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Sample records for successful primary percutaneous

  1. Spontaneous Bleeding from Internal Pudendal Artery associated with Abciximab after Primary Percutaneous Coronary Intervention: Successful Treatment with Percutaneous Gel-Foam Embolization

    PubMed Central

    Lee, Seung-Eun; Jo, Hee-Bum; Moon, Hyoung-Ho; Oh, Dong-Jun; Kwon, Ki-Hwan; Kwon, Jae-Hyun; Kim, Young-Kwon

    2016-01-01

    We describe a case of spontaneous bleeding from a branch of the right internal pudendal artery that resulted in massive scrotal swelling in a patient who had underwent primary percutaneous coronary intervention with the use of abciximab concurrent with conventional anticoagulation and dual antiplatelet therapies for the treatment of acute ST-segment elevation myocardial infarction. This unusual complication was promptly identified by percutaneous peripheral arteriography and successfully treated with gel-foam embolization. PMID:27014357

  2. Successful Aorta-osteal Stenting after Iatrogenic Acute Type-A Aortic Dissection during Primary Percutaneous Coronary Intervention

    PubMed Central

    Bekler, Adem; Özeren, Ali; Gazi, Emine; Temiz, Ahmet; Altun, Burak

    2014-01-01

    Background: Iatrogenic acute dissection of the ascending aorta following coronary angiography and percutaneous intervention is rare. This complication, if not managed urgently, can have critical results. Case Report: We present the case of a 70 year-old woman who was treated by primary percutaneous coronary intervention (PCI) of the right coronary artery (RCA) for acute inferior myocardial infarction; however, the procedure was complicated by anterograde dissection of the RCA with a simultaneous retrograde propagation to the proximal part of the ascending aorta. Successful stenting of the entry point was able to heal the RCA and restrict the retrograde propagation to the ascending aorta. The aortic dissection was monitored by means of computerised tomography and the dissection repaired itself spontaneously within a day. Conclusion: Treatment of the aorta coronary dissection (ACD) by urgent osteal stenting is a less invasive treatment compared with surgical treatment in appropriate cases. We demonstrated that immediate osteal stenting should be performed in ACD. PMID:25667792

  3. Successful Percutaneous Transluminal Angioplasty and Stenting in Acute Mesenteric Ischemia

    SciTech Connect

    Gartenschlaeger, Soeren Bender, Siegfried; Maeurer, Juergen; Schroeder, Ralf J.

    2008-03-15

    Acute mesenteric ischemia (AMI) is a life-threatening emergency. The complications are high by the time of diagnosis in most cases and therefore only few data on primary percutaneous intervention with percutaneous transluminal angioplasty (PTA) and stenting in AMI are available. We present the case of an 84-year-old woman who presented to our emergency department complaining of an acute worsening of pre-existing abdominal periumbilical pain, nausea, vomiting, and diarrhea. She had previously undergone percutaneous transluminal embolectomy for an acute occlusion of the left common femoral artery. Due to suspicion of intestinal infarction, conventional angiography of the aorta and the superior mesenteric artery (SMA) was performed and confirmed a proximal occlusion of the SMA. Percutaneous SMA recanalization with balloon dilation and subsequent stent implantation was carried out successfully. The abdominal symptoms subsided after this procedure. In AMI that is diagnosed early, endovascular stenting should be considered as an alternative treatment to the surgical approach that avoids the need for surgical bowel resection.

  4. Success in Primary School. Success in Schools

    ERIC Educational Resources Information Center

    Academy for Educational Development, 2010

    2010-01-01

    A quality education system is not measured solely by national test scores, but by whether all students are successful in primary school. This simply stated goal is surprisingly difficult to achieve where substantial numbers of children are at risk of failing to complete a primary education. This paper explores the challenges and the diverse

  5. Percutaneous Balloon Compression vs Percutaneous Retrogasserian Glycerol Rhizotomy for the Primary Treatment of Trigeminal Neuralgia

    PubMed Central

    Blomstedt, Patric; Bergenheim, A. Tommy

    2015-01-01

    BACKGROUND: Despite >30 years of clinical use, the literature is still sparse when it comes to comparisons between percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizolysis (PRGR) as treatments for trigeminal neuralgia. OBJECTIVE: To perform a retrospective cohort comparison between PBC and PRGR with regard to therapeutic effect, side effects, and complications. METHODS: Medical records and follow-up data from 124 primary PRGRs performed from 1986 to 2000 and 82 primary PBCs performed from 2000 to 2013 were reviewed. All patients had undergone clinical sensory testing and assessment of sensory thresholds. Analyses were performed to compare duration of pain relief, frequency of sensory disturbances, and side effects. RESULTS: Median duration of pain relief was 21 months after PRGR and 20 months after PBC. Both methods carried a high risk of hypesthesia/hypalgesia (P < .001) that was partly reversed with time. Decreased corneal sensibility was common after PRGR (P < .001) but not after PBC. Dysesthesia was more common after PRGR (23%) compared after PBC (4%; P < .001). Other side effects were noted but uncommon. CONCLUSION: PBC and PRGR are both effective as primary surgical treatment of trigeminal neuralgia. Both carry a risk of postoperative hypesthesia, but in this series, the side effect profile favored PBC. Furthermore, PBC is technically less challenging, whereas PRGR requires fewer resources. Between these 2 techniques, we propose PBC as the primary surgical technique for percutaneous treatment of trigeminal neuralgia on the basis of its lower incidence of dysesthesia, corneal hypesthesia, and technical failures. ABBREVIATIONS: MS, multiple sclerosis PBC, percutaneous balloon compression PRGR, percutaneous retrogasserian glycerol rhizotomy TN, trigeminal neuralgia PMID:26465639

  6. Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications*

    PubMed Central

    Maciel, Macello Jose Sampaio; Tyng, Chiang Jeng; Barbosa, Paula Nicole Vieira Pinto; Bitencourt, Almir Galvão Vieira; Matushita Junior, João Paulo Kawaoka; Zurstrassen, Charles Edouard; Chung, Wu Tu; Chojniak, Rubens

    2014-01-01

    Objective To determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. Materials and Methods Retrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results. Results Most patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paresthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p < 0.001), and in patients who underwent PET/CT-guided procedures (p = 0.011). Conclusion CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions. PMID:25741100

  7. Primary succession in Mount Pinatubo

    PubMed Central

    Marler, Thomas E; del Moral, Roger

    2013-01-01

    Vegetation structure on the east flank of Mount Pinatubo was investigated to determine the inventory of species at 15 y post-eruption, then to ascertain environmental variables that have influenced the early patterns of primary succession. Unconstrained and constrained ordination methods were used to determine the influence of spatial, elevation, and substrate patterns on vegetation. Vegetation was assigned to one of 3 habitat types. Scours were eroded flat surfaces, terraces were perched flat surfaces, and talus piles were created along the canyon edges as mass waste events. The influence of habitat type on vegetation was multifaceted because they represent different conditions and different histories. The talus piles have preferential access to colonists from the vegetation on the canyon walls above and a more benign microclimate than the exposed terrace and scour sites. Scoured sites on the valley floor exhibited the least vegetation cover, as these substrates had the least mature surfaces and the most restricted capacity for root exploration. Perched terraces exhibited greater plant dominance than did the other habitats in the early stages of succession because of the ubiquitous appearance of Parasponia rugosa as initial colonists on these relatively flat surfaces. Polynomial canonical correspondence analysis was more closely aligned with the pattern of vegetation than linear canonical correspondence analysis, and therefore more closely approximated accurate descriptions of correlations among site ordination positions and measured variables. These results confirm that a variety of statistical approaches can clarify applications for restoration ecology following landslide and volcanic disturbances or agriculture and forestry anthropogenic disturbances in the lowland tropics. PMID:24505499

  8. [Reperfusion therapy in acute myocardial infarction: primary percutaneous transluminal coronary angioplasty or thrombolysis?].

    PubMed

    Bilkis, Valdas; Kibarskis, Aleksandras; Abraitis, Vytautas

    2004-01-01

    Randomized controlled trials that compared primary percutaneous transluminal coronary angioplasty with thrombolysis have shown that primary angioplasty is more effective than intravenous thrombolysis in reducing mortality and morbidity in patients with acute myocardial infarction. Three large myocardial infarction registries - MITI, NRMI-2 and French registry - failed to show an advantage of primary angioplasty compared with thrombolysis. One of the latest trials mentioned in this paper restored the place of primary angioplasty as superior to thrombolysis in acute myocardial infarction. Data of patients treated with primary percutaneous transluminal coronary angioplasty in Clinic of Cardiology of Vilnius University are presented. PMID:15079110

  9. Balloon-assisted tracking during primary percutaneous coronary intervention.

    PubMed

    Pavlidis, Antonios N; Karamasis, Grigoris V; Rees, Paul

    2015-03-01

    Radial artery spasm is one of the most commonly encountered problems during transradial interventions with a reported incidence in the range of 6-10%. Balloon-assisted tracking (BAT) of guide catheter has recently been described as a novel technique to overcome difficult radial artery anatomies including tortuosity, loops and spasm. In this report, we describe the successful use of BAT in a patient with radial artery spasm during primary angioplasty. PMID:25635748

  10. [Successive application of percutaneous endoscopic gastrostomy with jejunal extension and percutaneous endoscopic jejunostomy in a case of multiple system atrophy].

    PubMed

    Ogawa, Tomoko; Oodaira, Hironori; Suzuki, Yutaka; Hashimoto, Ritsuo; Kato, Hiroyuki

    2009-06-01

    A 75-year-old man with multiple system atrophy received percutaneous endoscopic gastrostomy (PEG) because of dysphagia. But recurrent aspiration pneumonia occurred after PEG nutrition, which was due to gastroesophageal reflux. As he had floppy epiglottis, orally inserted endoscopic procedure caused upper airway obstruction, which required transient non-invasive positive-pressure ventilator (NIPPV) treatment. He underwent transgastrostomal jejunal tube (PEG-J) replacement under the nasal endoscopic guidance successfully, but tube was patent only for 5-months. Thereafter, endoscopic jejunostomy (PEJ) via gastric stoma was performed on NIPPV safely, and the patient is now stable. For the management of nutrition in the advanced stage of neurodegenerative disease patients, PEJ is one of useful choice. PMID:19618848

  11. [Interstitial percutaneous therapies in primary and secondary liver tumors].

    PubMed

    Torzilli, G; Livraghi, T; Olivari, N

    1999-01-01

    Multiple percutaneous interstitial systems to induce intrahepatic tumor necrosis are classifiable in two major groups: those using chemical agents (ethanol and acetic acid) and those adopting thermal effects (hot saline, radiofrequency, laser and microwave). Indication, technique and results of percutaneous ethanol injection (PEI) are considered. In the case of single hepatocellular carcinoma (HCC), < 5 cm and associated with cirrhosis Child class A long-term results of PEI are comparable with those of best surgical series with 5-years survival which range from 47 to 51%. No mortality and recurrence rates similar to those of surgical cases make PEI as an alternative to surgical resection although the difficulties in comparing retrospectively the different experiences do not enable definitive conclusions. In the case of liver metastases from colorectal cancer or endocrine tumors, which seem more sensitive to locoregional therapies, complete response rates are not adequate yet being 86%, 26%, 11% and 0% respectively in the case of < 2 cm, 2-3 cm, 3-4 cm and > 4 cm lesions and moreover no definitive data are available about long-term prognosis. Waiting for further validation about the encouraging data obtained with the other interstitial methods and in particular with radiofrequency (RF) and laser interstitial photocoagulation (FLI), PEI is a valid alternative to surgery for selected HCC patients and is a good palliation in cases with not resectable liver metastases which are anyway suitable for locoregional treatments. PMID:10434450

  12. [Instent rupture of a saphenous vein graft during percutaneous intervention successfully treated with a covered stent].

    PubMed

    Rekik, S; Wehrlin, C; Jacq, L; Bellemain, A; Bernasconi, F

    2014-11-01

    Percutaneous coronary interventions of saphenous vein grafts are associated with an increased risk of periprocedural complications; among these, the rupture of the vein graft is probably the less common and the most dangerous; it is even more exceptional when it occurs on a stented portion of the graft. We report the case of a 75-year-old man who presented during a balloon angioplasty of intent restenosis of a saphenous vein graft a spectacular graft rupture at the level of the previously stented site and who was ultimately successfully treated with a covered stent. PMID:25223830

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

    SciTech Connect

    Giavroglou, Constantinos; Tsifountoudis, Ioannis; Boutzetis, Theodoros; Kiskinis, Dimitrios

    2009-01-15

    We describe the clinical course of a 5-year-old girl with severe arterial hypertension that was uncontrollable with antihypertensive medication. Renal angiography revealed bilateral renal artery stenoses. Because percutaneous transluminal renal angioplasty (PTRA) failed to dilate the stenotic lesions, a renal artery bypass grafting in both renal arteries was performed. The patient remained normotensive for 7 months, and after that the arterial pressure increased again. Digital subtraction angiography demonstrated stenosis at the peripheral and central anastomosis of the vein graft that was used for revascularization of the left kidney. PTRA was decided on and successful patency was achieved. The patient has now been normotensive for a period of 5 years.

  14. Predictors of successful percutaneous coronary intervention in chronic total coronary occlusions

    PubMed Central

    Gür, Mustafa; Acele, Armağan; Şeker, Taner; Quisi, Alaa; Kıvrak, Ali; Yıldırım, Arafat; Uçar, Hakan; Akyol, Selahattin; Çaylı, Murat

    2016-01-01

    Introduction Percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) is one of the most challenging procedures of interventional cardiology and is associated with increased risk of significant complications. However, debate continues in regard to which factors adversely influence the success rate of PCI and whether the benefits of revascularization of CTO outweigh the risks and challenges. Aim To analyze the relationship between lesion characteristics and overall success rates as well as in-hospital outcomes after PCI for CTO. Material and methods We retrospectively examined the procedural outcomes of 173 consecutive native coronary artery CTO PCIs performed from February 2012 to March 2013 (78% men; mean age: 60.3 ±12.1 years). Results The CTO target vessel was the right coronary artery (53.8%), circumflex (10.4%) and left anterior descending artery (35.8%), respectively. The retrograde approach was used in 13.9% of all procedures. Successful revascularization was achieved in 83.2% of patients. Major complications occurred in 13.3% of patients. In multivariate analysis, bridge collaterals, severe calcification and tortuosity as well as tandem occlusions were independent predictors of procedural failure, whereas existence of micro-channels was the only predictor of procedural success. Conclusions Revascularization of coronary CTOs may be performed with high success and low major complication rates. Bridge collaterals, severe calcification and tortuosity, tandem/multiple occlusions and micro-channels were independent predictors of successful CTO revascularization. PMID:26966445

  15. Primary Succession on a Hawaiian Dryland Chronosequence

    PubMed Central

    Kinney, Kealohanuiopuna M.; Asner, Gregory P.; Cordell, Susan; Chadwick, Oliver A.; Heckman, Katherine; Hotchkiss, Sara; Jeraj, Marjeta; Kennedy-Bowdoin, Ty; Knapp, David E.; Questad, Erin J.; Thaxton, Jarrod M.; Trusdell, Frank; Kellner, James R.

    2015-01-01

    We used measurements from airborne imaging spectroscopy and LiDAR to quantify the biophysical structure and composition of vegetation on a dryland substrate age gradient in Hawaii. Both vertical stature and species composition changed during primary succession, and reveal a progressive increase in vertical stature on younger substrates followed by a collapse on Pleistocene-aged flows. Tall-stature Metrosideros polymorpha woodlands dominated on the youngest substrates (hundreds of years), and were replaced by the tall-stature endemic tree species Myoporum sandwicense and Sophora chrysophylla on intermediate-aged flows (thousands of years). The oldest substrates (tens of thousands of years) were dominated by the short-stature native shrub Dodonaea viscosa and endemic grass Eragrostis atropioides. We excavated 18 macroscopic charcoal fragments from Pleistocene-aged substrates. Mean radiocarbon age was 2,002 years and ranged from < 200 to 7,730. Genus identities from four fragments indicate that Osteomeles spp. or M. polymorpha once occupied the Pleistocene-aged substrates, but neither of these species is found there today. These findings indicate the existence of fires before humans are known to have occupied the Hawaiian archipelago, and demonstrate that a collapse in vertical stature is prevalent on the oldest substrates. This work contributes to our understanding of prehistoric fires in shaping the trajectory of primary succession in Hawaiian drylands. PMID:26066334

  16. Primary Succession on a Hawaiian Dryland Chronosequence.

    PubMed

    Kinney, Kealohanuiopuna M; Asner, Gregory P; Cordell, Susan; Chadwick, Oliver A; Heckman, Katherine; Hotchkiss, Sara; Jeraj, Marjeta; Kennedy-Bowdoin, Ty; Knapp, David E; Questad, Erin J; Thaxton, Jarrod M; Trusdell, Frank; Kellner, James R

    2015-01-01

    We used measurements from airborne imaging spectroscopy and LiDAR to quantify the biophysical structure and composition of vegetation on a dryland substrate age gradient in Hawaii. Both vertical stature and species composition changed during primary succession, and reveal a progressive increase in vertical stature on younger substrates followed by a collapse on Pleistocene-aged flows. Tall-stature Metrosideros polymorpha woodlands dominated on the youngest substrates (hundreds of years), and were replaced by the tall-stature endemic tree species Myoporum sandwicense and Sophora chrysophylla on intermediate-aged flows (thousands of years). The oldest substrates (tens of thousands of years) were dominated by the short-stature native shrub Dodonaea viscosa and endemic grass Eragrostis atropioides. We excavated 18 macroscopic charcoal fragments from Pleistocene-aged substrates. Mean radiocarbon age was 2,002 years and ranged from < 200 to 7,730. Genus identities from four fragments indicate that Osteomeles spp. or M. polymorpha once occupied the Pleistocene-aged substrates, but neither of these species is found there today. These findings indicate the existence of fires before humans are known to have occupied the Hawaiian archipelago, and demonstrate that a collapse in vertical stature is prevalent on the oldest substrates. This work contributes to our understanding of prehistoric fires in shaping the trajectory of primary succession in Hawaiian drylands. PMID:26066334

  17. Primary percutaneous coronary intervention in the Isfahan province, Iran; A situation analysis and needs assessment

    PubMed Central

    Reza Khosravi, Ali; Hoseinabadi, Mohamadhosein; Pourmoghaddas, Masoud; Shirani, Shahin; Paydari, Navid; Sadeghi, Mahmoud; Kanani, Soheila; Jozan, Mahnaz; Khosravi, Elham

    2013-01-01

    BACKGROUND Primary percutaneous coronary intervention (PPCI) is considered as a choice of treatment in ST-elevation myocardial infarction (STEMI). PPCI has been performed in the Isfahan Province for several years. This study was performed to describe the situation, and determine in-hospital and early (30 days) clinical outcomes of the patients in order to provide sufficient evidence to evaluate and modify this treatment modality if necessary. METHODS All patients, who underwent PPCI for STEMI from July to December 2011 at Chamran and Saadi Hospitals (PPCI centers in the Isfahan Province), were included in this case series study. Premedication, angioplasty procedure, and post-procedural treatment were performed using standard protocols or techniques. All discharged patients were followed for 30 days by phone. Endpoints consisted of clinical success rate, and in-hospital and 30 day major adverse cardiac events (MACEs) (death, reinfarction, stroke, and target vessel revascularization). RESULTS 93 patients (83 (89.2%) at Chamran Hospital and 10 (10.8%) patients at Saadi Hospital) had PPCI. Mean Age of the patients was 59.60 ± 11.10 and M/F ratio was 3.89. From the 181 involved vessels (involved vessels/patient ratio = 1.97 ± 0.70), the treatment of 105 lesions (lesions/patient ratio = 1.13 ± 0.368) was attempted. The clinical success rate was 72%. Pain-to-door and door-to-balloon times were, respectively, 255.1 ± 221.4 and 148.9 ± 168.5 min. The reason for failure was impaired flow (n = 17 (18.3%)), failure to cross with a guidewire (n = 2 (2.2%)), suboptimal angiographic results (n = 2 (2.2%)), and death in one patient. The in-hospital and 30 days MACE rates were, respectively, 8.6% and 3.2%. CONCLUSION Low success rate in our series could be due to prolonged pain-to-door and door-to-balloon times and lack of an established, definite protocol to regularly perform PPCI in a timely fashion. We should resolve these problems and improve our techniques in order to prevent and treat slow/no-reflow phenomenon. PMID:23696758

  18. A successful treatment of an intrarenal arteriovenous fistual by percutaneous embolization

    SciTech Connect

    Winkler, J.; Neuman-Levin, M.; Boner, G. Univ. of Tel-Aviv )

    1991-02-06

    A 37-year-old woman patient, known to have poorly controlled arterial hypertension that was diagnosed following a cerebrovascular accident at the age of 15 years, was referred to the authors' outpatient clinic for investigation in 1987. An intrarenal arteriovenous fistula was diagnosed by selective renal angiography. Embolization of the fistula was performed using four 15-mm/5-cm coils, which induced thrombosis and obstructed the fistula. The vascularization of the affected kidney improved immediately. During the following 4 months, the antihypertensive treatment was stopped gradually, and the patient remained normotensive. This is an unusual case of a large intrarenal arteriovenous fistula, whose etiology was not clear, that was successfully treated by percutaneous embolization.

  19. Diabetes Mellitus and Glucose as Predictors of Mortality in Primary Coronary Percutaneous Intervention

    PubMed Central

    David, Renato Budzyn; Almeida, Eduardo Dytz; Cruz, Larissa Vargas; Sebben, Juliana Cañedo; Feijó, Ivan Petry; Schmidt, Karine Elisa Schwarzer; Avena, Luísa Martins; Gottschall, Carlos Antonio Mascia; de Quadros, Alexandre Schaan

    2014-01-01

    Background Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate. Objective To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention. Methods Prospective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score. Results Among the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13), whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01). Conclusion In ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients. PMID:25352506

  20. Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI risk score).

    PubMed

    Addala, Srinivas; Grines, Cindy L; Dixon, Simon R; Stone, Gregg W; Boura, Judith A; Ochoa, Anthony B; Pellizzon, Gregory; O'Neill, William W; Kahn, Joel K

    2004-03-01

    We performed a pooled analysis of the Primary Angioplasty in Myocardial Infarction (PAMI) trials to examine predictors of death after primary percutaneous coronary intervention. Using these data, we developed a risk score with a range of 0 to 15 points. The PAMI risk score was found to be a strong predictor of late mortality. PMID:14996596

  1. Impact of proctoring on success rates for percutaneous revascularisation of coronary chronic total occlusions

    PubMed Central

    Sharma, Vinoda; Jadhav, S T; Harcombe, A A; Kelly, P A; Mozid, A; Bagnall, A; Richardson, J; Egred, M; McEntegart, M; Shaukat, A; Oldroyd, K; Vishwanathan, G; Rana, O; Talwar, S; McPherson, M; Strange, J W; Hanratty, C G; Walsh, S J; Spratt, J C; Smith, W H T

    2015-01-01

    Objective To assess the impact of proctoring for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in six UK centres. Methods We retrospectively analysed 587 CTO procedures from six UK centres and compared success rates of operators who had received proctorship with success rates of the same operators before proctorship (pre-proctored) and operators in the same institutions who had not been proctored (non-proctored). There were 232 patients in the pre-proctored/non-proctored group and 355 patients in the post-proctored group. Complexity was assessed by calculating the Japanese CTO (JCTO) score for each case. Results CTO PCI success was greater in the post-proctored compared with the pre-proctored/non-proctored group (77.5% vs 62.1%, p<0.0001). In more complex cases where JCTO≥2, the difference in success was greater (70.7% vs 49.5%, p=0.0003). After proctoring, there was an increase in CTO PCI activity in centres from 2.5% to 3.5%, p<0.0001 (as a proportion of total PCI), and the proportion of very difficult cases with JCTO score ≥3 increased from 15.3% (35/229) to 29.7% (105/354), p<0.0001. Conclusions Proctoring resulted in an increase in procedural success for CTO PCI, an increase in complex CTO PCI and an increase in total CTO PCI activity. Proctoring may be a valuable way to improve access to CTO PCI and the likelihood of procedural success. PMID:25852949

  2. Thrombolysis in the age of Primary Percutaneous Coronary Intervention: Mini-Review and Meta-analysis of Early PCI

    PubMed Central

    Al Shammeri, O; Garcia, LA

    2013-01-01

    Objective Primary Percutaneous Coronary Intervention (PCI) is the treatment of choice for ST-segment Elevation Myocardial Infarction (STEMI) if performed within 90 minutes from first medical contact. However, primary PCI is only available for less than 25% of patients with STEMI. Early PCI or Pharmaco-invasive strategy has evolved from facilitated PCI but with more delayed timing from thrombolysis to PCI. Aim Assess the safety and effectiveness of Early PCI. Patients and Method We reviewed the data of the available therapy options for patients with STEMI. Then we performed a meta-analysis for all randomized controlled trials of early PCI versus standard therapy Results Five studies fulfilled our inclusion criteria. Our meta-analysis showed improved cardiovascular events with early PCI compared to standard therapy (odd ratio of 0.54; 95% Confidence interval 0.47-0.7, p<0.001). There were no significant bleeding complications when doing early PCI 4 to 24 hours after successful thrombolysis Conclusion Early PCI should be done to all STEMI patients within 24 hours after successful thrombolysis. PMID:23559909

  3. Cytological Sampling Versus Forceps Biopsy During Percutaneous Transhepatic Biliary Drainage and Analysis of Factors Predicting Success

    SciTech Connect

    Tapping, C. R.; Byass, O. R.; Cast, J. E. I.

    2012-08-15

    Purpose: To assess the accuracy of cytological sampling and forceps biopsy in obstructing biliary lesions and to identify factors predictive of success. Methods: Consecutive patients (n = 119) with suspected malignant inoperable obstructive jaundice treated with percutaneous transhepatic biliary drainage during 7 years were included (60 male; mean age 72.5 years). All patients underwent forceps biopsy plus cytological sampling by washing the forceps device in cytological solution. Patient history, procedural and pathological records, and clinical follow-up were reviewed. Statistical analysis included chi-square test and multivariate regression analysis. Results: Histological diagnosis after forceps biopsy was more successful than cytology: Sensitivity was 78 versus 61%, and negative predictive value was 30 versus 19%. Cytology results were never positive when the forceps biopsy was negative. The cytological sample was negative and forceps sample positive in 2 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 1 case of benign disease. Diagnostic accuracy was predicted by low bilirubin (p < 0.001), aspartate transaminase (p < 0.05), and white cell count (p {<=} 0.05). Conclusions: This technique is safe and effective and is recommended for histological diagnosis during PTBD in patients with inoperable malignant biliary strictures. Diagnostic yield is greater when bilirubin levels are low and there is no sepsis; histological diagnosis by way of forceps biopsy renders cytological sampling unnecessary.

  4. Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

    PubMed Central

    Brogan, Richard A; Malkin, Christopher J; Batin, Phillip D; Simms, Alexander D; McLenachan, James M; Gale, Christopher P

    2014-01-01

    Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction (NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention (PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed. PMID:25228966

  5. Value of quantitative exercise thallium-201 scintigraphy for predicting restenosis after successful percutaneous transluminal coronary angioplasty

    SciTech Connect

    Stuckey, T.D.; Watson, D.D.; Nygaard, T.W.; Burwell, L.R.; Gibson, R.S.; Beller, G.A.

    1985-05-01

    The authors sought to determine the ability of quantitative exercise thallium-201 (Tl-201) scintigraphy (ex-T1) to predict early restenosis following angiographically successful percutaneous transluminal coronary angioplasty (PTCA). Ex-Tl was performed 2.6 +- 2.1 weeks (range 0-9) weeks following PTCA in 55 patients; exercise was symptom limited in 54 and heart rate limited in 1. During a mean followup period of 8.5 months (range 3-24), restenosis occurred in 11 patients (20%) and myocardial infarction in 1 (1.7%); restenosis occurred 2.2 +- 1.1 months following the procedure. Of this group, only one patient (1/12; 8%) demonstrated unequivocal redistribution in the scan region of the dilated vessel; other patterns included two patients with delayed washout, three with persistent defects, and six with normal Tl-201 uptake and washout. Eight patients (8/55; 15%) demonstrated redistribution in the scan region of the dilated vessel following PTCA. Of these, five had angiographic evidence of incomplete revascularization with stenosis (greater than or equal to 50%) involving the distal dilated vessel or side branches. The authors conclude that: 1) Normalization of myocardial perfusion as assessed by ex-Tl following PTCA does not preclude early restenosis; and 2) Evidence of residual ischemia by ex-Tl in the scan region of the dilated vessel following PTCA is frequently associated with angiographic evidence of incomplete revascularization.

  6. Spontaneous Hemoperitoneum due to Rupture of Uterine Varicose Veins during Labor Successfully Treated by Percutaneous Embolization

    PubMed Central

    Díaz-Murillo, Rebeca; Tobías-González, Pablo; López-Magallón, Sara; Magdaleno-Dans, Fernando; Bartha, José L.

    2014-01-01

    Hemoperitoneum during pregnancy is a rare but potentially lethal clinical condition. Improvements in antenatal and intrapartum care, especially in surgical and anesthetic techniques, have reduced maternal mortality; perinatal mortality remains very high (31%). Treatment is based on the systemic correction of hypovolemia and immediate surgery via laparotomy or laparoscopy in cases in the first trimester of pregnancy for hemostatic purposes. Sometimes, hysterectomy is needed. A 35-year-old Asiatic primigravid woman at 37 weeks' gestation with otherwise uneventful pregnancy came to the hospital referring abrupt-onset lumbar and abdominal pain. A bleeding uterine superficial varicocele of about 7 cm was found on the left uterine horn during Caesarean section. Interventional radiologic embolization of both uterine arteries was successfully performed. Posterior evolution of the patient was favorable. Percutaneous vascular embolization of the uterine arteries is an effective alternative treatment for many obstetrical and gynecological causes of bleeding. The main advantage of this technique is the low rate of serious complications and the preservation of reproductive function. To our knowledge, this is the first case of spontaneous intrapartum hemoperitoneum treated with this technique. An early diagnosis and a rapid indication of this therapeutic option are essential. Hemodynamic stability is needed to decide this conservative management. PMID:25114819

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

    SciTech Connect

    Corso, Rocco Carrafiello, Gianpaolo; Rampoldi, Antonio; Leni, Davide; Ticca, Cristiana; Vercelli, Ruggero; Vanzulli, Angelo

    2005-04-15

    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.

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

    PubMed Central

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

    2012-01-01

    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. PMID:23323019

  9. A rare case of unusual migrated foreign bodies in kidney and their successful extraction using retrograde percutaneous nephrostomy

    PubMed Central

    Upadhyay, Surjya Prasad; Zahir, Mohammad; Al Muttari, Hasan; Mallick, Piyush N

    2015-01-01

    Foreign body ingestion is a common presentation in the emergency room and most cases are without any major symptoms, or go unnoticed and later cause severe complications that can potentially threaten patient life. We report a case of multiple migrated metallic foreign bodies in the right kidney presenting as right renal colic and gross haematuria one year after its accidental ingestion, treated successfully with retrograde percutaneous nephrostomy. PMID:26535175

  10. Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction in a Patient Taking Dabigatran for Chronic Anticoagulation

    PubMed Central

    Ahmed, Imdad

    2015-01-01

    Interventional cardiologists have few data on which to base clinical decisions regarding optimal care for ST-segment-elevation myocardial infarction patients who are taking therapeutic chronic oral anticoagulation. We present what we believe to be the first reported case of emergency coronary angiography and primary percutaneous coronary intervention in an ST-segment-elevation myocardial infarction patient who was on a dabigatran regimen for atrial fibrillation. The patient tolerated the procedures well and had no observable bleeding sequelae. In addition to the patient's case, we discuss the current evidence regarding the periprocedural management of oral anticoagulation in patients who need coronary angiography and percutaneous coronary intervention. PMID:25873830

  11. Ectopic Jejunal Variceal Rupture in a Liver Transplant Recipient Successfully Treated With Percutaneous Transhepatic Coil Embolization: A Case Report.

    PubMed

    Abe, Satoru; Akamatsu, Nobuhisa; Hoshikawa, Mayumi; Shirata, Chikara; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi; Kokudo, Norihiro

    2015-11-01

    Here we present the rupture of ectopic jejunal varices developing in a liver transplant recipient without portal hypertension, which was successfully treated with percutaneous transhepatic coil embolization.A 48-year-old man with massive melena was admitted to our department. He had undergone liver transplantation for hepatitis B virus-related liver cirrhosis 8 months before, and his postoperative course was satisfactory except for an acute cellular rejection. No evidence of bleeding was detected by upper endoscopy or colonoscopy, but dynamic multidetector computed tomography of the whole abdomen revealed an intestinal varix protruding into the lumen of the jejunum with suspected extravasation. There was no evidence of portal venous stenosis or thrombosis. Immediately upon diagnosis of the ruptured ectopic jejunal varix, percutaneous transhepatic coil embolization was performed, achieving complete hemostasis. The portal venous pressure measured during the procedure was within normal limits. He was discharged from the hospital 11 days after embolization and remained in stable condition without re-bleeding 6 months after discharge.This is the first report of an ectopic intestinal variceal rupture in an uneventful liver transplant recipient that was successfully treated with interventional percutaneous transhepatic coil embolization. Clinicians encountering liver transplant recipients with melena should be aware of the possibility of late-onset rupture of ectopic varices, even in those having an uneventful post-transplant course without portal hypertension. PMID:26632745

  12. Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

    PubMed Central

    Kurtul, Alparslan; Murat, Sani Namik; Yarlioglues, Mikail; Duran, Mustafa; Celik, Ibrahim Etem; Kilic, Alparslan; Ocek, Adil Hakan

    2015-01-01

    OBJECTIVES: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention. The neutrophil-to-lymphocyte ratio has been associated with increased mortality and worse clinical outcomes in ST-segment elevation myocardial infarction. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would also be associated with a persistent Thrombolysis In Myocardial Infarction flow grade of 0 after wire insertion in patients undergoing primary percutaneous coronary intervention. METHODS: A total of 644 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours of symptom onset were included in our study. Blood samples were drawn immediately upon hospital admission. The patients were divided into 3 groups according to their Thrombolysis In Myocardial Infarction flow grade: Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion, Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. RESULTS: The neutrophil-to-lymphocyte ratio was significantly higher in the group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion compared with the group with Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and the group with Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate. Persistent coronary no-flow after wire insertion was independently associated with the neutrophil-to-lymphocyte ratio. CONCLUSIONS: An increased neutrophil-to-lymphocyte ratio on admission is significantly associated with persistent coronary no-flow after wire insertion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. PMID:25672427

  13. Predictors of cardiac rehabilitation attendance following primary percutaneous coronary intervention for ST-elevation myocardial infarction in Australia.

