Lee, Suk Hoon

2011-01-01

328

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG): RETROSPECTIVE ANALYSIS OF A 7-YEAR CLINICAL EXPERIENCE  

PubMed Central

Aims: Since its description in 1980, percutaneous endoscopic gastrostomy has become the modality of choice for providing enteral access to patients who require long-term enteral nutrition. This study aimed to evaluate current indications and complications associated with PEG feeding. Methods: We conducted a retrospective analysis of all patients who referred to our endoscopic unit of the Department of Gastroenterology and Hepatology of the Medical Center University of Sarajevo for PEG tube placement over a period of 7 years. Medical records of 359 patients dealing with PEG tube placement were reviewed to assess indications, technical success, complications and the need for repeat procedures. Results: The indications for enteral feeding tube placement were malignancy in 44% (n=158), of which 61% (n=97) patients were suffering of head and neck cancer and 39% (n=61) of other malignancy. Central nervous disease was the indication in 48.7 % (n=175) of patients. Cerebrovascular accidents (CVA) accounted for 20% (n=73), head injury for 16% (n=59) and cerebral palsy for 11% (n=38). In 6.13% (n=22) of patients minor complications occur which included wound infection (0.8%), inadvertent PEG removal (2.5%) and tube blockage (1.1%). 11 patients experienced major complications including hemorrhage, tube migration and perforation. There were no deaths related to PEG procedure placement and the overall 30-day mortality rate due to primary disease was 15.8%. Oral feeding was resumed in 23% of the patients and the tube was removed subsequently after 6 -12 months. Conclusions: Percutaneous endoscopic gastrostomy is a save and minimally invasive endoscopic procedure associated with a low morbidity (9.2%) rate, easy to follow-up and to replace when blockage occurs. Over a seven-year period we noticed an increase of 63% in PEG placement at our department.

Vanis, Nenad; Saray, Aida; Gornjakovic, Srdjan; Mesihovic, Rusmir

2012-01-01

329

The Conditions for Success. Council of Europe: Symposium on Modern Languages in Primary Education (Bakkerne, Holte [near Copenhagen], 20-25 September, 1976).  

ERIC Educational Resources Information Center

The main conditions necessary for the successful introduction of the early teaching of modern languages (ETML) are outlined. The processes that are usually involved in the introduction of ETML into a country or region are listed. Obstacles to the successful introduction of ETML and the role of European cooperation in overcoming obstacles are also…

Hoy, P. H.

330

An Implantable Left Atrial Pressure Sensor Lead Designed for Percutaneous Extraction Using Standard Techniques  

PubMed Central

Background An implantable left atrial pressure (LAP) monitoring system for guiding the management of patients with advanced heart failure has the potential to require extraction, particularly in the setting of infection. The LAP sensor lead was designed to be suitable for ease of percutaneous extraction using standard techniques for extracting pacemaker and defibrillator leads. The clinical experience, to date, with percutaneous extraction of the LAP sensor lead is presented. Methods A total of 82 patients underwent successful implantation of the LAP sensor lead using transseptal catheterization. Five patients of the 82 patients during a cumulative follow-up period of 267 patient-years (median of 2.9 years/patient) underwent percutaneous extraction using manual traction with a locking stylet and/or an excimer laser sheath to bore through adhesions. The distal fixation anchors of the LAP sensor lead are designed to fold forward during extraction so that the sensor module can easily separate from the interatrial septum. Results Percutaneous extraction of the LAP sensor lead was accomplished successfully in all five patients with no embolic events, vascular tears, perforations, or other complications requiring surgical intervention. Manual traction alone was sufficient to detach the LAP sensor lead from the interatrial septum in all cases. Use of the excimer laser sheath was needed in selected cases to bore through scar tissue within the venous insertion site, but not within the heart. Conclusions The extraction of the LAP sensor lead was accomplished safely using standard techniques and equipment for percutaneously extracting pacemaker and defibrillator leads.

PRETORIUS, VICTOR; BIRGERSDOTTER-GREEN, ULRIKA; HEYWOOD, J THOMAS; HAFELFINGER, WERNER; GUTFINGER, DAN E; EIGLER, NEAL L; LOVE, CHARLES J; ABRAHAM, WILLIAM T

2013-01-01

331

Ultrasound guided percutaneous biopsies of suspected mediastinal lesions.  

PubMed

Realtime ultrasonography with general purpose sector transducer was used to guide 87 percutaneous biopsies on 82 patients with lesions suspected to be mediastinal masses on plain chest radiographs. In seven patients who had dyspnea the biopsies were done in erect or semi-erect sitting positions. Definitive diagnosis was obtained from 66 lesions (80.5%) where 46 (70.0%) were mediastinal and the remaining 20 lesions (30.0%) arising from the lung. Of the 46 mediastinal lesions where specific diagnosis were made, 42 (91.0%) were anterior and four (0.9%) posterior mediastinal lesions. The majority of these anterior mediastinal masses were lymphomatous nodes followed by germ cell tumours whereas all four posterior mediastinal masses were neurogenic. Of the lung lesions, 19 were primary malignancies. The remaining lung lesion which was located posteriorly was cryptococcus infection. One patient developed massive hemothorax, but subsequently recovered. No significant complications were encountered in the remaining patients. Surgery was carried on 11 patients. There is correlation between definitive diagnosis from percutaneous biopsy and final diagnosis after surgery in 80% of patients. It is proposed that all percutaneous biopsies for thoracic masses which abut the chest wall and cause mediastinal widening on a plain chest radiograph be guided by ultrasound. It can be effectively accomplished with ease and safety even without the use of dedicated biopsy ultrasound probes or biopsy attachments, and on patients in erect or semi-erect positions. PMID:8183166

Samad, S A; Sharifah, N A; Zulfiqar, M A; Maimunah, A; Yahya, A; Zainudin, W

1993-12-01

332

Mediastinitis complicating a percutaneous endoscopic gastrostomy: a case report  

PubMed Central

Background Since its introduction in the early 1980s, percutaneous endoscopic gastrostomy has become the most popular method for performing a gastrostomy for long-term enteral feeding. It has been associated, however, with a lot of minor and major complications. Case presentation A case of mediastinitis with concominant sepsis caused by a masked esophageal perforation after percutaneous endoscopic gastrostomy in a multi-traumatized, brain-injured patient is presented. Ten – fourteen days after the procedure, the patient became febrile and gradually septic with tenderness of the sternum and upper abdomen. Computerized tomography of the thorax revealed mediastinitis. An urgent left thoracotomy and laparotomy were performed for drainage of the mediastinum, removal of the gastrostomy and insertion of a jejunostomy tube. The patient improved soon after the surgery. He was successfully weaned off the ventilator and was discharged from the Intensive Care Unit. Conclusion Perforating mediastinitis is a rare but potentially lethal complication of percutaneous endoscopic gastrostomy. When diagnosed and properly treated it may have a favourable outcome.

Papakonstantinou, Kalliopi; Karagiannis, Athanasios; Tsirantonaki, Maria; Konstantinidis, Anastasios; Spirou, Spiros; Skottis, Ion; Karabinis, Andreas

2003-01-01

333

Management of odontoid fractures with percutaneous anterior odontoid screw fixation  

PubMed Central

Minimally invasive techniques have revolutionized the management of a variety of spinal disorders. The authors of this study describe a new instrument and a percutaneous technique for anterior odontoid screw fixation, and evaluate its safety and efficacy in the treatment of patients with odontoid fractures. Ten patients (6 males and 4 females) with odontoid fractures were treated by percutaneous anterior odontoid screw fixation under fluoroscopic guidance from March 2000 to May 2002. Their mean age at presentation was 37.2 years (with a range from 21 to 55 years). Six cases were Type II and four were Type III classified by the Anderson and D’Alonzo system. The operation was successfully completed without technical difficulties, and without any soft tissue complications such as esophageal injury. No neurological deterioration occurred. Satisfactory results were achieved in all patients and all of the screws were in good placement. After a mean follow-up of 15.7 months (range 10–25 months), radiographic fusion was documented for 9 of 10 patients (90%). Neither clinical symptoms nor screw loosening or breakage occurred. Our preliminary clinical results suggest that the percutaneous anterior odontoid screw fixation procedure using a new instrument and fluoroscopy is technically feasible, safe, useful, and minimally invasive.

Wang, Xiang-Yang; Xu, Hua-Zi; Lin, Yan; Huang, Qi-Shan; Mao, Fang-Min; Ni, Wen-Fei; Wang, Sheng; Dai, Li-Yang

2007-01-01

334

Tumor Seeding of Percutaneous Nephrostomy Tract from Urothelial Carcinoma of the Kidney  

PubMed Central

Urothelial carcinoma (UC) of the renal pelvis has been rarely shown to metastasize to the skin. Tumor seeding from iatrogenic procedures is a source of spreading of UC to the skin. We herein present a case of primary UC of the renal pelvis with spreading to the skin from a percutaneous nephrostomy tract.

Welliver, R. C.; Nazeer, Tipu; Kaufman, Ronald P.

2013-01-01

335

Variation in Outcomes after Percutaneous Coronary Intervention in the United States and Predictors of Periprocedural Mortality  

Microsoft Academic Search

The objective of this study was to characterize variation in mortality rates across hospitals performing percutaneous coronary intervention (PCI) in the United States. For this purpose, data (n = 735,022) from the Nationwide Inpatient Sample from 1996 to 2001 were analyzed. The primary outcome for the analysis was postprocedural in-hospital mortality. Mortality rates were calculated by race, gender, geographic region,

Debabrata Mukherjee; Reid M. Wainess; Justin B. Dimick; John A. Cowan; Sanjay Rajagopalan; Stanley Chetcuti; Paul M. Grossman; Gilbert R. Upchurch

2005-01-01

336

Percutaneous dilatational tracheostomy in a medical ICU  

Microsoft Academic Search

Objective: To evaluate the safety of percutaneous dilatational tracheostomy. Design: A prospective clinical study. Setting: The intensive care unit of a university medical clinic. Patients: 137 critically ill patients admitted between May 1993 and September 1996. Intervention: Percutaneous dilatational tracheostomy at the bedside. Results: The median duration of translaryngeal intubation prior to tracheostomy was 8 days. Tracheostomy was carried out

S. Petros; L. Engelmann

1997-01-01

337

Percutaneous Lung Biopsy: Technique, Efficacy, and Complications  

PubMed Central

Computed tomography-guided percutaneous needle biopsy of the lung is an indispensable tool in the evaluation of pulmonary abnormalities due to its high diagnostic accuracy in the detection of malignancy. Percutaneous biopsy in the lung plays a critical role in obtaining pathologic proof of malignancy, guiding staging and planning treatment. This article reviews biopsy techniques and their related efficacy and complications.