    PubMed

    Soo Hoo, Soon Yeng; Gallagher, Robyn; Elliott, Doug

    2016-06-01

    Cardiac rehabilitation is an important component of recovery and secondary prevention following urgent primary percutaneous coronary intervention. However, attendance and factors that predict participation by patients admitted with ST-elevation myocardial infarction remain unclear. This Australian study was conducted using a descriptive, comparative design. Consecutive patients (n = 246) at two hospitals were interviewed by telephone at four weeks and six months. Open-ended questions were used to assess cardiac rehabilitation attendance, sociodemographics, modifiable risk factors, clinical outcomes, and post-discharge health support. Post-discharge home visits at four weeks (odds ratio: 2.64, 95% confidence interval: 1.48-4.71) and at six months were associated with better cardiac rehabilitation attendance; more males participated at four weeks and at six months. The results suggest the need to integrate post-discharge health support with cardiac rehabilitation to facilitate recovery after primary percutaneous coronary intervention, particularly for females with ST-elevation myocardial infarction. PMID:26858136

  14. Periprocedural temporary pacing in primary percutaneous coronary intervention for patients with acute inferior myocardial infarction

    PubMed Central

    Hwang, You Mi; Kim, Chul-Min; Moon, Keon-Woong

    2016-01-01

    Objective High-degree atrioventricular block (AVB), including complete AVB in acute inferior ST-elevation myocardial infarction (STEMI), is not uncommon. However, there is no study evaluating the clinical differences between patients who have undergone temporary pacing (TP) and patients who have not. The present study was designed to investigate whether TP has any prognostic significance in inferior STEMI complicated by complete AVB. Methods From January 2009 to December 2014, 295 consecutive patients diagnosed with inferior wall STEMI in a university hospital were reviewed. All of them underwent primary percutaneous coronary intervention (PCI). Among the 295 patients, there were 72 patients with complete AVB. The clinical characteristics, procedural data, and long-term major adverse cardiocerebrovascular events were compared in patients with and without TP. Results Baseline clinical and procedural characteristics were similar between patients with and without TP. Patients with TP were more likely to present with cardiogenic shock; thus, additional interventions were attempted via a femoral approach, as patients received further treatment with intra-aortic balloon pumps and were subjected to additional cardiopulmonary resuscitation. Most cases of complete AVB were primarily caused by right coronary artery occlusion. After a median follow-up period of 344 (range, 105.5–641) days, major adverse cardiocerebrovascular events did not differ between the groups (P=0.528). Conclusion We conclude that primary PCI without TP is acceptable in complete AVB-complicated acute inferior STEMI. To avoid delay in reperfusion, we suggest that primary PCI should be the first priority therapy rather than treating patients initially with TP. PMID:27022254

  15. Prediction of one-year mortality among 30-day survivors after primary percutaneous coronary interventions.

    PubMed

    Mehta, Rajendra H; O'neill, William W; Harjai, Kishore J; Cox, David A; Brodie, Bruce R; Boura, Judy; Grines, Lorelei; Stone, Gregg W; Grines, Cindy L

    2006-03-15

    Little information exists on the features that influence risk factors for death at 1 year among 30-day survivors of ST-elevation myocardial infarction (STEMI) that is treated with primary percutaneous coronary intervention (PCI). Accordingly, we examined 3,280 patients with STEMI who were enrolled in Stent-PAMI and CADILLAC trials, were treated with primary PCI, and survived >30 days after STEMI. Death at 1 year occurred in 74 patients (2.3%) who survived >30 days after their index STEMI. Patients who died at 1 year were more likely to be older and women and have lower body weight and greater prevalence of previous stroke. Similarly, the sum of ST elevations, 3-vessel or left anterior coronary disease, and final Thrombolysis In Myocardial Infarction grade <3 flow was higher, whereas left ventricular ejection fraction was lower among patients who died versus those who survived. The multivariate logistic regression model identified age >70 years (odds ratio [OR] 3.3 95% confidence interval [CI] 1.9 to 5.7), weight <80 kg (OR 1.9, 95% CI 1.1 to 3.6), any tachyarrhythmia during index hospitalization (defined as ventricular or supraventricular tachycardia that required treatment) (OR 2.4, 95% CI 1.2 to 4.8), number of diseased coronary arteries (OR 1.5, 95% CI 1.1 to 2.1), and left ventricular ejection fraction (each 10% decrease, OR 1.5, 95% CI 1.2 to 1.8) as factors independently associated with risk of death at 1 year among 30-day survivors. In conclusion, our study provides a method for clinicians to advise patients who are treated with primary PCI and survive the acute phase of STEMI with regard to patients' long-term prognosis, thus enhancing planning and setting up of realistic expectations. PMID:16516582

  16. The Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Patients With Vascular Access Failure

    PubMed Central

    Kim, Woo Shin; Pyun, Wook Bum

    2011-01-01

    Background and Objectives Dysfunction of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) contributes significantly to morbidity and hospitalization in the dialysis population. We evaluated the primary patency of AVFs following percutaneous transluminal angioplasty (PTA) in haemodialysis patients. Subjects and Methods We performed 231 interventions in 118 patients with a mean age of 62.1±12.9 years. We performed 122 interventions in 53 AVG patients (44.9%), and 109 interventions in 65 AVF patients (55.1%). If there was thrombosis of the vascular access, urokinase was administered and/or thrombus aspiration was performed. The stent was inserted when balloon dilatation did not expand sufficiently or elastic recoil occurred. Results For the 118 patients, the median patency time was 10.45±10.29 months at 92 months of follow-up. The primary patencies for stenotic AVFs at 6, 12, 24, 36, 48, and 60 months were 63.4%, 41.4%, 17.0%, 9.7%, 7.3%, and 2.4%, respectively. The primary patencies for AVGs at 6, 12, 24, and 36 months were 36.9%, 19.5%, 10.8%, 2.1%, respectively, and were obtained by means of the Kaplan-Meier analysis (log rank=6.42, p<0.05). The median patency time was 11.0 months and 4.45 months in the non-thrombus and thrombus groups, respectively. The complication rate was 1.73% (4/231); two cases of pseudoaneurysms and two cases of extravasation were detected. All therapy failures (5/231) occurred in thrombotic lesions of AVGs and were treated surgically. Conclusion PTA is an efficacious method for the correction of stenosis of AVFs for hemodialysis, thus prolonging the patency of the fistulas. PMID:22022326

  17. Successful percutaneous transluminal septal myocardial ablation through a right superior septal artery for a patient with hypertrophic obstructive cardiomyopathy.

    PubMed

    Kurita, Tairo; Tsuchikane, Etsuo; Tanaka, Nobuyoshi; Suzuki, Takahiko

    2015-10-01

    Percutaneous transluminal septal myocardial ablation (PTSMA) has been widely accepted as a therapeutic option for patients with hypertrophic obstructive cardiomyopathy (HOCM). To achieve success in PTSMA, we need to explore the target septal arteries, including any anomalous branches that feed the hypertrophic septal myocardium causing left ventricular outflow tract obstruction. An HOCM case in which PTSMA was performed through a dominant right superior septal (RSS) artery is presented. In cases without an effective septal branch artery arising from the left anterior descending artery, an RSS artery should be sought as an alternative route for PTSMA. PMID:25502014

  18. Platelet to lymphocyte ratio as a prognostic marker in primary percutaneous coronary intervention.

    PubMed

    Ayça, Burak; Akin, Fatih; Çelik, Ömer; Yüksel, Yasin; Öztürk, Derya; Tekiner, Fatih; Çetin, Şükrü; Okuyan, Ertuğrul; Dinçkal M, Hakan

    2015-01-01

    We assessed the prognostic value of the platelet to lymphocyte ratio (PLR) in primary percutaneous coronary intervention (pPCI). Patients (n = 440) with acute myocardial infarction (AMI) who underwent pPCI were divided into 2 groups: low PLR (<137) and high PLR (>137). "Thrombolysis In Myocardial Infarction" (TIMI) flow grades and Syntax scores (SXS) were calculated from initial angiograms. In-hospital mortality rate and cardiac adverse events were obtained from medical records. Patients with high PLR had more no-reflow, higher SXS and higher mortality rate (p < 0.001, p < 0.001 and p = 0.008, respectively). In receiver operating characteristic curve analysis, high PLR predicted development of no-reflow (specificity 71% and sensitivity 85%), SXS>22 (specificity 52% and sensitivity 61%) and adverse events (specificity 67% and sensitivity 63%). In multivariate regression analysis, PLR was an independent risk factor for no-reflow, SXS>22 and in-hospital adverse events. In addition to PLR, we present the relationship between mean platelet volume, red cell distribution width and neutrophil to lymphocyte ratio and no-reflow, SXS and in-hospital adverse events. PMID:25350375

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

    PubMed Central

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

    2013-01-01

    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. PMID:24222838

  20. Thrombus aspiration during primary percutaneous coronary intervention associated with reduced platelet activation

    PubMed Central

    Sahin, Muslum; Acar, Goksel; Kalkan, Mehmet E.; Acar, Rezzan D.; Kilicgedik, Alev; Teymen, Burak; Arslantas, Ugur; Kirma, Cevat

    2015-01-01

    Objectives: To determine the effect of thrombectomy on platelet function in patients undergoing primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI). Methods: This retrospective study included 413 consecutive STEMI patients who underwent PPCI between March 2012 and September 2013 at Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey that were assigned to the thrombus aspiration (TA) group or the non-TA group. Platelet count and mean platelet volume (MPV) were obtained at baseline and 24 hours (h), 48 h, and 72 h post PPCI. Results: Baseline MPV was similar in both groups, whereas the baseline platelet count was higher in the TA group (p=0.42 and p=0.002). The platelet count was higher in the TA group 24 h post PPCI (p=0.02), but was similar in both groups 48 h and 72 h post PPCI (p=0.18 and p=0.07). The MPV 48 h and 72 h post PPCI was higher in the non-TA group than in the TA group (8.4 ± 1.3 fL versus 8.7 ± 1.6 fL [p=0.04] and 8.5 ± 1.1 fL versus 8.9 ± 1.5 fL [p=0.04]). Conclusion: Thrombectomy reduced platelet activity via removal of thrombi from the coronary arteries in patients undergoing PPCI for STEMI. PMID:26219443

  1. New Multicentury Evidence for Dispersal Limitation during Primary Succession.

    PubMed

    Makoto, K; Wilson, Scott D

    2016-06-01

    Primary succession is limited by both ecosystem development and plant dispersal, but the extent to which dispersal constrains succession over the long-term is unknown. We compared primary succession along two co-occurring arctic chronosequences with contrasting spatial scales: sorted circles that span a few meters and may have few dispersal constraints and glacial forelands that span several kilometers and may have greater dispersal constraints. Dispersal constraints slowed primary succession by centuries: plots were dominated by cryptogams after 20 years on circles but after 270 years on forelands; plots supported deciduous plants after 100 years on circles but after >400 years on forelands. Our study provides century-scale evidence suggesting that dispersal limitations constrain the rate of primary succession in glacial forelands. PMID:27172599

  2. Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013

    PubMed Central

    Hall, M; Laut, K; Dondo, T B; Alabas, O A; Brogan, R A; Gutacker, N; Cookson, R; Norman, P; Timmis, A; de Belder, M; Ludman, P F; Gale, C P

    2016-01-01

    Objective Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is insufficiently implemented in many countries. We investigated patient and hospital characteristics associated with PPCI utilisation. Methods Whole country registry data (MINAP, Myocardial Ischaemia National Audit Project) comprising PPCI-capable National Health Service trusts in England (84 hospital trusts; 92 350 hospitalisations; 90 489 patients), 2003–2013. Multilevel Poisson regression modelled the relationship between incidence rate ratios (IRR) of PPCI and patient and trust-level factors. Results Overall, standardised rates of PPCI increased from 0.01% to 86.3% (2003–2013). While, on average, there was a yearly increase in PPCI utilisation of 30% (adjusted IRR 1.30, 95% CI 1.23 to 1.36), it varied substantially between trusts. PPCI rates were lower for patients with previous myocardial infarction (0.95, 0.93 to 0.98), heart failure (0.86, 0.81 to 0.92), angina (0.96, 0.94 to 0.98), diabetes (0.97, 0.95 to 0.99), chronic renal failure (0.89, 0.85 to 0.90), cerebrovascular disease (0.96, 0.93 to 0.99), age >80 years (0.87, 0.85 to 0.90), and travel distances >30 km (0.95, 0.93 to 0.98). PPCI rates were higher for patients with previous percutaneous coronary intervention (1.09, 1.05 to 1.12) and among trusts with >5 interventional cardiologists (1.30, 1.25 to 1.34), more visiting interventional cardiologists (1–5: 1.31, 1.26 to 1.36; ≥6: 1.42, 1.35 to 1.49), and a 24 h, 7-days-a-week PPCI service (2.69, 2.58 to 2.81). Half of the unexplained variation in PPCI rates was due to between-trust differences. Conclusions Following an 8 year implementation phase, PPCI utilisation rates stabilised at 85%. However, older and sicker patients were less likely to receive PPCI and there remained between-trust variation in PPCI rates not attributable to differences in staffing levels. Compliance with clinical pathways for STEMI is needed to ensure more equitable quality of care. PMID:26732182

  3. The Prognosis of Primary Percutaneous Coronary Intervention after One Year Clinical Follow Up

    PubMed Central

    Dadjoo, Yahya; Mahmoodi, Yadallah

    2013-01-01

    Objectives The aim of this study was to evaluate the clinical outcomes, one year after primary percutaneous coronary intervention(PCI). Patients and Methods From September 2009 to March 2012, primary PCI was performed on 70 cases, and the data relating to their catheterization were recorded. Peri-interventional treatment data included PCI with drug-eluting or bare-metal stent or balloon angioplasty alone. Results The mean age of the patients was 61.34+11.31 years, and 72.9% of them were males. The ratios of patients with diabetes, hypertension and, hyperlipidemia were 61.4%, 71.4%, and 52.9% respectively. In clinical follow-up, total incidence of death was 4.3%, with no death occurring during 30 days. However, 3 patients died after one-year, of which one patient (1.4%) had cardiac problem and the other 2 (2.9%) died because of non-cardiac reasons. Target vessel revascularization, reinfarction within 30 days, and mechanical complication or stroke were not found in any of the patients. Patients with hypertension (6%) and those with LAD ST-elevation myocardial infarction (5%) died after one year (P= 0.263 and P= 0.319 respectively). However, no mortality was reported in patients with RCA and LCX ST-elevation myocardial infarction. Of subjects with multivessel disease, 7% died after one-year (P= 0.161), but there was no reported mortality in those with single vessel disease. Conclusions The prognosis was satisfactory in patients undergoing PCI after one year clinical follow up. PMID:24757614

  4. Comparison of primary coronary percutaneous coronary intervention between Diabetic Men and Women with acute myocardial infarction

    PubMed Central

    Liu, Heng-Liang; Liu, Yang; Hao, Zhen-Xuan; Geng, Guo-Ying; Zhang, Zhi-Fang; Jing, Song-Bin; Ba, Ning; Guo, Wei

    2015-01-01

    Objective: This study aimed to explore the short-term efficacy and safety of primary percutaneous coronary intervention (PCI) in female diabetic patients complicated with acute myocardial infarction (AMI). Methods: A total of 169 diabetic patients with AMI who underwent primary PCI were selected and divided into group A (52 females) and group B (117 males). The clinical data, characteristics of coronary artery lesions, lengths of hospital stay, and incidences of complications were then compared between two groups. Results: The average age, history of hyperlipidemia, double branch lesions, triple branch lesions, and left main lesions were significantly higher in group A than in group B (P < 0.05). Smoking history, PCI history, and pre-infarction angina were distinctly lower in group A than in group B (P < 0.05). Thrombolysis in myocardial infarction 3 (TIMI3) flow and TIMI myocardial perfusion grade 3 (TMPG3) after PCI were markedly lower in group A than in group B (P < 0.001). Group A had a higher incidence of complications, such as severe arrhythmia, cardiac function Killip III/IV, cardiogenic shock, major, moderate and mild bleed event, as well as a 30-day mortality rate, compared with group B (P < 0.05). Conclusion: In summary, our study demonstrated that female diabetic patients with AMI had lower TIMI3 flow and TMPG3 following PCI than male patients, while there was higher incidence of complications and 30-day mortality rate. Therefore, more attention should be paid to the therapy of diabetic women with acute myocardial infarction as well as the control of risk factors. PMID:26101503

  5. Prognosis of primary percutaneous coronary intervention in elderly patients with ST-elevation myocardial infarction

    PubMed Central

    Alkhushail, Abdullah; Kohli, Sanjay; Mitchel, Andrew; Smith, Robert; Ilsely, Charles

    2014-01-01

    Objective To evaluate the prognosis of primary percutaneous coronary intervention (PPCI) and medical therapy (MT) in elderly patients presenting with ST-elevation myocardial infarction (STEMI). Methods A total of 238 STEMI patients aged above 80 and treated with PPCI (n = 186) and MT (n = 52) at Harefield Hospital, London were included in this study. Patients who did not have true STEMI based on non-diagnostic electrocardiogram (ECG) for STEMI and negative troponin, who presented with left bundle branch block (LBBB) and had normal coronaries were excluded from this study. Primary PCI was defined as any use of a guidewire for more than diagnostic purposes in patients with STEMI, whereas conventional MT was defined as treatment of patients with anti-platelets and anti-thrombotic medications without thrombolysis. Results The survival rate of PPCI patients was 86% (n = 160) at month 1 followed by 83.9% (n = 156) at month 6, and 81.2% (n = 151) at month 12. The survival rate of MT patients was 44.2% (n = 23) at month 1 followed by 36.5% (n = 19) at month 6, and 34.6% (n = 18) at month 12. Compared to MT, significantly fewer comorbidities were found in the PPCI group. Ventricular fibrillation (VF) (4.8%) and consequent admission to intensive care unit (7%) were the major complications of the PPCI group. Conclusion PPCI has a higher survival rate and, compared to MT, fewer comorbidities were observed in the PPCI group of elderly patients presenting with STEMI. PMID:25870501

  6. PERCUTANEOUS BIOPSY OF PRIMARY TUMOR IN METASTATIC RENAL CELL CARCINOMA TO PREDICT HIGH RISK PATHOLOGIC FEATURES: COMPARISON WITH NEPHRECTOMY ASSESSMENT

    PubMed Central

    Abel, E. Jason; Culp, Stephen H.; Matin, Surena; Tamboli, Pheroze; Wallace, Michael J.; Jonasch, Eric; Tannir, Nizar M.; Wood, Christopher G.

    2016-01-01

    PURPOSE As treatment options evolve in metastatic renal cell carcinoma (mRCC), there is need for predictive information to help guide therapy. The purpose of this study was to assess accuracy of percutaneous primary tumor biopsy in mRCC by comparing biopsy findings to final nephrectomy pathology in patients undergoing cytoreductive nephrectomy (CN). MATERIALS AND METHODS Using an institutional database, we reviewed records of patients who underwent percutaneous primary tumor biopsy prior to CN. For patients who underwent biopsy at an outside institution, pathology was re-reviewed at our institution. Differences in accuracy based on biopsy technique, imaging modality, and biopsy time period were determined using chi-square analysis. RESULTS We identified 166 patients who underwent percutaneous biopsy of the primary tumor prior to CN between 1991 and 2007 and had data available for review. Median pathologic tumor size was 9.1 cm (range 3–32). Median time from biopsy to surgery was 46 days (range 6–717). Of 104 patients whose biopsy was assigned a Fuhrman nuclear grade, 33 (31.7%) had the same grade in the nephrectomy specimen or 74 of 109 (67.9%) when only high or low grade was considered. Grade change by more than 2 points was seen in 18 of 104 (17.3%) patients. Sarcomatoid features were present in 34 of 166 (20.5%) nephrectomy specimens, however only 4 (11.8%) were identified pre-operatively. CONCLUSIONS In patients with mRCC, percutaneous renal biopsy has poor accuracy for assessment of Fuhrman nuclear grade or sarcomatoid features. Physicians should use caution when using biopsy data to guide therapy. PMID:20850148

  7. Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution thallium scintigraphy

    SciTech Connect

    Wijns, W.; Serruys, P.W.; Reiber, J.H.; de Feyter, P.J.; van den Brand, M.; Simoons, M.L.; Hugenholtz, P.G.

    1985-02-01

    The value of exercise testing and thallium scintigraphy in predicting recurrence of angina pectoris and restenosis after a primary successful transluminal coronary angioplasty (PTCA) was prospectively evaluated. In 89 patients, a symptom-limited exercise electrocardiogram (ECG) and thallium scintigraphy were performed 4 weeks after they had undergone successful PTCA. Thereafter, the patients were followed for 6.4 +/- 2.5 months (mean +/- standard deviation) or until recurrence of angina. They all underwent a repeat coronary angiography at 6 months or earlier if symptoms recurred. PTCA was considered successful if the patients had no symptoms and if the stenosis was reduced to less than 50% of the luminal diameter. Restenosis was defined as an increase of the stenosis to more than 50% luminal diameter. The ability of the thallium scintigram (presence of a reversible defect) to predict recurrence of angina was 66%, vs 38% for the exercise ECG (ST-segment depression or angina at peak workload). Restenosis was predicted in 74% of patients by thallium scintigraphy, but only in 50% of patients by the exercise ECG. Thus, thallium scintigraphy was highly predictive but the exercise ECG was not (p less than 0.005). These results suggest that restenosis had occurred to some extent already at 4 weeks after the PTCA in most patients in whom it was going to occur.

  8. Clinical and procedural predictors of no-reflow in patients with acute myocardial infarction after primary percutaneous coronary intervention

    PubMed Central

    Zhou, Hua; He, Xiao-yan; Zhuang, Shao-wei; Wang, Juan; Lai, Yan; Qi, Wei-gang; Yao, Yi-an; Liu, Xue-bo

    2014-01-01

    BACKGROUND: The treatment of acute myocardial infarction (AMI) is thought to restore antegrade blood flow in the infarct-related artery (IRA) and minimize ischemic damage to the myocardium as soon as possible. The present study aimed to identify possible clinical predictors for no-reflow in patients with AMI after primary percutaneous coronary intervention (PCI). METHODS: A total of 312 consecutive patients with AMI who had been treated from January 2008 to December 2010 at the Cardiology Department of East Hospital, Tongji University School of Medicine were enrolled in this study. Inclusion criteria were: (i) patients underwent successfully primary PCI within 12 hours after the appearance of symptoms; or (ii) patients with ischemic chest pain for more than 12 hours after a successful primary PCI within 24 hours after appearance of symptoms. Exculsion criteria were: (i) coronary artery spasm; (ii) diameter stenosis of the culprit lesion was <50% and coronary blood flow was normal; (iii) patients with severe left main coronary or multivessel disease, who had to require emergency revascularization. According to thrombolysis in myocardial infarction (TIMI), the patients were divided into a reflow group and a no-reflow group. The clinical data, angiography findings and surgical data were compared between the two groups. Univariate and multivariate logistic regressions were used to determine the predictors for no-reflow. RESULTS: Fifty-four (17.3%) of the patients developed NR phenomenon after primary PCI. Univariate analysis showed that age, time from onset to reperfusion, systolic blood pressure (SBP) on admission, Killip class of myocardial infarction, intra-aortic balloon pump (IABP) use before primary PCI, TIMI flow grade before primary PCI, type of occlusion, thrombus burden on baseline angiography, target lesion length, reference luminal diameter and method of reperfusion were correlated with no-reflow (P<0.05 for all). Multiple logistic regression analysis identified that age >65 years [OR=1.470, 95% confidence interval (CI) 1.460–1.490, P=0.007], long time from onset to reperfusion >6 hours (OR=1.270, 95%CI 1.160–1.400, P=0.001), low SBP on admission <100 mmHg (OR=1.910, 95%CI 1.018–3.896, P=0.004), IABP use before PCI (OR= 1.949, 95%CI 1.168–3.253, P=0.011), low (≤1) TIMI flow grade before primary PCI (OR=1.100, 95%CI 1.080–1.250, P<0.001), high thrombus burden (OR=1.600, 95%CI 1.470–2.760, P=0.030), and long target lesion (OR=1.948, 95%CI 1.908–1.990, P=0.019) on angiography were independent predictors of no-reflow. CONCLUSION: The occurrence of no-reflow after primary PCI for acute myocardial infarction can predict clinical, angiographic and procedural features. PMID:25215156

  9. Effect of Melatonin on Cardiac Injury after Primary Percutaneous Coronary Intervention: a Randomized Controlled Trial.

    PubMed

    Ghaeli, Padideh; Vejdani, Shaghayegh; Ariamanesh, Atefeh; Hajhossein Talasaz, Azita

    2015-01-01

    Several studies have reported that the antioxidant properties of melatonin can provide cardiac protection through scavenging of free radicals. This study sought to investigate the efficacy of melatonin on cardiac biomarkers, myocardial-specific protein high sensitive troponin-T (hs-TnT) and creatine kinase-MB (CK-MB), in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). In this randomized clinical trial, a total of 40 patients with STEMI planned to undergo pPCI were randomly assigned to two groups of receiving melatonin plus standard treatment [n=20] and control group, receiving only standard therapy [n=20]. The following parameters including hsTnT and CK-MB were assessed preoperatively (baseline) and at 6 hours after procedure. Melatonin could significantly reduce the level of CK-MB (118.2 ± 21.09 IU/L in the treated group versus 198.24 ± 20.94 IU/L in the control group; p-value = 0.01). However, there was no difference in the mean hs-TnT level between two groups (2491 ± 664 μg/L vs. 2801 ± 620 μg/L; p value = 0.73). Our results revealed that melatonin can be considered as a safe adjunctive medication to the standard regimen after pPCI for the aim of decreasing cardiovascular events. Meanwhile, this was a pilot study with a small number of patients and further studies are needed to confirm the beneficial effect of melatonin in patients with STEMI. PMID:26330873

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

    PubMed Central

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

    2014-01-01

    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

  11. Torsades de pointes related to transient marked QT prolongation following successful emergent percutaneous coronary intervention for acute coronary syndrome.

    PubMed

    Kawabata, Mihoko; Hirao, Kenzo; Takeshi, Sasaki; Sakurai, Kaoru; Inagaki, Hiroshi; Hachiya, Hitoshi; Isobe, Mitsuaki

    2008-01-01

    We report 2 patients in whom transient marked QT prolongation occurred after successful emergent percutaneous coronary intervention (PCI) for acute coronary syndrome. One patient developed torsades de pointes. In both cases, the QT interval became markedly prolonged within 24 hours after PCI, and this prolongation persisted for 4 days. The T waves had a giant and bizarre negative shape with a prolonged T-wave peak to T-wave end interval. No new-onset ischemia or congenital long QT syndrome was related to the episodes. The patients had not taken any drugs that could have prolonged the QT interval, and their serum potassium levels were within normal limits. Torsades de pointes following successful PCI for acute coronary syndrome is uncommon, but acquired long QT syndrome should be considered and treated in patients in whom giant and bizarre negative T waves and QT prolongation develop after PCI. PMID:18328336

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

    PubMed

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

    2000-02-01

    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

  13. Importance of Hospital Entry: Walk-in STEMI and Primary Percutaneous Coronary Intervention

    PubMed Central

    Bansal, Eric; Dhawan, Rahul; Wagman, Brittany; Low, Garren; Zheng, Ling; Chan, Linda; Newton, Kim; Swadron, Stuart P.; Testa, Nicholas; Shavelle, David M.

    2014-01-01

    Introduction Patients with ST elevation myocardial infarction (STEMI) require rapid identification and triage to initiate reperfusion therapy. Walk-in STEMI patients have longer treatment times compared to emergency medical service (EMS) transported patients. While effective triage of large numbers of critically ill patients in the emergency department is often cited as the reason for treatment delays, additional factors have not been explored. The purpose of this study was to evaluate baseline demographic and clinical differences between walk-in and EMS-transported STEMI patients and identify factors associated with prolonged door to balloon (D2B) time in walk-in STEMI patients. Methods We performed a retrospective review of 136 STEMI patients presenting to an urban academic teaching center from January 2009 through December 2010. Baseline demographics, mode of hospital entry (walk-in versus EMS transport), treatment times, angiographic findings, procedures performed and in-hospital clinical events were collected. We compared walk-in and EMS-transported STEMI patients and identified independent factors of prolonged D2B time for walk-in patients using stepwise logistic regression analysis. Results Walk-in patients (n=51) were more likely to be Latino and presented with a higher heart rate, higher systolic blood pressure, prior history of diabetes mellitus and were more likely to have an elevated initial troponin value, compared to EMS-transported patients. EMS-transported patients (n=64) were more likely to be white and had a higher prevalence of left main coronary artery disease, compared to walk-in patients. Door to electrocardiogram (ECG), ECG to catheterization laboratory (CL) activation and D2B times were significantly longer for walk-in patients. Walk-in patients were more likely to have D2B time >90 minutes, compared to EMS- transported patients; odds ratio 3.53 (95% CI 1.03, 12.07), p=0.04. Stepwise logistic regression identified hospital entry mode as the only independent predictor for prolonged D2B time. Conclusion Baseline differences exist between walk-in and EMS-transported STEMI patients undergoing primary percutaneous coronary intervention (PCI). Hospital entry mode was the most important predictor for prolonged treatment times for primary PCI, independent of age, Latino ethnicity, heart rate, systolic blood pressure and initial troponin value. Prolonged door to ECG and ECG to CL activation times are modifiable factors associated with prolonged treatment times in walk-in STEMI patients. In addition to promoting the use of EMS transport, efforts are needed to rapidly identify and expedite the triage of walk-in STEMI patients. PMID:24578769

  14. Prognostic significance of transient no-reflow during primary percutaneous coronary intervention for ST-elevation acute myocardial infarction.

    PubMed

    Mehta, Rajendra H; Harjai, Kishore J; Boura, Judy; Cox, David; Stone, Gregg W; O'Neill, William; Grines, Cindy L

    2003-12-15

    We found that of 1,192 patients who underwent primary percutaneous coronary intervention and who had final Thrombolysis In Myocardial Infarction grade 3 flow at the conclusion of the procedure, transient no-reflow occurred in 16 patients (1.3%). Compared with patients without transient no-reflow during the procedure, those with transient no-reflow had higher in-hospital (2% vs 13%, p=0.04) and 6-month mortality (3% vs 31%, adjusted odds ratio 5.4, 95% confidence interval 1.01 to 29.0, p=0.0001). PMID:14675583

  15. A stoichiometric model of early plant primary succession.

    PubMed

    Marleau, Justin N; Jin, Yu; Bishop, John G; Fagan, William F; Lewis, Mark A

    2011-02-01

    The relative importance of plant facilitation and competition during primary succession depends on the development of ecosystem nutrient pools, yet the interaction of these processes remains poorly understood. To explore how these mechanisms interact to drive successional dynamics, we devised a stoichiometric ecosystem-level model that considers the role of nitrogen and phosphorus limitation in plant primary succession. We applied this model to the primary plant community on Mount St. Helens, Washington State, to check the validity of the proposed mechanisms. Our results show that the plant community is colimited by nitrogen and phosphorus, and they confirm previous suggestions that the presence of a nitrogen-fixing legume, Lupinus lepidus, can enhance community biomass. In addition, the observed nutrient supply rates may promote alternative successional trajectories that depend on the initial plant abundances, which may explain the observed heterogeneity in community development. The model further indicates the importance of mineralization rates and other ecosystem parameters to successional rates. We conclude that a model framework based on ecological stoichiometry allows integration of key biotic processes that interact nonlinearly with biogeochemical aspects of succession. Extension of this approach will improve the understanding of the process of primary succession and its application to ecosystem rehabilitation. PMID:21460559

  16. Acute kidney injury among ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention: a multifactorial entity.

    PubMed

    Shacham, Yacov; Steinvil, Arie; Arbel, Yaron

    2016-04-01

    Acute kidney injury is a frequent complication among ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and is associated with adverse outcomes. While contrast nephropathy is considered the most important reason for worsening of renal function, recent data have suggested the role of other important factors among this specific patient population. In the present review, we examine the various factors leading to renal impairment in STEMI patients and place the findings in the context of this specific patient population in the era of primary PCI. These factors include contrast nephropathy, time to coronary reperfusion, cardiac pump function and hemodynamics as well as various inflammatory and metabolic markers. PMID:26861658

  17. The Factors Associated With the Successful Outcomes of Percutaneous Disc Decompression in Patients With Lumbar Herniated Nucleus Pulposus

    PubMed Central

    Lee, Sang Heon; Kim, Nack Hwan; Park, Hyeun Jun; Yoo, Hyun-Joon; Jo, Soo Yung

    2015-01-01

    Objective To determine clinical and radiological factors that predict the successful outcome of percutaneous disc decompression (PDD) in patients with lumbar herniated nucleus pulposus (HNP). Methods We retrospectively reviewed the clinical and radiological features of patients who underwent lumbar PDD from April 2009 to March 2013. Sixty-nine patients with lumbar HNP were studied. Clinical outcome was assessed by the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Multivariate logistic regression analysis was performed to assess relationship among clinical and radiological factors and the successful outcome of the PDD. Results The VAS and the ODI decreased significantly at 1 year follow-up (p<0.01). One year after PDD, the reduction of the VAS (ΔVAS) was significantly greater in the patients with pain for <6 months (p=0.03) and subarticular HNP (p=0.015). The reduction of the ODI (ΔODI) was significantly greater in the patients with high intensity zone (p=0.04). Multivariate logistic regression analysis revealed the following 5 factors that were associated with the successful outcome after PDD: pain duration for <6 months (odds ratio [OR]=14.036; p=0.006), positive straight leg raising test (OR=8.425, p=0.014), the extruded HNP (OR=0.106, p=0.04), the sequestrated HNP (OR=0.037, p=0.026), and the subarticular HNP (OR=10.876, p=0.012). Conclusion PDD provided significant improvement of pain and disability of patients. The results of the analysis indicated that the duration of pain <6 months, positive straight leg raising test, the subarticular HNP, and the protruded HNP were predicting factors associated with the successful response of PDD in patients with lumbar HNP. PMID:26605171

  18. Reducing Door to- Balloon- Time for Acute ST Elevation Myocardial Infarction In Primary Percutaneous Intervention: Transformation using Robust Performance Improvement.

    PubMed

    Ellahham Md, Samer; Aljabbari, Samir; Harold Mananghaya, Tristan; J Raji, Salama; Al Zubaidi, Abdulmajeed

    2015-01-01

    Cardiovascular diseases (CVDs) are the leading causes of death in the UAE. Prompt reperfusion access is essential for patients who have Myocardial Infarction (MI) with ST-segment elevation as they are at a relatively high risk of death.This risk may be reduced by primary percutaneous coronary intervention (PCI), but only if it is performed in a timely manner. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon (D2B) time) during primary PCI should be 90 minutes or less. The earlier therapy is initiated, the better the outcome. Our aim was to decrease the door-to-balloon time for patients with ST segment elevation myocardial infarction (STEMI) who come through the emergency department (ED) in Sheikh Khalifa Medical City,a tertiary hospital in UAE, to meet the standard of less than 90 minutes. A multidisciplinary team was formed including interventional cardiologists, catheterization laboratory personnel, emergency department caregivers and quality staff. The project utilized the Lean Six Sigma Methodology which provided a powerful approach to quality improvement. The process minimized waste and variation, and a decreased median door-to-balloon time from 75.9 minutes to 60.1 minutes was noted. The percentage of patients who underwent PCI within 90 minutes increased from 73% to 96%. In conclusion, implementing the Lean Six Sigma methodology resulted in having processes that are leaner, more efficient and minimally variable. While recent publication failed to provide evidence of better outcome, the lessons learned were extrapolated to other primary percutaneous coronary intervention centers in our system.This would have marked impact on patient safety, quality of care and patient experience. PMID:26734321

  19. Reducing Door to- Balloon- Time for Acute ST Elevation Myocardial Infarction In Primary Percutaneous Intervention: Transformation using Robust Performance Improvement

    PubMed Central

    Ellahham, MD, Samer; Aljabbari, Samir; Harold Mananghaya, Tristan; J. Raji, Salama; Al Zubaidi, Abdulmajeed

    2015-01-01

    Cardiovascular diseases (CVDs) are the leading causes of death in the UAE. Prompt reperfusion access is essential for patients who have Myocardial Infarction (MI) with ST-segment elevation as they are at a relatively high risk of death.This risk may be reduced by primary percutaneous coronary intervention (PCI), but only if it is performed in a timely manner. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon (D2B) time) during primary PCI should be 90 minutes or less. The earlier therapy is initiated, the better the outcome. Our aim was to decrease the door-to-balloon time for patients with ST segment elevation myocardial infarction (STEMI) who come through the emergency department (ED) in Sheikh Khalifa Medical City,a tertiary hospital in UAE, to meet the standard of less than 90 minutes. A multidisciplinary team was formed including interventional cardiologists, catheterization laboratory personnel, emergency department caregivers and quality staff. The project utilized the Lean Six Sigma Methodology which provided a powerful approach to quality improvement. The process minimized waste and variation, and a decreased median door-to-balloon time from 75.9 minutes to 60.1 minutes was noted. The percentage of patients who underwent PCI within 90 minutes increased from 73% to 96%. In conclusion, implementing the Lean Six Sigma methodology resulted in having processes that are leaner, more efficient and minimally variable. While recent publication failed to provide evidence of better outcome, the lessons learned were extrapolated to other primary percutaneous coronary intervention centers in our system.This would have marked impact on patient safety, quality of care and patient experience. PMID:26734321

  20. The extent of irreversible myocardial damage and the potential for left ventricular repair after primary percutaneous coronary intervention.

    PubMed

    Esposito, Giovanni; Dellegrottaglie, Santo; Chiariello, Massimo

    2010-12-01

    Primary percutaneous coronary intervention (PCI) is currently recognized as a highly effective therapy for acute myocardial infarction (AMI) and has been shown to decrease myocardial damage and improve prognosis. Several diagnostic tools have been proposed to evaluate the myocardium at risk, the occurrence of no-reflow, the final scar size, and the presence of residual viable myocardium in patients treated by primary PCI. A large body of literature documents the relevant impact of each of these variables on outcomes in patients treated for AMI. In patients undergoing primary PCI, a number of treatment approaches have been proposed recently to improve efficacy by increasing myocardial salvage. This article describes the principal diagnostic tools (ie, serum biochemical markers, electrocardiography, echocardiography, nuclear imaging techniques, magnetic resonance imaging, and multidetector computed tomography) applicable for evaluation of the size and severity of myocardial damage in patients with AMI undergoing primary PCI. Proposed therapeutic strategies to repair irreversible myocardial damage in patients treated with primary PCI are also considered, with particular focus on the value of stem cell therapy in this specific setting. PMID:21147291

  1. Congenital pulmonic stenosis in a 77-year-old woman successfully treated with percutaneous balloon valvuloplasty

    PubMed Central

    Ayad, Ramy F.; Johnston, Stephen B.; Grayburn, Paul A.; Schmidt, Tyson T.

    2010-01-01

    Congenital pulmonic stenosis (PS) rarely presents in patients over the age of 55 years. A stable asymptomatic course into late adulthood is the usual history of mild to moderate PS. Balloon valvuloplasty has become the procedure of choice for congenital PS, especially in children and young adults. There are rare reports of its use in older adults. Significant valve calcium is believed to limit its success. We present a case of a 77-year-old woman with symptomatic congenital PS and severe valve calcium who underwent successful balloon valvuloplasty. PMID:20157499

  2. Temporal trends and in-hospital outcomes of primary percutaneous coronary intervention in nonagenarians with ST-segment elevation myocardial infarction

    PubMed Central

    Kim, Joon Young; Jeong, Myung Ho; Choi, Yong Woo; Ahn, Yong Keun; Chae, Shung Chull; Hur, Seung Ho; Hong, Taek Jong; Kim, Young Jo; Seong, In Whan; Chae, In Ho; Cho, Myeong Chan; Yoon, Jung Han; Seung, Ki Bae

    2015-01-01

    Background/Aims: Data regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in nonagenarians are very limited. The aim of the present study was to evaluate the temporal trends and in-hospital outcomes of primary PCI in nonagenarian STEMI patients. Methods: We retrospectively reviewed data from the Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008, and from the Korea Working Group on Myocardial Infarction (KorMI) from February 2008 to May 2010. Results: During this period, the proportion of nonagenarians among STEMI patients more than doubled (0.59% in KAMIR vs. 1.35% in KorMI), and the rate of use of primary PCI also increased (from 62.5% in KAMIR to 81.0% in KorMI). We identified 84 eligible study patients for which the overall in-hospital mortality rate was 21.4% (25.0% in KAMIR vs. 20.3% in KorMI, p = 0.919). Multivariate analysis identified two independent predictors of in-hospital mortality, namely a final Thrombolysis in Myocardial Infarction (TIMI) flow < 3 (odds ratio [OR], 13.7; 95% confidence interval [CI], 3.2 to 59.0; p < 0.001) and cardiogenic shock during hospitalization (OR, 6.7; 95% CI, 1.5 to 30.3; p = 0.013). Conclusions: The number of nonagenarian STEMI patients who have undergone primary PCI has increased. Although a final TIMI flow < 3 and cardiogenic shock are independent predictors of in-hospital mortality, primary PCI can be performed with a high success rate and an acceptable in-hospital mortality rate. PMID:26552457

  3. Thrombus aspiration during primary percutaneous coronary intervention for acute myocardial infarction: A review of clinical evidence and guidelines.

    PubMed

    Mahmood, Muhammad Muzaffar; Watt, Jonathan; Ahmed, Javed M

    2015-12-26

    Acute ST segment elevation myocardial infarction (STEMI) is characterized by complete thrombotic occlusion of a major coronary artery. Early recanalization of the infarct-related artery is most efficiently delivered by primary percutaneous coronary intervention (PPCI), however this does not always restore normal myocardial perfusion, mainly due to distal embolization of the thrombus and microvascular obstruction. Early evidence for manual thrombus aspiration during PPCI was promising and this was once considered an important aspect of the procedure, especially in patients with a high thrombus burden. However, a large body of evidence from recent major randomized controlled trials (notably TASTE and TOTAL) does not support the routine use of manual thrombus aspiration in patients with STEMI undergoing PPCI. PMID:26730294

  4. Thrombus aspiration during primary percutaneous coronary intervention for acute myocardial infarction: A review of clinical evidence and guidelines

    PubMed Central

    Mahmood, Muhammad Muzaffar; Watt, Jonathan; Ahmed, Javed M

    2015-01-01

    Acute ST segment elevation myocardial infarction (STEMI) is characterized by complete thrombotic occlusion of a major coronary artery. Early recanalization of the infarct-related artery is most efficiently delivered by primary percutaneous coronary intervention (PPCI), however this does not always restore normal myocardial perfusion, mainly due to distal embolization of the thrombus and microvascular obstruction. Early evidence for manual thrombus aspiration during PPCI was promising and this was once considered an important aspect of the procedure, especially in patients with a high thrombus burden. However, a large body of evidence from recent major randomized controlled trials (notably TASTE and TOTAL) does not support the routine use of manual thrombus aspiration in patients with STEMI undergoing PPCI. PMID:26730294

  5. A successful percutaneous mechanical vegetation debulking used as a bridge to surgery in acute tricuspid valve endocarditis

    PubMed Central

    Makdisi, George; Casciani, Thomas; Wozniak, Thomas C.; Roe, David W.

    2016-01-01

    Timing of surgical management of acute infective endocarditis is a major challenge, with respect to surgical complications, risks of recurrences and optimal valve repair or replacement. We present a case of a 24-year-old male with a history of intravenous drug abuse, who was referred to our center after 10 days of medical management of acute infective endocarditis. Upon arrival he was in septic shock, multi-organ failure, and mobile vegetations on the tricuspid valve with severe tricuspid regurgitation. He also had bilateral pulmonary infarcts and an ischemic stroke in the right parietal lobe. A successful percutaneous transcatheter mechanical vegetation debulking was performed followed by surgical valve replacement seven days later. This case introduces a new option in the management of right-sided endocarditis in critically ill patient, and demonstrates the technical feasibility of a debulking procedure in this setting, which led subsequently to a significant improvement in patient’s condition, and he was ultimately able to undergo definitive surgery. PMID:26904243

  6. A successful percutaneous mechanical vegetation debulking used as a bridge to surgery in acute tricuspid valve endocarditis.

    PubMed

    Makdisi, George; Casciani, Thomas; Wozniak, Thomas C; Roe, David W; Hashmi, Zubair A

    2016-01-01

    Timing of surgical management of acute infective endocarditis is a major challenge, with respect to surgical complications, risks of recurrences and optimal valve repair or replacement. We present a case of a 24-year-old male with a history of intravenous drug abuse, who was referred to our center after 10 days of medical management of acute infective endocarditis. Upon arrival he was in septic shock, multi-organ failure, and mobile vegetations on the tricuspid valve with severe tricuspid regurgitation. He also had bilateral pulmonary infarcts and an ischemic stroke in the right parietal lobe. A successful percutaneous transcatheter mechanical vegetation debulking was performed followed by surgical valve replacement seven days later. This case introduces a new option in the management of right-sided endocarditis in critically ill patient, and demonstrates the technical feasibility of a debulking procedure in this setting, which led subsequently to a significant improvement in patient's condition, and he was ultimately able to undergo definitive surgery. PMID:26904243

  7. Long-term outcomes of patients sent emergently to the catheterization laboratory for possible primary percutaneous coronary intervention.

    PubMed

    Turner, Tyson E; Waldo, Stephen W; Kulkarni, Ameya; Armstrong, Ehrin J; Hoffmayer, Kurt S; Kinlay, Scott; Hsue, Priscilla; Ganz, Peter; McCabe, James M

    2013-12-01

    Current guidelines advocate primary percutaneous coronary intervention as the therapy of choice for ST-segment elevation myocardial infarction (STEMI) when available. Little is known about the outcomes of patients without a culprit lesion after referral for primary percutaneous coronary intervention for a presumed STEMI. Subjects were identified within a registry containing consecutive patients who underwent emergent angiography for a potential STEMI from October 2008 to July 2012. Vital status was obtained from the medical record and Social Security Death Index. Cox proportional hazards models were created to evaluate the relation between the angiographic findings and cardiovascular outcomes, including major adverse cardiovascular events (MACE) and mortality. Among 539 patients who underwent emergent angiography, 65 (12%) had no coronary artery disease (CAD), 110 (20%) had CAD without a culprit lesion, and 364 (68%) had a culprit lesion. Kaplan-Meier analysis of MACE demonstrated that patients with CAD who lack a culprit lesion had a similar rate of MACE to those with a culprit lesion (p = 0.64), and both groups had significantly increased risk compared with those with no CAD (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.01 to 3.41 and HR 2.0, 95% CI 1.15 to 3.54, respectively). Kaplan-Meier analysis of mortality illustrated a nonsignificant trend toward increased mortality in patients having a culprit lesion (HR 1.7, 95% CI 0.59 to 4.80) and those having CAD without a culprit lesion (HR 1.2, 95% CI 0.39 to 3.81) compared with those with no CAD. In conclusion, patients found to have CAD without a culprit lesion in emergent angiography after a presumptive STEMI diagnosis have similar long-term rates of MACE compared with those requiring emergent revascularization. PMID:24063836

  8. Do bacterial and fungal communities assemble differently during primary succession?

    PubMed

    Schmidt, S K; Nemergut, D R; Darcy, J L; Lynch, R

    2014-02-01

    High-throughput sequencing technologies are now allowing us to study patterns of community assembly for diverse microbial assemblages across environmental gradients and during succession. Here we discuss potential explanations for similarities and differences in bacterial and fungal community assembly patterns along a soil chronosequence in the foreland of a receding glacier. Although the data are not entirely conclusive, they do indicate that successional trajectories for bacteria and fungi may be quite different. Recent empirical and theoretical studies indicate that smaller microbes (like most bacteria) are less likely to be dispersal limited than are larger microbes - which could result in a more deterministic community assembly pattern for bacteria during primary succession. Many bacteria are also better adapted (than are fungi) to life in barren, early-successional sediments in that some can fix nitrogen and carbon from the atmosphere - traits not possessed by any fungi. Other differences between bacteria and fungi are discussed, but it is apparent from this and other recent studies of microbial succession that we are a long way from understanding the mechanistic underpinnings of microbial community assembly during ecosystem succession. We especially need a better understanding of global and regional patterns of microbial dispersal and what environmental factors control the development of microbial communities in complex natural systems. PMID:26010467

  9. In-hospital and six-month outcomes of elderly patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial infarction

    PubMed Central

    Noohi, Fereydoon; Hashemi, Isa; Sanati, Hamid Reza; Peighambari, Mohammad Mehdi; Kiavar, Majid; Maadani, Mohsen; Bassiri, Hossein Ali; Zahedmehr, Ali; Shakerian, Farshad; Firouzi, Ata; Kiani, Reza; Abdi, Seifollah

    2016-01-01

    BACKGROUND Elderly patients constitute a rapidly growing proportion of the population, and hence the increasing rises in the number of patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI), which is now established as the preferred reperfusion strategy in STEMI patients, has been inadequately investigated in this high-risk group. The aim of the present study was to investigate the in-hospital and 6-month outcomes of primary PCI in elderly patients (≥ 75 years) with STEMI. METHODS A total of 100 elderly patients with STEMI including those with cardiogenic shock were included. Primary PCI procedures were performed in a tertiary referral center between 2009 and 2014. In-hospital and 6-month outcomes of patients were recorded and analyzed. RESULTS The average age of the patients was 79.6 ± 3.8 years (range = 75-90 years) and 27.0% were women. Cardiovascular risk factors and prior events were common. Nearly, half of the patients had three-vessel disease and the left anterior descending artery (LAD) was the most common infarct-related artery. The presence of cardiogenic shock but not the other variables was associated with less anatomic and procedural success (P < 0.001). It was also the major independent predictors of 6-month mortality in the patients aged ≥ 75 years, [hazard ratio (HR) = 8.02; 95% confidence interval (CI): 1.75-25.97, P < 0.001]. In-hospital mortality was 2.4% in the patients without and 83.0% in those with cardiogenic shock. CONCLUSION Primary PCI in aged patients could be associated with low complication rates and improved survival if performed in high-volume centers with experienced operators. Considering the very high rate of mortality in patients with cardiogenic shock, there should be measures to treat these patients before the onset of hemodynamic instability.

  10. Percutaneous peripheral excimer laser angioplasty: immediate success rate and short-term outcome

    NASA Astrophysics Data System (ADS)

    Visona, Adriana; Liessi, Guido; Bonanome, Andrea; Lusiani, Luigi; Miserocchi, Luigi; Pagnan, Antonio

    1991-05-01

    Excimer Laser Angioplasty was attempted in 47 patients (36 males, 11 females, mean age 62+/- 7 years, range 39-77 years), affected by peripheral vascular disease. Thirty-seven patients had a total occlusion of the superficial femoral artery, 3 of the iliac artery and 1 of the popliteal artery; 6 patients showed a subocclusive stenosis of the superficial femoral artery. Occlusions and subocclusive stenoses were classified by length: < 10 cm (28 cases), > 10 cm (19 cases). A commercial excimer laser (Technolas Max-10) was used at the Xenon- Chloride wavelength of 308 nm. The laser operated at 60 ns pulse length and at 20-40 Hz repetition rate. Applied energy fluence was 20 mJ/pulse. The energy was delivered through a multifiber catheter, which combines 12 (7F) or 18 (9F) fibers (260 micron diameter each), concentrically arranged. Balloon dilatation was associated to complete the procedure in 38 cases. The treated arteries were successfully recanalized in 41 out of 47 patients (87%). Hemodynamic improvement was confirmed by a significant increase of ankle/brachial systolic pressure index (from 0.60+/- 0.17 to 0.79+/- 0.20, p < 0.005). Failure to recanalize arterial occlusion occurred in 6 cases, and was due to dissection in 3 patients and inability to cross the final segment of a long occlusion in 3 patients. The success rate was higher for lesions < 10 cm in length. Early reocclusion was observed in 7 patients and was associated with poor run-off. The cumulative patency rate at 1 month was 90.7%. Preliminary results are encouraging. More suitable catheters and better selection of patients should improve the efficacy of laser angioplasty and should allow to perform laser procedures without combining balloon angioplasty.

  11. Integrating primary care with occupational health services: a success story.

    PubMed

    Griffith, Karen; Strasser, Patricia B

    2010-12-01

    This article describes the process used by a large U.S. manufacturing company to successfully integrate full-service primary care centers at two locations. The company believed that by providing employees with health promotion and disease prevention services, including screening, early diagnosis, and uncomplicated illness treatment, its health care costs could be significantly reduced while saving employees money. To accurately demonstrate the cost-effectiveness of adding primary care to existing occupational health services, a thorough financial analysis projected the return on investment (ROI) of the program. Decisions were made about center size, the scope of services, and staffing. A critical part of the ROI analysis involved evaluating employee health claim data to identify the actual cost of health care services for each center and the projected costs if the services were provided on-site. The pilot initiative included constructing two on-site health center facilities staffed with primary care physicians, nurse practitioners, physical therapists, and other health care professionals. Key outcome metrics from the pilot clinics exceeded goals in three of four categories. In addition, clinic use after 12 months far exceeded benchmarks for similar clinics. Most importantly, the pilot clinics were operating with a positive cash flow within the first year and demonstrated an increasingly positive ROI. PMID:21188796

  12. Ischemia-driven target vessel revascularization after-primary percutaneous coronary intervention: patients at risk and their outcomes.

    PubMed

    Mehta, Rajendra H; Harjai, Kishore J; Boura, Judy; O'Neill, William; Grines, Cindy L

    2005-06-01

    Clinical and angiographic correlates of ischemia-driven target vessel revascularization (ITVR) in patients undergoing primary percutaneous coronary interventions (PCI) are currently less well known. Accordingly, we examined 2,981 patients enrolled in different Primary Angioplasty in Myocardial Infarction trials, who underwent primary PCI to evaluate risk factors and outcomes of individuals requiring subsequent ITVR. At 6 months, ITVR was required in 321 patients (11%). Compared to the cohort without ITVR, patients requiring ITVR were younger (P=0.036), females (P=0.018), and more likely to have systolic blood pressure >100 mmHg on presentation (P=0.022), family history of premature coronary artery disease (P=0.035), and postprocedure dissection (P=0.001). In contrast, Killip Class >I on presentation (P=0.05), left circumflex as infarct-related artery (P=0.022), and the use of ticlopidine (P=0.044) and stents (p=0.057) were less frequent among ITVR patients. Multivariate analysis identified younger age (for each 10-year decrease, odds ratio [OR], 1.18; 95% confidence interval [CI], 1.06-1.32), female gender (OR: 1.41, 95% CI: 1.05-1.89), and final dissection (OR: 1.69, 95% CI: 1.23-2.33) as independent risk factors for ITVR. In-hospital reinfarction (P < 0.001) was increased and at 6 months remained higher in ITVR patients; in-hospital and 6-month mortality did not differ between the two groups. Our study identifies the incidence, risk factors, and outcomes of patients requiring ITVR after primary PCI. Importantly, our data suggest that no increase in mortality occur, if ITVR is promptly performed to treat recurrent ischemia after primary PCI. PMID:15966917

  13. Impact of oral beta-blocker therapy on mortality after primary percutaneous coronary intervention for Killip class 1 myocardial infarction.

    PubMed

    Hioki, Hirofumi; Motoki, Hirohiko; Izawa, Atsushi; Kashima, Yuichirou; Miura, Takashi; Ebisawa, Souichirou; Tomita, Takeshi; Miyashita, Yusuke; Koyama, Jun; Ikeda, Uichi

    2016-05-01

    The use of beta-blockers therapy has been recommended to reduce mortality in patients with left ventricular dysfunction after acute myocardial infarction (AMI). Primary percutaneous coronary intervention (PCI), which has become the mainstay of treatment for AMI, is associated with a lower mortality than fibrinolysis. The benefits of beta-blockers after primary PCI in AMI patients without pump failure are unclear. We hypothesized that oral beta-blocker therapy after primary PCI might reduce the mortality in AMI patients without pump failure. The assessment of lipophilic vs. hydrophilic statin therapy in acute myocardial infarction (ALPS-AMI) study was a multi-center study that enrolled 508 AMI patients to compare the efficacy of hydrophilic and lipophilic statins in secondary prevention after myocardial infarction. We prospectively tracked cardiovascular events for 3 years in 444 ALPS-AMI patients (median age 66 years; 18.2 % women) who had Killip class 1 on admission and were discharged alive. The primary endpoint was all-cause mortality. The 3-year follow-up was completed in 413 patients (93.0 %). During this follow-up, 21 patients (4.7 %) died. In Kaplan-Meier analysis, patients on beta-blockers had a significantly lower incidence of all-cause mortality (2.7 vs. 7.3 %, log-rank p = 0.025). After adjusting for the calculated propensity score for using beta-blockers, their use remained an independent predictor of all-cause mortality (hazard ratio 0.309; 95 % confidence interval 0.116-0.824; p = 0.019). In the statin era, the use of beta-blocker therapy after primary PCI is associated with lower mortality in AMI patients with Killip class 1 on admission. PMID:25863805

  14. Age- and Gender-related Disparities in Primary Percutaneous Coronary Interventions for Acute ST-segment elevation Myocardial Infarction

    PubMed Central

    Tal, Kali; Erne, Paul; Radovanovic, Dragana; Windecker, Stephan; Jüni, Peter

    2015-01-01

    Background Previous analyses reported age- and gender-related differences in the provision of cardiac care. The objective of the study was to compare circadian disparities in the delivery of primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) according to the patient’s age and gender. Methods We investigated patients included into the Acute Myocardial Infarction in Switzerland (AMIS) registry presenting to one of 11 centers in Switzerland providing primary PCI around the clock, and stratified patients according to gender and age. Findings A total of 4723 patients presented with AMI between 2005 and 2010; 1319 (28%) were women and 2172 (54%) were ≥65 years of age. More than 90% of patients <65 years of age underwent primary PCI without differences between gender. Elderly patients and particularly women were at increased risk of being withheld primary PCI (males adj. HR 4.91, 95% CI 3.93–6.13; females adj. HR 9.31, 95% CI 7.37–11.75) as compared to males <65 years of age. An increased risk of a delay in door-to-balloon time >90 minutes was found in elderly males (adj HR 1.66 (95% CI 1.40–1.95), p<0.001) and females (adj HR 1.57 (95% CI 1.27–1.93), p<0.001), as well as in females <65 years (adj HR 1.47 (95% CI 1.13–1.91), p = 0.004) as compared to males <65 years of age, with significant differences in circadian patterns during on- and off-duty hours. Conclusions In a cohort of patients with AMI in Switzerland, we observed discrimination of elderly patients and females in the circadian provision of primary PCI. PMID:26352574

  15. Is Antibiotic Prophylaxis for Percutaneous Radiofrequency Ablation (RFA) of Primary Liver Tumors Necessary? Results From a Single-Center Experience

    SciTech Connect

    Bhatia, Shivank S.; Echenique, Ana Froud, Tatiana Suthar, Rekha Lawson, Ivy Dalal, Ravi; Yrizarry, Jose Narayanan, Govindarajan

    2015-08-15

    PurposeThe purpose of this study was to evaluate need for antibiotic prophylaxis for radiofrequency ablation (RFA) of liver tumors in patients with no significant co-existing risk factors for infection.Materials and MethodsFrom January 2004 to September 2013, 83 patients underwent 123 percutaneous RFA procedures for total of 152 hepatocellular carcinoma (HCC) lesions. None of the patients had pre-existing biliary enteric anastomosis (BEA) or any biliary tract abnormality predisposing to ascending biliary infection or uncontrolled diabetes mellitus. No pre- or post-procedure antibiotic prophylaxis was provided for 121 procedures. Data for potential risk factors were reviewed retrospectively and analyzed for the frequency of infectious complications, including abscess formation.ResultsOne patient (1/121 (0.8 %) RFA sessions) developed a large segment 5 liver abscess/infected biloma communicating with the gallbladder 7 weeks after the procedure, successfully treated over 10 weeks with IV and PO antibiotic therapy and percutaneous catheter drainage. This patient did not receive any antibiotics prior to RFA. During the procedure, there was inadvertent placement of RFA probe tines into the gallbladder. No other infectious complications were documented.ConclusionThese data suggest that the routine use of prophylactic antibiotics for liver RFA is not necessary in majority of the patients undergoing liver ablation for HCC and could be limited to patients with high-risk factors such as the presence of BEA or other biliary abnormalities, uncontrolled diabetes mellitus, and large centrally located tumors in close proximity to central bile ducts. Larger randomized studies are needed to confirm this hypothesis.

  16. Spontaneous coronary artery dissection in men presenting with acute coronary syndrome, successfully managed by intravascular ultrasound-guided percutaneous coronary intervention

    PubMed Central

    Thomas, Bethan Nia; Aslam, Sajid; Cullen, James; Anantharaman, Rajaram

    2014-01-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. It is most commonly seen in young women, without atherosclerosis, in the peripartum period. Management options include conservative medical treatment, percutaneous coronary intervention or a surgical approach depending on the presentation, extent of dissection and luminal stenosis. We describe three unusual cases of spontaneous coronary artery dissection occurring in young/middle-aged men—the first in association with heavy mechanical work, the second in association with high levels of anxiety and emotional distress and the third in association with intense physical exercise. In each case we report the use of coronary angiography and intravascular ultrasound in the diagnosis of the condition, and their successful management using percutaneous coronary intervention. PMID:24717852

  17. Experiences in US-Guided Percutaneous Radiofrequency Ablation of 44 Renal Tumors in 31 Patients: Analysis of Predictors for Complications and Technical Success

    SciTech Connect

    Veltri, Andrea Calvo, Amedeo; Tosetti, Irene; Pagano, Eva; Genovesio, Andrea; Virzi, Valentina; Ferrando, Ugo; Fontana, Dario; Gandini, Giovanni

    2006-10-15

    Purpose. Preliminary clinical studies have shown the feasibility, safety, and efficacy of radiofrequency thermal ablation (RFA) of renal tumors, but only a few have analyzed the prognostic factors for technical success and there are no long-term results. Our objective was to statistically evaluate our mid-term results of percutaneous US-guided RFA in order to define predictors for complications and technical success. Methods. We selected for treatment 44 tumors in 31 patients (24 with renal cell carcinoma, 7 with hereditary tumors, 15 with a solitary kidney), up to 5 cm in diameter. Results. Eight adverse events occurred; 3 (6.8%) were major complications, successfully treated with interventional radiology procedures in 2 cases. Exophytic extension of the tumor was protective against complications (p 0.040). Technical success was obtained in 38 lesions after one RFA session and in 39 (89%) after one more session, when possible. At the end of treatment, central extension was the only negative predictor for technical success (p = 0.007), while neither size >3 cm (p = 0.091) nor other prognostic factors were statistically significant. Conclusion. US-guided percutaneous RFA can be proposed for non-central renal tumors up to 5 cm, also in patients without surgical contraindications, thanks to a low incidence of complications and a high success rate. Randomized controlled trials versus surgery are now needed to investigate long-term comparative results.

  18. Coronary Stents in Patients with ST-Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention

    PubMed Central

    Ahmed, Khurshid; Chakraborty, Rabin; Ahmed, Sumera; Hong, Young Joon; Sim, Doo Sun; Park, Keun Ho; Kim, Ju Han; Ahn, Youngkeun; Kang, Jung Chaee; Cho, Myeong Chan; Kim, Chong Jin; Kim, Young Jo

    2012-01-01

    Background and Objectives Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI). We sought to compare different coronary stents used during primary PCI in patients with ST-elevation myocardial infarction (STEMI) and CKD. Subjects and Methods We selected 2408 consecutive STEMI patients with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) undergoing primary PCI and divided them into 5 groups based on the type of stent implanted: 1) bare metal stent (BMS), 2) paclitaxel-eluting stent (PES), 3) sirolimus-eluting stent (SES), 4) zotarolimus-eluting stent (ZES), or 5) everolimus-eluting stent (EES). The study endpoint was the number of major adverse cardiac events (MACE) at 12 months. Results There was no significant difference in the incidence of 12-month myocardial infarction, target lesion revascularization, or target vessel revascularization between stent groups; however, the overall rate of repeat revascularization differed significantly between groups. All-cause death differed significantly among the groups. The incidence of 12-month MACE in BMS, PES, SES, ZES, and EES was 8.3%, 9.8%, 8.6%, 5.5%, and 2.6%, respectively (p<0.001). Kaplan-Meier analysis did not show a significant differences in 12-month MACE-free survival among the groups (log-rank p=0.076). This finding remained the same after adjusting for multiple confounders (p=0.147). Conclusion Any of the 5 stents can be used to treat STEMI patients with CKD undergoing primary PCI; all have similar risk of 12-month MACE. This result is hypothesis-generating and warrants further evaluation with a long-term randomized study. PMID:23323121

  19. Primary succession in Mount Pinatubo: Habitat availability and ordination analysis.

    PubMed

    Marler, Thomas E; Del Moral, Roger

    2013-11-01

    Vegetation structure on the east flank of Mount Pinatubo was investigated to determine the inventory of species at 15 y post-eruption, then to ascertain environmental variables that have influenced the early patterns of primary succession. Unconstrained and constrained ordination methods were used to determine the influence of spatial, elevation, and substrate patterns on vegetation. Vegetation was assigned to one of 3 habitat types. Scours were eroded flat surfaces, terraces were perched flat surfaces, and talus piles were created along the canyon edges as mass waste events. The influence of habitat type on vegetation was multifaceted because they represent different conditions and different histories. The talus piles have preferential access to colonists from the vegetation on the canyon walls above and a more benign microclimate than the exposed terrace and scour sites. Scoured sites on the valley floor exhibited the least vegetation cover, as these substrates had the least mature surfaces and the most restricted capacity for root exploration. Perched terraces exhibited greater plant dominance than did the other habitats in the early stages of succession because of the ubiquitous appearance of Parasponia rugosa as initial colonists on these relatively flat surfaces. Polynomial canonical correspondence analysis was more closely aligned with the pattern of vegetation than linear canonical correspondence analysis, and therefore more closely approximated accurate descriptions of correlations among site ordination positions and measured variables. These results confirm that a variety of statistical approaches can clarify applications for restoration ecology following landslide and volcanic disturbances or agriculture and forestry anthropogenic disturbances in the lowland tropics. PMID:24505499

  20. Common Iliac Artery Thrombosis following Pelvic Surgery Resulting in Kidney Allograft Failure Successfully Treated by Percutaneous Transluminal Angioplasty with Balloon-Expandable Covered Stent

    PubMed Central

    Golla, Maheswara S.; Acharjee, Subasit; Jaber, Bertrand L.; Garcia, Lawrence A.