Winokur, Ronald S.; Pua, Bradley B.; Sullivan, Brian W.; Madoff, David C.

2013-01-01

338

Fascial Closure Following Percutaneous Endovascular Aneurysm Repair  

Microsoft Academic Search

IntroductionThere are potential benefits of percutaneous over open femoral access for endovascular aneurysm repair (EVAR). Subsequent arterial closure using percutaneous devices is costly, whilst open repair risks potential wound complications and delayed discharge. The technique of fascial closure has perceived advantages but its efficacy is unclear. The aim of this study was to assess the safety and durability of fascial

G. J. Harrison; D. Thavarajan; J. A. Brennan; S. R. Vallabhaneni; R. G. McWilliams; R. K. Fisher

2011-01-01

339

Clinical Relevance of the Primary Findings of the MTA: Success Rates Based on Severity of ADHD and ODD Symptoms at the End of Treatment  

Microsoft Academic Search

ObjectivesTo develop a categorical outcome measure related to clinical decisions and to perform secondary analyses to supplement the primary analyses of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit\\/Hyperactivity Disorder (MTA).

JAMES M. SWANSON; HELENA C. KRAEMER; STEPHEN P. HINSHAW; L. EUGENE ARNOLD; C. KEITH CONNERS; HOWARD B. ABIKOFF; WALTER CLEVENGER; MARK DAVIES; GLEN R. ELLIOTT; LAURENCE L. GREENHILL; LILY HECHTMAN; BETSY HOZA; PETER S. JENSEN; JOHN S. MARCH; JEFFREY H. NEWCORN; ELIZABETH B. OWENS; WILLIAM E. PELHAM; ELLEN SCHILLER; JOANNE B. SEVERE; STEVE SIMPSON; BENEDETTO VITIELLO; KAREN WELLS; TIMOTHY WIGAL; MIN WU

2001-01-01

340

Percutaneous aspiration of fluid for management of peritonitis in space  

NASA Technical Reports Server (NTRS)

BACKGROUND: As a medical emergency that can affect even well-screened, healthy individuals, peritonitis developing during a long-duration space exploration mission may dictate deviation from traditional clinical practice due to the absence of otherwise indicated surgical capabilities. Medical management can treat many intra-abdominal processes, but treatment failures are inevitable. In these circumstances, percutaneous aspiration under sonographic guidance could provide a "rescue" strategy. Hypothesis: Sonographically guided percutaneous aspiration of intra-peritoneal fluid can be performed in microgravity. METHODS: Investigations were conducted in the microgravity environment of NASA's KC-135 research aircraft (0 G). The subjects were anesthetized female Yorkshire pigs weighing 50 kg. The procedures were rehearsed in a terrestrial animal lab (1 G). Colored saline (500 mL) was introduced through an intra-peritoneal catheter during flight. A high-definition ultrasound system (HDI-5000, ATL, Bothell, WA) was used to guide a 16-gauge needle into the peritoneal cavity to aspirate fluid. RESULTS: Intra-peritoneal fluid collections were easily identified, distinct from surrounding viscera, and on occasion became more obvious during weightless conditions. Subjectively, with adequate restraint of the subject and operators, the procedure was no more demanding than during the 1-G rehearsals. CONCLUSIONS: Sonographically guided percutaneous aspiration of intra-peritoneal fluid collections is feasible in weightlessness. Treatment of intra-abdominal inflammatory conditions in spaceflight might rely on pharmacological options, backed by sonographically guided percutaneous aspiration for the "rescue" of treatment failures. While this risk mitigation strategy cannot guarantee success, it may be the most practical option given severe resource limitations.

Kirkpatrick, A. W.; Nicolaou, S.; Campbell, M. R.; Sargsyan, A. E.; Dulchavsky, S. A.; Melton, S.; Beck, G.; Dawson, D. L.; Billica, R. D.; Johnston, S. L.; Hamilton, D. R.

2002-01-01

341

Percutaneous Endoscopic Retrieval and Replacement of a Knitted (Ultraflex) Biliary Stent  

SciTech Connect

A knitted (Ultraflex) biliary stent became obstructed after 5 months causing recurrent jaundice in a 92-year-old man with pancreatic cancer. The obstructed stent was successfully removed percutaneously by retrieval forceps under guidance by an 8.4 Fr fiberoptic biliary endoscope. A new stent was placed. No complications were encountered.

Sawada, Satoshi [Department of Radiology, University Hospital of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-01 (Japan); Kobayashi, Masami [Department of Radiology, Tottori University Hospital, 36-1 Nishimachi, Yonago 683 (Japan); Tanigawa, Noboru; Okuda, Yoshikazu; Mishima, Kazuya; Ohmura, Naoto; Kobayashi, Midori [Department of Radiology, University Hospital of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-01 (Japan)

1997-09-15

342

Variations in delineation of the obex by contrast radiography during percutaneous trigeminal tractotomy  

Microsoft Academic Search

Twenty patients have undergone percutaneous trigeminal tractotomy (PTT) for relief of intractable facial pain. The floor of the fourth ventricle, the obex, and the dorsum of the medulla oblongata were outlined successfully on the lateral X-ray film by the use of 1 cc of Pantopaque emulsified with 1 cc of cerebrospinal fluid injected through a midline cisterna magna puncture. Injection

John L. Fox

1973-01-01

343

Results of percutaneous double-balloon mitral commissurotomy in one medical center in Tunisia  

Microsoft Academic Search

Percutaneous balloon mitral commissurotomy was attempted in Tunisia, where rheumatic fever is still endemic, in 463 consecutive patients with severe rheumatic mitral valve stenosis. Their mean age ±SD was 33 ± 12 years (range 8 to 68), 324 patients (70%) were women, and 327 (71%) were in sinus rhythm. Valvotomy was technically successful in 454 patients (98%). The mean mitral

Mohamed Ben Farhat; Fethi Betbout; Habib Gamra; Faouzi Maatouk; Mokdad Ayari; Ali Cherif; Mourad Jarrar; Habib Boussadia; Sonia Hammami; Iheb Chahbani

1995-01-01

344

Ureteroscopy-Assisted Retrograde Nephrostomy for Percutaneous Nephrolithotomy after Urinary Diversion  

PubMed Central

A 33-year-old male with an ileal conduit was referred to our department for the treatment of left renal calculi. After inserting a ureteral access sheath, a ureteroscopy-assisted retrograde nephrostomy was made. Percutaneous nephrolithotomy was successfully achieved using this nephrostomy.

Kawahara, Takashi; Ito, Hiroki; Terao, Hideyuki; Ogawa, Takehiko; Uemura, Hiroji; Kubota, Yoshinobu; Matsuzaki, Junichi

2012-01-01

345

Sclerotic Vertebral Metastases: Pain Palliation Using Percutaneous Image-Guided Cryoablation  

SciTech Connect

Cryoablative therapies have been proposed to palliate pain from soft-tissue or osteolytic bone tumors. A case of a patient with painful thoracic and sacral spine sclerotic metastases successfully treated by image-guided percutaneous cryoablation with the aid of insulation techniques and thermosensors is reported in this case report.

Costa de Freitas, Ricardo Miguel, E-mail: ricardomcfreitas@gmail.com; Menezes, Marcos Roberto de [Instituto do Cancer do Estado de Sao Paulo, Department of Radiology (Brazil); Cerri, Giovanni Guido [Sirio Libanes Hospital, Department of Radiology (Brazil); Gangi, Afshin [Strasbourg University Hospital, Department of Radiology (France)

2011-02-15

346

Prediction of Primary Slow-Pathway Ablation Success Rate according to the Characteristics of Junctional Rhythm Developed during the Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia  

PubMed Central

Background Nowadays, developed junctional rhythm (JR) that occurs during slow-pathway radiofrequency (RF) catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) has been focused upon as a highly sensitive surrogate end point for successful radiofrequency ablation. This study was conducted to assess the relationship between the presence and pattern of developed JR during the RF ablation of AVNRT and a successful outcome. Methods Seventy-five patients aged between 14 and 88 who underwent slow-pathway RF ablation due to symptomatic AVNRT were enrolled into the study and received a total of 162 RF energy applications. Combined anatomic and electrogram mapping approach was used for slow-pathway RF ablation. The ablation procedure consisted of 60-second, 60 °C temperature-controlled energy delivery. After each ablation pulse, successful ablation was assessed according to the loss of AVNRT inducibility via isoproterenol infusion. Four different patterns were considered for the developed JR, namely sparse, intermittent, continuous, and transient block. Success ablation rate was assessed with respect to the position, pattern, and number of junctional beats. Results Successful RF ablation with a loss of AVNRT inducibility was achieved in 43 (57.3%) patients using 119 RF energy applications (73.5%). JR developed in 133 of the 162 (82.1%) applications with a given sensitivity of 90.8% and low specificity of 41.9% as an end point of successful RF ablation, with a negative predictive value of 62.1%. The mean number of the developed junctional beats was significantly higher in the successful ablations (p value < 0.001), and the ROC analysis revealed that the best cut-off point of the cumulative junctional beats for identifying accurate AVNRT ablation therapy is 14 beats with 90.76 % sensitivity and 90.70% specificity. There were no significant differences in terms of successful ablation rates according to the four different patterns of JR and its positions (p value=0.338, p value=0.105, respectively) in the univariate analyses. Conclusion JR is a sensitive but non-specific predictor of the successful RF ablation of AVNRT. Nevertheless, according to the results, its specificity could increase with the presence of more than 14 cumulative junctional beats. Although the development of JR during slow-pathway RF ablation seems not to be reliable as a success end point, its absences could be a marker of requiring more energy application to ablate the slow pathway.

Bagherzadeh, Ataallah; Rezaee, Mohammad Esmaeel; Farahani, Maryam Moshkani

2011-01-01

347

Percutaneous embolization of a chylous leak from thoracic duct injury in a child.  