    2015-01-01

    We report the case of a 66-year-old woman who developed acute kidney allograft failure due to thrombotic occlusion of the common iliac artery after hysterectomy requiring emergent allograft rescue. She underwent percutaneous transluminal angioplasty with endovascular balloon expandable covered stent graft placement in the right common iliac artery. Although there are a handful of case reports of acute limb ischemia secondary to acute common iliac artery thrombosis, this is the first case reported in the literature resulting in successful kidney allograft rescue following pelvic surgery. PMID:26355669

  1. Assessment of Inducible Myocardial Ischemia, Quality of Life, and Functional Status After Successful Percutaneous Revascularization in Patients With Chronic Total Coronary Occlusion.

    PubMed

    Rossello, Xavier; Pujadas, Sandra; Serra, Antoni; Bajo, Ester; Carreras, Francesc; Barros, Antonio; Cinca, Juan; Pons-Lladó, Guillermo; Vaquerizo, Beatriz

    2016-03-01

    The benefits of chronic total coronary occlusion (CTO) revascularization are not well established. In this prospective cohort study, 47 consecutive patients with successful percutaneous recanalization of CTO underwent adenosine stress cardiac magnetic resonance (CMR), 6-minute walk test (6MWT), and the Short Form-36 Health Survey before and 6 months after the procedure. Successful recanalization of a CTO was followed by significant improvement of (1) global physical and mental health status; (2) the distance walked in the 6MWT; (3) the incidence of chest pain at the end of the 6MWT; and (4) the score of a novel CMR ischemic burden index on the basis of the characteristics of adenosine stress perfusion defects (extension, persistence, transmurality, and induced contractile regional dysfunction). Patients with greater CMR ischemic index before percutaneous revascularization showed better improvement in the 6MWT. In conclusion, successful recanalization of a CTO leads to a concurrent improvement in ischemic burden, exercise tolerance, angina frequency, and quality of life scores. Patients with a high ischemic CMR score before CTO recanalization showed the better improvement in exercise tolerance. PMID:26747733

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

    SciTech Connect

    Veerapong, Jula; Wahlgren, Carl Magnus; Jolly, Neeraj; Bassiouny, Hisham

    2008-07-15

    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.

  3. Can we improve length of hospitalization in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention?

    PubMed Central

    Kotowycz, Mark A; Syal, Renu Pal; Afzal, Rizwan; Natarajan, Madhu K

    2009-01-01

    BACKGROUND: Patients with ST elevation myocardial infarction have traditionally been hospitalized for five to seven days to monitor for serious complications such as heart failure, arrhythmias, reinfarction and death. The Zwolle primary percutaneous coronary intervention (PCI) index is an externally validated risk score that has been used to identify low-risk primary PCI patients who can safely be discharged from the hospital within 48 h to 72 h. METHODS: The Zwolle score was retrospectively applied to all ST elevation myocardial infarction patients treated with primary PCI between April 2004 and February 2006 at a large Canadian teaching hospital. The goal was to characterize length of stay (LOS) in low-risk patients and to identify variables that correlate with patients who were hospitalized longer than expected. RESULTS: Data were collected on 255 patients. The mean LOS was 7.2±7.7 days (median 5.0 days [interquartile range 3.5 days]). A total of 179 patients (70%) had a Zwolle score of 3 or lower, identifying them as low risk. There was one death in the low-risk group (0.6% 30-day mortality) and 15 deaths in the higher-risk group (19.7% 30-day mortality), validating the Zwolle score in the population. A contraindication to early discharge was identified in 34 of the low-risk patients. Among the 144 remaining low-risk patients, the mean LOS was 5.1±3.3 days (median 4.0 days [interquartile range 3.0 days]). Only 8% were discharged within 48 h and only 28% within 72 h. It was determined that fewer patients were discharged on weekends and Wednesdays (when medical residents were away for teaching) than on other weekdays. LOS was longer among patients who were discharged on warfarin (7.6 days versus 4.6 days, P=0.006), and among patients who were transferred back to their presenting hospital rather than being discharged directly from the hospital where PCI was performed (5.6 days versus 4.0 days, P<0.001). CONCLUSIONS: Seventy-two per cent of low-risk primary PCI patients were hospitalized longer than 72 h. The following three factors were identified as correlating with prolonged LOS in this population: fewer discharges on days when there was less resident staffing; the use of warfarin at discharge; and transfer of patients back to their presenting hospital rather than discharging them directly from the PCI-performing hospital. A programmed approach to the identification and early discharge of low-risk patients could have significant cost savings and should be investigated prospectively. PMID:19812804

  4. Pharmacoinvasive and Primary Percutaneous Coronary Intervention Strategies in ST-Elevation Myocardial Infarction (from the Mayo Clinic STEMI Network).

    PubMed

    Siontis, Konstantinos C; Barsness, Gregory W; Lennon, Ryan J; Holmen, Jody L; Wright, R Scott; Bell, Malcolm R; Gersh, Bernard J

    2016-06-15

    The effectiveness of a pharmacoinvasive strategy consisting of fibrinolysis and transfer for percutaneous coronary intervention (PCI) compared to primary PCI (PPCI) in patients presenting to non-PCI-capable hospitals with ST-elevation myocardial infarction (STEMI) is not well defined. We analyzed data from the Mayo Clinic STEMI database of patients treated with a pharmacoinvasive strategy (favored in those presenting early after symptom onset) or PPCI in a regional STEMI network from 2004 to 2012. A total of 364 and 1,337 patients were included in the pharmacoinvasive and PPCI groups, respectively. Patients in the PPCI group were older and more frequently had cardiogenic shock at the time of presentation (12.1% vs 7.7%, p = 0.018). Death from any cause occurred in 58 (16%) and 314 (23%) patients in the pharmacoinvasive and PPCI groups, respectively (median follow-up 3.9 and 4.4 years, respectively). In multivariate analyses adjusting for age, gender, and other variables for which the 2 groups differed at baseline, there was no significant difference between the 2 strategies for 30-day (hazard ratio 0.66, 95% confidence interval 0.36 to 1.21) or overall mortality (hazard ratio 0.84, 95% confidence interval 0.63 to 1.12). Shorter door-to-balloon time was associated with increased effectiveness of PPCI (p for trend = 0.015), but there was no difference between the 2 strategies even when considering only the patients with door-to-balloon time in the lowest quartile. In conclusion, fibrinolysis followed by transfer for PCI represents a reasonable alternative when PPCI is not readily available especially in patients presenting early after symptom onset. PMID:27131614

  5. Neutrophil to Lymphocyte Ratio Predicts Left Ventricular Remodeling in Patients with ST Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention

    PubMed Central

    Börekçi, Abdurrezzak; Gür, Mustafa; Türkoğlu, Caner; Baykan, Ahmet Oytun; Şahin, Durmuş Yıldıray; Harbalıoğlu, Hazar; Elbasan, Zafer; Topuz, Mustafa; Çaylı, Murat

    2016-01-01

    Background and Objectives It has been demonstrated that the neutrophil/lymphocyte ratio (NLR) might be a useful marker to predict cardiovascular risk and events. We aimed to investigate the role of the NLR to predict ventricular remodeling (VR) in patients with anterior ST-elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention. Subjects and Methods We prospectively included 274 consecutive anterior STEMI patients. Echocardiography was performed during admission and at six months after myocardial infarction. VR was defined as at least 20% increase from baseline in left ventricular end-diastolic volume. Patients were divided into two groups according to their VR status: VR (n=67) and non-VR (n=207). Total and differential leukocyte count, N-terminal pro-brain natriuretic peptide (NT-proBNP) and other biochemical markers were measured at admission and 24 hours later. Results Compared with the non-VR group, peak creatine kinase MB (CK-MB), NT-proBNP (24 h), neutrophil/lymphocyte ratio, presence of diabetes, no-reflow frequency and wall motion score index were significantly higher in patients with VR (p<0.05 for all). On multivariate logistic regression analysis, NLR (β=2.000, 95% confidence interval=1.577-2.537, p<0.001) as well as peak CK-MB, NT-proBNP (24 h), WMSI and diabetes incidence were associated with VR. The cutoff value of the neutrophil/lymphocyte ratio obtained by receiver operator characteristic curve analysis was 4.25 for the prediction of VR (sensitivity: 79 %, specificity: 74%). Conclusion In patients with anterior STEMI, initial NLR and NT-proBNP measured 24 hours after admission may be useful for predicting adverse cardiovascular events including left VR. PMID:26798381

  6. Outcomes of Primary Percutaneous Coronary Intervention for Patients with Previous Coronary Artery Bypass Grafting Presenting with STsegment Elevation Myocardial Infarction

    PubMed Central

    Garg, Pankaj; Kamaruddin, Hazlyna; Iqbal, Javaid; Wheeldon, Nigel

    2015-01-01

    Background: There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting acutely as ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI). Objectives: To compare outcomes in STEMI patients undergoing PPCI with or without previous CABG surgery. Methods: An all-comer single-centre observational registry from a cardiothoracic centre in UK. All consecutive patients presenting for PPCI between 2007 and 2012 were included. Electronic records were used to extract relevant information. Mortality data were obtained from the Office of National Statistics. Overall median follow-up period was 1.7 years (intraquartile range 0.9-2.5). Results: Complete data were available for 2133 (97%) patients. 47-patients had previous history of CABG. Out of these, the infarct related artery (IRA) was native vessel in 22 and graft in 25 patients. Post re-vascularization TIMI flow was inferior in CABG cohort (

  7. The Role of Manual Aspiration Thrombectomy in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI.

    PubMed

    Alak, Aiman; Jolly, Sanjit S

    2016-03-01

    In STEMI, primary PCI restores macrovascular coronary blood flow effectively but microvascular perfusion remains a challenge. Thrombus has the potential to embolize to the microvasculature limiting effective coronary blood flow. Thrombus burden is associated with a higher mortality and manual aspiration thrombectomy has the potential to reduce thrombus burden. The first large trial of routine aspiration thrombectomy (TAPAS, N = 1071) showed an improvement in myocardial blush and an unexpected reduction in mortality. Reinforcing the enthusiasm for this finding meta-analysis of small trials also showed a reduction in mortality, which led to routine manual thrombectomy becoming a class IIa recommendation in the American and European Guidelines for STEMI. Subsequently; however, large trials such as TOTAL (N = 10,732) and TASTE (N = 7244) and meta-analysis showed an increase in the risk of stroke with routine manual thrombectomy but no improvement in mortality, myocardial infarction, stent thrombosis, or severe heart failure. As such, manual thrombectomy should not be routinely used instead saving it as a bailout procedure as indicated. PMID:26892810

  8. Assessment and Learning in the Primary School. Successful Teaching Series.

    ERIC Educational Resources Information Center

    Wragg, E. C.

    Noting that improving the quality of learning in primary schools and preparing children for a long, complex life in the twenty-first century requires the highest quality of teaching and professional training, this book is part of a series to improve teachers' skills in the classroom. The book is intended to offer primary school teachers a means of…

  9. 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

    2010-01-01

    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. PMID:20858263

  10. Percutaneous management of multiple liver abscesses

    SciTech Connect

    Greenwood, L.H.; Collins, T.L.; Yrizarry, J.M.

    1982-08-01

    Percutaneous catheter drainage is now an accepted technique in the management of hepatic and other intraabdominal abscesses. Most abscesses accepted by the radiologist for drainage are unilocular with a safe percutaneous approach. This report demonstrates that even multiple hepatic abscesses may be successfully managed by percutaneous drainage. The use of computed tomography (CT) for diagnosis and sonography for safe puncture guidance is discussed.

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

    ERIC Educational Resources Information Center

    Howkins, Elizabeth; Allison, Althea

    1997-01-01

    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)

  12. Social Obstacles Towards Success of Pupils in Polish Primary Schools.

    ERIC Educational Resources Information Center

    Nakielska, Zofia

    In 1973, the Polish Minister of Education ordered objective competitions at the primary school level in the fields of Polish studies, Russian language, and math. In order to determine whether such subject competitions were justified and if they contributed equally to the development of interests and abilities among the rural and urban and…

  13. Planning for Success: Introducing a Primary Language Program.

    ERIC Educational Resources Information Center

    Howden, Bruce

    1993-01-01

    Discusses Australian state and federal initiatives to place languages other than English within the primary schools' core curriculum. Presents a model structure for appropriate investigative action. Research findings reveal the need for a clearly articulated philosophy for a language program that would promote cultural awareness, global…

  14. Primary Students' Success on the Structured Number Line

    ERIC Educational Resources Information Center

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

    2010-01-01

    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…

  15. Design development of graphite primary structures enables SSTO success

    NASA Astrophysics Data System (ADS)

    Biagiotti, V. A.; Yahiro, J. S.; Suh, Daniel E.; Hodges, Eric R.; Prior, Donald J.

    1997-01-01

    This paper describes the development of a graphite composite wing and a graphite composite intertank primary structure for application toward Single-Stage to Orbit space vehicles such as those under development in NASA's X-33/Reusable Launch Vehicle (RLV) Program. The trade study and designs are based on a Rockwell vertical take-off and horizontal landing (VTHL) wing-body RLV vehicle. Northrop Grumman's approach using a building block development technique is described. Composite Graphite/Bismaleimide (Gr/BMI) material characterization test results are presented. Unique intertank and wing composite subcomponent test article designs are described and test results to date are presented. Wing and intertank Full Scale Section Test Article (FSTA) objectives and designs are outlined. Trade studies, supporting building block testing, and FSTA demonstrations combine to develop graphite primary structure composite technology that enables developing X-33/RLV design programs to meet critical SSTO structural weight and operations performance criteria.

  16. Successful use of the TandemHeart percutaneous ventricular assist device as a bridge to recovery for acute cellular rejection in a cardiac transplant patient.

    PubMed

    Velez-Martinez, M; Rao, K; Warner, J; Dimaio, J; Ewing, G; Mishkin, J D; Mammen, P P A; Drazner, M H; Markham, D W; Patel, P C

    2011-12-01

    In this report, we presented a patient who benefited from hemodynamic support with the TandemHeart percutaneous ventricular assist device (pVAD; Cardiac Assist, Inc) implantation in the setting of early acute graft rejection 2 months after orthotopic heart transplant. The TandemHeart initially had been used for temporary hemodynamic assistance during postcardiotomy heart failure and high-risk coronary interventions. More recently, its use in patients with cardiogenic shock from acute myocardial infarction, fulminant myocarditis, and critical aortic stenosis has been reported. To our knowledge, this is one of the first reported cases in which the TandemHeart pVAD served as a successful device for support during acute cardiac transplant rejection. PMID:22172864

  17. A patient with Marfan's syndrome presented with severe rheumatic mitral stenosis and successfully treated with percutaneous transmitral balloon commissurotomy - Report of first case.

    PubMed

    Nagesh, Chamrajnagar Mahadevappa; Patra, Soumya; Singh, Ajitpal; Badnur, Srinivas C; Reddy, Babu; Nanjappa, Manjunath C

    2013-12-01

    Marfan's syndrome (MFS) is an inherited autosomal dominant disorder of connective tissue with mutation on the fibrillin-1 gene encoding for fibrillin. This frequently involves the cardiovascular system with prevalence is 1:5000-10,000. The clinical major criteria involve the skeletal and ocular apparatus and the cardiovascular and central nervous system. In Marfan's syndrome mitral valve prolapse and aortic dilation are the main cardiovascular manifestations. According to the literature database the prevalence of aortic dilatation is 76%, 62% for mitral valve prolapse, 29% for mitral valve regurgitation and 26% for aortic regurgitation, in adult patients with Marfan's syndrome. We are reporting a case who presented with severe rheumatic mitral stenosis & later on examination found to be a case of Marfan's syndrome. This patient was successfully treated with percutaneous transmitral balloon commissurotomy. In medline search, so far there is no other case of Marfan's syndrome reported to have rheumatic mitral stenosis. PMID:24653594

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

    SciTech Connect

    Carrafiello, Gianpaolo Lagana, Domenico; Lumia, Domenico; Giorgianni, Andrea; Mangini, Monica; Santoro, Domenico; Cuffari, Salvatore; Marconi, Alberto; Novario, Raffaele; Fugazzola, Carlo

    2007-09-15

    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.

  19. Design development of graphite primary structures enables SSTO success

    SciTech Connect

    Biagiotti, V.A.; Yahiro, J.S.; Suh, D.E.; Hodges, E.R.; Prior, D.J.

    1997-01-01

    This paper describes the development of a graphite composite wing and a graphite composite intertank primary structure for application toward Single-Stage to Orbit space vehicles such as those under development in NASA{close_quote}s X-33/Reusable Launch Vehicle (RLV) Program. The trade study and designs are based on a Rockwell vertical take-off and horizontal landing (VTHL) wing-body RLV vehicle. Northrop Grumman{close_quote}s approach using a building block development technique is described. Composite Graphite/Bismaleimide (Gr/BMI) material characterization test results are presented. Unique intertank and wing composite subcomponent test article designs are described and test results to date are presented. Wing and intertank Full Scale Section Test Article (FSTA) objectives and designs are outlined. Trade studies, supporting building block testing, and FSTA demonstrations combine to develop graphite primary structure composite technology that enables developing X-33/RLV design programs to meet critical SSTO structural weight and operations performance criteria. {copyright} {ital 1997 American Institute of Physics.}

  20. 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

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

    2013-01-01

    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. PMID:24124401

  1. Embolization of Bleeding Stomal Varices by Direct Percutaneous Approach

    SciTech Connect

    Arulraj, Ramakrishnan; Mangat, Kamarjit S.; Tripathi, Dhiraj

    2011-02-15

    Stomal varices can occur in patients with stoma in the presence of portal hypertension. Suture ligation, sclerotherapy, angiographic embolization, stoma revision, beta blockade, portosystemic shunt, and liver transplantation have been described as therapeutic options for bleeding stomal varices. We report the case of a 21-year-old patient with primary sclerosing cholangitis and colectomy with ileostomy for ulcerative colitis, where stomal variceal bleeding was successfully treated by direct percutaneous embolization. We consider percutaneous embolization to be an effective way of treating acute stomal bleeding in decompensated patients while awaiting decisions regarding shunt procedures or liver transplantation.

  2. Is Extracorporeal Membrane Oxygenator a New Weapon to Improve Prognosis in Patients With Profound Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention?

    PubMed

    Sung, Pei-Hsun; Wu, Chiung-Jen; Yip, Hon-Kan

    2016-02-25

    Despite advancements in pharmacological therapy and refinement of the tools and technique of primary percutaneous coronary intervention (PCI) and coronary artery bypass surgery, patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock (CS) still have unacceptably high in-hospital mortality and unfavorable long-term outcome. Thus, there is an imminent need of a new and safe treatment modality in the management of AMI complicated by profound CS. Growing evidence suggests that extracorporeal membrane oxygenator (ECMO)-supported primary PCI is an effective therapeutic option for saving lives under such conditions. In this review, we describe and interpret the potential role of circulatory mechanical support by ECMO in the setting of AMI complicated by profound CS for improving clinical outcomes. (Circ J 2016; 80: 572-578). PMID:26853720

  3. Long-Term Outcomes of Patients with Acute Cholecystitis after Successful Percutaneous Cholecystostomy Treatment and the Risk Factors for Recurrence: A Decade Experience at a Single Center

    PubMed Central

    Wang, Chih-Hung; Wu, Cheng-Yi; Yang, Justin Cheng-Ta; Lien, Wan-Ching; Wang, Hsiu-Po; Liu, Kao-Lang; Wu, Yao-Ming; Chen, Shyr-Chyr

    2016-01-01

    Background Percutaneous cholecystostomy tube (PCT) has been effectively used for the treatment of acute cholecystitis (AC) for patients unsuitable for early cholecystectomy. This retrospective study investigated the recurrence rate after successful PCT treatment and factors associated with recurrence. Methods We reviewed patients treated with PCT for AC from October 2004 through December 2013. Patients with successful PCT treatment were those who were free from persistent PCT drainage. We used multivariable logistic regression analysis sequentially to identify factors associated with each outcome. Results The study included 184 patients (mean age: 70.1 years). The average duration for parenteral antibiotics was 14.4 days and 20.0 days for PCT drainage. The one-year recurrence rate was 9.2% (17/184) with most recurrences occurring within two months (6.5%, 12/184) of the procedure. Complicated cholecystitis (odds ratio [OR]: 4.67; 95% confidence interval [CI]: 1.44–15.70; P = 0.01) and PCT drainage duration >32 days (OR: 4.92; 95% CI: 1.03–23.53; P = 0.05) positively correlated with one-year recurrence; parenteral antibiotics duration >10 days (OR: 0.21; 95% CI: 0.05–0.68; P = 0.01) was inversely associated with one-year recurrence. Conclusions The recurrence rate was low for patients after successful PCT treatment. Predictors for recurrence included the severity of initial AC and subsequently provided treatments. PMID:26821150

  4. Predicting Factors for Successful Maturation of Autogenous Haemodialysis Fistulas After Salvage Percutaneous Transluminal Angioplasty in Diabetic Nephropathy: A Study on Follow-Up Doppler Ultrasonography

    PubMed Central

    Jeon, Eui-Yong; Cho, Young Kwon; Cho, Sung Bum; Yoon, Dae Young; Suh, Seong O

    2016-01-01

    Background: Maturation failure of autogenous arteriovenous fistula (aAVF) has been increasing after surgical procedures and the salvage percutaneous transluminal angioplasty (sPTA) for immature aAVF has been identified as an effective treatment modality. Objectives: The aim of this study was to identify factors predicting successful aAVF maturation and to determine positive technical aspects of sPTA. Patients and Methods: We retrospectively reviewed medical records and radiological images of 59 patients who had undergone sPTA for non-maturing aAVFs. We analysed images from pre-surgical mapping Doppler ultrasonography, angiography, and angioplasty and follow-up Doppler ultrasonography performed within two weeks after sPTA. We assessed the following factors, for their ability to predict successful aAVF maturation: 1) patient factors (age; sex; co-morbidities; and aAVF age, side and type); 2) vessel factors (cephalic vein diameter and depth, presence of accessory veins, and pre- and postoperative radial artery disease); 3) lesion factors (stenosis number, location and severity); and 4) technical factors (presence of residual stenosis and anatomic success ratio (ASR) on follow-up Doppler ultrasonography). Results: The technical and clinical success rates were both 94.9% (56/59); the mean ASR was 0.84. An ASR of ≥ 0.7 and no significant residual stenosis (< 30%) (both P < 0.001) on two-week follow-up Doppler ultrasonography predicted successful aAVF maturation. Conclusion: For more precise prediction of successful aAVF maturation after sPTA, short-term follow-up Doppler ultrasonography (< 2 weeks) was useful. If the ASR was < 0.7 or if residual stenosis was ≥ 30%, immediate repeat sPTA is recommended.

  5. Role of primary stability for successful osseointegration of dental implants: Factors of influence and evaluation

    PubMed Central

    Ahmed, Hameeda Bashir; Crespi, Roberto; Romanos, Georgios E.

    2013-01-01

    A secure implant primary (mechanical) stability is positively associated with a successful implant integration and long-term successful clinical outcome. Therefore, it is essential to assess the initial stability at different time-points to ensure a successful osseointegration. The present study critically reviews the factors that may play a role in achieving a successful initial stability in dental implants. Databases were searched from 1983 up to and including October 2013 using different combinations of various keywords. Bone quality and quantity, implant geometry, and surgical technique adopted may significantly influence primary stability and overall success rate of dental implants. PMID:24381734

  6. Comparison of the predictive value of four different risk scores for outcomes of patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention.

    PubMed

    Lev, Eli I; Kornowski, Ran; Vaknin-Assa, Hana; Porter, Avital; Teplitsky, Igal; Ben-Dor, Itsik; Brosh, David; Fuchs, Shmuel; Battler, Alexander; Assali, Abid

    2008-07-01

    Accurate risk stratification has an important role in the management of patients with acute coronary syndromes. Even in patients with ST-elevation acute myocardial infarction (STEMI), for whom early therapeutic options are well defined, risk stratification has an impact on early and late therapeutic decision making. We aimed to compare the prognostic value of 4 risk scores used to evaluate patients with STEMI. We conducted a prospective registry of all patients treated with primary percutaneous coronary intervention for STEMI from January 2001 to June 2006. Excluded were patients with cardiogenic shock. A total of 855 consecutive patients were included in the analysis (age 60.5 +/- 13 years, 19% women, 28% with diabetes, and 48% with anterior wall myocardial infarction). For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), Primary Angioplasty in Myocardial Infarction (PAMI), and Global Registry for Acute Coronary Events (GRACE) risk scores were calculated using specific clinical variables and angiographic characteristics. Thirty-day and 1-year clinical outcomes were assessed. The predictive accuracy of the 4 risk scores was evaluated using the area under the curve or C statistic method. The CADILLAC, TIMI, and PAMI risk scores all had relatively high predictive accuracy for 30-day and 1-year mortality (C statistic range 0.72 to 0.82), with slight superiority of the CADILLAC score. These 3 risk scores also performed well for prediction of reinfarction at 30 days (C statistic range 0.6 to 0.7). The GRACE score did not perform as well and had low predictive accuracy for mortality (C statistic 0.47). In conclusion, risk stratification of patients with STEMI undergoing primary percutaneous coronary intervention using the CADILLAC, TIMI, or PAMI risk scores provide important prognostic information and enables accurate identification of high-risk patients. PMID:18572028

  7. Comparison of coronary stenting versus conventional balloon angioplasty on five-year mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

    PubMed

    Mehta, Rajendra H; Harjai, Kishore J; Cox, David A; Stone, Gregg W; Brodie, Bruce R; Boura, Judy; Grines, Lorelei; O'Neill, William; Grines, Cindy L

    2005-10-01

    Little is known about the influence of stenting versus balloon angioplasty on long-term outcomes (particularly mortality) after primary percutaneous coronary intervention (PCI). We evaluated 2,087 patients with ST-elevation myocardial infarction enrolled in various Primary Angioplasty in Myocardial Infarction (PAMI) trials in the United States, who underwent primary PCI. The main outcome was all-cause mortality at 5 years, obtained through the National Death Index. Of the 2,087 patients, stenting was performed in 692 (33%). The absolute difference in the hospital (2.2% vs 3.3%), 1-year (3.3% vs 5.2%), and 5-year (10% vs 13%) mortality rates favored patients receiving a stent versus conventional balloon therapy, with the difference increasing with time. A multivariate Cox model identified stent use (vs balloon alone) as an independent correlate of lower 5-year mortality (hazard ratio 0.60, 95% confidence interval 0.42 to 0.85). The absolute reduction in mortality was greatest in the highest risk group. In conclusion, compared with balloon angioplasty, stenting during primary PCI not only resulted in better angiographic and short-term outcomes, but also in a sustained beneficial effect on mortality at 5 years. These data support the routine use of coronary stenting in most patients undergoing primary PCI, when feasible. PMID:16188513

  8. Comparison of Outcomes of Patients With ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention Analyzed by Age Groups (<75, 75 to 85, and >85 Years); (Results from the Bremen STEMI Registry).

    PubMed

    Fach, Andreas; Bünger, Stefanie; Zabrocki, Robert; Schmucker, Johannes; Conradi, Paulina; Garstka, Daniela; Fiehn, Eduard; Hambrecht, Rainer; Wienbergen, Harm

    2015-12-15

    As old patients, who were treated by percutaneous coronary interventions (PCI) for ST-segment elevation myocardial infarction (STEMI), are regularly excluded or underrepresented in randomized trials, data on treatment and outcomes of this patient group at high risk have to be collected by registries. The study population of the German Bremen STEMI Registry was divided into the age groups G1: <75 years (n = 4,108, young), G2: 75 to 85 years (n = 1,032, old), and G3: >85 years (n = 216, very old) and was evaluated for clinical management and course. PCI failure (Thrombolysis In Myocardial Infarction flow 0 or 1 after PCI) was observed more often with increasing age. Patients >85 years without successful PCI had a very high inhospital mortality (40.0% without PCI success vs 18.1% with PCI success, p <0.05). Despite a reduced rate of periinterventional treatment with glycoprotein IIb/IIIa inhibitors in elderly patients of G2 and G3, inhospital bleedings (Thrombolysis In Myocardial Infarction/Bleeding Academic Research Consortium ≥2) occurred more frequently in these patients (G1: 5.4% vs G2: 11.0% vs G3: 19.6%, p <0.0001). Mortality rates during inhospital and long-term course increased with increasing age. In a multivariate analysis successful PCI was associated with improved outcomes in all age groups; even in very old patients successful PCI was associated with a significantly lower inhospital mortality rate (odds ratio 0.26, 95% confidence interval 0.08 to 0.81) and a trend toward a lower 1-year mortality. In conclusion, the present "real-world" data demonstrate an elevated rate of PCI failure, bleeding complications, and mortality in elderly patients treated by primary PCI for STEMI. However, a beneficial effect of successful PCI on mortality was observed in all age groups, even in very old patients, indicating the crucial role of revascularization therapy. PMID:26602071

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

    PubMed Central

    2014-01-01

    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. PMID:24804102

  10. Primary succession of Bistorta vivipara (L.) Delabre (Polygonaceae) root-associated fungi mirrors plant succession in two glacial chronosequences.

    PubMed

    Davey, Marie; Blaalid, Rakel; Vik, Unni; Carlsen, Tor; Kauserud, Håvard; Eidesen, Pernille B

    2015-08-01

    Glacier chronosequences are important sites for primary succession studies and have yielded well-defined primary succession models for plants that identify environmental resistance as an important determinant of the successional trajectory. Whether plant-associated fungal communities follow those same successional trajectories and also respond to environmental resistance is an open question. In this study, 454 amplicon pyrosequencing was used to compare the root-associated fungal communities of the ectomycorrhizal (ECM) herb Bistorta vivipara along two primary succession gradients with different environmental resistance (alpine versus arctic) and different successional trajectories in the vascular plant communities (directional replacement versus directional non-replacement). At both sites, the root-associated fungal communities were dominated by ECM basidiomycetes and community composition shifted with increasing time since deglaciation. However, the fungal community's successional trajectory mirrored the pattern observed in the surrounding plant community at both sites: the alpine site displayed a directional-replacement successional trajectory, and the arctic site displayed a directional-non-replacement successional trajectory. This suggests that, like in plant communities, environmental resistance is key in determining succession patterns in root-associated fungi. The need for further replicated study, including in other host species, is emphasized. PMID:25580779

  11. Percutaneous connections in man.

    PubMed

    Klomp, G F; Womack, M; Dobelle, W H

    1979-01-01

    Neuroprostheses research provides on application of percutaneous access. We have investigated a number of clinical situations requiring chronic percutaneous transmission of either fluid or electricity in man to explore other uses. Selection criteria for new models include the following considerations: 1) it should allow use of a skull mounted pedestal; 2) it should offer the potential of benefit to the patient with minimal extra risks; 3) it should be a common enough problem to provide sufficient clinical material; and 4) it should not require major new developments of technology. Other potential uses include the artifical pancreas, artificial heart, and hyperalimentation. With some modification, it might be possible to provide access to devices located in the chest via the jugular vein. Similarly, other uses for this percutaneous device warrant investigation. Our twenty man-years of experience with the device indicates that it provides successful chronic access when used with appropriate skill. PMID:583312

  12. The evolving role of cardiac imaging in percutaneous valvular intervention.

    PubMed

    Leong, Darryl P; Joseph, Majo X; Sinhal, Ajay; Selvanayagam, Joseph B

    2013-09-01

    Surgical therapies have represented the primary evidence-based intervention to alter the natural history of valvular heart disease (VHD), however, the increasing incidence of patients at high surgical risk due to age and related co-morbid conditions has given rise to the need for alternative strategies. Thus, percutaneous approaches to VHD therapy have emerged as an important therapeutic option. Cardiovascular imaging plays a critical role in patient screening for percutaneous valvular interventions, during the procedure itself, and as part of follow-up for the identification of implant success/failure and complications. The technical demands on imaging in this context are highly specific. Although imaging has a significant role in the broader evaluation of valvular heart disease mechanism and severity, the purpose of this paper is to summarise the particular goals of cardiovascular imaging in the work-up for, during, and in the follow-up of percutaneous valvular intervention. PMID:23721698

  13. Incidence of post myocardial infarction left ventricular thrombus formation in the era of primary percutaneous intervention and glycoprotein IIb/IIIa inhibitors. A prospective observational study

    PubMed Central

    Rehan, Arshad; Kanwar, Manpreet; Rosman, Howard; Ahmed, Sujood; Ali, Arshad; Gardin, Julius; Cohen, Gerald

    2006-01-01

    Background Before the widespread use of primary percutaneous coronary intervention (PCI) and glycoprotein IIb/IIIa inhibitors (GP IIb/IIIa) left ventricular (LV) thrombus formation had been reported to complicate up to 20% of acute myocardial infarctions (AMI). The incidence of LV thrombus formation with these treatment modalities is not well known. Methods 92 consecutive patients with ST-elevation AMI treated with PCI and GP IIb/IIIa inhibitors underwent 2-D echocardiograms, with and without echo contrast agent, within 24–72 hours. Results Only 4/92 (4.3%) had an LV thrombus, representing a significantly lower incidence than that reported in the pre-PCI era. Use of contrast agents did not improve detection of LV thrombi in our study. Conclusion The incidence of LV thrombus formation after acute MI, in the current era of rapid reperfusion, is lower than what has been historically reported. PMID:16600036

  14. Impact of the prehospital activation strategy in patients with ST-elevation myocardial infarction undergoing primary percutaneous revascularization: a single center community hospital experience.