PubMed

Postoperative chylous leak may result from thoracic duct injury during surgical procedures in the chest or neck and can be successfully treated with percutaneous embolization. We report the case of a child with persistent chylothorax and chyloperitoneum following multivisceral transplantation, which was performed due to unresectable inflammatory myofibroblastic tumor of the retroperitoneum. Intranodal lymphangiography was used to demonstrate the site of chylous leak from the lower segment of the thoracic duct and the leak resolved within days following percutaneous embolization of the thoracic duct. PMID:24385224

Snow, Aisling L; Uller, Wibke; Kim, Hueng Bae; Alomari, Ahmad I

2014-08-01

348

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

SciTech Connect

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 of the target at low pressures.

Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Ozkan, Ugur; Gumus, Burcak [Baskent University Faculty of Medicine, Department of Radiology (Turkey)

2009-09-15

349

Percutaneous Salvage of Crushed Bilateral Aorto-Iliac Stents: Case Report  

SciTech Connect

There are multiple reports of externally deformed or crimped intravascular stents. Percutaneous salvage has been described in multiple anatomic locations including the carotid artery,coronary artery bypass grafts, and hemodialysis conduits. We report successful percutaneous salvage of severely crushed aortoiliac stents in a patient status post low anterior resection, chemotherapy, and radiation therapy for rectal carcinoma. A review of the literature describing approaches to externally deformed stents in other anatomic regions, the limited experience with crushed iliac stents, and our technique is presented.

Soares, Gregory M.; Coiner, Leonard G.; Gunlock, Michael G. [Department of Radiology, WilfordHall Medical Center, 2200 Bergquist Drive, Suite 1, Lackland Air Force Base, TX 78236-5300 (United States); Hagino, Ryan T. [Department of Vascular Surgery, Wilford Hall Medical Center, 2200 Bergquist Drive, Suite 1, Lackland Air Force Base, TX 78236-5300 (United States)

2002-12-15

350

Cardiac resynchronisation therapy after percutaneous trans-coronary-venous mitral annuloplasty.  

PubMed

We present a case of a 45-year-old man with symptomatic heart failure and ischaemic functional mitral regurgitation (FMR), who underwent a successful percutaneous trans-coronary venous mitral annuloplasty with the Carillon system. The procedure resulted in clinical improvement as well as in a decrease in the degree of MR as assessed by echocardiography. Fifteen months later, the patient underwent cardiac resynchronisation (CRT) device implantation, resulting in a further improvement in echocardiographic measures of FMR. This case not only confirms the feasibility of CRT after percutaneous trans-coronary-venous mitral annuloplasty, but also suggests a possible synergistic effect of both therapies, warranting future clinical trials. PMID:24399586

Siminiak, Tomasz; Jerzykowska, Olga; Kalmucki, Piotr; Link, Rafa?; Baszko, Artur

2013-01-01

351

Endocarditis of Amplatzer occluder devices after percutaneous closure of a mitral paravalvular leak.  

PubMed

Symptomatic paravalvular leaks (PVL) are a relatively uncommon, but potentially significant postoperative complication of valve replacement surgery. Percutaneous repair of PVLs has become an increasingly utilized approach in patients whose comorbidities obviate surgical repair. We present an interesting case of a gentleman who underwent successful repair of a mitral PVL with Amplatzer devices following initial aortic and mitral valve replacements for bacterial endocarditis. He later developed fungal endocarditis that ultimately required re-operation to remove the devices and replace his mitral and aortic valves. This complication of closure devices, although reportedly rare, should be considered when contemplating a percutaneous approach. © 2012 Wiley Periodicals, Inc. PMID:23225750

Lee, Candice Y; Ling, Frederick S; Knight, Peter A

2013-06-01

352

Current status of percutaneous coronary intervention of chronic total occlusion  

PubMed Central

This paper describes the current status of percutaneous coronary intervention (PCI) for totally occluded coronary arteries. Chronic total occlusion is associated with 10%–20% of all PCI procedures. Results show that opening an occluded vessel, especially one supplying a considerable area of myocardium, may be beneficial for a patient’s angina relief and heart function. We describe the devices used currently in re-canalization such as new wires, microcatheters (including Tonus and Cosair) and intravascular ultrasound guidance. Different techniques to improve the success rate and reduce complications are discussed in detail.

Ge, Jun-bo

2012-01-01

353

Percutaneous Transhepatic Duodenal Diversion for the Management of Duodenal Fistulae  

Microsoft Academic Search

Purpose  The aim of this study was to determine the success of the nonoperative management of persistent duodenal fistulae (DF) with\\u000a percutaneous transhepatic duodenal diversion (PTDD).\\u000a \\u000a \\u000a \\u000a Methods  Retrospective chart review identified six patients with DF managed by PTDD from 2006 to 2007. Patient outcomes and complications\\u000a were assessed.\\u000a \\u000a \\u000a \\u000a Results  The etiology of DF included pancreatic surgery (three patients), gastrectomy (two patients), and Crohn’s

Jessica G. Zarzour; John D. Christein; Ernesto R. Drelichman; Rachel F. Oser; Mary T. Hawn

2008-01-01

354

Percutaneous Transluminal Angioplasty in Peripheral Vascular Disease: A Review  

PubMed Central

Percutaneous transluminal angioplasty is a relatively new technique employed in the treatment of stenoses or occlusions of peripheral arteries. While the longterm success rates have yet to be determined, short-term results have been excellent. The procedure has greatest value in the dilatation of localized lesions, avoiding surgery and its attendant risks. However, PTA and surgery are complementary, not competing, modes of therapy. PTA complements the traditional therapy of peripheral vascular disease, which remains reconstructive surgery. ImagesFig. 7Fig. 8Fig. 9Fig. 10Fig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6

Louis, Eugene L. St.; Provan, John L.; Gray, Robin R.; Grosman, Harvey; Ameli, F. Michael; Elliott, David S.

1982-01-01

355

Percutaneous Transcatheter Ethanol Sclerotherapy and Catheter Drainage of Postoperative Pelvic Lymphoceles  

SciTech Connect

The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol scleortherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15-2900 mL). The mean catheterization duration was 11.8 days (1-60 days). The mean follow up time was 25.8 months (2-64 months). The initial treatment was successful in 46 out of 50 (91%) lymphoceles treated with PTES and 7 out of 10 (70%) lymphoceles treated with percutaneous catheter drainage. Minor complications (secondary infection and catheter dislodgement) were noted in seven (11.6%) patients. Recurrence developed in four and three patients who were treated by PTES and percutaneous catheter drainage, respectively. Five of these patients were treated with PTES without further recurrence. Percutaneous transcatheter ethanol sclerotherapy is an effective and reliable method for the treatment of postoperative lymphoceles.

Akhan, Okan, E-mail: musturayk@yahoo.com; Karcaaltincaba, Musturay; Ozmen, Mustafa N.; Akinci, Devrim [Hacettepe University School of Medicine, Department of Radiology (Turkey); Karcaaltincaba, Deniz; Ayhan, Ali [Hacettepe University School of Medicine, Department of Obstetrics and Gynecology (Turkey)

2007-04-15

356

Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery: treatment by percutaneous stent placement  

Microsoft Academic Search

.   Spontaneous and isolated dissection of the superior mesenteric artery is a rare and often fatal event which has been successfully\\u000a treated by surgery in several reported cases. We present a patient with acute mesenteric ischemia due to superior mesenteric\\u000a artery dissection who was successfully treated by percutaneous endovascular placement of a Wallstent.

D. A. Leung; E. Schneider; R. Kubik-Huch; B. Marincek; T. Pfammatter

2000-01-01

357

Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery: treatment by percutaneous stent placement.  

PubMed

Spontaneous and isolated dissection of the superior mesenteric artery is a rare and often fatal event which has been successfully treated by surgery in several reported cases. We present a patient with acute mesenteric ischemia due to superior mesenteric artery dissection who was successfully treated by percutaneous endovascular placement of a Wallstent. PMID:11305570

Leung, D A; Schneider, E; Kubik-Huch, R; Marincek, B; Pfammatter, T

2000-01-01

358

Can we reduce secondary surgical interventions and length of hospitalization in percutaneous nephrolithotomy?  

PubMed

Purpose: To evaluate the success and complication rates of percutaneous nephrolithotomy (PNL) operations and to determine the effect of postoperative late removal of an open-end ureter catheter on hospital stay and on secondary interventions. Materials and Methods: The records of 198 patients (97 female, 101 male) who had PNL between May 2009 and February 2012 were retrospectively reviewed. The open-end ureter catheter which was placed during the operation was removed at the end of the operation in the first 53 patients ( group 1) and 12 hours after the nephrostomy catheter in 145 patients ( group 2). Results: PNL intervention was performed in 198 patients with a mean age of 40.83 ± 13.64 years and mean stone load of 9.82 ± 5.37cm2 (range 2 to 26 cm2). When clinically insignificant stone pieces < 4 mm were accepted as successful, the total success rate was 80.80 % (79.2% in group1 and 81.4% in group 2, P = .50). The hospitalization period was significantly reduced in group 2 (3.45 ± 0.95 days vs. 2.61 ± 0.65 days; P = .006). While secondary surgical intervention was not necessary in any of the patients in group 2 (0.0%), but 4 patients (7.5%) required ureterorenoscopy plus double-J stent placement following the primary procedure in group 1 (P = .006). Conclusion: PNL is a safe procedure with a high success rate and a short hospitalization period. There was a significant decrease in the hospitalization period and secondary surgical intervention rates with the postoperative late removal of the open-end ureter catheter. PMID:25015599

Delikta?, Hasan; Yapici, Onur; Ozen, Utku; Yalçin, Engin; Sahin, Hayrettin

2014-01-01

359

Prevention of restenosis by lovastatin after successful coronary angioplasty  

Microsoft Academic Search

Prevention of restenosis after successful percutaneous transluminal coronary angioplasty (PTCA) remains a major challenge. To determine whether lovastatin could prevent restenosis, between December 1987 and July 1988, a total of 157 patients undergoing successful PTCA were randomly and prospectively assigned to the lovastatin group or a control group. Seventy-nine patients received lovastatin (20 mg daily if the serum cholesterol level

R. Sahni; A. R. Maniet; G. Voci; V. S. Banka

1991-01-01

360

The current role of percutaneous chemolysis in the management of urolithiasis: review and results.  