    PubMed

    Horvath, Sofia A; Xu, Ke; Nwanyanwu, Francis; Chan, Richard; Correa, Luis; Nass, Nouri; Jaraki, Abdul-Rahman; Jurkovich, David; Kennedy, Richard; Andrzejewski, Lee; Vignola, Paul A; Cubeddu, Roberto J

    2012-12-01

    The strategy of prehospital activation by the emergency medical system (EMS) in patients with ST-elevation myocardial infarction (STEMI) has been poorly adopted among the US hospitals that currently offer 24/7 primary percutaneous coronary intervention. In this study, we report a single center experience after the implementation of this strategy. From 2008 to 2011, we identified a total 188 STEMI patients (age 65 15 years) presenting via EMS for primary percutaneous coronary intervention. Of these, 112 (59.6%) underwent prehospital activation (EMS group), whereas the remaining 76 (40.4%) underwent emergency department activation [emergency department (ED) group]. Baseline demographic characteristics were similar between both groups. The overall median door-to-balloon (DTB) time was 49 14 minutes. Patients undergoing prehospital activation had on average significantly lower overall DTB times (EMS 44 11 minutes vs. ED 57 15 minutes; P < 0.001). Concordantly, DTB times <60 minutes were much more commonly achieved with this strategy (EMS 95.5% vs. ED 64.5%; P < 0.001). Fallouts beyond the recommended 90-minute DTB time were seen among ED patients only. No difference in in-hospital death (EMS 5.4% vs. ED 6.6%; P = 0.75) or cumulative 30-day mortality (EMS 6.3% vs. ED 7.9%; P = 0.68) was observed between both groups. However, on average, EMS patients had higher postinfarct left ventricular ejection fraction (EMS 48 9.5% vs. ED 39 14.6%; P = 0.004). Differences in DTB time and left ventricular ejection fraction remained significant after adjusting for differences in baseline characteristics. In conclusion, the prehospital activation strategy is largely effective and should be systematically adopted in the treatment scheme of STEMI patients to lower mechanical reperfusion times and reduce the potential for untoward clinical outcomes. PMID:23149360

  15. The Influence of Primary Caregivers in Fostering Success in Twice-Exceptional Children

    ERIC Educational Resources Information Center

    Neumeister, Kristie Speirs; Yssel, Nina; Burney, Virginia H.

    2013-01-01

    Using grounded theory, this study investigated primary caregivers' perceptions of the role they play in influencing the academic success of students formally identified as twice-exceptional. Data from interviews were coded and analyzed for themes. Results indicated that primary caregivers (mothers) perceived that they played a major role in…

  16. Relationships among Preservice Primary Mathematics Teachers' Gender, Academic Success and Spatial Ability

    ERIC Educational Resources Information Center

    Turgut, Melih; Yilmaz, Suha

    2012-01-01

    The aim of this work is to investigate relationships among pre-service primary mathematics teachers' gender, academic success and spatial ability. The study was conducted in Izmir with 193 pre-service primary mathematics teachers of Dokuz Eylul University. In the work, spatial ability test, which consists of two main sub-tests measuring spatial…

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

    ERIC Educational Resources Information Center

    Cetin, Hatice; Ertekin, Erhan

    2011-01-01

    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…

  18. The Influence of Primary Caregivers in Fostering Success in Twice-Exceptional Children

    ERIC Educational Resources Information Center

    Neumeister, Kristie Speirs; Yssel, Nina; Burney, Virginia H.

    2013-01-01

    Using grounded theory, this study investigated primary caregivers' perceptions of the role they play in influencing the academic success of students formally identified as twice-exceptional. Data from interviews were coded and analyzed for themes. Results indicated that primary caregivers (mothers) perceived that they played a major role in

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

    ERIC Educational Resources Information Center

    Dyson, Lily

    2012-01-01

    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…

  20. Constructing a Successful Cross-National Virtual Learning Environment in Primary and Secondary Education

    ERIC Educational Resources Information Center

    Ligorio, Maria Beatrice; van Veen, Klaas

    2006-01-01

    Virtual environments are more and more used in primary schools. One of the most interesting potentialities of these environments is to foster cross-national applications. Yet, this specific feature is not fully exploited. This paper presents a successful virtual learning environment for primary education involving two European countries and…

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

    ERIC Educational Resources Information Center

    Dyson, Lily

    2012-01-01

    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

  2. Association Between Visit-to-Visit Variability in Blood Pressure and Cardiovascular Events in Hypertensive Patients After Successful Percutaneous Coronary Intervention

    PubMed Central

    Gondo, Kouki; Miura, Shin-ichiro; Suematsu, Yasunori; Shiga, Yuhei; Kuwano, Takashi; Sugihara, Makoto; Ike, Amane; Iwata, Atsushi; Motozato, Kota; Kusumoto, Takaaki; Nishikawa, Hiroaki; Saku, Keijiro

    2015-01-01

    Background Visit-to-visit variability (VVV) in blood pressure (BP) in addition to high BP has been shown to be a strong predictor of coronary events and stroke. Therefore, we investigated the associations between VVV in BP or BP levels and cardiovascular events after successful percutaneous coronary intervention (PCI). Methods We enrolled 176 hypertensive patients who had undergone successful PCI and who had four clinic visits to measure BP until follow-up coronary angiography (CAG) at 6 - 9 months after PCI. The patients were divided into those with acute coronary syndrome (ACS group; n = 50) and those with stable angina pectoris (SAP group; n = 126). We determined VVV in BP expressed as the standard deviation (SD) of average BP, average, and the maximum and minimum BP during the follow-up period. Major adverse cardiovascular events (MACEs) (myocardial infarction (MI), target lesion revascularization (TLR) and all-cause death) were also analyzed. Results There were no significant differences in VVV in BP, average BP or maximum or minimum BP between the patients with and without MACE in all patients, the ACS and SAP groups. Interestingly, in the ACS group, VVV in SBP and maximum SBP in patients with MI were significantly higher than those in patients without MI. The cut-off levels for VVV in BP and maximum SBP that gave the greatest sensitivity and specificity for MI in the ACS group were 15.1 and 138 mm Hg, respectively. Conclusion Higher VVV in SBP and maximum SBP in patients with ACS after successful PCI were associated with the onset of MI. PMID:26015820

  3. Anaphylaxis-induced acute ST-segment elevation myocardial ischemia treated with primary percutaneous coronary intervention: report of two cases.

    PubMed

    Del Furia, Francesca; Matucci, Andrea; Santoro, Giovanni M

    2008-03-01

    Acute coronary syndromes have been described as potential complications of any type of anaphylactic reaction. The real pathogenic mechanism inducing acute myocardial ischemia in the setting of anaphylaxis is not yet completely understood. Some pathogenic mechanisms, like coronary vasospasm, plaque activation and systemic hypotension, have been suggested. The hypothesis of a central role of mast cell and inflammatory cell activation and release of potent vasoactive mediators, inducing the mechanisms mentioned above, is the mainstay of so-called "cardiac anaphylaxis". We report two cases of anaphylaxis-induced acute ST-segment elevation myocardial ischemia which occurred during coronary angiography. The first one was probably related to contrast media contact, the second one to latex glove contact. Both of them were treated with percutaneous coronary intervention that immediately resolved the myocardial ischemia. PMID:18316836

  4. Clinical outcome of percutaneous thrombectomy of dialysis access thrombosis by an interventional nephrologist

    PubMed Central

    Lee, Hyung-Seok; Park, Pyoung-Ju

    2014-01-01

    Background Traditionally, the treatment of a thrombosed dialysis access in hemodialysis patients in Korea has been primarily performed by vascular surgeons and interventional radiologists. The objective of this study was to evaluate the outcome of percutaneous thrombectomy procedures performed by an interventional nephrologist. Methods From October 2010 to May 2014, 75 consecutive percutaneous thrombectomies were performed on 42 patients treated with maintenance hemodialysis. All percutaneous thrombectomy procedures were performed by an interventional nephrologist in a single hospital in Jeju, Korea. The thrombosed arteriovenous graft and arteriovenous fistula were declotted by thromboaspiration mechanical thrombectomy or pharmacomechanical thrombolysis. KaplanMeier survival analysis was performed to analyze the primary and secondary patency after the initial successful thrombectomy. Success and complication rates were identified and compared with the recommendations of the Kidney Disease Dialysis Outcomes Quality Initiative (KDOQI) guideline. Results The overall clinical success rate was 89.3% (67/75). In the successful cases, the postintervention primary (unassisted) patency rates at 30 days, 90 days, and 180 days were 79.9%, 56.6%, and 25.6%, respectively. The secondary patency rates at 30 days, 90 days, and 180 days were 92.2%, 85.7%, and 83.7%, respectively. There were no major complications, and all complications were treated successfully during the procedure. Conclusion The clinical success rate and primary patency rate at 3 months exceeded the recommendations of the KDOQI guideline, and were comparable to that of other reports. Percutaneous thrombectomy by an interventional nephrologist was safe and effective. PMID:26885478

  5. Clinical effect of postconditioning in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention: a meta-analysis of randomized controlled trials*

    PubMed Central

    Hu, Xian-qing; Cheng, Jian; Tang, Biao; Zhang, Zhong-heng; Huang, Ke; Yang, Yi-ping; Mao, Yan-yan; Zhong, Ming; Fu, Shen-wen

    2015-01-01

    Objective: To evaluate the clinical effect of postconditioning on patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods: Randomized controlled trials were identified by searching relevant databases published up to April 2nd, 2014. A meta-analysis of eligible studies was performed by Stata 12.0 and Review Manager 5.2 with a fixed-effect model. Results: Ten studies providing adverse cardiac events in a total of 1346 STEMI patients treated with primary PCI were identified. The occurrence of heart failure was significantly reduced in patients treated with postconditioning compared with usual care (risk ratio (RR) 0.533; 95% confidence intervals (CI) 0.368–0.770), whereas non-fatal reinfarction slightly increased in the postconditioning group (RR 2.746; 95% CI 1.007–7.488). No significant difference in total major adverse cardiac events (MACEs) was observed between the two groups (RR 0.876; 95% CI 0.671–1.144). Conclusions: Postconditioning in STEMI patients undergoing primary PCI significantly reduces the risk of heart failure, but fails to decrease the incidence of total MACEs and the risk of non-fatal reinfarction. PMID:25743121

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

    PubMed

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

    2013-07-01

    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

  7. Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage

    PubMed Central

    Teoh, Anthony Yuen Bun; Dhir, Vinay; Jin, Zhen-Dong; Kida, Mitsuhiro; Seo, Dong Wan; Ho, Khek Yu

    2016-01-01

    AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage. METHODS: Comparative studies published between January 1980 and May 2014 were identified on PubMed, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities. RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound (EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies compared EUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits. CONCLUSION: In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities. PMID:27014427

  8. Differences of regional coronary flow reserve assessed by adenosine thallium-201 scintigraphy early and six months after successful percutaneous transluminal coronary angioplasty or stent implantation.

    PubMed

    Versaci, F; Tomai, F; Nudi, F; Gaspardone, A; De Fazio, A; Ciavolella, M; Crea, F; Mango, L; Chiariello, L; Gioffrè, P A

    1996-11-15

    This study assesses regional coronary flow reserve using adenosine thallium-201 scintigraphy early and 6 months after angiographically successful percutaneous transluminal coronary angioplasty (PTCA) or stent implantation. Seventeen consecutive men with a significant isolated left anterior descending coronary artery stenosis were scheduled for repeat coronary angiography and adenosine-planar thallium-201 scintigraphy within 24 hours and 6 months after successful PTCA (n = 8) or stent implantation (n = 9). After background subtraction, left ventricular segmental uptake was semiquantitatively assessed on thallium images. The perfusion defect severity was scored from 0 (normal) to 3. Coronary angiograms were analyzed using an automated edge contour detection computer analysis system. Data are expressed as mean value +/- 1 SD, and proportions as percentage. The residual narrowing was 17 +/- 8% after PTCA and 9 +/- 2% after stent implantation (p = 0.02). Twenty-four hours after the procedure, hypoperfused segments were detected in all patients (100%) and in 4 patients (44%) (p = 0.05), respectively. The total number of hypoperfused segments was greater after PTCA than after stent implantation (16 [40%] vs 7 [16%], p = 0.001, respectively) as was the perfusion defect severity (4.4 +/- 3.1 vs 1 +/- 1.2, p = 0.006). Six months after the procedure, 3 of the 5 patients who had undergone PTCA without restenosis still had reversible perfusion defects. None of the stent-treated patients had restenosis or reversible perfusion defects (p = 0.05). Among PTCA-treated patients without restenosis, the total number of hypoperfused segments and the perfusion defect severity were 9 of 25 (36%) and 0.8 +/- 0.8, respectively. Thus, a regional reduction in coronary flow reserve, occasionally observed early after successful stent implantation, is probably due to a transient alteration of small coronary vessels, as was also supported by the absence of perfusion defects 6 months after the procedure. The more severe impairment of regional coronary flow reserve observed early after successful PTCA is probably also due to angiographic underestimation of the residual stenosis, as suggested also by the persistence of reversible perfusion defects 6 months after the procedure in a few patients. PMID:8914870

  9. Percutaneous Aspiration Thrombectomy for the Treatment of Arterial Thromboembolic Occlusions Following Percutaneous Transluminal Angioplasty

    SciTech Connect

    Schleder, Stephan; Diekmann, Matthias; Manke, Christoph; Heiss, Peter

    2015-02-15

    PurposeThis study was designed to evaluate the technical success and the early clinical outcome of patients undergoing percutaneous aspiration thrombectomy (PAT) for the treatment of arterial thromboembolism following percutaneous infrainguinal transluminal angioplasty (PTA).MethodsIn this single-center study, during a period of 7 years retrospectively, 47 patients (22 male, 47 %) with a mean age of 73 (range 53–96) years were identified in whom PAT was performed for the treatment of thromboembolic complications of infrainguinal PTA. Primary technical success was defined as residual stenosis of <50 % in diameter after sole PAT, whereas secondary technical success was defined as residual stenosis of <50 % in diameter after PAT and additional PTA and/or stenting. Clinical outcome parameters (e.g., need for further intervention, minor/major amputation) were evaluated for the 30-day postinterventional period.ResultsPrimary technical success was achieved in 64 % of patients (30/47); secondary technical success was obtained in 96 % of patients (45/47). Clinical outcome data were available in 38 patients. In 87 % of patients (33/38), there was no need for further intervention within the 30-day postinterventional period. In three patients, minor amputations were conducted due to preexisting ulcerations (Rutherford Category 5 respectively).ConclusionsPAT enables endovascular treatment of iatrogenic thromboembolic complications after PTA with good technical and early clinical results and minimal morbidity.

  10. Coronary artery calcification as a new predictor of non-target lesion revascularization during the chronic phase after successful percutaneous coronary intervention.

    PubMed

    Honda, Yohsuke; Toyama, Takuji; Miyaishi, Yusuke; Kan, Hakuken; Kawaguchi, Ren; Adachi, Hitoshi; Hoshizaki, Hiroshi; Oshima, Shigeru

    2014-10-01

    In the drug-eluting stent era, the outcome of patients undergoing percutaneous coronary intervention (PCI) has remarkably improved. Nevertheless, non-target lesion revascularization (non-TLR) is often performed even after successful PCI and optimized medical therapy. This study aimed to determine the predictor of non-TLR. In all, 125 consecutive patients with stable angina pectoris underwent intravascular ultrasound (IVUS)-guided PCI and were followed up for 3.3 ± 0.5 years. We performed oral glucose-tolerance tests in patients with no history of known diabetes mellitus (DM) to investigate glucose tolerance. To evaluate the severity of coronary artery calcification (CAC), we calculated CAC score by multiplying the arc (degree) with the length (mm) of the superficial calcium deposit detected by IVUS. Fourteen patients underwent non-TLR (non-TLR group); the remaining 111 did not (reference group). Glycosylated hemoglobin (HbA1c; %) and prevalence of known DM were similar in both groups, but the non-TLR group had higher fasting blood glucose (103 ± 16 vs. 94 ± 11 mg/dl, p = 0.04) and blood glucose (196 ± 60 vs. 149 ± 48 μU/ml, p = 0.01) and insulin at 2 h (184 ± 241 vs. 67 ± 49 μU/ml, p < 0.01) than did the reference group. CAC score was significantly higher in the non-TLR group (788 ± 585 vs. 403 ± 466, p = 0.01). Multiple logistic analysis indicated that CAC score is an independent predictor of non-TLR (p = 0.008). Non-TLR-free rate was significantly higher for patients with CAC score ≥400 than for those with CAC score <400 (p = 0.01). Non-TLR is associated with abnormal glucose tolerance and CAC score; CAC score is an independent predictor of non-TLR. Secondary prevention is especially important in patients with high CAC scores. PMID:24906449

  11. Successful treatment of a cat with primary hypoadrenocorticism and severe hyponatremia with desoxycorticosterone pivalate (DOCP)

    PubMed Central

    Woolcock, Andrew D.; Ward, Cynthia

    2015-01-01

    A 6-year-old, castrated male Siamese cat was diagnosed with primary hypoadrenocorticism, confirmed by an adrenocorticotopic hormone (ACTH) stimulation test documenting both hypocortisolism and hypoaldosteronism. The cat was successfully treated using a combination of prednisolone and desoxycorticosterone pivalate (DOCP). This case demonstrates that DOCP can be used successfully as mineralocorticoid supplementation in cats with hypoadrenocorticism and may have a longer therapeutic duration than that in dogs. PMID:26538671

  12. A simple technique for successful primary closure after excision of pilonidal sinus disease.

    PubMed

    Williams, R S

    1990-09-01

    Primary closure after excision of postanal pilonidal sinus disease frequently has been complicated by wound break-downs. Healing by second intention takes many weeks and requires supervised wound care. A simple technique has been developed which has resulted in primary healing in 28 of 31 patients treated in a 5-year period. Sepsis and haematoma formation, the causes of wound breakdown after pilonidal sinus excision, have been prevented by preoperative preparation, prophylactic antibiotic administration, wound irrigation with povidone-iodine and simple skin closure over a Redivac suction drain for at least 4 days. This series suggests that primary closure can be successful using the technique described. PMID:2221767

  13. A simple technique for successful primary closure after excision of pilonidal sinus disease.

    PubMed Central

    Williams, R. S.

    1990-01-01

    Primary closure after excision of postanal pilonidal sinus disease frequently has been complicated by wound break-downs. Healing by second intention takes many weeks and requires supervised wound care. A simple technique has been developed which has resulted in primary healing in 28 of 31 patients treated in a 5-year period. Sepsis and haematoma formation, the causes of wound breakdown after pilonidal sinus excision, have been prevented by preoperative preparation, prophylactic antibiotic administration, wound irrigation with povidone-iodine and simple skin closure over a Redivac suction drain for at least 4 days. This series suggests that primary closure can be successful using the technique described. PMID:2221767

  14. Comparison of six-month outcomes for primary percutaneous revascularization for acute myocardial infarction with drug-eluting versus bare metal stents (from the APEX-AMI study).

    PubMed

    Patel, Manesh R; Pfisterer, Matthias E; Betriu, Amadeo; Widmisky, Petr; Holmes, David R; O'Neill, William W; Stebbins, Amanda; Van de Werf, Frans; Armstrong, Paul W; Granger, Christopher B

    2009-01-15

    We evaluated the use and outcomes of drug-eluting stents (DESs) and bare metal stents (BMSs) in a large primary percutaneous coronary intervention (PCI) acute ST-elevation myocardial infarction (MI) trial. Recently concerns have been raised with "off-label" use of DESs for short- and long-term clinical outcomes. Limited randomized data exist evaluating DESs versus BMSs in ST-elevation MI. Patients (n=5,745) in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial were categorized by stent type used. Baseline variables and clinical outcomes were collected at 90 days and 6 months. Outcomes by stent type were adjusted for using conventional multivariable predictors of 90-day mortality (age, anterior location, total ST-segment deviation, and Killip class), time to PCI, and Thrombolysis In Myocardial Infarction grade flow. Stents were deployed (at the investigator's discretion) in 5,124 patients (89.2%) with acute MI, with DES use in 2,221 (43.3%) and BMS use in 2,903 (56.7%). Patients receiving DESs were younger (median 59 vs 63 years of age, p<0.001), had left anterior descending coronary artery PCI (57.9% vs 48.1%, p<0.001), and often were treated in the United States (58.2%). DES-treated patients had a lower adjusted mortality at 90 days (hazard ratio 0.73, 95% confidence interval [CI] 0.54 to 0.99, p=0.046) and trended toward lower mortality (hazard ratio 0.77, 95% CI 0.58 to 1.03, p=0.084) and recurrent MI (hazard ratio 0.81, 95% CI 0.59 to 1.11, p=0.186) at 6 months compared with BMSs. In conclusion, in this observational analysis of stent use from a large primary percutaneous intervention for acute MI trial, DESs appear as safe as BMSs with similar 6-month clinical outcomes with regard to death and recurrent MI. PMID:19121433

  15. Factors Associated With Infarct-Related Artery Patency Before Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction (from the FAST-MI 2010 Registry).

    PubMed

    Bailleul, Clotilde; Puymirat, Etienne; Aissaoui, Nadia; Schiele, François; Ducrocq, Gregory; Coste, Pierre; Blanchard, Didier; Brasselet, Camille; Elbaz, Meyer; Steg, Philippe Gabriel; Le Breton, Hervé; Bonnefoy-Cudraz, Eric; Montalescot, Gilles; Cottin, Yves; Goldstein, Patrick; Ferrières, Jean; Simon, Tabassome; Danchin, Nicolas

    2016-01-01

    Early infarct-related artery (IRA) patency is associated with better clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). Using the French Registry of ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010 registry, we investigated factors related to IRA patency (thrombolysis in myocardial infarction [TIMI] 2/3 flow) at the start of procedure in patients admitted for primary percutaneous coronary intervention. FAST-MI 2010 is a nationwide French registry including 4,169 patients with acute MI. Of 1,452 patients with STEMI with primary percutaneous coronary intervention, 466 (32%) had TIMI 2/3 flow of IRA before the procedure. Mean age (62 ± 14 years in both groups), Global Registry of Acute Coronary Event score (141 ± 31 vs 142 ± 34), and time from onset to angiography (472 ± 499 vs 451 ± 479 minutes) did not differ according to IRA patency (TIMI 2/3 vs TIMI 0/1). Using multivariate logistic regression analysis, IRA patency was more frequently found in patients having called earlier (time from onset to electrocardiogram [ECG] <120 minutes; odds ratio [OR] 1.49; 95% confidence interval [CI] 1.17 to 1.89), or receiving rapid-onset of action (prasugrel or glycoprotein IIb-IIIa) antiplatelet therapy in the prehospital setting (OR 1.59, 95% CI 1.14 to 2.21). Increasing time from diagnostic ECG to angiography was also associated with IRA patency (>90 minutes; OR 1.37, 95% CI 1.08 to 1.75). In conclusion, preprocedural IRA patency is observed in one third of patients with STEMI, it is more frequently found in patients having received fast-acting antiplatelet therapy before angiography, and in patients having called early. Higher IRA patency with increasing time delays from qualifying ECG to angiography suggests an additional role of spontaneous or medication-mediated fibrinolysis. PMID:26541905

  16. Randomized Trial of Complete Versus Lesion-Only Revascularization in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI and Multivessel Disease

    PubMed Central

    Gershlick, Anthony H.; Khan, Jamal Nasir; Kelly, Damian J.; Greenwood, John P.; Sasikaran, Thiagarajah; Curzen, Nick; Blackman, Daniel J.; Dalby, Miles; Fairbrother, Kathryn L.; Banya, Winston; Wang, Duolao; Flather, Marcus; Hetherington, Simon L.; Kelion, Andrew D.; Talwar, Suneel; Gunning, Mark; Hall, Roger; Swanton, Howard; McCann, Gerry P.

    2015-01-01

    Background The optimal management of patients found to have multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction is uncertain. Objectives CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a U.K. open-label randomized study comparing complete revascularization at index admission with treatment of the infarct-related artery (IRA) only. Methods After they provided verbal assent and underwent coronary angiography, 296 patients in 7 U.K. centers were randomized through an interactive voice-response program to either in-hospital complete revascularization (n = 150) or IRA-only revascularization (n = 146). Complete revascularization was performed either at the time of P-PCI or before hospital discharge. Randomization was stratified by infarct location (anterior/nonanterior) and symptom onset (≤3 h or >3 h). The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 12 months. Results Patient groups were well matched for baseline clinical characteristics. The primary endpoint occurred in 10.0% of the complete revascularization group versus 21.2% in the IRA-only revascularization group (hazard ratio: 0.45; 95% confidence interval: 0.24 to 0.84; p = 0.009). A trend toward benefit was seen early after complete revascularization (p = 0.055 at 30 days). Although there was no significant reduction in death or MI, a nonsignificant reduction in all primary endpoint components was seen. There was no reduction in ischemic burden on myocardial perfusion scintigraphy or in the safety endpoints of major bleeding, contrast-induced nephropathy, or stroke between the groups. Conclusions In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the composite primary endpoint at 12 months compared with treating only the IRA. In such patients, inpatient total revascularization may be considered, but larger clinical trials are required to confirm this result and specifically address whether this strategy is associated with improved survival. (Complete Versus Lesion-only Primary PCI Pilot Study [CvLPRIT]; ISRCTN70913605) PMID:25766941

  17. Season of Birth and School Success in the Early Years of Primary Education

    ERIC Educational Resources Information Center

    Verachtert, Pieter; De Fraine, Bieke; Onghena, Patrick; Ghesquiere, Pol

    2010-01-01

    Several studies have reported significant relationships between children's season of birth and measures of their academic success (i.e., the "season of birth effect"). Whereas most of these studies were cross-sectional, the current study uses growth curve modelling to analyse longitudinal data on 3,187 children in Flemish primary education. The…

  18. Work-Shadowing as a Process for Facilitating Leadership Succession in Primary Schools

    ERIC Educational Resources Information Center

    Simkins, Tim; Close, Paul; Smith, Robin

    2009-01-01

    Work-shadowing is an under-researched aspect of leadership development. This paper places workshadowing in the broader context of responses to the challenges of managing leadership succession in schools, drawing on an evaluation of a pilot shadowing programme for aspiring primary headteachers. The paper identifies a number of key themes in…

  19. Does proximal location of culprit lesion confer worse prognosis in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction?

    PubMed

    Harjai, Kishore J; Mehta, Rajendra H; Stone, Gregg W; Boura, Judy A; Grines, Lorelei; Brodie, Bruce R; Cox, David A; O'Neill, William W; Grines, Cindy L

    2006-08-01

    ST segment elevation myocardial infarction (STEMI) from proximally located culprit lesion is associated with greater myocardium at jeopardy. In STEMI patients treated with thrombolytics, proximal culprit lesions are known to have worse prognosis. This relation has not been studied in patients undergoing primary percutaneous coronary intervention (PCI). In 3,535 STEMI patients with native coronary artery occlusion pooled from the primary angioplasty in myocardial infarction database, we compared in-hospital and 1-year outcomes between those with proximal (n = 1,606) versus non-proximal (n = 1,929) culprit lesions. Patients with proximal culprits were more likely to die and suffer major adverse cardiovascular events (MACE) during the index hospital stay (3.8% vs 2.2%, P = 0.006; 8.2% vs 5.8%, P = 0.0066, respectively) as well as during 1-year follow-up (6.9% vs 4.5%, P = 0.0013; 22% vs 17%, P = 0.003, respectively) compared to those with non-proximal culprits. After adjustment for baseline differences, proximal culprit was independently predictive of in-hospital death (adjusted odds ratio% 1.58, 95% confidence intervals, CI 1.05-2.40) and MACE (OR 1.41, CI 1.06-1.86), but not 1-year death or MACE. In addition, proximal culprit was independently associated with higher incidence of ventricular arrhythmias and sustained hypotension during the index hospitalization. The univariate impact of proximal culprit lesion on in-hospital death and MACE was comparable to other adverse angiographic characteristics, such as multivessel disease and poor initial thrombolysis in myocardial infarction flow, and greater than that of anterior wall STEMI. In conclusion, proximal location of the culprit lesion is a strong independent predictor of worse in-hospital outcomes in patients with STEMI undergoing primary PCI. PMID:16881971

  20. Clinical Benefit of Low Molecular Weight Heparin for ST-segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention with Glycoprotein IIb/IIIa Inhibitor

    PubMed Central

    Cho, Jung Sun; Her, Sung-Ho; Baek, Ju Yeal; Park, Mahn-Won; Kim, Hyoung Doo; Ahn, Young keun; Chae, Shung Chull; Hur, Seung Ho; Hong, Taek Jong; Kim, Young Jo; Seong, In Whan; Chae, Jei Keon; Rhew, Jay Young; Chae, In Ho; Cho, Myeong Chan; Bae, Jang Ho; Rha, Seung Woon; Kim, Chong Jim; Choi, Donghoon; Jang, Yang Soo; Yoon, Junghan; Chung, Wook Sung; Cho, Jeong Gwan; Seung, Ki Bae; Park, Seung Jung

    2010-01-01

    The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation acute myocardial infarction (STEMI) undergoing PCI in the Korean Acute Myocardial Infarction Registry (KAMIR) were assigned to either of two groups: a group with Gp IIb/IIIa inhibitor (n=476) or a group without Gp IIb/IIIa inhibitor (n=2,059). These groups were further subdivided according to the use of LMWH with low dose UFH (n=219) or UFH alone (n=257). The primary end points were cardiac death or myocardial infarction during the 30 days after the registration. The primary end point occurred in 4.1% (9/219) of patients managed with LMWH during PCI and Gp IIb/IIIa inhibitor and 10.8% (28/257) of patients managed with UFH and Gp IIb/IIIa inhibitor (odds ratio [OR], 0.290; 95% confidence interval [CI], 0.132-0.634; P=0.006). Thrombolysis In Myocardial Infarction (TIMI) with major bleeding was observed in LMHW and UFH with Gp IIb/IIIa inhibitor (1/219 [0.5%] vs 1/257 [0.4%], P=1.00). For patients with STEMI managed with a primary PCI and Gp IIb/IIIa inhibitor, LMWH is more beneficial than UFH. PMID:21060749

  1. Optical coherence tomography assessment of efficacy of thrombus aspiration in patients undergoing a primary percutaneous coronary intervention for acute ST-elevation myocardial infarction

    PubMed Central

    Yamaguchi, Tomoyuki; Ino, Yasushi; Matsuo, Yoshiki; Shiono, Yasutsugu; Yamano, Takashi; Taruya, Akira; Nishiguchi, Tsuyoshi; Shimokado, Aiko; Orii, Makoto; Tanaka, Atsushi; Hozumi, Takeshi; Akasaka, Takashi

    2015-01-01

    Objective We used optical coherence tomography (OCT) to assess the impact of thrombus aspiration before angioplasty on poststenting tissue protrusions in patients undergoing a primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods and results A total of 188 patients with STEMI who underwent thrombus-aspiration PCI (n=113) or standard PCI (n=75) were examined in this study. OCT was performed immediately after primary PCI to assess lesion morphology in the stented segment. The minimum stent area was similar between the thrombus-aspiration PCI group and the standard PCI group [7.4 interquartile range (IQR): 5.89.4 vs. 7.4 IQR: 5.88.9?mm2, P=0.788]. The maximum tissue protrusion area [0.6 (IQR: 0.31.1) vs. 1.2 (IQR: 0.81.9)?mm2, P<0.001], the mean tissue protrusion area [0.1 (IQR: 0.10.2) vs. 0.5 (IQR: 0.30.8)?mm2, P<0.001], and tissue protrusion volume [2.3 (IQR: 1.34.3) vs. 8.3 (IQR: 5.414.6)?mm3, P<0.001] were significantly smaller in the thrombus-aspiration PCI group compared with the standard PCI group. Minimum lumen area was significantly greater in the thrombus-aspiration PCI group compared with the standard PCI group [6.9 (IQR: 5.48.8) vs. 6.3 (IQR: 4.67.8)?mm2, P=0.033]. Conclusion Thrombus aspiration before angioplasty in patients with STEMI was associated with significantly smaller tissue protrusion and larger lumen poststenting compared with standard PCI. Thrombus aspiration in primary PCI favorably influenced lesion morphologies in the stented segment. PMID:26230885

  2. Effect of Intravenous Administration of Liposomal Prostaglandin E1 on Microcirculation in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention

    PubMed Central

    Wei, Li-Ye; Fu, Xiang-Hua; Li, Wei; Bi, Xi-Le; Bai, Shi-Ru; Xing, Kun; Wang, Yan-Bo

    2015-01-01

    Background: Several studies have demonstrated that primary percutaneous coronary intervention (PCI) can result in reperfusion injury. This study aims to investigate the effectiveness of liposomal prostaglandin E1 (Lipo-PGE1, Alprostadil, Beijing Tide Pharmaceutical Co., Ltd.) for enhancing microcirculation in reperfusion injury. In addition, this study determined the optimal administration method for acute ST elevation myocardial infarction (STEMI) patients undergoing primary PCI. Methods: Totally, 68 patients with STEMI were randomly assigned to two groups: intravenous administration of Lipo-PGE1 (Group A), and no Lipo-PGE1 administration (Group B). The corrected thrombolysis in myocardial infarction (TIMI) frame count (cTFC) and myocardial blush grade (MBG) were calculated. Patients were followed up for 6 months. Major adverse cardiac events (MACE) were also measured. Results: There was no significant difference in the baseline characteristics between the two groups. The cTFC parameter in Group A was significantly lower than Group B (18.06 ± 2.06 vs. 25.31 ± 2.59, P < 0.01). The ratio of final MBG grade-3 was significantly higher (P < 0.05) in Group A (87.9%) relative to Group B (65.7%). There was no significant difference between the two groups in final TIMI-3 flow and no-reflow. Patients were followed up for 6 months, and the occurrence of MACE in Group A was significantly lower than that in Group B (6.1% vs. 25.9% respectively, P < 0.05). Conclusions: Myocardial microcirculation of reperfusion injury in patients with STEMI, after primary PCI, can be improved by administering Lipo-PGE1. PMID:25947394

  3. [Treatment of malignant biliary obstructions via the percutaneous approach].