PubMed

The treatment of urolithiasis has changed dramatically over the past several decades. Novel technologies have led to new management protocols. Percutaneous chemolysis as a primary or adjuvant treatment for urinary tract stones has widely been neglected. We present our own experience with it and discuss it in the light of an extensive literature review. From a MEDLINE search on percutaneous chemolysis we evaluated the most important studies, a total of 58 articles, 43 case series and 15 review articles. In our unit between 2001 and 2011, 29 patients (mean age 62 years) with infectious staghorn calculi were treated with adjuvant percutaneous chemolysis post-percutaneous nephrolithotripsy. There were 17 women, with 10 complete and 14 partial staghorn stones (mean size 32 mm). Patients were generally deemed at high risk to undergo another procedure in the future. Suby G solution was used following an established protocol. Sixteen patients (55.1 %) were stone free after chemolysis, eight stones showed partial dissolution, half of them with so-called "insignificant" residual fragments <4 mm. Patients with residual stones underwent SWL. Mean follow-up was 5.25 years (1-11). One stone-free patient (6 %) and three of eight patients (37.5 %) with residual fragments post local chemolysis, developed new stones during follow-up. The often neglected percutaneous chemolysis represents a significant and effective. PMID:23743991

Kachrilas, Stefanos; Papatsoris, Athanasios; Bach, Christian; Bourdoumis, Andreas; Zaman, Faruquz; Masood, Junaid; Buchholz, Noor

2013-08-01

361

Osteoid osteoma: percutaneous resection with CT guidance.  

PubMed

In 24 patients with presumed osteoid osteoma in the appendicular skeleton (n = 23) and lumbar spine (n = 1), percutaneous resection with a drill system and computed tomographic (CT) guidance was performed. In the procedure, a 7-mm-diameter toothed drill inserted over a guide wire is used to remove the nidus. Twenty-three patients were successfully treated. Histologic confirmation of osteoid osteoma was obtained in 19 cases. In one patient, open surgery with bone grafting and osteosynthesis was necessary because of inadvertent extensive bone resection resulting from damage to the drill. All patients have remained free of pain and recurrence for 3-24 months. Although the procedure was effective in all patients, the 7-mm diameter of the toothed drill may cause difficulty in small bones or even danger in areas such as the posterior vertebral arch. In locations such as the tubular bones of the lower extremity and the femoral neck, however, this technique is feasible and may become the treatment of choice for osteoid osteoma. PMID:8327712

Assoun, J; Railhac, J J; Bonnevialle, P; Poey, C; Salles de Gauzy, J; Baunin, C; Cahuzac, J P; Clement, J L; Coustets, B; Railhac, N

1993-08-01

362

A novel vacuum assisted closure therapy model for use with percutaneous devices.  

PubMed

Long-term maintenance of a dermal barrier around a percutaneous prosthetic device remains a common clinical problem. A technique known as Negative Pressure Wound Therapy (NPWT) uses negative pressure to facilitate healing of impaired and complex soft tissue wounds. However, the combination of using negative pressure with percutaneous prosthetic devices has not been investigated. The goal of this study was to develop a methodology to apply negative pressure to the tissues surrounding a percutaneous device in an animal model; no tissue healing outcomes are presented. Specifically, four hairless rats received percutaneous porous coated titanium devices implanted on the dorsum and were bandaged with a semi occlusive film dressing. Two of these animals received NPWT; two animals received no NPWT and served as baseline controls. Over a 28-day period, both the number of dressing changes required between the two groups as well as the pressures were monitored. Negative pressures were successfully applied to the periprosthetic tissues in a clinically relevant range with a manageable number of dressing changes. This study provides a method for establishing, maintaining, and quantifying controlled negative pressures to the tissues surrounding percutaneous devices using a small animal model. PMID:24685323

Cook, Saranne J; Nichols, Francesca R; Brunker, Lucille B; Bachus, Kent N

2014-06-01

363

Laparoscopic Simple Nephrectomy After Previous Ipsilateral Open Versus Percutaneous Renal Surgery  

PubMed Central

Background and Objectives: Fibrosis after previous open or percutaneous renal surgery may interfere with ipsilateral laparoscopic nephrectomy. We prospectively compared the outcome of laparoscopic nephrectomy in patients with previous open renal surgery or percutaneous nephrolithotomy. Patients and Methods: During the study period, 38 patients with previous ipsilateral open renal surgery (n = 22) or percutaneous nephrolithotomy (n = 16) who underwent transperitoneal laparoscopic nephrectomy were evaluated. All patients had symptomatic nonfunctioning small or hydronephrotic kidneys. Results: Mean age was 57.6 y (range, 15 to 77). Both groups were age and sex matched. Two procedures (both in patients with previous open renal surgery) were converted to open surgery because of difficult pedicle dissection. Mean operative time was nonsignificantly longer in group 1 (111 versus 97 min; P = .22). Intraoperative complications consisted of symptomatic capnothorax and diaphragmatic rupture in 1 case per group, managed successfully by inserting a chest tube or laparoscopic repair. Intraoperative blood loss and mean postoperative hematocrit drop were similar in the 2 groups. No significant differences were found between groups in postoperative variables, including time to oral intake, hospital stay, and time to ambulation. Conclusion: Transperitoneal laparoscopic nephrectomy in patients with a history of ipsilateral open or percutaneous renal surgery is feasible in a timely manner. Given adequate laparoscopic experience, similar perioperative outcomes can be achieved in both groups. When laparoscopic nephrectomy is used, the precautions that need to be considered are similar for patients with previous percutaneous nephrolithotomy and those with previous open flank surgery.

Goshtasbi, Bahman

2012-01-01

364

Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy.  

PubMed

The micro-percutaneous nephrolithotomy (microperc) is a recently introduced percutaneous nephrolithotomy (PNL) technique that is performed through a 4.8 Fr all-seeing needle. We aimed to measure the intrarenal pelvic pressure (IPP) during microperc and compare it with the levels of conventional PNL. A total of 20 patients with 1- to 3-cm renal calculi resistant to shock wave lithotripsy were treated either with microperc (Group-1, n: 10) or conventional PNL (Group-2, n: 10) by the same surgical team. The IPP was measured during different stages (entrance into the collecting system, stone fragmentation, and before termination) of the procedures by an urodynamic machine using the 6 Fr ureteral catheter. All the variables were statistically compared between the two groups. The demographic values of the patients were similar. The operation time and duration of hospitalization were significantly prolonged in conventional PNL group (p = 0.034, p = 0.01, respectively). The mean drop in hematocrit levels was significantly lower in microperc group (3.5 ± 1.5 vs. 1.8 ± 0.8; p = 0.004). The IPP was significantly higher in microperc group during all steps of the procedure. The highest level of the IPP was measured as 30.3 ± 3.9 and 20.1 ± 3.1 mmHg in Group 1 and Group 2, respectively (p < 0.0001). However, the complication and success rates were found comparable. In conclusion, we demonstrate that the level of IPP is significantly increased during microperc compared to conventional PNL. Microperc should be used cautiously in cases with impaired drainage of the collecting system. PMID:24522489

Tepeler, Abdulkadir; Akman, Tolga; Silay, Mesrur Selcuk; Akcay, Muzaffer; Ersoz, Cevper; Kalkan, Senad; Armagan, Abdullah; Sarica, Kemal

2014-06-01

365

Renal Subcapsular Hematoma after Percutaneous Transfemoral Angiography  

PubMed Central

Vascular complications after percutaneous angiography include hematoma, pseudoaneurysm, arteriovenous fistula, thromboembolism, arterial laceration and infection. Hematomas may occur in the groin, thigh, retroperitoneal, intraperitoneal, or abdominal wall. A 54-year-old female underwent percutaneous transfemoral angiography for the evaluation of cerebral aneurysm. Renal subcapsular hematoma developed 3 hours after the procedure. Renal subcapsular hematoma after percutaneous angiography is very rare. We investigated the possible causes of renal subcapsular hematoma. To avoid this rare complication, we need to perform guide-wire passage carefully from the beginning of the procedure under full visual monitoring.

Yi, Jin-Seok; Lee, Hong-Jae; Yang, Ji-Ho

2014-01-01

366

Renal subcapsular hematoma after percutaneous transfemoral angiography.  

PubMed

Vascular complications after percutaneous angiography include hematoma, pseudoaneurysm, arteriovenous fistula, thromboembolism, arterial laceration and infection. Hematomas may occur in the groin, thigh, retroperitoneal, intraperitoneal, or abdominal wall. A 54-year-old female underwent percutaneous transfemoral angiography for the evaluation of cerebral aneurysm. Renal subcapsular hematoma developed 3 hours after the procedure. Renal subcapsular hematoma after percutaneous angiography is very rare. We investigated the possible causes of renal subcapsular hematoma. To avoid this rare complication, we need to perform guide-wire passage carefully from the beginning of the procedure under full visual monitoring. PMID:24653804

Yi, Jin-Seok; Lee, Hyung-Jin; Lee, Hong-Jae; Yang, Ji-Ho

2014-02-01

367

Percutaneous catheterisation of the radial artery in newborn babies using transillumination.  

PubMed Central

A technique for inserting radial artery catheters percutaneously in newborn babies using transillumination is described. Catheterisation was successful in 69% of the 107 babies in whom it was attempted. In the last 30 attempts there was an 85% success rate with an average useful life of 100 hours. The average weight of these babies was 1405 g, with a range of 620--4250 g. The method has several advantages over previous methods. Images Fig. 2 Fig. 3 Fig. 4

Pearse, R G

1978-01-01

368

Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation  

PubMed Central

Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors’ clinic and treated by PCN. The patients’ gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 ± 10.2 years). The levels of involvement were 21 cases at C3–4, 30 cases at C4–5, 40 cases at C5–6, and 35 cases at C6–7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) ?11° or horizontal displacement (HD) ?3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no significant difference in stability either preoperatively or postoperatively (P > 0.05). Our findings confirm that PCN for the treatment of cervical disc herniation results in a good outcome without any tampering of the stability of the cervical spine. Hence, PCN as a procedure is safe, minimally invasive, less traumatic, requiring less time with an excellent clinical outcome. PCN should be performed for those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery.

Li, Jian; Zhang, Zai-Heng

2008-01-01

369

Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients.  