    PubMed

    Radeleff, B A; López-Benítez, R; Hallscheidt, P; Grenacher, L; Libicher, M; Richter, G M; Kauffmann, G W

    2005-11-01

    This paper gives an overview of experience and success of percutaneous transhepatic interventions in malignant biliary obstruction. Even after exhaustion of surgical and endoscopic therapy options, the percutaneously inserted stents provide effective palliation. The palliative treatment of malignant jaundice using a stent is an established procedure in clinical practice, particularly whenever the endoscopic, transpapillary approach is not possible due to high obstructions or previous surgery. The technical success rate is very high (about 95-100%), and the complication rate is about 10-30%. Since the patency rate of stents is higher than that of plastic endoprostheses, their primary use is justified despite higher costs, provided the patients are adequately selected. PMID:16240139

  4. Percutaneous connectors

    NASA Technical Reports Server (NTRS)

    Picha, G. J.; Taylor, S. R.

    1981-01-01

    A surface possessing a regular array of micro-pillars was evaluated with regard to its ability to control epithelial downgrowth at the percutaneous interface. A range of pillar sizes were applied to the vertical segment of T shaped Biomer (R) implants. These percutaneous tabs were implanted into the dorsum of cats for a period of 6 weeks using a standardized surgical technique. Comments were made post-operatively and at the time of retrieval. A quantitative scoring system was applied to these observations as well as histological results. As observed, the pillar morphology used displayed the ability to control epithelial downgrowth. Collagen ingrowth into the interpillar spaces and possibly direct interactions of the epithelial cells with the morphology may account for the inhibition. The reproducibility of epithelial inhibition is, however, limited by other factors which are currently not well understood. These factors and potential methods of assessment are discussed.

  5. A Comparative Pharmacodynamic Study of Ticagrelor versus Clopidogrel and Ticagrelor in Patients Undergoing Primary Percutaneous Coronary Intervention: The CAPITAL RELOAD Study

    PubMed Central

    Pourdjabbar, Ali; Simard, Trevor; Ramirez, F. Daniel; Moudgil, Rohit; Blondeau, Melissa; Labinaz, Marino; Dick, Alexander; Glover, Christopher; Froeschl, Michael; Marquis, Jean-François; So, Derek Y. F.; Le May, Michel R.

    2014-01-01

    Background In patients undergoing primary percutaneous coronary intervention (PPCI) ticagrelor is superior to clopidogrel in reducing cardiovascular events. This study sought to evaluate the effect of clopidogrel pretreatment on the pharmacodynamics of ticagrelor in patients undergoing PPCI. Methods We measured platelet reactivity using the VerifyNow P2Y12 assay at baseline, 1, 2, 4, 6, 12, 24, and 48 hours following ticagrelor bolus in patients previously loaded with clopidogrel (C+T) and in thienopyridine-naive patients (T) referred to our centre for PPCI. Results In total, 52 consecutive eligible patients with ST-elevation myocardial infarction (STEMI) were enrolled (27 C+T and 25 T). Baseline characteristics and mean baseline platelet reactivity units (PRUs) were similar between the groups. The primary endpoint, the proportion of patients achieving a PRU<208 at 2 hours, was more frequently achieved in the C+T group compared to T treatment (76.0% vs 44.4%, p = 0.026). Notably, C+T therapy resulted in fewer patients with high platelet reactivity at 1 hour (56.0% vs. 14.8%), 4 hours (100.0% vs. 61.5%) and 6 hours (100.0% vs. 64%, p<0.01 for all comparisons). Furthermore, C+T therapy was associated with lower PRU values from 2 to 48 hours. Conclusions In patients referred for PPCI, ticagrelor bolus following clopidogrel resulted in more rapid and profound platelet inhibition, demonstrating a positive pharmacodynamic interaction. Further study is needed to determine if this pharmacodynamic effect translates into reduced clinical events. PMID:24651043

  6. Impact of TIMI 3 patency before primary percutaneous coronary intervention for ST-elevation myocardial infarction on clinical outcome: results from the ASSENT-4 PCI study

    PubMed Central

    Huber, Kurt; Fu, Yuling; Ross, Allan; Granger, Christopher; Goldstein, Patrick; van de Werf, Frans; Armstrong, Paul

    2012-01-01

    Background: Early restoration of blood flow of the infarct-related artery is associated with an improved outcome in patients with ST-elevation myocardial infarction (STEMI). Previous studies have shown a low mortality in patients with TIMI 3 flow before primary percutaneous coronary intervention (PCI). Most likely these patients had spontaneous recanalization of the infarct vessel and might constitute a low-risk subgroup. The purpose of the present analysis was to investigate whether TIMI 3 flow obtained with fibrinolysis before PCI is associated with a clinical outcome comparable to that in patients with spontaneous TIMI 3 flow. Methods: Patients with STEMI <6 hours enrolled in the ASSENT-4 PCI study were randomized to facilitated PCI with tenecteplase or primary PCI. For this analysis, patients were divided into three groups according to the TIMI flow of the infarct vessel before PCI: TIMI 0/1, TIMI 2, and TIMI 3. Results: From a total of 1617 patients, 861 had TIMI 0/1, 279 had TIMI 2, and 477 TIMI 3 flow. The rates of TIMI 3 flow after PCI were 84.6, 89.7, and 95.6%, respectively. Complete ST resolution was observed most often in the TIMI 3 flow group (47.5, 53.6, and 58.6%). The incidence of cardiogenic shock (6.2, 5.5, and 3.6%) and 90-day mortality (6.1, 4.7, and 4.0%) were lowest in the group with TIMI 3 patency before PCI, respectively. The rate of TIMI 3 flow before PCI was higher in the facilitated PCI group than in the primary PCI group (43.9 vs. 15.2%). The 90-day mortality in patients with TIMI 3 before PCI was identical in the facilitated and the primary PCI groups (14/353, 4.0% vs. 5/124, 4.0%). Conclusion: In this post-hoc analysis of ASSENT-4 PCI, TIMI grade 3 flow in the infarct-related artery before PCI, occurring either spontaneously or obtained by fibrinolysis, is associated with a higher TIMI patency after PCI, better improved ST resolution and a trend towards a favourable clinical outcome after 90 days. PMID:24062901

  7. Impact of Chronic Total Occlusion in a Noninfarct-related Artery on Clinical Outcomes in Patients With Acute ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

    PubMed Central

    Zhang, Hui-Ping; Zhao, Ying; Li, Hui; Tang, Guo-Dong; Ai, Hu; Zheng, Nai-Xin; Liu, Jing-Hua; Sun, Fu-Cheng

    2016-01-01

    Abstract In the setting of primary percutaneous coronary intervention (PCI), encountering with chronic total occlusion (CTO) in a noninfarct-related artery (IRA) is not a rare situation. Limited information on the impact of CTO on clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI has raised more concerns. The aim of the present study was to evaluate the effect of concurrent CTO in a non-IRA on the clinical outcomes in patients with STEMI undergoing primary PCI. In the present prospective study, 555 consecutive patients with STEMI who underwent early primary PCI from January 2010 to December 2013 were included. The patients were divided into 2 groups: no CTO and CTO. Data on 12 months follow-up was obtained from 449 patients. The primary endpoint was the composite of hospitalization from angina, reinfarction, heart failure, or re-revascularization, and cardiac death at 12 months follow-up. Of the 555 patients, 75 (13.5%) had CTO in a non-IRA. Compared with patients in no CTO group, more patients in CTO group had hypertension (62.7% vs 46.5%, P = 0.009), diabetes (49.3% vs 35.0%, P = 0.024), and 3-vessel disease (52.0% vs 32.3%, P = 0.001). Patients with CTO had a lower left ventricular ejection fraction (LVEF) (40.1% ± 16.8% vs 54.3% ± 12.1%, P = 0.038), more presented with cardiogenic shock on admission (13.3% vs 4.8%, P = 0.008), compared with patients without CTO. Complete revascularization (CR) was less achieved in CTO group than in no CTO group (33.3% vs 49.1%, P = 0.013). The 12-month cardiac mortality rate was 14.5% versus 6.2% (P = 0.039), the incidence of 12-month primary endpoint was 38.7% versus 21.2% (P = 0.003) for CTO and no CTO group, respectively. Multivariate analysis revealed that after correction for baseline differences, CTO in a non-IRA (hazard ratio 4.183, 95% confidence interval 1.940–6.019, P = 0.001), cardiogenic shock on admission (hazard ratio 3.286, 95% confidence interval 1.097–9.845, P = 0.034), and 3-vessel disease (hazard ratio 2.678, 95% confidence interval 1.221–5.874, P = 0.014) remained an independent predictor of 1-year cardiac mortality in patients with STEMI undergoing primary PCI. CTO in a non-IRA in patients with STEMI undergoing primary PCI is associated with a poor prognosis. The presence of CTO in a non-IRA, cardiogenic shock on admission and 3-vessel disease might be an independent risk factor for greater 1-year cardiac mortality in patients with acute STEMI undergoing primary PCI. PMID:26765429

  8. Palliative Care Partnership: a successful model of primary/secondary integration.

    PubMed

    Stewart, Bruce; Allan, Simon; Keane, Barry; Marshall, Bridget; Ayling, Jane; Luxford, Tai

    2006-01-01

    The health reforms of the 1990s and early 21st century have seen unheralded change in the delivery of health services in New Zealand, and the concept of integration of primary and specialist or secondary services into a seamless health delivery service is one of the key planks of national and regional healthcare planning in New Zealand. This paper reports on a successful primary secondary integration project. Starting with commentary on the historical difficulties that acted as a catalyst to this initiative, it reports on the development process, how the model works in practice, and outlines some initial evaluation work done as part of its quality improvement component. Given the collaborative nature of this project and its scope across primary and specialist care sectors, the authors believe this model has implications and relevance across a wide spectrum of the New Zealand health service. PMID:16998577

  9. Just a drop of cement: a case of cervical spine bone aneurysmal cyst successfully treated by percutaneous injection of a small amount of polymethyl-methacrylate cement.

    PubMed

    Fahed, Robert; Clarençon, Frédéric; Riouallon, Guillaume; Cormier, Evelyne; Bonaccorsi, Raphael; Pascal-Mousselard, Hugues; Chiras, Jacques

    2016-01-01

    Aneurysmal bone cyst (ABC) is a benign hemorrhagic tumor, commonly revealed by local pain. The best treatment for this lesion is still controversial. We report the case of a patient with chronic neck pain revealing an ABC of the third cervical vertebra. After percutaneous injection of a small amount of polymethyl-methacrylate bone cement, the patient experienced significant clinical and radiological improvement. PMID:25526916

  10. Serial assessment of the index of microcirculatory resistance during primary percutaneous coronary intervention comparing manual aspiration catheter thrombectomy with balloon angioplasty (IMPACT study): a randomised controlled pilot study

    PubMed Central

    Hoole, Stephen P; Jaworski, Catherine; Brown, Adam J; McCormick, Liam M; Agrawal, Bobby; Clarke, Sarah C; West, Nick E J

    2015-01-01

    Objective Utilising a novel study design, we evaluated serial measurements of the index of microcirculatory resistance (IMR) in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) to assess the impact of device therapy on microvascular function, and determine what proportion of microvascular injury is related to the PPCI procedure, and what is an inevitable consequence of STEMI. Design 41 patients undergoing PPCI for STEMI were randomised to balloon angioplasty (BA, n=20) or manual thrombectomy (MT, n=21) prior to stenting. Serial IMR measurements, corrected for collaterals, were recorded at baseline and at each stage of the procedure. Microvascular obstruction (MVO) and infarct size at 24 h and 3 months were measured by troponin and cardiac MRI (CMR). Results IMR did not change significantly following PPCI, but patients with lower IMR values (<32, n=30) at baseline had a significant increase in IMR following PPCI (baseline: 21.2±7.9 vs post-stent: 33.0±23.7, p=0.01) attributable to prestent IRA instrumentation (baseline: 21.7±8.0 vs post-BA or MT: 36.9±25.9, p=0.006). Post-stent IMR correlated with early MVO on CMR (p=0.01). There was no significant difference in post-stent IMR, presence of early MVO or final infarct size between patients with BA and patients treated with MT. Conclusions Patients with STEMI and less microcirculatory dysfunction may be susceptible to acute iatrogenic microcirculatory injury from prestent coronary devices. MT did not appear to be superior to BA in maintaining microcirculatory integrity when the guide wire partially restores IRA flow during PPCI. Trial registration number ISRCTN31767278. PMID:26019882

  11. Impact of Prolonged Door-to-Balloon Times on the Diastolic Function in Acute ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

    PubMed Central

    Wang, Yu-Chen; Wu, Hung-Pin; Lo, Ping-Hang; Liang, Hsin-Yueh; Chang, Kuan-Cheng

    2015-01-01

    Background Emerging evidence indicates that diastolic left ventricular (LV) function is a powerful outcome predictor after acute ST-elevation myocardial infarction (STEMI). We hypothesized that shorter door-to-balloon (D2B) times with early restoration of coronary perfusion may preserve diastolic LV function in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Methods This study enrolled 340 consecutive STEMI patients who underwent PPCI with D2B times of < 90 min in 232 patients and D2B times ≥ 90 min in 108 patients, who all received subsequent echocardiographic examination within 48 hours of hospitalization. Results Although the LV ejection fraction was similar (50.92% vs. 51.66%, p = 0.573), the proportion of E/E’ ratio > 15 was greater in patients with D2B times ≥ 90 min compared to those with D2B times < 90 min (44.4% vs. 30.6%, p = 0.013). Logistic regression analysis revealed that D2B time ≥ 90 min [odds ratio (OR): 1.82, 95% confidence interval (Cl): 1.04-3.17, p = 0.035] was an independent predictor for LV diastolic dysfunction. The effect was more prominent in patients ≥ 65 years of age (OR: 2.77, 95% CI: 1.09-7.00, p = 0.032), in whom the fraction of LV diastolic dysfunction increased proportionally with prolonged D2B times. Conclusions Prolonged D2B time of greater than 90 min predicted LV diastolic dysfunction, particularly in aged subjects. D2B times shortening is important to preserve diastolic heart function after PPCI. PMID:27122884

  12. Intra-Aortic Balloon Pump Counterpulsation during Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction and Cardiogenic Shock: Insights from the British Columbia Cardiac Registry

    PubMed Central

    Iqbal, M. Bilal; Robinson, Simon D.; Ding, Lillian; Fung, Anthony; Aymong, Eve; Chan, Albert W.; Hodge, Steven; Della Siega, Anthony; Nadra, Imad J.

    2016-01-01

    Background Cardiogenic shock complicating ST-elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality. In the primary percutaneous coronary intervention (PPCI) era, randomized trials have not shown a survival benefit with intra-aortic balloon pump (IABP) therapy. This differs to observational data which show a detrimental effect, potentially reflecting bias and confounding. Without robust and valid risk adjustment, findings from non-randomized studies may remain biased. Methods We compared long-term mortality following IABP therapy in patients with cardiogenic shock undergoing PPCI during 2008–2013 from the British Columbia Cardiac Registry. We addressed measured and unmeasured confounding using propensity score and instrumental variable methods. Results A total of 12,105 patients with STEMI were treated with PPCI during the study period. Of these, 700 patients (5.8%) had cardiogenic shock. Of the patients with cardiogenic shock, 255 patients (36%) received IABP therapy. Multivariable analyses identified IABP therapy to be associated with increased mortality up to 3 years (HR = 1.67, 95% CI:1.20–2.67, p<0.001). This association was lost in propensity-matched analyses (HR = 1.23, 95% CI: 0.84–1.80, p = 0.288). When addressing measured and unmeasured confounders, instrumental variable analyses demonstrated that IABP therapy was not associated with mortality at 3 years (Δ = 16.7%, 95% CI: -12.7%, 46.1%, p = 0.281). Subgroup analyses demonstrated IABP was associated with increased mortality in non-diabetics; patients not undergoing multivessel intervention; patients without renal disease and patients not having received prior thrombolysis. Conclusions In this observational analysis of patients with STEMI and cardiogenic shock, when adjusting for confounding, IABP therapy had a neutral effect with no association with long-term mortality. These findings differ to previously reported observational studies, but are in keeping with randomized trial data. PMID:26870950

  13. Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials).

    PubMed

    DeGeare, V S; Stone, G W; Grines, L; Brodie, B R; Cox, D A; Garcia, E; Wharton, T P; Boura, J A; O'Neill, W W; Grines, C L

    2000-07-01

    Advanced age is associated with increased mortality in acute myocardial infarction (AMI) but the mechanism remains unclear. We performed a pooled analysis of 3,032 patients from the Primary Angioplasty in Myocardial Infarction (PAMI)-2, Stent-PAMI, and PAMI-No Surgery On Site trials to determine which clinical, hemodynamic, and angiographic characteristics in the elderly were associated with in-hospital death. There were 452 patients aged >/=75 years and 2,580 patients aged <75 years. Older patients had a lower number of risk factors for coronary artery disease but more comorbidities. Acute catheterization demonstrated more 3-vessel disease, higher left ventricular (LV) end-diastolic pressure, lower LV ejection fraction, and higher initial rates of Thrombolysis In Myocardial Infarction (TIMI) trial 2 or 3 flow. Elderly patients were equally likely to undergo percutaneous intervention but had a lower procedural success rate and lower rates of final TIMI 3 flow, and older patients were more likely to have post-AMI complications. In-hospital mortality was 10.2% and 1.8%, respectively (p = 0.001). Cardiac and noncardiac mortality was higher in elderly patients, and no significant differences in causes of death were identified. Multivariate analysis revealed that the strongest predictors of death were age >/=75 years, lower LV ejection fraction, lower final TIMI flow, higher Killip class, need for an intra-aortic balloon pump (IABP), and post-AMI stroke/transient ischemic attack, or significant arrhythmia. Despite avoiding thrombolysis, elderly patients remain at increased risk of bleeding, stroke, and other post-AMI complications, and death. Cardiac risk factor analysis and acute catheterization offer prognostic information but do not completely explain the mechanism of increased in-hospital mortality in the elderly. PMID:10867088

  14. Percutaneous Aspiration Embolectomy Using Guiding Catheter for the Superior Mesenteric Artery Embolism

    PubMed Central

    Choi, Kyu Sung; Kim, Ji Dae; Min, Sang-Il; Min, Seung-Kee; Jae, Hwan Jun; Chung, Jin Wook

    2015-01-01

    Objective To evaluate the technical feasibility and clinical outcome of percutaneous aspiration embolectomy for embolic occlusion of the superior mesenteric artery (SMA). Materials and Methods Between January 2010 and December 2013, 9 patients with embolic occlusion of the SMA were treated by percutaneous aspiration embolectomy in 2 academic teaching hospitals. The aspiration embolectomy procedure was performed with the 6-Fr and 7-Fr guiding catheter. Thrombolysis was performed with urokinase using a multiple-sidehole infusion catheter. The clinical outcome was investigated retrospectively. Results Superior mesenteric artery occlusion was initially diagnosed by computed tomography (CT) in all patients, and all patients had no obvious evidence of bowel infarction on CT scan. Percutaneous aspiration embolectomy was primarily performed in 6 patients, and thrombolysis was initially performed in 3 patients. In 3 patients who received primary thrombolysis, percutaneous aspiration was undertaken because the emboli were resistant to urokinase. Complete angiographic success was achieved in 6 patients and partial angiographic success was accomplished in 3 patients. One patient underwent bowel resection. One patient died of whole bowel necrosis and sepsis, and 8 patients survived without complications. Conclusion Percutaneous aspiration embolectomy is a useful tool in recanalization of embolic occlusion of the SMA in select patients. PMID:26175572

  15. Successful Ultrasound-Guided Percutaneous Drainage of Multiple Splenic Abscesses in a Kidney Transplant Patient With Encapsulated Sclerosing Peritonitis: A Case Report.

    PubMed

    Tuğcu, M; Ruhi, Ç; Boynueğri, B; Kasapoğlu, U; Can, Ö; Kiliçoğlu, G; Şahin, G; Titiz, M

    2015-06-01

    Differential diagnosis of post-transplant infections should include rare/uncommon foci and pathogens. We present a rare case of life-threatening infection, a splenic abscess in a 53-year-old woman who was transplanted with a cadaveric kidney 5 months previously. The patient was admitted to our clinic with chills, shivering, and fever. She required a kidney transplant because of end-stage renal disease secondary to systemic lupus erythematosus, which had previously been treated by means of peritoneal dialysis for 7 years, until encapsulated sclerosing peritonitis developed, at which time therapy was changed to hemodialysis for 1 year. On physical examination, the patient was slightly lethargic and had tenderness in the left upper quadrant of the abdomen. Laboratory evaluation revealed leukocytosis and high acute phase reactant. Abdominal ultrasonography (US) revealed multiple abscesses in the spleen, but splenectomy was not recommended because of her history of sclerosing peritonitis. Percutaneous drainage catheters were placed under US guidance. Culture of blood and fluid drained from the abscess revealed imipenem-sensitive Escherichia coli and Klebsiella spp. Imipenem (500 mg IV q6hr) was initiated, and the drainage volume was 40 to 50 mL/day in the first week and gradually decreased through the third week. The abscess was completely drained over a period of 6 weeks, as confirmed by computed tomography; percutaneous catheters were then removed. Although splenic abscesses are life-threatening, especially for immunocompromised patients, this case suggests that percutaneous drainage guided by US or computed tomography is an efficient treatment alternative to splenectomy. PMID:26093760

  16. 15N Content Reflects Development of Mycorrhizae and Nitrogen Dynamics During Primary Succession

    NASA Astrophysics Data System (ADS)

    Hobbie, E. A.; Jumpponen, A.

    2004-05-01

    Mycorrhizal fungi are ubiquitous symbionts on terrestrial plants that are particularly important for plant nitrogen nutrition. 15N content appears to be a useful marker of the mycorrhizal role in plant nitrogen supply because of an apparent fractionation against 15N during transfer of nitrogen from mycorrhizal fungi to host plants. Because plants developing during primary succession are gradually colonized by mycorrhizal fungi, such situations provide good opportunities to study interactions between mycorrhizal colonization and plant 15N content. Here, we present results of a study of nitrogen isotope patterns in ecosystem components during the first 100 years of ecosystem development after glacial retreat, and compare those patterns with those on adjacent mature terrain. Soils in primary succession were depleted in 15N relative to nitrogen-fixing plants. Nonmycorrhizal plants and plants generally colonized by ectomycorrhizal, ericoid, or arbuscular fungi showed similar 15N content very early in succession (-4 to -6‰ ), corresponding to low colonization levels of all plant species. Subsequent colonization of evergreen plants by ectomycorrhizal and ericoid fungi led to a 5-6‰ decline in 15N content, indicating transfer of 15N-depleted N from fungi to plants. The values recorded (-10 to -14‰ ) are among the lowest yet observed in vascular plants. Nonmycorrhizal plants and plants colonized by arbuscular mycorrhizal fungi did not decline in 15N content. Most ectomycorrhizal and saprotrophic fungi were similar in 15N content in early succession (-1 to -3‰ ), with the notable exception of ectomycorrhizal fungi suspected of proteolytic capabilities, which were 15N enriched relative to all other fungi. 15N contents in both plants and soil from the mature site were 5‰ greater than in recently exposed sites. We conclude that 1) the primary nitrogen source to this ecosystem must be atmospheric deposition, 2) low plant 15N content generally corresponds with greater influence of mycorrhizal fungi on plant N supply, and 3) 15N content of mycorrhizal fungi may be a marker of proteolytic capabilities, and may therefore indicate the importance of organic nitrogen cycling to plant nitrogen supply.

  17. Trophic Interactions during Primary Succession: Herbivores Slow a Plant Reinvasion at Mount St. Helens.

    PubMed

    Fagan; Bishop

    2000-02-01

    Lupines (Lupinus lepidus var. lobbii), the earliest plant colonists of primary successional habitats at Mount St. Helens, were expected to strongly affect successional trajectories through facilitative effects. However, their effects remain localized because initially high rates of reinvasive spread were short lived, despite widespread habitat availability. We experimentally tested whether insect herbivores, by reducing plant growth and fecundity at the edge of the expanding lupine population, could curtail the rate of reinvasion and whether those herbivores had comparable impacts in the older, more successionally advanced core region. We found that removing insect herbivores increased both the areal growth of individual lupine plants and the production of new plants in the edge region, thereby accelerating the lupine's intrinsic rate of increase at the front of the lupine reinvasion. We found no such impacts of herbivory in the core region, where low plant quality or a complex of recently arrived natural enemies may hold herbivores in check. In the context of invasion theory, herbivore-mediated decreases in lupine population growth rate in the edge region translate into decreased rates of lupine spread, which we quantify here using diffusion models. In the Mount St. Helens system, decreased rate of lupine reinvasion will result in reductions in rates of soil formation, nitrogen input, and entrapment of seeds and detritus that are likely to postpone or alter trajectories of primary succession. If the type of spatial subtleties in herbivore effects we found here are common, with herbivory focused on the edge of an expanding plant population and suppressed or ineffective in the larger, denser central region (where the plants might be more readily noticed and studied), then insect herbivores may have stronger impacts on the dynamics of primary succession and plant invasions than previously recognized. PMID:10686163

  18. Successful primary staple-repair of thoracic oesophagus after delayed presentation of a spontaneous perforation

    PubMed Central

    Leoncini, Giacomo; Novello, Luca; Denegri, Andrea; Morelli, Lucia; Ratto, Giovanni B.

    2015-01-01

    Introduction Spontaneous perforation of the oesophagus is diagnosed late in over 50% of cases. Misdiagnosis may be due to atypical presentations. Primary repair is technically demanding in this setting and the risk of failure is high. Presentation of case An 85 year-old lady presented with an atypical cohort of mild nonspecific symptoms in spite of a pleuro-mediastinal purulent collection secondary to an undiagnosed spontaneous perforation of the oesophagus occurred seven days before. Despite the extent of perforation (3 cm in length), the late diagnosis and the necrosis of the muscular wall, the oesophagus was successfully repaired by means of a stapler. Discussion The mechanism of the atypical presentation is discussed and possible modalities of treatment of delayed oesophageal perforations are reviewed, with particular reference to primary repair and to the possible use of staplers within this setting. Conclusion Even large spontaneous perforations of the oesophagus can result in a contained abscess, with no frank sepsis. Diagnosis can be missed for days in these cases. The attempt at primary repair of the oesophagus is still indicated. The use of a stapler is preferable in such cases as a perfect mucosal approximation is provided with minimal manipulation and with the use of inert, well tolerated material, which does not tend to become infected. PMID:26279260

  19. Predictive Value of Gamma-Glutamyl Transferase Levels for Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention.

    PubMed

    Oksuz, Fatih; Yarlioglues, Mikail; Cay, Serkan; Celik, Ibrahim Ethem; Mendi, Mehmet Ali; Kurtul, Alparslan; Cankurt, Tayyar; Kuyumcu, Serdar; Canpolat, Uğur; Turak, Osman

    2015-09-01

    Contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PPCI) is associated with adverse short- and long-term outcomes. The aim of this study was to evaluate the predictive value of gamma-glutamyl transferase (GGT) for risk of CIN in patients with ST-segment elevation myocardial infarction who underwent PPCI. A total of 473 patients were enrolled in the study. A relative increase in serum creatinine ≥25%, or an absolute increase ≥0.5 mg/dl, from the baseline within 72 hours of contrast exposure was defined as CIN. Patients were divided into 3 groups according to GGT tertiles (tertile 1, GGT <19 U/L; tertile 2, GGT 19 to 33 U/L; and tertile 3, GGT >33 U/L) on admission. Demographics, clinical risk factors, laboratory parameters, CIN incidence, and other inhospital clinical outcomes were compared among GGT tertiles. CIN incidence was significantly higher in tertile 3 (29%) compared with tertiles 1 (11%) and 2 (11%, p <0.001). Inhospital death incidence was significantly increased across tertiles (from tertile 1 to tertiles 2 and 3, 1%, 4%, and 5%, respectively, p <0.05). In receiver operating characteristic analysis, a threshold value of GGT >26.5 U/L had 70% sensitivity and 60% specificity for CIN. After including variables found significant in univariate analysis, the presence of diabetes mellitus (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.22 to 2.31, p <0.001), C-reactive protein (for each 1 mg/L increase; OR 1.01, 95% CI 1.00 to 1.02, p = 0.007), contrast volume (for each 1-ml increase; OR 1.01, 95% CI 1.00 to 1.02, p = 0.012), and GGT >26.5 U/L (OR 2.59, 95% CI 1.48 to 4.53, p <0.001) were found as independent associates of CIN in multivariate regression analysis. Each 1 U/L increase in GGT was also associated with CIN risk (OR 1.04, 95% CI 1.03 to 1.06, p <0.001). In conclusion, GGT on admission was a significant and independent predictor of CIN after PPCI in patients with ST-segment elevation myocardial infarction. PMID:26116992

  20. Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent? Gender difference in STEMI stratified on age

    PubMed Central

    Maas, Angela HEM; Ottervanger, Jan Paul; Kloosterman, Anita; van ’t Hof, Arnoud WJ; Dambrink, Jan Henk E; Gosselink, AT Marcel; Hoorntje, Jan CA; Suryapranata, Harry; de Boer, Menko Jan

    2013-01-01

    Aim: Poorer outcomes in women with ST-elevation myocardial infarction (STEMI) are often attributed to gender differences in baseline characteristics. However, these may be age dependent. We examined the importance of gender in separate age groups of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Methods and results: Data of 6746 consecutive patients with STEMI admitted for PPCI between 1998 and 2008 in our hospital were evaluated. Age was stratified into two groups, <65 years (young group) and ≥65 years (elderly). Endpoints were enzymic infarct size as well as 30-day and 1 year mortality. We studied a total of 4991 (74.0%) men and 1755 (26.0%) women; 40% of women were <65 years and 60% of men were <65 years of age. In the elderly group (≥65 years), women had more frequently diabetes and hypertension while they smoked less frequently than men. Younger women smoked more often than similarly aged men and had more hypertension. At angiography, single-vessel disease and TIMI 3 flow before PPCI was more present in younger women than men, whereas these differences were not found in the older age group. Patient delay before admission was shorter in men at all ages, while women had lower creatine kinase levels. Younger women had a higher mortality after 30 days (HR 2.1, 95% CI 1.3−3.4) and at 1 year (HR 1.7, 95% CI 1.2−2.6), whereas in the older age group women mortality rates were higher at 30 days (HR 1.5, 95% CI 1.1−2.0) but not at 1 year (HR 1.2, 95% CI 0.9−1.5). After multivariate analysis, 1-year mortality remained significantly higher in women at younger age (HR 1.7, 95% CI 1.1−2.5). Patient delay before admission was shorter in men in both age groups. Creatine kinase levels were in both age groups higher in men. Conclusions: Differences in mortality between men and women with STEMI treated with PPCI are age dependent. Although young women have less obstructive coronary artery disease and more often TIMI 3 flow before PCI (suggesting a lower risk), survival was worse compared to similarly aged men. Women had a longer patient delay compared to men, but this was not related to gender-specific mortality. PMID:24338292

  1. Early Discharge After Primary Percutaneous Coronary Intervention: The Added Value of N‐Terminal Pro–Brain Natriuretic Peptide to the Zwolle Risk Score

    PubMed Central

    Schellings, Dirk A. A. M.; Adiyaman, Ahmet; Giannitsis, Evangelos; Hamm, Christian; Suryapranata, Harry; ten Berg, Jurrien M.; Hoorntje, Jan C. A.; van‘t Hof, Arnoud W. J.