PubMed

The purpose of this study was to assess the feasibility, safety and efficacy of radiofrequency ablation (RFA) with the use of artificial ascites for hepatocellular carcinoma (HCC) adjacent to the diaphragm and gastrointestinal tract. One hundred forty-three patients with 181 HCCs who underwent US-guided percutaneous RFA with the use of artificial ascites were retrospectively reviewed. Among the 181 HCCs, 148 HCCs were defined as problematic nodules for two major reasons: poor sonic window or possible thermal injury. We artificially induced ascites before performing RFA by dripping 5% dextrose in a water solution. We assessed the technical success of introducing artificial ascites, technical feasibility of the use of artificial ascites and complications. The technical success rate, as well as the primary and secondary technique success rate, was assessed by regular follow-up CT examinations. RFA with artificial ascites was successfully achieved in 130 of 143 patients. The primary technique effectiveness was 85.3%. During follow-up (mean, 20.4 months), remote intrahepatic recurrence occurred in 49 patients and local tumor progression occurred in 15 patients. Three (2.1%) of the 143 patients experienced major complications (hemoperitoneum, lobar infarction and biloma) related to the RFA procedure. The use of artificial ascites is a simple and useful technique to minimize collateral thermal injury and to improve the sonic window. PMID:19557416

Song, Inyoung; Rhim, Hyunchul; Lim, Hyo K; Kim, Young-Sun; Choi, Dongil

2009-11-01

370

Successful Eradication of Relapsed Primary Effusion Lymphoma with High-Dose Chemotherapy and Autologous Stem Cell Transplantation in a Patient Seronegative for Human Immunodeficiency Virus  

Microsoft Academic Search

Primary effusion lymphoma (PEL) is a recently recognized disease that occurs most often in immunosuppressed patients, either\\u000a with human immunodeficiency virus (HIV) or in the posttransplantation setting, and it occasionally occurs in nonim-munosuppressed\\u000a patients. Patients present with lymphomatous effusions in serous cavities—pleura, pericardium, or peritoneum–without any identifiable\\u000a tumor mass. PEL rarely responds to systemic chemotherapy, and the prognosis is poor,

Jong-Ho Won; Seung-Hyo Han; Sang-Byung Bae; Chan-Kyu Kim; Nam-Su Lee; Kyu-Taeg Lee; Sung-Kyu Park; Dae-Sik Hong; Dong-Wha Lee; Hee-Sook Park

2006-01-01

371

Splenic irradiation-induced gastric variceal bleeding in a primary splenic diffuse large B-cell lymphoma patient: a rare complication successfully treated by splenectomy with short gastric vein ligation  

PubMed Central

Primary splenic diffuse large B-cell lymphoma (DLBCL) is a rare clinical condition, which is generally treated by six to eight cycles of chemotherapy involving a combination of rituximab and the cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) regimen. However, the treatment for chemorefractory primary splenic DLBCL remains controversial. Therapeutic splenic irradiation (SI) might be a reasonable and possibly the only treatment option with curative intention for patients with chemorefractory primary splenic DLBCL. However, the efficacy and safety of therapeutic SI are unclear. Herein, we present the case of a primary splenic DLBCL patient who was refractory to multiple chemotherapy regimens but achieved complete remission after administration of therapeutic SI. However, his condition was complicated with severe gastric variceal bleeding due to splenic venous thrombosis, which was successfully treated via splenectomy and short gastric vein ligation. On the basis of our findings, we concluded that the splenic venous thrombosis-induced gastric variceal bleeding was a rare but life-threatening adverse effect of the therapeutic SI administered for primary splenic DLBCL. Surgical intervention involving splenectomy and short gastric vein ligation is mandatory and should be performed as soon as possible for such patients.

2012-01-01

372

FIBRIN SEALANT ENABLES TUBELESS PERCUTANEOUS STONE SURGERY  

Microsoft Academic Search

Purpose:Fibrin sealant has been demonstrated to be safe and effective as a hemostatic agent and urinary tract sealant. We assessed the ability of fibrin sealant to facilitate tubeless management after uncomplicated percutaneous nephrolithotomy (PCNL).

MARK W. NOLLER; STEVEN M. BAUGHMAN; ALLEN F. MOREY; BRIAN K. AUGE

2004-01-01

373

Caring for Your Percutaneous Nephrostomy Tube  

MedlinePLUS

... I care for the nephrostomy tube? Changing the dressing Keep the skin around the nephrostomy tube clean. ... Caring for your percutaneous 4 nephrostomy tube Nephrostomy dressing change: after the new tube is placed Supplies ? ...

374

Why a successful task substitution in glaucoma care could not be transferred from a hospital setting to a primary care setting: a qualitative study  

PubMed Central

Background Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders’ perceived feasibility of transferring hospital-based monitoring of stable glaucoma patients to primary care optometrists. Methods A case study was undertaken in the Rotterdam Eye Hospital (REH) using semi-structured interviews and document reviews. They were inductively analysed using three implementation related theoretical perspectives: sociological theories on professionalism, management theories, and applied political analysis. Results Currently it is not feasible to use primary care optometrists as substitutes for optometrists and ophthalmic technicians working in a hospital-based glaucoma follow-up unit (GFU). Respondents’ narratives revealed that: the glaucoma specialists’ sense of urgency for task substitution outside the hospital diminished after establishing a GFU that satisfied their professionalization needs; the return on investments were unclear; and reluctant key stakeholders with strong power positions blocked implementation. The window of opportunity that existed for task substitution in person and setting in 1999 closed with the institutionalization of the GFU. Conclusions Transferring the monitoring of stable glaucoma patients to primary care optometrists in Rotterdam did not seem feasible. The main reasons were the lack of agreement on professional boundaries and work domains, the institutionalization of the GFU in the REH, and the absence of an appropriate reimbursement system. Policy makers considering substituting tasks to other professionals should carefully think about the implementation process, especially in a two-step implementation process (substitution in person and in setting) such as this case. Involving the substituting professionals early on to ensure all stakeholders see the change as a normal step in the professionalization of the substituting professionals is essential, as is implementing the task substitution within the window of opportunity.

2013-01-01

375

A Case of Rheumatoid Arthritis and Limited Systemic Sclerosis Overlap Successfully Treated with Tocilizumab for Arthritis and Concomitant Generalized Lymphadenopathy and Primary Biliary Cirrhosis  

PubMed Central

A 57-year-old woman with rheumatoid arthritis (RA) and limited systemic sclerosis (lSSc) was suspected to have lymphadenopathy and primary biliary cirrhosis (PBC). Lymph node biopsy showed reactive follicular lymphadenopathy with intrafollicular plasmacyte infiltration that was interleukin-6 positive by immunohistostaining. Because of gradually worsening arthritis, tocilizumab was administered and arthritis improved markedly. Interestingly, lymphadenopathy and PBC improved simultaneously. This suggested that interleukin-6 might play an important role in reactive lymphadenopathy and PBC associated with RA/lSSc.

Saito, Eiko; Sato, Shinji; Nogi, Shinichi; Sasaki, Noriko; Chinen, Naofumi; Honda, Kiri; Wakabayashi, Takayuki; Yamada, Chiho; Nakamura, Naoya; Suzuki, Yasuo

2014-01-01

376

[Percutaneous liver biopsy in outpatients].  

PubMed

We studied prospectively 44 patients with diffuse liver disease. We performed percutaneous liver biopsy in these outpatients. They were required to be in absolute response during the following 4-6 hours after the biopsy was completed. After that period, they could go home and have a relative rest for the remnant day. These patients were followed by clinical evaluation and by real time abdominal ultrasound. We found some complications: Transitory arterial hypotension, pain in the site of puncture, hepatic hematomas. Only one of the patients with hematomas required hospitalization during 24 hours. The mortality was 0%. According to our experience, the hepatic biopsy is a procedure that can be performed in outpatients with a wide margin of security. An important point of view to consider is the economic advantage since it means a decrease in costs by each hepatic biopsy accomplished considering the cost/day of hospitalization. PMID:2152257

Ocampo, M E; Piñero, R; Urquiola, G; Marsicano, L; Salomón, A; Poleo, J R

1990-01-01

377

Percutaneous Access to the Urinary Tract  

Microsoft Academic Search

Percutaneous access to the kidney is the most important step in percutaneous nephrolithotomy because the site of puncture\\u000a determines how easily the targeted stone can be treated. Strategies to maximize the use of rigid instruments and allow for\\u000a the performance of concurrent procedures, such as endopyelotomy, while minimizing patient discomfort and pleural morbidity\\u000a should be considered when planning the site

Samuel C. Kim; James E. Lingeman

378

Thrombolysis, Mechanical Thrombectomy and Percutaneous Aspiration Therapy  

Microsoft Academic Search

Percutaneous therapy has an established role as an alternative to surgery in the treatment of intravascular thrombus. Thrombolysis\\u000a and mechanical thrombectomy may be used on their own or in combination to achieve the best result. Patients with thrombus\\u000a of less than 14 days in age who have co-morbidities making them high risk for surgery should be treated by percutaneous means.

Graham Munneke; Robert Morgan; Anna-Maria Belli

379

Combined elective percutaneous coronary intervention and transapical transcatheter aortic valve implantation  

PubMed Central

There is no established strategy of how and when to treat coronary artery disease (CAD) in patients referred for transcatheter aortic valve implantation (TAVI). Simultaneous, single-stage treatment of both pathologies is a possible solution. We report our initial results of simultaneously performed transapical TAVI and elective percutaneous coronary interventions (PCI) in high-risk patients with severe aortic valve stenosis. Between April 2008 and July 2011, a total of 419 patients underwent transapical TAVI. Combined elective PCI and TAVI were performed in 46 (11%) patients. Only the most significant coronary lesion or lesions were treated. Technical success of the combined approach was 100%. The mean count of implanted stents per patient was 1.6 ± 1.0 (range, 1–5 stents). The 30-day mortality rates in the PCI and TAVI group was 4.3%. Survival at 12, 24 and 36 months of the PCI and TAVI group 87.1 ± 5.5, 69.7 ± 10.3 and 69.7 ± 10.3%, respectively. The results showed that the single-stage approach with combined elective PCI and TAVI is feasible and safe. It has become our primary choice for treatment of high-risk patients with severe aortic valve stenosis and CAD.

Pasic, Miralem; Dreysse, Stephan; Unbehaun, Axel; Buz, Semih; Drews, Thorsten; Klein, Christoph; D'Ancona, Giuseppe; Hetzer, Roland

2012-01-01

380

Clinical and immunological study of percutaneous revaccination in children who originally received smallpox vaccine subcutaneously.  

PubMed Central

In a large multicenter smallpox vaccination study carried out from 1970 to 1973, it was found that 39% of children who were initially immunized by the subcutaneous route and then challenged percutaneously with a standard vaccination did not have measurable neutralizing antibody upon follow-up. Because of this finding, a percutaneous revaccination study was conducted at the St. Louis study center in 1975 and 1976. There were four study groups, which were composed on the basis of route of primary immunization (subcutaneous or percutaneous) and whether neutralizing antibody was detectable following the original percutaneous challenge immunization. Of 52 children revaccinated, all but four had accelerated reactions. There was no difference in size of lesions or day of maximum erythema among the four study groups. Only 66% of children originally vaccinated subcutaneously who did not have postchallenge neutralizing antibody had measurable neutralizing antibody following revaccination. Transformation studies with vaccinia viral antigen before and after revaccination were performed on lymphocytes from 50 children. There was no appreciable differences in responses either before or after revaccination when the four groups were compared. However, the mean stimulation ratio for the total group increased from 2.4 before revaccination to 4.6 3 weeks later. In primary subcutaneous vaccine recipients without pre-revaccination neutralizing antibody, lymphocyte transformation correlated directly with the neutralizing antibody response.

Cherry, J D; Rolfe, U T; Dudley, J P; Garakian, A J; Murphy, M

1978-01-01

381

The effectiveness of percutaneous laser disc decompression for the prolapsed lumbar intervertebral disc  

NASA Astrophysics Data System (ADS)

Objective: to investigate the role of associated factors in the effectiveness of laser treatment for prolapsed lumber intervertebral disc. Method: 302 prolapsed lumber intervertebral discs in 212 patients were treated with percutaneous laser disc decompression (PLDD). Patients were followed up by 12month, the associated factors which affecting the effectiveness of treatment, ie age, duration of illness were analyzed. Results: Punctual Success rate was 100%. After 12 month's follow up, 86% successful outcomes were obtained, in which 93% successful outcomes were obtained in patients less than 50 years old, 92% successful outcomes was obtained in the patients whose duration of illness less than 1 year.

Mu, Ming Wei; Liu, Wei; Feng, Wei; Ma, Nan

2009-07-01

382

Successful bortezomib/dexamethasone induction therapy with lenalidomide in an elderly patient with primary plasma cell leukemia complicated by renal failure and pulmonary hypertension.  

PubMed

Primary plasma cell leukemia (PPCL) is a rare disease that progresses rapidly. In such cases, it is difficult to achieve remission, and early intensive chemotherapy is recommended. We herein describe the case of a 76-year-old man with PPCL complicated by renal failure and pulmonary hypertension. Bortezomib/dexamethasone induction therapy with lenalidomide was administered in association with continuous hemodiafiltration (CHDF). Complete remission was achieved after a single course of treatment, resulting in the cessation of CHDF. With the patient in remission, the administration of beraprost and bosentan resulted in improvements in the pulmonary hypertension. The results of this case report support the use of bortezomib/lenalidomide/dexamethasone combination therapy as an effective treatment for elderly PPCL patients with various complications. PMID:24881743

Tamura, Shinobu; Koyama, Asumi; Shiotani, Chieko; Kurihara, Toshio; Nishikawa, Akinori; Okamoto, Yukiharu; Fujimoto, Tokuzo

2014-01-01

383

Percutaneous Tracheostomy: Ciaglia Blue Rhino Versus the Basic Ciaglia Technique of Percutaneous Dilational Tracheostomy  

Microsoft Academic Search

Percutaneous dilational tracheostomy (PDT), according to Ciaglia's technique described in 1985, has become the most popular technique for percutaneous tracheostomy and is demonstrably as safe as surgical tracheostomy. In 1999, an extensively modified technique of PDT was intro- duced, the Ciaglia Blue Rhino (CBR; Cook Critical Care, Bloomington, IL), that consists of one-step dilation by means of a curved dilator

Christian Byhahn; Hans-Joachim Wilke; Stephan Halbig; Volker Lischke; Klaus Westphal

2000-01-01

384

Drug and radiation sensitivity measurements of successful primary monolayer culturing of human tumor cells using cell-adhesive matrix and supplemented medium  

SciTech Connect

The limitations of the agar suspension culture method for primary culturing of human tumor cells prompted development of a monolayer system optimized for cell adhesion and growth. This method grew 83% of fresh human tumor cell biopsy specimens, cultured and not contaminated, from a heterogeneous group of 396 tumors including lung cancer (93 of 114, 82%); melanoma (54 of 72, 75%); sarcoma (46 of 59, 78%); breast cancer (35 of 39, 90%); ovarian cancer (16 of 21, 76%); and a miscellaneous group consisting of gastrointestinal, genitourinary, mesothelioma, and unknown primaries (78 of 91, 86%). Cell growth was characterized morphologically with Papanicolaoustained coverslip cultures and cytogenetically with Giemsastained metaphase spreads. Morphological features such as nuclear pleomorphism, chromatin condensation, basophilic cytoplasm, and melanin pigmentation were routinely seen. Aneuploid metaphases were seen in 90% of evaluable cultures, with 15 of 28 showing 70% or more aneuploid metaphases. Colony-forming efficiency ranged between 0.01 and 1% of viable tumor cells, with a median efficiency of 0.2%. This culture system uses a low inoculum of 25,000 viable cells per well which permitted chemosensitivity testing of nine drugs at four doses in duplicate from 2.2 X 10(6) viable tumor cells and radiation sensitivity testing at five doses in quadruplicate from 0.6 X 10(6) cells. Cultures were analyzed for survival by computerized image analysis of crystal violet-stained cells. Drug sensitivity studies showed variability in sensitivity and in survival curve shape with exponential cell killing for cisplatin, Adriamycin, and etoposide, and shouldered survival curves for 5-fluorouracil frequently seen. Radiation sensitivity studies also showed variability in both sensitivity and survival curve shape. Many cultures showed exponential cell killing, although others had shouldered survival curves.

Baker, F.L.; Spitzer, G.; Ajani, J.A.; Brock, W.A.; Lukeman, J.; Pathak, S.; Tomasovic, B.; Thielvoldt, D.; Williams, M.; Vines, C.

1986-03-01

385

Percutaneous ultrasound-guided thermal ablation for intrahepatic cholangiocarcinoma  

PubMed Central

Objective The objective of this study was to evaluate the treatment efficacy and overall survival (OS) of percutaneous ultrasound-guided thermal ablation by means of microwave ablation or radiofrequency ablation for intrahepatic cholangiocarcinoma (ICC). Methods 18 patients with 25 ICC nodules underwent ultrasound-guided thermal ablation with curative intention. 8 patients were primary cases and 10 were recurrent cases after curative resection. The local treatment response, complications and survivals were analysed. Results Complete ablation was achieved in 23 (92.0%, 23/25) nodules (diameter, 0.7–4.3 cm; mean, 2.5±0.9 cm) and incomplete ablation was found in 2 (8.0%, 2/25) larger tumours (6.4 and 6.9 cm in diameter). No death associated with the treatment was found. The major complication rate was 5.5% (1/18). The follow-up periods ranged from 1.3 to 86.2 months (mean, 20.5±26.3 months; median, 8.7 months). OS rates for all patients at 6, 12, 36 and 60 months were 66.7%, 36.3%, 30.3% and 30.3%, respectively. By univariate analysis, the patient source (primary or recurrent case) was found to be a significant prognostic factor for OS rates (p=0.001). The patient source (p=0.001) and the number of nodules (p=0.038) were found to be significant prognostic factors for recurrence-free survival. OS rates for the primary ICC at 6, 12, 36 and 60 months were 87.5%, 75.0%, 62.5% and 62.5%, respectively. Conclusion Percutaneous ultrasound-guided thermal ablation is a safe and effective therapeutic technique for ICC. Acceptable survival can be achieved in primary ICCs, whereas the prognosis of recurrent ICCs is relatively poor.

Xu, H-X; Wang, Y; Lu, M-D; Liu, L-N

2012-01-01

386

Comparison between Double J (DJ) Ureteral Stenting and Percutaneous Nephrostomy (PCN) in Obstructive Uropathy  

PubMed Central

Objective: To compare the complications rate of percutaneous nephrostomy and double J ureteral stenting in the management of obstructive uropathy. Methodology: Total number of 300 patients of age 20-80 years who underwent JJ stenting or percutaneous nephrostomy for obstructive uropathy were included in this study. Patients were divided in two groups i.e. A & B. In group A, 100 patients who underwent double J ureteral stenting while in group B, 200 patients who underwent percutaneous nephrostomy tube insertion were included. The stent was inserted retrograde by using cystoscope, under mild sedation or local anesthesia. While the percutaneous nephrostomy was done under ultrasound guidance by using local anesthetic agent. Complications were noted in immediate post-operative period and on follow up. Results: Majority of the patients were between 36 to 50 years of age with male to female ratio was 2.6:1. The most common cause of obstructive uropathy was stone disease i.e. renal, ureteric or both. Post DJ stent, complications like painful trigon irritation, septicemia, haematuria and stent encrustation were seen in 12.0%, 7.0%, 10.0% and 5.0% patients respectively. On the other hand, post-PCN septicemia, bleeding and tube dislodgment or blockage was seen in 3.5%, 4.5% and 4.5% respectively. In this study, overall success rate for double J stenting was up to 83.0% and for percutaneous nephrostomy (PCN) was 92.0% (p<0.0001). Conclusion: Percutaneous nephrostomy is a safe and better method of temporary urinary diversion than double J stenting for management of obstructive uropathy with lower incidence of complications.

Ahmad, Iftikhar; Saeed Pansota, Mudassar; Tariq, Muhammad; Shahzad Saleem, Muhammad; Ali Tabassum, Shafqat; Hussain, Akbar

2013-01-01

387

Percutaneous revascularization of persistent renal artery in-stent restenosis.  