    2014-01-01

    Background The Zwolle Risk Score (ZRS) identifies ST‐elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) eligible for early discharge. We aimed to investigate whether baseline N‐terminal pro–brain natriuretic peptide (NT‐proBNP) is also able to identify these patients and could improve future risk strategies. Methods and Results PPCI patients included in the Ongoing Tirofiban in Myocardial Infarction Evaluation (On‐TIME) II study were candidates (N=861). We analyzed whether ZRS and baseline NT‐proBNP predicted 30‐day mortality and assessed the occurrence of major adverse cardiac events (MACEs) and major bleeding. Receiver operating characteristic curve analysis was used to assess discriminative accuracy for ZRS, NT‐pro‐BNP, and their combination. After multiple imputation, 845 patients were included. Both ZRS >3 (hazard ratio [HR]=9.42; P<0.001) and log NT‐pro‐BNP (HR=2.61; P<0.001) values were associated with 30‐day mortality. On multivariate analysis, both the ZRS (HR=1.41; 95% confidence interval [CI]=1.27 to 1.56; P<0.001) and log NT‐proBNP (HR=2.09; 95% CI=1.59 to 2.74; P<0.001) independently predicted death at 30 days. The area under the curve for 30‐day mortality for combined ZRS/NT‐proBNP was 0.94 (95% CI=0.90 to 0.99), with optimal predictive values of a ZRS ≥2 and a NT‐proBNP value of ≥200 pg/mL. Using these cut‐off values, 64% of the study population could be identified as very low risk with zero mortality at 30 days follow‐up and low occurrence of MACEs and major bleeding between 48 hours and 10 days (1.3% and 0.6%, respectively). Conclusion Baseline NT‐proBNP identifies a large group of low‐risk patients who may be eligible for early (48‐ to 72‐hour) discharge, whereas optimal predictive accuracy is reached by the combination of both baseline NT‐proBNP and ZRS. PMID:25389283

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

    PubMed Central

    Arróniz-Crespo, María; Pérez-Ortega, Sergio; De los Ríos, Asunción; Green, T. G. Allan; Ochoa-Hueso, Raúl; Casermeiro, Miguel Ángel; de la Cruz, María Teresa; Pintado, Ana; Palacios, David; Rozzi, Ricardo; Tysklind, Niklas; Sancho, Leopoldo G.

    2014-01-01

    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. PMID:24819926

  3. Bryophyte-cyanobacteria associations during primary succession in recently Deglaciated areas of Tierra del Fuego (Chile).

    PubMed

    Arróniz-Crespo, María; Pérez-Ortega, Sergio; De Los Ríos, Asunción; Green, T G Allan; Ochoa-Hueso, Raúl; Casermeiro, Miguel Ángel; de la Cruz, María Teresa; Pintado, Ana; Palacios, David; Rozzi, Ricardo; Tysklind, Niklas; Sancho, Leopoldo G

    2014-01-01

    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. PMID:24819926

  4. Transition of Students with Autistic Spectrum Disorders from Primary to Post-Primary School: A Framework for Success

    ERIC Educational Resources Information Center

    Deacy, Evelyn; Jennings, Fiona; O'Halloran, Ailbhe

    2015-01-01

    The purpose of this research was to investigate best practice in relation to the planning, process and strategies that support the transition of students with ASD from primary to post-primary school. A questionnaire survey was sent to graduates of a postgraduate Certificate/Diploma in SEN (ASD) in Ireland who were working in primary and…

  5. Percutaneous Achilles Tendon Lengthening

    MedlinePlus

    ... Toes All Site Content AOFAS / FootCareMD / Treatments Percutaneous Achilles Tendon Lengthening Page Content ​ Pre-operative incision markings ... tendon. What is the goal of a percutaneous Achilles tendon lengthening? The goal of this procedure is ...

  6. Primary synovial sarcoma of the lung successfully resected under temporary bypass

    PubMed Central

    Ichimura, Hideo; Kikuchi, Shinji; Ozawa, Yuichiro; Matsuzaki, Kanji

    2013-01-01

    A 48-year old man presented with chest pain and haemoptysis. Chest computed tomography showed a 60-mm mass in the left upper lobe of the lung, adjacent to the distal aortic arch. Bronchoscopic cytology revealed the presence of malignant cells and, in the absence of evidence of distant metastasis, a thoracotomy was performed. Although the tumour was firmly adherent to the distal aortic arch, under temporary bypass from the left subclavian artery to the descending aorta, it was successfully resected en bloc with the section of the aorta attached to it. The tumour was diagnosed as a primary synovial sarcoma of the lung on the basis of histopathological findings and fluorescent chromogenic in situ hybridization, showing SS18 gene rearrangement. PMID:23760220

  7. A Study on the Playing of Computer Games, Class Success and Attitudes of Parents to Primary School Students

    ERIC Educational Resources Information Center

    Pepe, Kadir

    2011-01-01

    This study is a descriptive study based on the screening model, and was conducted in order to inquire the effect of games and the relation between gender and class success variables and game preferences in primary school students. The universe of the study was the primary schools in city center in Province of Burdur and the sample group of the…

  8. A Study on the Playing of Computer Games, Class Success and Attitudes of Parents to Primary School Students

    ERIC Educational Resources Information Center

    Pepe, Kadir

    2011-01-01

    This study is a descriptive study based on the screening model, and was conducted in order to inquire the effect of games and the relation between gender and class success variables and game preferences in primary school students. The universe of the study was the primary schools in city center in Province of Burdur and the sample group of the

  9. Public and Private School Distinction, Regional Development Differences, and Other Factors Influencing the Success of Primary School Students in Turkey

    ERIC Educational Resources Information Center

    Sulku, Seher Nur; Abdioglu, Zehra

    2015-01-01

    This study investigates the factors influencing the success of students in primary schools in Turkey. TIMSS 2011 data for Turkey, measuring the success of eighth-grade students in the field of mathematics, were used in an econometric analysis, performed using classical linear regression models. Two hundred thirty-nine schools participated in the…

  10. Current Status of Percutaneous Endografting.

    PubMed

    Patel, Parag J; Kelly, Quinton; Hieb, Robert A; Lee, Cheong Jun

    2015-09-01

    Totally percutaneous endovascular abdominal aortic aneurysm repair (PEVAR) using suture-mediated closure devices (SMCDs) has several well-established advantages over standard open femoral exposure as a direct consequence of being less invasive and having shorter times to hemostasis and procedure completion. The first multicenter randomized controlled trial designed to assess the safety and efficacy of PEVAR and to compare percutaneous access with standard open femoral exposure was recently published (the PEVAR trial). The PEVAR trial demonstrated that percutaneous endografting is safe, effective, and noninferior to standard open femoral exposure among trained operators. The study reaffirmed the results of several recent single center and nonrandomized studies, demonstrating that percutaneous access facilitated shorter procedures, shorter times to secure hemostasis, and improved quality of life for patients. As PEVAR has gained popularity among patients and physicians, refinements to the technique and patient selection process have been made. There has been growing interest in treating patients with anatomical characteristics previously thought to be unsuitable for PEVAR, such as common femoral artery (CFA) calcifications, scarred groins, small CFA diameter, and high patient body mass index (BMI). However, observance of strict procedural technique and consideration for patient selection criteria remain paramount in achieving acceptable technical success rates with PEVAR. PMID:26327747

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

    SciTech Connect

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

    1988-01-01

    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.

  12. Mycorrhizal fungal growth responds to soil characteristics, but not host plant identity, during a primary lacustrine dune succession.

    PubMed

    Sikes, Benjamin A; Maherali, Hafiz; Klironomos, John N

    2014-04-01

    Soil factors and host plant identity can both affect the growth and functioning of mycorrhizal fungi. Both components change during primary succession, but it is unknown if their relative importance to mycorrhizas also changes. This research tested how soil type and host plant differences among primary successional stages determine the growth and plant effects of arbuscular mycorrhizal (AM) fungal communities. Mycorrhizal fungal community, plant identity, and soil conditions were manipulated among three stages of a lacustrine sand dune successional series in a fully factorial greenhouse experiment. Late succession AM fungi produced more arbuscules and soil hyphae when grown in late succession soils, although the community was from the same narrow phylogenetic group as those in intermediate succession. AM fungal growth did not differ between host species, and plant growth was similarly unaffected by different AM fungal communities. These results indicate that though ecological filtering and/or adaptation of AM fungi occurs during this primary dune succession, it more strongly reflects matching between fungi and soils, rather than interactions between fungi and host plants. Thus, AM fungal performance during this succession may not depend directly on the sequence of plant community succession. PMID:24141906

  13. Percutaneous Management of High-Output Chylothorax: Case Reviews

    SciTech Connect

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

    2009-07-15

    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.

  14. Percutaneous nephrostomy by direct puncture technique: An observational study.

    PubMed

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

    2010-04-01

    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. PMID:20835322

  15. Percutaneous nephrostomy by direct puncture technique: An observational study

    PubMed Central

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

    2010-01-01

    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. PMID:20835322

  16. Percutaneous drainage of lung abscess.

    PubMed

    Shim, C; Santos, G H; Zelefsky, M

    1990-01-01

    Most lung abscesses are successfully treated with antibiotics. However, occasional patients with lung abscesses that drain poorly, causing persistent fever and toxic symptoms, may require surgical intervention. Lobectomy is the most frequent surgical procedure. Some patients are debilitated and have underlying medical conditions such as heart disease, chronic pulmonary disease, or liver disease that may render surgical intervention risky. Recently there have been reports of percutaneous drainage of lung abscess with good results. We have successfully carried out percutaneous drainage of lung abscess in 4 patients and an infected bulla in 1. All patients had failed to respond to therapy with antibiotics and postural drainage. There was prompt disappearance of the fluid level in the cavity, decline in temperature, and abatement of toxic symptoms with drainage. The cavities closed gradually over the next 6-12 weeks. The patients tolerated the chest tube well and there were no side effects from the tube drainage. Percutaneous tube drainage is the surgical treatment of choice in the medically complicated patient with a poorly draining lung abscess. PMID:2122136

  17. Removal of a Trapped Endoscopic Catheter from the Gallbladder via Percutaneous Transhepatic Cholecystostomy: Technical Innovation

    SciTech Connect

    Stay, Rourke M.; Sonnenberg, Eric van Goodacre, Brian W.; Ozkan, Orhan S.; Wittich, Gerhard R.

    2006-12-15

    Background. Percutaneous cholecystostomy is used for a variety of clinical problems. Methods. Percutaneous cholecystostomy was utilized in a novel setting to resolve a problematic endoscopic situation. Observations. Percutaneous cholecystostomy permitted successful removal of a broken and trapped endoscopic biliary catheter, in addition to helping treat cholecystitis. Conclusion. Another valuable use of percutaneous cholecystostomy is demonstrated, as well as emphasizing the importance of the interplay between endoscopists and interventional radiologists.

  18. Percutaneous sclerotherapy of varicocele.

    PubMed

    Pisco, J M; Basto, I; Batista, A M; Pereira, N M; Dias, J R; Silva, H; Silva, M M

    1992-10-01

    Percutaneous sclerotherapy of varicocele was considered in 21 patients with left sided varicocele, 16 of whom had recurrences after left spermatic vein ligation in the past. Percutaneous sclerotherapy was possible in 17 patients (80.9%). There were no serious complications with venography or sclerotherapy, and the recurrence rate was 17.6%. Percutaneous sclerotherapy is therefore a simple, safe and effective treatment of testicular vein insufficiency. PMID:1481716

  19. Navigated open, laparoscopic, and percutaneous liver surgery.

    PubMed

    Bale, R; Widmann, G; Jaschke, W

    2011-10-01

    Resection and thermal ablation procedures are frequently used for the treatment of primary and secondary liver tumors. Various tools for the virtual planning of liver resections and ablation are available and some of them are already used clinically. Resection planes and ablation volumes can be optimized for sufficient safety margins while preserving a maximal amount of functional liver tissue. Connecting the pre-operative planning with intraoperative guidance based on the 3D imaging data would be desirable. Interactive image guided surgery enables visualization of the actual spatial location of the surgical instrument on preoperatively acquired images in real time. However, extensive soft tissue deformations during open and laparoscopic surgical and ablative procedures may occur, causing unacceptable inaccuracies. The current focus of research is the adaptation of the preoperative virtual planning models to surgery by using intraoperative imaging and biomechanical models. In contrast to open and laparoscopic surgical procedures percutaneous punctures can be performed with high accuracy under stereotactic conditions. Important prerequisites include patient immobilization, respiratory triggering and intraoperative imaging. Due to the high accuracy of probe positioning the virtual preoperative ablation plan can be precisely transferred into the real patient. A total of 350 patients with primary and secondary liver tumors have already successfully been treated with stereotactic radiofrequency ablation (SRFA). Due to its low complication rates and similar local recurrence and survival rates as compared to conventional surgery SRFA is an attractive alternative for the treatment for primary and secondary liver tumors. PMID:22117210

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

    ERIC Educational Resources Information Center

    Cardak, Osman; Dikmenli, Musa; Saritas, Ozge

    2008-01-01

    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…

  1. Value of Contrast-Enhanced Ultrasound in Guidance of Percutaneous Biopsy in Peripheral Pulmonary Lesions

    PubMed Central

    Dong, Yi; Mao, Feng; Wang, Wen-Ping; Ji, Zhen-Biao; Fan, Pei-Li

    2015-01-01

    Objectives. To investigate the value of contrast-enhanced ultrasound (CEUS) in guidance of percutaneous biopsy in peripheral pulmonary lesions. Methods. This study focused on 53 patients (male: 38, female: 15, and mean age: 55.7 years ± 10.7) with 53 single peripheral pulmonary lesions. Before core needle (16-gauge) percutaneous biopsy, CEUS were performed in all lesions, with injection of 2.4 mL SonoVue (Bracco, Italy). The contrast-enhancement pattern, display rate of internal necrosis (nonenhanced) and active (obviously enhanced) areas, biopsy success rate, and pathological diagnosis rate were recorded. Results. All the peripheral pulmonary lesions were proved pathologically as benign lesions (n = 7), primary malignancies (n = 41), or metastasis (n = 5). Forty (86.9%) malignant lesions and 4 (57.1%) benign lesions showed internal necrosis areas on CEUS. The detection rate and average size of internal necrosis areas had been significantly improved compared to conventional ultrasound (P < 0.05). After CEUS, core needle percutaneous biopsies were performed successfully in the active areas of all lesions. The sampling success rate and pathological diagnosis rate were 100% and 98.1%. Conclusions. CEUS before biopsy provided useful diagnostic information about peripheral pulmonary lesions. By depicting internal necrotic and active areas, it is a promising technique for guaranteeing the accuracy, success, and safety of core needle biopsy. PMID:26576426

  2. Enhancing Children's Success in Science Learning: An Experience of Science Teaching in Teacher Primary School Training

    ERIC Educational Resources Information Center

    Ferreira, Maria Eduarda; Porteiro, Ana Cláudia; Pitarma, Rui

    2015-01-01

    The Environmental Studies curricular area, taught at primary school level in Portugal, is a challenging context for curricular interdisciplinarity and the achievement of small-scale research and creative and innovative experiences, inside and outside the classroom. From that assumption, we present, under the master course of primary teacher…

  3. Percutaneous fixation of scaphoid fractures.

    PubMed

    Slade, J F; Jaskwhich, D

    2001-11-01

    The scaphoid proximal pole and waist fractures presented here were treated by a novel dorsal percutaneous technique with arthroscopic assistance. All fractures healed, with good final functional results and no complications. The advantages of the dorsal percutaneous approach to scaphoid fixation are: (1) the proximal-to-distal placement of the guide pin and screw allow for more precise placement along the central axis of the scaphoid, which decreases healing time and reduces risk of screw thread exposure. (2) The dorsal approach avoids injuring the vulnerable volar ligament anatomy. And (3) the insertion of the screw from the proximal to distal direction allows the more rigid fixation of proximal scaphoid fractures. Arthroscopy allows confirmation of fracture reduction and screw implantation as well as evaluation of concurrent ligament injuries not detected with standard imaging. Percutaneous K-wires act as joysticks to reduce and compress fracture fragments prior to fixation. The presented technique allows for early, rigid internal fixation with minimal associated morbidity. Patients successfully treated with this technique include those with stable and unstable acute fractures of the scaphoid at all locations, including the proximal pole. Nondisplaced fractures that present with delayed or fibrous union without evidence of avascular necrosis, cyst formation, or bony sclerosis may also be treated with this technique. This technique allows for faster rehabilitation and an earlier return to work or avocation without restriction once CT scan confirms a solid union. Some articles document extraordinary rapid healing by standard radiographs; however, we caution that scaphoid bone healing cannot accurately be determined without CT scan. Percutaneous, arthroscopically assisted internal fixation by a dorsal approach may be considered in all acute scaphoid fractures selected for surgical fixation. The dorsal guidewire permits dorsal and volar implantation of a cannulated screw along the central axis of the scaphoid. This technique permits the reduction of displaced fractures and the stable repair of fractures of the proximal pole. In addition, selected scaphoid fibrous union or delayed union may also be repaired, with realistic expectations of healing. The proven benefits of the percutaneous technique include decreased soft tissue trauma; arthroscopic visualization of the fracture, ensuring anatomic reduction; and stable fixation, allowing early physical rehabilitation. The theoretical benefits of the technique include decreased risk of interruption of the tenuous scaphoid blood supply. Percutaneous internal fixation of scaphoid fractures provides faster rehabilitation, earlier return to work, and quicker bony union in most patients. PMID:11775468

  4. Percutaneous Cryoablation for Liver Cancer

    PubMed Central

    Niu, Li-Zhi; Li, Jia-Liang; Xu, Ke-Cheng

    2014-01-01

    Based on the primary tumor site, liver cancer can be divided into two categories: (1) primary liver cancer and (2) metastatic cancer to the liver from a distant primary site. Guided cryoablation via many imaging methods induces iceball formation and tumor necrosisand is an attractive option for treating unresectable hepatocellular carcinoma (HCC) and metastatic liver cancer. There are several advantages to using cryoablation for the treatment of liver cancer: it can be performed percutaneously, intraoperatively, and laparoscopically; iceball formation can be monitored; it has little impact on nearby large blood vessels; and it induces a cryo-immunological response in situ. Clinically, primary research has shown that percutaneous cryoablation of liver cancer is relatively safe and efficient, and it can be combined with other methods, such as radiation therapy, chemotherapy, and immunology, to control disease. Although research is preliminary, cryosurgery is fast becoming an alternative treatment method for HCC or liver tumors. Here, we review the mechanisms of liver tumor cryoablation, cryoablation program selection, clinical efficiency, and complications following treatment. PMID:26355719

  5. Needle track seeding: A real hazard after percutaneous radiofrequency ablation for colorectal liver metastasis

    PubMed Central

    Liu, Shirley Yuk-Wah; Lee, Kit-Fai; Lai, Paul Bo-San

    2009-01-01

    Neoplastic needle track seeding following percutaneous radiofrequency ablation (RFA) of secondary liver tumors is exceedingly rare. Reports on cutaneous tumor seeding after percutaneous RFA for colorectal liver metastasis are even rarer in the literature. Here we report a case of a 46-year-old female who developed an ulcerating skin lesion along the needle track of a previous percutaneous RFA site around 6 mo after the procedure. The previous RFA was performed by the LeVeen® needle for a secondary liver tumor from a primary rectal cancer. The diagnosis of secondary skin metastasis was confirmed by fine needle aspiration cytology. The lesion was successfully treated with wide local excision. We believe that tumor seeding after percutaneous RFA in our patient was possibly related to its unfavorable subcapsular location and the use of an expansion-type needle. Hence, prophylactic ablation of the needle track should be performed whenever possible. Otherwise, alternative routes of tumor ablation such as laparoscopic or open RFA should be considered. PMID:19340913

  6. Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.

    PubMed

    Brkovic, Voin; Dobric, Milan; Beleslin, Branko; Giga, Vojislav; Vukcevic, Vladan; Stojkovic, Sinisa; Stankovic, Goran; Nedeljkovic, Milan A; Orlic, Dejan; Tomasevic, Miloje; Stepanovic, Jelena; Ostojic, Miodrag

    2013-08-01

    This study evaluated additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). All six scores were calculated in 209 consecutive STEMI patients undergoing pPCI. Primary end-point was the major adverse cardiovascular event (MACE--composite of cardiovascular mortality, non-fatal myocardial infarction and stroke); secondary end point was cardiovascular mortality. Patients were stratified according to the SYNTAX score tertiles (≤12; between 12 and 19.5; >19.5). The median follow-up was 20 months. Rates of MACE and cardiovascular mortality were highest in the upper tertile of the SYNTAX score (p < 0.001 and p = 0.003, respectively). SYNTAX score was independent multivariable predictor of MACE and cardiovascular mortality when added to GRACE, TIMI, ZWOLLE, and PAMI risk scores. However, the SYNTAX score did not improve the Cox regression models of MACE and cardiovascular mortality when added to the CADILLAC score. The SYNTAX score has predictive value for MACE and cardiovascular mortality in patients with STEMI undergoing primary PCI. Furthermore, SYNTAX score improves prognostic performance of well-established GRACE, TIMI, ZWOLLE and PAMI clinical scores, but not the CADILLAC risk score. Therefore, long-term survival in patients after STEMI depends less on detailed angiographical characterization of coronary lesions, but more on clinical characteristics, myocardial function and basic angiographic findings as provided by the CADILLAC score. PMID:23443340

  7. The Impact of SYNTAX Score of Non-Infarct-Related Artery on Long- Term Outcome among Patients with Acute ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

    PubMed Central

    Su, Min-I; Tsai, Cheng-Ting; Yeh, Hung-I; Chen, Chun-Yen

    2014-01-01

    Objective We investigated the impact of the severity of stenosis in a non-infarct-related artery (IRA) on the long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods Three hundred one consecutive patients (age: 59.7 ± 13.2 years, 85.5% men) underwent primary PCI during 2009–2012. Receiver operating characteristic curve analysis found the optimal cutoff for non-IRA SYNTAX score (SS) to be 2.5. We divided the patients into two groups according to this cutoff value. Results By multivariable analysis, non-IRA SS (≥2.5) was an independent predictor of major adverse cardiac events (hazard ratio [HR]: 2.15, 95% confidence interval [CI]: 1.21–3.79, P  =  0.008) and all-cause mortality (HR: 3.49, 95% CI: 1.13–10.8, P  =  0.03). However, the prediction of cardiovascular mortality had only borderline significance (HR: 3.29, 95% CI: 0.90–12.08, P  =  0.07). Conclusion STEMI patients treated with primary PCI and moderate to severe non-IRA stenosis (SS ≥2.5) have more subsequent cardiac events. Those populations should be treated with more aggressive preventive and medical management. PMID:25303079

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

    ERIC Educational Resources Information Center

    Negis-Isik, Ayse; Gursel, Musa

    2013-01-01

    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…

  9. Interaction of plant and earthworm during primary succession in heaps after coal

    NASA Astrophysics Data System (ADS)

    Roubíčková, Alena; Frouz, Jan

    2015-04-01

    These results of field manipulation experiment show that earthworms can remarkably influence vegetation succession on spoil heaps, namely promoting grasses and late succession species. This is in agreement with concurrent appearance of earthworms and some plant species typical for late-succession communities of meadows and forests aren't purely coincidental. On the other hand, facilitation of soil conditions by plant communities during succession is an important factor in earthworm distribution on the spoil heaps; earthworms showed a low survival on sites with sparse vegetation cover and thin litter layer, which means that their occurrence in certain stages of succession isn't determined only by migration abilities or passive dispersal. More field experiments are needed to test if earthworms could be used in directed succession management practices to speed up the natural rate of succession. Preliminary results from an experiment with introduction earthworms to a 20- year old, earthworm-free site indicate that colonization of this site from a single deposition of about 100 specimen of epigeic and 100 endogeic earthworms is slow and not very efficient. Results show that interaction between earthworm and vegetation are important in ecosystem development in post mining sites.

  10. Biodiversity, abundance, and activity of nitrogen-fixing bacteria during primary succession on a copper mine tailings.

    PubMed

    Huang, Li-Nan; Tang, Feng-Zao; Song, Yong-Sheng; Wan, Cai-Yun; Wang, Sheng-Long; Liu, Wei-Qiu; Shu, Wen-Sheng

    2011-12-01

    Microorganisms are important in soil development, inputs and biogeochemical cycling of nutrients and organic matter during early stages of ecosystem development, but little is known about their diversity, distribution, and function in relation to the chemical and physical changes associated with the progress of succession. In this study, we characterized the community structure and activity of nitrogen-fixing microbes during primary succession on a copper tailings. Terminal fragment length polymorphism (T-RFLP) and clone sequencing of nifH genes indicated that different N(2) -fixing communities developed under primary succession. Phylogenetic analysis revealed a diversity of nifH sequences that were mostly novel, and many of these could be assigned to the taxonomic divisions Proteobacteria, Cyanobacteria, and Firmicutes. Members of the Cyanobacteria, mostly affiliated with Nostocales or not closely related to any known organisms, were detected exclusively in the biological soil crusts and represented a substantial fraction of the respective diazotrophic communities. Quantitative PCR (and statistical analyses) revealed that, overall, copy number of nifH sequences increased with progressing succession and correlated with changes in physiochemical properties (including elementary elements such as carbon and nitrogen) and the recorded nitrogenase activities of the tailings. Our study provides an initial insight into the biodiversity and community structure evolution of N(2) -fixing microorganisms in ecological succession of mine tailings. PMID:22066852

  11. Percutaneous forefoot surgery.

    PubMed

    Bauer, T

    2014-02-01

    Percutaneous methods can be used to perform many surgical procedures on the soft tissues and bones of the forefoot, thereby providing treatment options for all the disorders and deformities seen at this site. Theoretical advantages of percutaneous surgery include lower morbidity rates and faster recovery with immediate weight bearing. Disadvantages are the requirement for specific equipment, specific requirements for post-operative management, and lengthy learning curve. At present, percutaneous hallux valgus correction is mainly achieved with chevron osteotomy of the first metatarsal, for which internal fixation and a minimally invasive approach (2 cm incision) seem reliable and reproducible. This procedure is currently the focus of research and evaluation. Percutaneous surgery for hallux rigidus is simple and provides similar outcomes to those of open surgery. Lateral metatarsal malalignment and toe deformities are good indications for percutaneous treatment, which produces results similar to those of conventional surgery with lower morbidity rates. Finally, fifth ray abnormalities are currently the ideal indication for percutaneous surgery, given the simplicity of the procedure and post-operative course, high reliability, and very low rate of iatrogenic complications. The most commonly performed percutaneous techniques are described herein, with their current indications, main outcomes, and recent developments. PMID:24412043

  12. The Impact of Admission Serum Creatinine Derived Estimated Glomerular Filtration Rate on Major Adverse Cardiac Events in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

    PubMed Central

    Uluganyan, Mahmut; Karaca, Gurkan; Ulutas, Turker Kemal; Ekmekci, Ahmet; Tusun, Eyup; Murat, Ahmet; Koroglu, Bayram; Uyarel, Huseyin; Bakhshaliyev, Nijad; Eren, Mehmet

    2016-01-01

    Background The impact of Cockroft-Gault (C-G) derived estimated glomerular filtration rate (eGFR) on mortality and major adverse cardiac events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was assessed. Methods A total of 884 patients were classified into four categories according to admission creatine derived eGFR: < 60, 60 - < 90, 90 - < 120, and ≥ 120 mL/min/1.73 m2. Results In-hospital and long-term MACEs were significantly higher in eGFR < 60 mL/min/1.73 m2 subgroup (P < 0.001 and P = 0.028). Multivariate analysis demonstrated 7.78-fold (95% CI: 0.91 - 66.8) higher mortality risk in eGFR < 60 mL/min/1.73 m2 subgroup. Conclusion As an easily applicable bedside method, C-G derived eGFR could be important for prediction of in-hospital and long-term mortality and MACE in STEMI patients undergoing primary PCI. PMID:26985253

  13. Percutaneous ablation of hepatocellular carcinoma: current status.

    PubMed

    McWilliams, Justin P; Yamamoto, Shota; Raman, Steven S; Loh, Christopher T; Lee, Edward W; Liu, David M; Kee, Stephen T

    2010-08-01

    Hepatocellular carcinoma (HCC) is an increasingly common disease with dismal long-term survival. Percutaneous ablation has gained popularity as a minimally invasive, potentially curative therapy for HCC in nonoperative candidates. The seminal technique of percutaneous ethanol injection has been largely supplanted by newer modalities, including radiofrequency ablation, microwave ablation, cryoablation, and high-intensity focused ultrasound ablation. A review of these modalities, including technical success, survival rates, and complications, will be presented, as well as considerations for treatment planning and follow-up. PMID:20656230

  14. Relationships: The Key to Successful Transition from Primary to Secondary School?

    ERIC Educational Resources Information Center

    Coffey, Anne

    2013-01-01

    Although change can be considered an inevitable part of life, the process itself can be both challenging and confronting. This is no less the case than for early adolescents as they negotiate the transition from primary to secondary school. Whilst this transition can be considered a regular part of the formal school experience, it can represent a…

  15. Embracing value co-creation in primary care services research: a framework for success.

    PubMed

    Janamian, Tina; Crossland, Lisa; Jackson, Claire L

    2016-04-18

    Value co-creation redresses a key criticism of researcher-driven approaches to research - that researchers may lack insight into the end users' needs and values across the research journey. Value co-creation creates, in a step-wise way, value with, and for, multiple stakeholders through regular, ongoing interactions leading to innovation, increased productivity and co-created outcomes of value to all parties - thus creating a "win more-win more" environment. The Centre of Research Excellence (CRE) in Building Primary Care Quality, Performance and Sustainability has co-created outcomes of value that have included robust and enduring partnerships, research findings that have value to end users (such as the Primary Care Practice Improvement Tool and the best-practice governance framework), an International Implementation Research Network in Primary Care and the International Primary Health Reform Conference. Key lessons learned in applying the strategies of value co-creation have included the recognition that partnership development requires an investment of time and effort to ensure meaningful interactions and enriched end user experiences, that research management systems including governance, leadership and communication also need to be "co-creative", and that openness and understanding is needed to work across different sectors and cultures with flexibility, fairness and transparency being essential to the value co-creation process. PMID:27078794

  16. Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

    PubMed Central

    Nakazone, Marcelo A.; Machado, Maurício N.; Barbosa, Raphael B.; Santos, Márcio A.; Maia, Lilia N.

    2010-01-01

    Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case. PMID:21052501

  17. Successful Treatment of Primary Cutaneous Mucormycosis Complicating Anti-TNF Therapy with a Combination of Surgical Debridement and Oral Posaconazole.

    PubMed

    Camargo, Jose F; Yakoub, Danny; Cho-Vega, Jeong Hee

    2015-10-01

    Lipid formulations of amphotericin B remain the first-line antifungal therapy for invasive mucormycosis. Posaconazole is an alternative for salvage therapy, but its use as primary therapy is not recommended due to the paucity of clinical data. Here we describe the case of a 57-year-old diabetic woman receiving etanercept and prednisone for the treatment of psoriatic arthritis who developed primary cutaneous mucormycosis after a minor gardening injury. Infection was successfully treated with aggressive surgical debridement followed by a 6-week course of the new delayed-release tablet formulation of posaconazole and temporary withholding of anti-TNF treatment. Primary antifungal therapy with posaconazole can be considered in selected cases of cutaneous mucormycosis. PMID:26112998

  18. Clinical Success Rate of Compomer and Amalgam Class II Restorations in First Primary Molars: A Two-year Study

    PubMed Central

    Ghaderi, Faezeh; Mardani, Ali

    2015-01-01

    Background and aims. The majority of failures in Class II amalgam restorations occur in the first primary molar teeth; in addition, use of compomer instead of amalgam for primary molar teeth restorations is a matter of concern. The aim ofthe present study was to compare the success rate of Class II compomer and amalgam restorations in the first primary molars. Materials and methods. A total of 17 amalgams and 17 compomer restorations were placed in 17 children based on a split-mouth design. Restorations were assessed at 12- and 24-month intervals for marginal integrity, the anatomic form and recurrent caries. Data were analyzed with SPSS 11. Chi-squared test was applied for the analysis. Statistical significance was set at P<0.05. Results. A total 34 restorations of 28 restorations (14 pairs) of the total restorations still survived after 24 months. Compomerrestorations showed significantly better results in marginal integrity. Recurrent caries was significantly lower incompomer restorations compared to amalgam restorations. Cumulative success rate at 24-month interval was significantlyhigher in compomer restorations compared to amalgam restorations. There was no statistically significant difference inanatomic form between the two materials. Conclusion. Compomer appears to be a suitable alternative to amalgam for Class II restorations in the first primary mo-lars. PMID:26236434

  19. Clinical Success Rate of Compomer and Amalgam Class II Restorations in First Primary Molars: A Two-year Study.

    PubMed

    Ghaderi, Faezeh; Mardani, Ali

    2015-01-01

    Background and aims. The majority of failures in Class II amalgam restorations occur in the first primary molar teeth; in addition, use of compomer instead of amalgam for primary molar teeth restorations is a matter of concern. The aim ofthe present study was to compare the success rate of Class II compomer and amalgam restorations in the first primary molars. Materials and methods. A total of 17 amalgams and 17 compomer restorations were placed in 17 children based on a split-mouth design. Restorations were assessed at 12- and 24-month intervals for marginal integrity, the anatomic form and recurrent caries. Data were analyzed with SPSS 11. Chi-squared test was applied for the analysis. Statistical significance was set at P<0.05. Results. A total 34 restorations of 28 restorations (14 pairs) of the total restorations still survived after 24 months. Compomerrestorations showed significantly better results in marginal integrity. Recurrent caries was significantly lower incompomer restorations compared to amalgam restorations. Cumulative success rate at 24-month interval was significantlyhigher in compomer restorations compared to amalgam restorations. There was no statistically significant difference inanatomic form between the two materials. Conclusion. Compomer appears to be a suitable alternative to amalgam for Class II restorations in the first primary mo-lars. PMID:26236434

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

    ERIC Educational Resources Information Center

    Brundrett, Mark; Rhodes, Christopher; Gkolia, Chrysanthi

    2006-01-01

    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…

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

    ERIC Educational Resources Information Center

    Woods, Charlotte; Armstrong, Paul; Pearson, Diana

    2012-01-01

    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…

  2. Predicting Success on a Bachelor of Arts Primary Education Degree Course

    ERIC Educational Resources Information Center

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

    2012-01-01

    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…

  3. LUPINE EFFECTS ON SOIL QUALITY AND FUNCTION DURING PRIMARY SUCCESSION AT MOUNT ST. HELENS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Lupines, early legume colonists of Mount St. Helens pyroclastic flows, are important mediators of above and belowground succession because they are sources of C and N that impact soil genesis, establishment of other plant species and soil microbial communities. Rates of N2 fixation by lupines can va...