PubMed

Percutaneous renal artery stenting is a common means of treating atherosclerotic renal artery stenosis. However, renal artery restenosis remains a frequent problem. The optimal treatment of restenosis has not been established and may involve percutaneous renal artery angioplasty or deployment of a second stent. Other modalities include cutting balloon angioplasty, repeat stenting with drug-eluting stents or endovascular brachytherapy. Most recently, use of polytetrafluoroethylene (PTFE)-covered stents may offer a new and innovative way to treat recurrent renal artery stenosis. We describe a case in a patient who initially presented with renal insufficiency and multi-drug hypertension in the setting of severe bilateral renal artery stenosis. Her renal artery stenosis was initially successfully treated by percutaneous deployment of bilateral bare metal renal artery stents. After initial improvement of her hypertension and renal insufficiency, both parameters declined and follow-up duplex evaluation confirmed renal artery in-stent restenosis. Owing to other medical co-morbidities she was felt to be a poor surgical candidate and was subsequently treated first with bilateral cutting balloon angioplasty and second with drug-eluting stent deployment. Each procedure was associated with initial improvement of renal function and blood pressure control, which then later deteriorated with the development of further significant in-stent restenosis. It was then decided to treat the restenosis using PTFE-covered stents. At 12 months of follow-up, the blood pressure had remained stable and renal function had normalized. The covered stents remained free of any significant neointimal tissue or obstruction. PMID:19651676

Patel, Pranav M; Eisenberg, Jonathan; Islam, M Ashequl; Maree, Andrew O; Rosenfield, Kenneth A

2009-08-01

388

Percutaneous transhepatic cholangiography for choledocholithiasis after laparoscopic gastric bypass surgery  

PubMed Central

INTRODUCTION Gallstones are a common condition in bariatric patients after a laparoscopic Roux-en-Y gastric bypass (LRYGB). The management of ductal stones is challenging due to the altered gastrointestinal anatomy. Various techniques have been reported to manage bile duct stones. PRESENTATION OF CASE We present the successful percutaneous trans hepatic management of common bile duct stones after LRYGB. One year after a LRYGB for morbid obesity, a 59-year-old female presented with acute cholecystitis. One month after laparoscopic cholecystectomy a 1 cm calculus was found within the distal CBD and patient underwent a percutaneous trans hepatic cholangiography under local anesthetic. This involved a right sided anterior segmental duct puncture. With the sphincter dilated to 10 mm, a balloon catheter was used to push the stone into the duodenum leaving an internal- external drain. Patient recovered completely at follow up. DISCUSSION Patients with morbid obesity have a higher incidence of gallstones. After LRYGB, the altered anatomy does not allow the conventional endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. Various techniques have been reported as means of managing bile duct stones in LRYGB patients. These include a double balloon enteroscope-assisted ERCP, laparoscopic transgastric ERCP, laparoscopic or open biliary surgery and interventional radiology. We report a non-surgical approach using percutaneous transhepatic technique under local anesthetic that resulted effective and could be applied more extensively. CONCLUSION Due to the increase of global obesity, bariatric centers need to strategically plan resources such as interventional radiology in order to manage post LRYGB choledocholithiasis safely, efficiently and in a cost effective manner.

Milella, Marialessia; Alfa-Wali, Maryam; Leuratti, Luca; McCall, James; Bonanomi, Gianluca

2014-01-01

389

Canadian quality indicators for percutaneous coronary interventions  

PubMed Central

BACKGROUND: Quantifying adherence to quality indicators can serve as a direct measure of quality of care and provide the foundation for quality improvement. However, quality indicators for percutaneous coronary intervention (PCI) have not been developed in Canada. OBJECTIVE: To develop a set of quality and outcome indicators for PCI that can be used across Canada. METHODS: A 12-member national expert panel was selected to represent practice in different regions of Canada. Potential quality indicators were identified by a detailed search of published guidelines, randomized trials and outcomes studies. A two-step modified Delphi process was employed with an initial screening round of indicator ratings, followed by a national quality indicator panel meeting, and follow-up discussions to obtain consensus. RESULTS: A total of 26 indicators including six structure indicators, nine process indicators, and 11 outcomes indicators were identified by the national expert panel to be representative of high quality of care for PCI. Pharmacological indicators included prescription of acetylsalicylic acid, clopidogrel and statin therapy as adjunctive therapy for PCI. Nonpharmacological process indicators included minimal procedure volumes, door-to-balloon time in primary PCI, prevention of contrast-induced nephropathy and selected patient education counselling instructions. Outcome indicators included death, myocardial infarction, target vessel revascularization and vascular access complications after PCI. CONCLUSIONS: A new set of PCI quality indicators for use in the Canadian health care system was developed. The widespread adoption and implementation of PCI quality indicators in clinical practice will facilitate the identification of practice gaps to enable quality improvement efforts and to optimize the outcomes of patients undergoing PCI throughout Canada.

Ko, Dennis T; Wijeysundera, Harindra C; Zhu, Xiaofu; Richards, Janice; Tu, Jack V

2008-01-01

390

Successful control of refractory and life-threatening autoimmune hemolytic anemia with intravenous immunoglobulins in a man with the primary antiphospholipid syndrome.  

PubMed

A 58-year old man with a history of hypothyroidism and primary antiphospholipid syndrome (with recurrent thromboembolic disease and therapy-refractory autoimmune thrombocytopenic purpura) presented with a life-threatening crisis of warm autoimmune hemolytic anemia (AIHA) while under chronic low-dose steroid therapy. The exacerbation was eventually controlled with a 5-day course of intravenous immunoglobulin (IVIG, Sandoglobulin) (400 mg/kg per day) but hemolysis rapidly recurred, despite therapy with steroids, azathioprine, and cyclosporin, necessitating a second course of IVIG. Control of packed cell transfusion needs for about 7 months was achieved by weekly administration of IVIG (800 mg/kg), although there is no direct evidence that IVIG therapy reduced the production of anticardiolipin or RBC antibodies. Three months after discontinuation of IVIG and change to maintenance with intermediate-dose corticosteroids plus cyclosporin A, the patient succumbed to duodenal perforation with peritonitis and invasive pulmonary aspergillosis. The case illustrates that IVIG therapy may be helpful in selected life-threatening and refractory cases of AIHA. It also sadly illustrates the long-term toxicity of standardly used therapeutics in refractory AIHA. PMID:8959944

Vandenberghe, P; Zachee, P; Verstraete, S; Demuynck, H; Boogaerts, M A; Verhoef, G E

1996-11-01

391

Similar Success Rates with Bivalirudin and Unfractionated Heparin in Bare-Metal Stent Implantation  

SciTech Connect

Background. Unfractionated heparin (UFH) is the traditional agent utilized during percutaneous peripheral interventions (PPIs) despite its well-known limitations. Bivalirudin, a thrombin-specific anticoagulant, overcomes many of the limitations of UFH and has consistently demonstrated comparable efficacy with significantly fewer bleeding complications. The purpose of this study was to compare procedural success in patients undergoing bare-metal stent implantation for atherosclerotic blockage of the renal, iliac, and femoral arteries and receiving either bivalirudin (0.75 mg/kg bolus/1.75 mg/kg/hr infusion) or UFH (50-70 U/kg/hr bolus) as the primary anticoagulant. Methods. This study was an open-label, nonrandomized retrospective registry with the primary endpoint of procedural success. Secondary endpoints included incidence of: death, myocardial infarction (MI), urgent revascularization, amputation, and major and minor bleeding. Results. One hundred and five consecutive patients were enrolled (bivalirudin = 53; heparin = 52). Baseline demographics were comparable between groups. Patients were pretreated with clopidogrel (approx. 71%) and aspirin (approx. 79%). Procedural success was achieved in 97% and 96% of patients in the bivalirudin- and heparin-treated groups, respectively. Event rates were low and similar between groups. Conclusion. Bivalirudin maintained an equal rate of procedural success in this cohort without sacrificing patient safety. Results of this study add to the growing body of evidence supporting the safety and efficacy of bivalirudin as a possible substitute for UFH in anticoagulation during peripheral vascular bare-metal stent implantation.

Hallak, Omar [Centers for Clinical Science Research, CAMC Institute (United States); Shams, S. Ali [Charleston Area Medical Center, Department of Internal Medicine (United States); Broce, Mike; Lavigne, P. Scott; Lucas, B. Daniel; Elhabyan, Abdul-Karim; Reyes, Bernardo J. [Centers for Clinical Science Research, CAMC Institute (United States)], E-mail: bernardo.reyes@camc.org

2007-09-15

392

Pioneer dwarf willow may facilitate tree succession by providing late colonizers with compatible ectomycorrhizal fungi in a primary successional volcanic desert.  

PubMed

To advance understanding of the contribution of ectomycorrhizal (ECM) fungi to tree successional processes, natural establishment patterns of secondary colonizing hosts and their ECM fungal communities were investigated with special reference to pioneer hosts. In the volcanic desert on Mount Fuji, Japan, vegetation is sparsely distributed, resembling islands in a sea of scoria. Of 509 vegetation islands in the research area, 161 contained Salix reinii (Salix), the first colonizing ECM host species. The spatial coincidence between secondary colonizing timber species and Salix was analysed, and ECM fungal communities were studied using molecular identification methods. I found 39 and 26 individuals of Betula ermanii and Larix kaempferi, respectively. Without exception, these individuals were all accompanied by Salix. The ECM fungal communities of these timber species showed high similarity to that of Salix and were dominated by generalists that were compatible with two or more plant families. In this desert, available ECM propagules are limited. Pioneer Salix may contribute to tree succession by providing adjacent late colonizers with compatible ECM fungal symbionts. PMID:16771994

Nara, Kazuhide

2006-01-01

393

Genetic structure and reproduction dynamics of Salix reinii during primary succession on Mount Fuji, as revealed by nuclear and chloroplast microsatellite analysis.  

PubMed

The early stage of volcanic desert succession is underway on the southeastern slope of Mount Fuji. We used markers of nuclear microsatellites (simple sequence repeats; SSR) and chloroplast microsatellites (cpSSR) to investigate the population genetic structure and reproduction dynamics of Salix reinii, one of the dominant pioneer shrubs in this area. The number of S. reinii genets in a patch and the area of the largest genet within the patch increased with patch area, suggesting that both clonal growth and seedling recruitment are involved in the reproduction dynamics of S. reinii. Five polymorphic cpSSR markers were developed for S. reinii by sequencing the noncoding regions between universal sequences in the chloroplast genome. Nineteen different cpSSR haplotypes were identified, indicating that S. reinii pioneer genets were created by the long-distance dispersal of seeds originating from different mother genets around the study site, where all vegetation was destroyed during the last eruption. Furthermore, the clustered distributions of different haplotypes within each patch or plot suggested that newly colonized genets tended to be generated from seeds dispersed near the initially established mother genets. These results revealed that the establishment of the S. reinii population on the southeastern slope of Mount Fuji involved two sequential modes of seed dispersal: long-distance dispersal followed by short-distance dispersal. PMID:12675817

Lian, Chunlan; Oishi, Ryuya; Miyashita, Naoya; Nara, Kazuhide; Nakaya, Hironobu; Wu, Bingyun; Zhou, Zhihua; Hogetsu, Taizo

2003-03-01

394

Percutaneous Transluminal Angioplasty for Obstructive Lesions of Arteriovenous Dialysis Fistulas.  

National Technical Information Service (NTIS)

Percutaneous transluminal angioplasty (PTA) is the percutaneous, fluoroscopically guided use of balloon-tipped catheters to remove or relieve stenotic or occlusive lesions of the vascular system. Since its introduction in 1964, PTA has been widely used to...

M. Erlichman

1984-01-01

395

Percutaneous Transluminal Angioplasty for Obstructive Lesions of the Aortic Arch.  

National Technical Information Service (NTIS)

Percutaneous transluminal angioplasty (PTA) is the percutaneous, fluoroscopically guided use of balloon-tipped catheters to remove or relieve stenotic or occlusive lesions of the vascular system. Since its introduction in 1964, PTA has been widely used to...

M. Erlichman

1984-01-01

396

Successful Aging.  

ERIC Educational Resources Information Center

Summarizes the central findings of the MacArthur Foundation Research Network on Successful Aging. Proposes a conceptual framework for successful aging and considers some pathways or mechanisms that make for successful aging. Focuses on health, risk factors, cognitive functioning, physical functioning, social relations, productive activities, and…

Rowe, John W.; Kahn, Robert L.

1997-01-01

397

Percutaneous nephrolithotomy for pediatric urolithiasis  

PubMed Central

Pediatric urolithiasis is a management dilemma as a number of treatment options are available such as shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). PCNL offers good clearance rates in a single hospital stay. The concerns with PCNL include the use of large instrument in pediatric kidneys, parenchymal damage and the associated effects on renal function, radiation exposure with fluoroscopy, and the risk of major complications including sepsis and bleeding. Evolution of pediatric PCNL technique such as miniaturization of instruments, limitation of tract size and advanced intracorporeal lithotripters have resulted in this technique being widely utilized for achieving stone-free status in appropriate patients. Many of the patients in our country come from remote areas thereby requiring special considerations during treatment. This also necessitates complete clearance in a single shorter hospital stay. PCNL appears to be the optimal option available in this scenario. The literature suggests that even complex and staghorn calculi can be tackled with this approach. The choice of the method to gain access is a matter of experience and personal preference. Ultrasound offers the advantage of visualization of spleen, liver and avoids injury. Miniaturization of instruments, particularly smaller nephroscopes and the potential to use lasers will decrease the morbidity and improve the clearance rates further. In this article, we analyze the management of pediatric urolithiasis with PCNL. We discuss our technique and analyze the results, complications and technique mentioned in the contemporary literature.

Ganpule, Arvind P.; Mishra, Shashikant; Desai, Mahesh R.

2010-01-01

398

Percutaneous Tumor Ablation with Radiofrequency  

PubMed Central

BACKGROUND Radiofrequency thermal ablation (RFA) is a new minimally invasive treatment for localized cancer. Minimally invasive surgical options require less resources, time, recovery, and cost, and often offer reduced morbidity and mortality, compared with more invasive methods. To be useful, image-guided, minimally invasive, local treatments will have to meet those expectations without sacrificing efficacy. METHODS Image-guided, local cancer treatment relies on the assumption that local disease control may improve survival. Recent developments in ablative techniques are being applied to patients with inoperable, small, or solitary liver tumors, recurrent metachronous hereditary renal cell carcinoma, and neoplasms in the bone, lung, breast, and adrenal gland. RESULTS Recent refinements in ablation technology enable large tumor volumes to be treated with image-guided needle placement, either percutaneously, laparoscopically, or with open surgery. Local disease control potentially could result in improved survival, or enhanced operability. CONCLUSIONS Consensus indications in oncology are ill-defined, despite widespread proliferation of the technology. A brief review is presented of the current status of image-guided tumor ablation therapy. More rigorous scientific review, long-term follow-up, and randomized prospective trials are needed to help define the role of RFA in oncology.

Wood, Bradford J.; Ramkaransingh, Jeffrey R.; Fojo, Tito; Walther, McClellan M.; Libutti, Stephen K.

2008-01-01

399

Neurologic Complications in Percutaneous Nephrolithotomy  

PubMed Central

Purpose Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. Materials and Methods We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. Results The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. Conclusions It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection.

Basiri, Abbas; Soltani, Mohammad Hossein; Kamranmanesh, Mohammadreza; Tabibi, Ali; Mohsen Ziaee, Seyed Amir; Nouralizadeh, Akbar; Sharifiaghdas, Farzaneh; Poorzamani, Mahtab; Gharaei, Babak; Ozhand, Ardalan; Lashay, Alireza; Ahanian, Ali; Aminsharifi, Alireza; Sichani, Mehrdad Mohammadi; Asl-Zare, Mohammad; Ali Beigi, Faramarz Mohammad; Najjaran, Vahid; Abedinzadeh, Mehdi

2013-01-01

400

Does percutaneous nephrolithotomy cause elevated cardiac troponins?  

PubMed Central

BACKGROUND Percutaneous nephrolithotomy is the treatment of choice in large and staghorn renal stones, and myocardial infarction is one the possible complications during and after the surgery. We investigated if renal and skeletal muscle injury, caused by percutaneous nephrolithotomy, can cause elevation in cardiac troponins (cTn). METHODS This study was conducted on otherwise healthy patients with renal stone undergoing percutaneous nephrolithotomy. A baseline 12-lead electrocardiogram, echocardiography, and cTn assessment confirmed no cardiac pathology in any patients. Cardiac troponins T (cTnT) and I (cTnI), and also creatine kinase (CK) were assessed before and after surgery. RESULTS A total of 55 patients (69.1% males, mean age: 40.5 ± 13.8 year) were included. Serum creatinine level ranged from 0.7 to 1.3 mg/dl (mean = 1.03 ± 0.17). The level of CK was significantly increased by 469.5 ± 201.4 U/l (P < 0.001), and no positive cTnT or cTnI was observed after surgery. CONCLUSION The results of the present study showed that renal cell injury, caused by percutaneous nephrolithotomy, is not associated with elevated cardiac troponins. These findings show that increasing troponins in patients undergoing percutaneous nephrolithotomy indicate a cardiovascular pathology.

Shemirani, Hassan; Khanjani, Reza; Mohammadi-Sichani, Mehrdad; Mozafarpour, Sarah; Rabbani, Majid; Shahabi, Javad

2014-01-01

401

Thoracoscopic ASD closure is a reliable supplement for percutaneous treatment  

PubMed Central

Objective: To determine the feasibility and effectiveness of endoscopic atrial septal defect (ASD) closure when percutaneous ASD closure is impossible or has failed. Patients: Between March 1997 and February 2003, 74 patients (63% female, mean (SD) age 44 (16) years) underwent an endoscopic ASD closure. Median preoperative New York Heart Association functional class was I. Clinical and echocardiographic follow up was obtained for all patients (mean (SD) 38 (19) months). Patients were assessed for scar aesthetics, procedure related pain, functional recovery, and overall patient satisfaction. Results: ASD closure was successful in all patients (two primum ASD, 68 secundum ASD, four sinus venosus type). Patch repair was performed in 42%. Mean aortic cross clamp and cardiopulmonary bypass times were 54 (24) minutes and 98 (35) minutes, respectively. There were no in-hospital deaths and no conversions to sternotomy. Complications included one iliac vein stenting, one femoral arterioplasty, two revisions for suspected bleeding, and seven cases of atrial fibrillation. Two patients required late reoperation: one for atrial thrombus and another for tricuspid regurgitation. Echocardiographic control confirmed complete ASD closure in 71 patients and a small residual shunt in three patients. Ninety three per cent of the patients were highly satisfied with very low procedure related pain and 97% felt they had an aesthetically pleasing scar. Conclusion: Endoscopic ASD closure can be safely done with a high degree of patient satisfaction. It is now the authors’ exclusive surgical approach whenever percutaneous treatment is not indicated or has failed.

Casselman, F P; Dom, H; De Bruyne, B; Vermeulen, Y; Vanermen, H

2005-01-01

402

Percutaneous laser discectomy: experience and long term follow-up.  

PubMed

The classical microsurgical approach in the treatment of herniated nucleus pulposus (HNP) has been substituted over the years by endoscopical approach, in which it is possible to practice via endoscopy a laser thermo-discoplasty, and by percutaneous laser disc decompression and nucleotomy. Percutaneous laser disc decompression and nucleotomy have been performed worldwide in more than 40,000 cases of HNP. Because water is the major component of the intervertebral disc and in HNP pain is caused by disc protrusion pressing against the nerve root, a 980 nm Diode (Biolitec AG-Germany) laser introduced via a 21-G needle under X-ray or CT-scan guidance and local anesthesia, vaporizes a small amount of the nucleous pulposus shrinking the disc and relieving the pressure on the nerve root. A multicentric retrospective study with a mean follow-up of 6 years was performed on 900 patients suffering from relevant symptoms that had been therapy-resistant for 6 months on average before consulting our department. Evaluation included 585 (65%) males and 315 (35%) females. The average age of patients operated was 46 years (18-54). The success rate at a mean follow-up of 5 years (2-6 years) was about 70% with a very low complication rate. PMID:21107947

Menchetti, P P M; Canero, G; Bini, W

2011-01-01

403

Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Tube Placement  

PubMed Central

Background: Percutaneous endoscopic gastrostomy (PEG) is the most common way of placing a feeding tube. Sometimes PEG cannot be used to safely place a feeding tube, most commonly secondary to an inability to