  4. Successful treatment of primary intracranial sarcoma with the ICE chemotherapy regimen and focal radiation in children.

    PubMed

    Lafay-Cousin, Lucie; Lindzon, Gillian; Taylor, Michael D; Hader, Walter; Hawkins, Cynthia; Nordal, Robert; Laperriere, Normand; Laughlin, Suzanne; Bouffet, Eric; Bartels, Ute

    2016-03-01

    OBJECT Primary CNS sarcomas are very rare pediatric tumors with no defined standard of care. METHODS This study was a retrospective review of children diagnosed with a primary CNS sarcoma and treated at 2 Canadian tertiary care centers between 1995 and 2012. This report focuses on patients with cerebral hemispheric tumor location due to their specific clinical presentation. RESULTS Fourteen patients with nonmetastatic primary CNS sarcoma were identified; in 9 patients, tumors were located in the cerebral hemisphere and 7 of these patients presented with intratumoral hemorrhage. One infant who died of progressive disease postoperatively before receiving any adjuvant therapy was not included in this study. The final cohort therefore included 8 patients (4 males). Median patient age at diagnosis was 11.8 years (range 5.8-17 years). All tumors were located in the right hemisphere. Duration of symptoms prior to diagnosis was very short with a median of 2 days (range 3-7 days), except for 1 patient. Three (37.5%) patients had an underlying diagnosis of neurofibromatosis Type 1 (NF1). Gross-total resection was achieved in 5 patients. The dose of focal radiation therapy (RT) ranged between 54 Gy and 60 Gy. Concomitant etoposide was administered during RT. ICE (ifosfamide, carboplatin, etoposide) chemotherapy was administered prior to and after RT for a total of 6-8 cycles. Seven of the 8 patients were alive at a median time of 4.9 years (range 1.9-17.9 years) after treatment. CONCLUSIONS In this retrospective series, patients with primary CNS sarcomas located in the cerebral hemisphere most commonly presented with symptomatic acute intratumoral hemorrhage. Patients with NF1 were overrepresented. The combination of adjuvant ICE chemotherapy and focal RT provided encouraging outcomes. PMID:26588458

  5. Successful Treatment of an Adolescent with Naegleria fowleri Primary Amebic Meningoencephalitis

    PubMed Central

    Linam, W. Matthew; Ahmed, Mubbasheer; Cope, Jennifer R.; Chu, Craig; Visvesvara, Govinda S.; da Silva, Alexandre J.; Qvarnstrom, Yvonne; Green, Jerril

    2015-01-01

    Naegleria fowleri is a thermophilic free-living ameba that causes primary amebic meningoencephalitis. Infections are nearly always fatal. We present the third well-documented survivor of this infection in North America. Survival most likely resulted from a combination of early identification and treatment, use of a combination of antimicrobials including miltefosine and management of elevated intracranial pressure based on traumatic brain injury principles. PMID:25667249

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

    NASA Technical Reports Server (NTRS)

    Orr, James K.; Peltier, Daryl

    2010-01-01

    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.

  7. Successful childhood obesity management in primary care in Canada: what are the odds?

    PubMed Central

    Kuhle, Stefan; Doucette, Rachel; Piccinini-Vallis, Helena

    2015-01-01

    Background. The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada. Methods. Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada. Results. We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process. Conclusions. In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated. PMID:26623175

  8. Gopher mounds decrease nutrient cycling rates and increase adjacent vegetation in volcanic primary succession.

    PubMed

    Yurkewycz, Raymond P; Bishop, John G; Crisafulli, Charles M; Harrison, John A; Gill, Richard A

    2014-12-01

    Fossorial mammals may affect nutrient dynamics and vegetation in recently initiated primary successional ecosystems differently than in more developed systems because of strong C and N limitation to primary productivity and microbial communities. We investigated northern pocket gopher (Thomomys talpoides) effects on soil nutrient dynamics, soil physical properties, and plant communities on surfaces created by Mount St. Helens' 1980 eruption. For comparison to later successional systems, we summarized published studies on gopher effects on soil C and N and plant communities. In 2010, 18 years after gopher colonization, we found that gophers were active in ~2.5% of the study area and formed ~328 mounds ha(-1). Mounds exhibited decreased species density compared to undisturbed areas, while plant abundance on mound margins increased 77%. Plant burial increased total soil carbon (TC) by 13% and nitrogen (TN) by 11%, compared to undisturbed soils. Mound crusts decreased water infiltration, likely explaining the lack of detectable increases in rates of NO3-N, NH4-N or PO4-P leaching out of the rooting zone or in CO2 flux rates. We concluded that plant burial and reduced infiltration on gopher mounds may accelerate soil carbon accumulation, facilitate vegetation development at mound edges through resource concentration and competitive release, and increase small-scale heterogeneity of soils and communities across substantial sections of the primary successional landscape. Our review indicated that increases in TC, TN and plant density at mound margins contrasted with later successional systems, likely due to differences in physical effects and microbial resources between primary successional and older systems. PMID:25260998

  9. Primary proximal epithelioid sarcoma of the lung successfully treated with pneumonectomy and adjuvant chemotherapy.

    PubMed

    Saha, Debjit; Basu, Arnab; Maiti, Abhishek; Rodriguez, Estelamari

    2016-01-01

    Primary sarcomas of the lung and proximal epithelial sarcomas (PESs) are extremely rare. Inactivation of INI1 has been found in the majority of epithelioid sarcoma (ES). We report the third known case of a primary PES of the lung along with immunohistochemical data. A 41-year-old man with HIV infection, on highly active antiretroviral therapy, presented with haemoptysis, shortness of breath and progressive weight loss for 2 months. He was eventually diagnosed with stage IIA cT2bN0M0 grade-2 primary PES of the lung. This patient underwent pneumonectomy and adjuvant chemotherapy with ifosfamide and doxorubicin. He remains in remission 36 months since diagnosis. Our case stands to help other clinicians as treatment of such rare cases is often reliant on case reports. We also posit a possible pathogenic mechanism given a history of HIV infection in this patient. The association of INI1 mutation with other atypical sarcomas in patients with HIV infection merits further evaluation. PMID:27045049

  10. Percutaneous Endoscopic Gastrostomy (PEG)

    MedlinePlus

    ... Spanish) Patient Information (Chinese) Find a Doctor Patient Education ... (PEG) What is a PEG? PEG stands for percutaneous endoscopic gastrostomy, a procedure in which a flexible feeding tube is placed through the abdominal wall ...

  11. [Percutaneous Endoscopic Gastrostomy (PEG)].

    PubMed

    Rosenbaum, Anika; Riemann, Jrgen F; Schilling, Dieter

    2015-07-01

    Percutaneous endoscopic gastrostomy represents a standard for long-term enteral nutrition. In our detailed instructions indications and contra-indications of the method are listed and the correct procedure is explained step-by-step. PMID:26182256

  12. Distribution of Root-Associated Bacterial Communities Along a Salt-Marsh Primary Succession.

    PubMed

    Wang, Miao; Yang, Pu; Falcão Salles, Joana

    2015-01-01

    Proper quantification of the relative influence of soil and plant host on the root-associated microbiome can only be achieved by studying its distribution along an environmental gradient. Here, we used an undisturbed salt marsh chronosequence to study the bacterial communities associated with the soil, rhizosphere and the root endopshere of Limonium vulgare using 454-pyrosequencing. We hypothesize that the selective force exerted by plants rather than soil would regulate the dynamics of the root-associated bacterial assembly along the chronosequence. Our results showed that the soil and rhizosphere bacterial communities were phylogenetically more diverse than those in the endosphere. Moreover, the diversity of the rhizosphere microbiome followed the increased complexity of the abiotic and biotic factors during succession while remaining constant in the other microbiomes. Multivariate analyses showed that the rhizosphere and soil-associated communities clustered by successional stages, whereas the endosphere communities were dispersed. Interestingly, the endosphere microbiome showed higher turnover, while the bulk and rhizosphere soil microbiomes became more similar at the end of the succession. Overall, we showed that soil characteristics exerted an overriding influence on the rhizosphere microbiome, although plant effect led to a clear diversity pattern along the succession. Conversely, the endosphere microbiome was barely affected by any of the environmental measurements and very distinct from other communities. PMID:26779222

  13. Distribution of Root-Associated Bacterial Communities Along a Salt-Marsh Primary Succession

    PubMed Central

    Wang, Miao; Yang, Pu; Falcão Salles, Joana

    2016-01-01

    Proper quantification of the relative influence of soil and plant host on the root-associated microbiome can only be achieved by studying its distribution along an environmental gradient. Here, we used an undisturbed salt marsh chronosequence to study the bacterial communities associated with the soil, rhizosphere and the root endopshere of Limonium vulgare using 454-pyrosequencing. We hypothesize that the selective force exerted by plants rather than soil would regulate the dynamics of the root-associated bacterial assembly along the chronosequence. Our results showed that the soil and rhizosphere bacterial communities were phylogenetically more diverse than those in the endosphere. Moreover, the diversity of the rhizosphere microbiome followed the increased complexity of the abiotic and biotic factors during succession while remaining constant in the other microbiomes. Multivariate analyses showed that the rhizosphere and soil-associated communities clustered by successional stages, whereas the endosphere communities were dispersed. Interestingly, the endosphere microbiome showed higher turnover, while the bulk and rhizosphere soil microbiomes became more similar at the end of the succession. Overall, we showed that soil characteristics exerted an overriding influence on the rhizosphere microbiome, although plant effect led to a clear diversity pattern along the succession. Conversely, the endosphere microbiome was barely affected by any of the environmental measurements and very distinct from other communities. PMID:26779222

  14. Spatial structure of genetic variation and primary succession in the pioneer tree species Antirhea borbonica on La Réunion.

    PubMed

    Litrico, I; Ronfort, J; Verlaque, R; Thompson, J D

    2005-04-01

    In habitats where colonization and extinction are recurrent, the distribution of gene frequencies among patches of suitable habitat may reflect the age structure of different populations. In this study, we quantify population genetic structure for a pioneer tree species, Antirhea borbonica, in a chrono-sequence of primary succession on the lava flows of the Piton de La Fournaise volcano (La Réunion). Using microsatellite loci and amplified fragment length polymorphism (AFLP) markers, we quantified genetic variation within and among populations for early- and late-succession populations in a landscape where extinction and recolonization are recurrent (the 'Grand Brûlé') and for late-succession populations in a more stable landscape. This study produced three main results. First, we detected no evidence that founder events increase genetic differentiation among colonizing populations; F(ST) values among early- and among late-succession populations were similar. Second, we found no evidence for isolation by distance; genetic distance was not correlated with spatial distance within and among populations. Third, F(IS) values are consistently high in all populations, despite the fact that A. borbonica populations are functionally close to dioecy and thus expected to have an outcrossing mating system. Multiple colonization events from different sources may limit differentiation among young populations and spatial isolation may enhance differentiation among late-succession populations. Ecological processes acting during colonization may create the conditions for spatial aggregation within pioneer populations, and thus contribute to the high F(IS) values. PMID:15813795

  15. Successful radiotherapy in postoperative recurrence of a primary mediastinal yolk sac tumor: A case report

    PubMed Central

    Maebayashi, Toshiya; Aizawa, Takuya; Ishibashi, Naoya; Fukushima, Shoko; Saito, Tsutomu

    2015-01-01

    Abstract A woman in her 60s was evaluated for anterior chest pain. Computed tomography (CT) revealed a 50 mm mass with irregular contrast enhancement in the anterior mediastinum. α‐fetoprotein (AFP) level was elevated to 1188 ng/mL. A germ cell tumor was diagnosed, mostly comprising of a yolk sac tumor (YST). Two courses of chemotherapy with cisplatin (CDDP) and etoposide (VP16) were administered and surgical tumor resection was then performed. The final diagnosis was YST. CDDP and VP16 were continued postoperatively; however, because the AFP level increased about six months after surgery, the chemotherapy regimen was altered to bleomycin and CPT‐11. As the AFP again increased and a CT scan revealed tumor re‐enlargement, recurrent YST was diagnosed and radiotherapy was administered. The patient received a total of 60 Gy (2 Gy per fraction). The tumor started to shrink during radiotherapy and AFP levels decreased. By one month post‐radiotherapy, AFP levels had normalized and the tumor had disappeared. As of six years after radiotherapy, the patient remains alive without recurrence. Mediastinal YSTs are rare, and treatment usually includes surgery and preoperative and postoperative chemotherapy with cisplatin‐based regimens. Successful treatment with radiotherapy has occasionally been reported. Our patient showed recurrence of a YST after surgery and chemotherapy, but achieved long‐term survival after radiotherapy. Few patients with YST have undergone radiotherapy, but this approach was successful in our patient. In cases of postoperative recurrent YST resistant to chemotherapy, radiotherapy, together with salvage surgery, may offer a valuable option. PMID:27148423

  16. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications

    PubMed Central

    Halpern, Joshua; Mittal, Sameer; Pereira, Keith; Bhatia, Shivank; Ramasamy, Ranjith

    2016-01-01

    There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele. PMID:26658060

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

    PubMed Central

    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

    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. PMID:22690975

  18. Successful Chemo-Radiotherapy for Primary Anaplastic Large Cell Lymphoma of the Lung: A Case Report and Literature Review

    PubMed Central

    Zhao, Qian; Liu, Yongmei; Chen, Huijiao; Zhang, Yan; Du, Zedong; Wang, Jin; Wang, Yongsheng

    2016-01-01

    Patient: Male, 39 Final Diagnosis: Primary anaplastic large cell lymphoma of the lung Symptoms: Hemoptysis • palpitation • shortness of breath Medication: Cyclophosphamide • Doxorubicin • Vincristine • Prednisone Clinical Procedure: Chemoradiotherapy Specialty: Oncology Objective: Rare disease Background: Primary anaplastic large cell lymphoma (ALCL) of the lung is an extremely rare disease. This disease is a great challenge for pneumologists due to its nonspecific clinical presentations and radiological findings. Appropriate invasive biopsy and immunohistochemistry are important for diagnosis. There is currently no standard treatment. Case Report: We report a very rare case of primary pulmonary ALCL in a 39-year-old man. The clinical features, imaging, pathological findings, treatment outcomes, and prognosis, are described. Successful treatment outcomes were achieved after 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy followed by involved field radiotherapy of 54Gy/27f. The patient was disease-free after follow-up for 65 months. Conclusions: Our study found that chemotherapy (such as CHOP) is recognized as the first-line regimen for primary ALCL of the lung. For patients with dyspnea caused by a mass blocking the main bronchus, chemoradiotherapy may be a reasonable therapeutic option. The prognosis is better for patients with positive ALK staining. CD56(+), age older than 60 years, Ann Arbor stage III or IV, survivin expression, PS>2, and high serum LDH level and IPI scores are the poor prognostic factors of ALCL. PMID:26852792

  19. Percutaneous Decortication of Cystic Renal Disease

    PubMed Central

    Tehranchi, Ali

    2011-01-01

    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. PMID:22087364

  20. Percutaneous Endovascular Treatment of Chronic Iliac Artery Occlusion

    SciTech Connect

    Carnevale, F. C. De Blas, Mariano; Merino, Santiago; Egana, Jose M.; Caldas, Jose G.M.P.

    2004-09-15

    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.

  1. Primary succession of Acrididae (Orthoptera): Differences in displacement capacities in early and late colonizers of new habitats

    NASA Astrophysics Data System (ADS)

    Picaud, F.; Petit, D. P.

    2007-07-01

    Rehabilitated mine sites are suitable environments for the study of primary ecological succession. Following the monitoring of Plant and Orthoptera communities for 4 years on 7 sites in the Limousin region (France), covering 9 years of rehabilitation, three grasshopper seres were defined. It is expected that these seres are conditioned by both displacement capacities and reproductive characteristics. This study compares by field experiments the jumping flights and walking speed of the most abundant Caelifera belonging to the defined seres. A strong link emerged between the successional stages, the distances covered by jumping flights and sexual dimorphism. Walking speed is poorly related to the successional stage. We show that the high density of some species, as observed in the medium stage of succession, significantly reduces the walking distance of late colonisers, suggesting a mechanism that reduces further colonisation.

  2. Percutaneous Management of Abscess and Fistula Following Pancreaticoduodenectomy

    SciTech Connect

    AAssar, O. Sami; LaBerge, Jeanne M.; Gordon, Roy L.; Wilson, Mark W.; Mulvihill, Sean J.; Way, Lawrence W.; Kerlan, Robert K.

    1999-01-15

    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.

  3. Percutaneous diode laser disc nucleoplasty

    NASA Astrophysics Data System (ADS)

    Menchetti, P. P.; Longo, Leonardo

    2004-09-01

    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%.

  4. A case of primary central nervous system vasculitis diagnosed by second brain biopsy and treated successfully.

    PubMed

    Mizuno, Yuri; Shigeto, Hiroshi; Yamada, Takeshi; Maeda, Norihisa; Suzuki, Satoshi O; Kira, Jun-Ichi

    2016-03-30

    We report a case of primary central nervous system vasculitis (PCNSV) diagnosed by second brain biopsy. A 53-year-old man initially presented with left lateral gaze diplopia. Brain MRI revealed multiple enhanced lesions in the bilateral frontal lobe, bilateral basal ganglia, left cerebellum and brainstem. An initial brain biopsy of the right frontal lobe suggested immune-related encephalitis with angiocentric accumulation of chronic inflammatory cells, while malignant lymphoma could not be completely ruled out. The patient deteriorated despite being treated with repeated methylprednisolone pulse therapy, cyclophosphamide, and plasmapheresis. A second brain biopsy of the right temporal lobe was then performed. The biopsied specimens showed vascular wall disruption and fibrinoid necrosis with perivascular inflammatory infiltrates, mainly composed of CD8-positive T cells, and PCNSV was diagnosed. He was treated with high dose corticosteroids, in combination with methotrexate (8 mg/week), which reduced the brain lesions. As brain biopsy is an essential investigation for the histological diagnosis of PCNSV; subsequent biopsies may be required when a histopathological diagnosis has not been obtained by the first biopsy, and further aggressive therapy is being considered. PMID:26960271

  5. Lack of effect of oral beta-blocker therapy at discharge on long-term clinical outcomes of ST-segment elevation acute myocardial infarction after primary percutaneous coronary intervention.

    PubMed

    Ozasa, Neiko; Kimura, Takeshi; Morimoto, Takeshi; Hou, Heigen; Tamura, Toshihiro; Shizuta, Satoshi; Nakagawa, Yoshihisa; Furukawa, Yutaka; Hayashi, Yasuhiko; Nakao, Koichi; Matsuzaki, Masunori; Nobuyoshi, Masakiyo; Mitsudo, Kazuaki

    2010-11-01

    Beta-blocker therapy is recommended after ST-segment elevation acute myocardial infarction (STEMI) in current guidelines, although its efficacy in those patients who have undergone primary percutaneous coronary intervention (PCI) has not been adequately evaluated. Of 12,824 consecutive patients who underwent sirolimus-eluting stent implantation in the J-Cypher registry, we identified 910 patients who underwent PCI within 24 hours from onset of STEMI. Three-year outcomes were evaluated according to use of β blockers at hospital discharge (349 patients in β-blocker group and 561 patients in no-β-blocker group). Patients in the β-blocker group more frequently had hypertension, low left ventricular ejection fraction (LVEF), a left anterior descending artery infarct, and statin use than those in the no-β-blocker group. No difference was observed between the β-blocker and no-β-blocker groups in mortality (6.6% vs 6.6%, p = 0.85; propensity score adjusted hazard ratio 1.10, 95% confidence interval 0.64 to 1.90, p = 0.70) or in incidence of major adverse cardiac events (all-cause death, recurrent myocardial infarction, and heart failure hospitalization, 13.5% vs 12.1%, p = 0.91; hazard ratio 1.13, 95% confidence interval 0.76 to 1.66, p = 0.53). Better outcomes were observed in the β-blocker group than in the no-β-blocker group in a subgroup of patients with LVEF ≤40% (n = 125, death 6.4% vs 17.4%, p = 0.04; major adverse cardiac events 14.5% vs 31.8%, p = 0.009). In conclusion, β-blocker therapy was not associated with better 3-year clinical outcomes in patients with STEMI who underwent primary PCI and had preserved LVEF. PMID:21029817

  6. Penetrating intracranial nail-gun injury to the middle cerebral artery: A successful primary repair

    PubMed Central

    Isaacs, Albert M.; Yuh, Sung-Joo; Hurlbert, R. John; Mitha, Alim P.

    2015-01-01

    Background: Penetrating nail-gun injuries to the head are rare, however, the incidence has been gradually rising over the last decade. While there is a large volume of case reports in the literature, there are only a few incidences of cerebrovascular injury. We present a case of a patient with a nail-gun injury to the brain, which compromised the cerebral vasculature. In this article, we present the case, incidence, pathology, and a brief literature review of penetrating nail-gun injuries to highlight the principles of management pertaining to penetration of cerebrovascular structures. Case Description: A 26-year-old male presented with a penetrating nail-gun injury to his head. There were no neurological deficits. Initial imaging revealed that the nail had penetrated the cranium and suggested the vasculature to be intact. However, due to the proximity of the nail to the circle of Willis the operative approach was tailored in anticipation of a vascular injury. Intraoperatively removal of the foreign body demonstrated a laceration to the M1 branch of the middle cerebral artery (MCA), which was successfully repaired. Conclusion: To our knowledge, this is the first reported case of a vascular arterial injury to the MCA from a nail-gun injury. It is imperative to have a high clinical suspicion for cerebrovascular compromise in penetrating nail-gun injuries even when conventional imaging suggests otherwise. PMID:26500798

  7. Successful GP intervention with frequent attenders in primary care: randomised controlled trial

    PubMed Central

    Bellón, Juan Ángel; Rodríguez-Bayón, Antonina; de Dios Luna, Juan; Torres-González, Francisco

    2008-01-01

    Background Frequent attenders to GP clinics can place an unnecessary burden on primary care. Interventions to reduce frequent attendance have had mixed results. Aim To assess the effectiveness of a GP intervention to reduce frequent-attender consultations. Design of study Randomised controlled trial with frequent attenders divided into an intervention group and two control groups (one control group was seen by GPs also providing care to patients undergoing the intervention). Setting A health centre in southern Spain. Method Six GPs and 209 randomly-selected frequent attenders participated. Three GPs were randomly allocated to perform the new intervention: of the 137 frequent attenders registered with these three GPs, 66 were randomly allocated to receive the intervention (IG) and 71 to a usual care control group (CG2). The other three GPs offered usual care to the other 72 frequent attenders (CG1). The main outcome measure was the total number of consultations 1 year post-intervention. Baseline measurements were recorded of sociodemographic characteristics, provider–user interface, chronic illnesses, and psychosocial variables. GPs allocated to the new intervention received 15 hours' training which incorporated biopsychosocial, organisational, and relational approaches. After 1 year of follow-up frequent attenders were contacted. An intention-to-treat analysis was used. Results A multilevel model was built with three factors: time, patient, and doctor. After adjusting for covariates, the mean number of visits at 1 year in IG was 13.10 (95% confidence interval [CI] = 11.39 to 14.94); in the CG1 group was 19.37 (95% CI = 17.31 to 21.55); and in the CG2 group this was 16.72 (95% CI =14.84 to 18.72). Conclusion The new intervention with GPs resulted in a significant and relevant reduction in frequent-attender consultations. Although further trials are needed, this intervention is recommended to GPs interested in reducing consultations by their frequent attenders. PMID:18482486

  8. [Percutaneous endoscopic gastrostomy].

    PubMed

    Frimberger, E

    1993-09-01

    Probes for the percutaneous endoscopic gastrostomy (PEG) are placed by pull-through methods or by direct puncture of the stomach. Depending on the length of the interior branch of the probe, gastral or (duodeno-) jejunal feeding is possible; the latter may also be achieved by direct percutaneous endoscopic jejunostomy (PEJ). Small calibre endoscopes can be introduced via large-bore PEG probes; after the extraction of such a probe the resulting fistulous tract itself may also be used für percutaneous endoscopy by using pediatric endoscopes. The usual external fixation of the probes with compresses fixed by sticking plaster creates a humid chamber favouring the growth of bacteria. This can be avoided by an open well-aired fixation using a ring. Indications for the probes are prolonged enteral feeding in patients enable to swallow or to consume adequate nutrition orally, decompression in gastrointestinal obstruction, instillation of percutaneously drained bile and percutaneous endoscopy, e.g. for repeated retrograde laser application as a palliative treatment in patients with tumour obstruction of the oesophagus. Complications due to PEG/PEJ probes are relatively rare; severe are aspiration in cases of gastro-oesophageal reflux and peritonitis. PMID:8251742

  9. Regime Shift by an Exotic Nitrogen-Fixing Shrub Mediates Plant Facilitation in Primary Succession

    PubMed Central

    Stinca, Adriano; Chirico, Giovanni Battista; Incerti, Guido; Bonanomi, Giuliano

    2015-01-01

    Ecosystem invasion by non-native, nitrogen-fixing species is a global phenomenon with serious ecological consequences. However, in the Mediterranean basin few studies addressed the impact of invasion by nitrogen-fixing shrubs on soil quality and hydrological properties at local scale, and the possible effects on succession dynamics and ecosystem invasibility by further species. In this multidisciplinary study we investigated the impact of Genista aetnensis (Biv.) DC., an exotic nitrogen-fixing shrub, on the Vesuvius Grand Cone (Southern Italy). Specifically, we tested the hypotheses that the invasion of G. aetnensis has a significant impact on soil quality, soil hydrological regime, local microclimate and plant community structure, and that its impact increases during the plant ontogenetic cycle. We showed that G. aetnensis, in a relatively short time-span (i.e. ~ 40 years), has been able to build-up an island of fertility under its canopy, by accumulating considerable stocks of C, N, and P in the soil, and by also improving the soil hydrological properties. Moreover, G. aetnensis mitigates the daily range of soil temperature, reducing the exposure of coexisting plants to extremely high temperatures and water loss by soil evaporation, particularly during the growing season. Such amelioration of soil quality, coupled with the mitigation of below-canopy microclimatic conditions, has enhanced plant colonization of the barren Grand Cone slopes, by both herbaceous and woody species. These results suggest that the invasion of G. aetnensis could eventually drive to the spread of other, more resource-demanding exotic species, promoting alternative successional trajectories that may dramatically affect the local landscape. Our study is the first record of the invasion of G. aetnensis, an additional example of the regime shifts driven by N-fixing shrubs in Mediterranean region. Further studies are needed to identity specific management practices that can limit the spread and impacts of this species. PMID:25835015

  10. Keys to success for a school-based malaria control program in primary schools in Thailand.

    PubMed

    Okabayashi, Hironori; Thongthien, Pimpimon; Singhasvanon, Pratap; Waikagul, Jitra; Looareesuwan, Sornchai; Jimba, Masamine; Kano, Shigeyuki; Kojima, Somei; Takeuchi, Tsutomu; Kobayashi, Jun; Tateno, Seiki

    2006-06-01

    School-based malaria control has been recognized as a new approach for the control of this disease in the Greater Mekong Subregion since 2000. We evaluated a school-based malaria control program near the western border of Thailand using a before-after intervention study. The major intervention activities included teacher training with specialized malaria teaching materials and participatory learning methods. The target population was 17 school principals, 111 teachers and 852 schoolchildren of grade 3, 4, and 5 in 17 schools. After the intervention, the teachers taught about malaria more actively than before. The teachers who could design a lesson plan on malaria increased from 30.7% to 47.7% (p=0.015) and the teachers who had taught about malaria increased from 71.9% to 84.3% (p=0.035). As a result of the program, the schoolchildren changed their behavior positively towards malaria prevention with significant difference in 6 of 7 questions. For example, the schoolchildren 'who always took care of mosquito bites' increased from 42.7% to 62.1% (p<0.001) and the schoolchildren 'who always reported their parents or teachers when they had fever' increased from 36.0% to 56.0% (p<0.001). In conclusion, the keys to a successful intervention lie in good teaching materials and a participatory approach utilizing the well-established Thailand's school health system. Beyond Thailand, school-based malaria control could be applied to other Greater Mekong Subregion countries with careful analysis of school health context in each country. PMID:16406685

  11. Regime shift by an exotic nitrogen-fixing shrub mediates plant facilitation in primary succession.

    PubMed

    Stinca, Adriano; Chirico, Giovanni Battista; Incerti, Guido; Bonanomi, Giuliano

    2015-01-01

    Ecosystem invasion by non-native, nitrogen-fixing species is a global phenomenon with serious ecological consequences. However, in the Mediterranean basin few studies addressed the impact of invasion by nitrogen-fixing shrubs on soil quality and hydrological properties at local scale, and the possible effects on succession dynamics and ecosystem invasibility by further species. In this multidisciplinary study we investigated the impact of Genista aetnensis (Biv.) DC., an exotic nitrogen-fixing shrub, on the Vesuvius Grand Cone (Southern Italy). Specifically, we tested the hypotheses that the invasion of G. aetnensis has a significant impact on soil quality, soil hydrological regime, local microclimate and plant community structure, and that its impact increases during the plant ontogenetic cycle. We showed that G. aetnensis, in a relatively short time-span (i.e. ~ 40 years), has been able to build-up an island of fertility under its canopy, by accumulating considerable stocks of C, N, and P in the soil, and by also improving the soil hydrological properties. Moreover, G. aetnensis mitigates the daily range of soil temperature, reducing the exposure of coexisting plants to extremely high temperatures and water loss by soil evaporation, particularly during the growing season. Such amelioration of soil quality, coupled with the mitigation of below-canopy microclimatic conditions, has enhanced plant colonization of the barren Grand Cone slopes, by both herbaceous and woody species. These results suggest that the invasion of G. aetnensis could eventually drive to the spread of other, more resource-demanding exotic species, promoting alternative successional trajectories that may dramatically affect the local landscape. Our study is the first record of the invasion of G. aetnensis, an additional example of the regime shifts driven by N-fixing shrubs in Mediterranean region. Further studies are needed to identity specific management practices that can limit the spread and impacts of this species. PMID:25835015

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

    SciTech Connect

    Thanos, Loukas; Mylona, Sofia; Giannoulakos, Nikolaos; Ptohis, Nikolaos; Galani, Panagiota; Pomoni, Maria

    2008-11-15

    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.

  13. Ectopic Varices in the Gastrointestinal Tract: Short- and Long-Term Outcomes of Percutaneous Therapy

    SciTech Connect

    Macedo, Thanila A. Andrews, James C.; Kamath, Patrick S.

    2005-04-15

    To evaluate the results of percutaneous management of ectopic varices, a retrospective review was carried out of 14 patients (9 men, 5 women; mean age 58 years) who between 1992 and 2001 underwent interventional radiological techniques for management of bleeding ectopic varices. A history of prior abdominal surgery was present in 12 of 14 patients. The interval between the surgery and percutaneous intervention ranged from 2 to 38 years. Transhepatic portal venography confirmed ectopic varices to be the source of portal hypertension-related gastrointestinal bleeding. Embolization of the ectopic varices was performed by a transhepatic approach with coil embolization of the veins draining into the ectopic varices. Transjugular intrahepatic portosystemic shunt (TIPS) was performed in the standard fashion. Eighteen procedures (12 primary coil embolizations, 1 primary TIPS, 2 re-embolizations, 3 secondary TIPS) were performed in 13 patients. One patient was not a candidate for percutaneous treatment. All interventions but one (re-embolization) were technically successful. In 2 of 18 interventions, re-bleeding occurred within 72 hr (both embolization patients). Recurrent bleeding (23 days to 27 months after initial intervention) was identified in 9 procedures (8 coil embolizations, 1 TIPS due to biliary fistula). One patient had TIPS revision because of ultrasound surveillance findings. New encephalopathy developed in 2 of 4 TIPS patients. Percutaneous coil embolization is a simple and safe treatment for bleeding ectopic varices; however, recurrent bleeding is frequent and reintervention often required. TIPS can offer good control of bleeding at the expense of a more complex procedure and associated risk of encephalopathy.

  14. Primary succession of soil enzyme activity and heterotrophic microbial communities along the chronosequence of Tianshan Mountains No. 1 Glacier, China.

    PubMed

    Zeng, Jun; Wang, Xiao-Xia; Lou, Kai; Eusufzai, Moniruzzaman Khan; Zhang, Tao; Lin, Qing; Shi, Ying-Wu; Yang, Hong-Mei; Li, Zhong-Qing

    2015-02-01

    We investigated the primary successions of soil enzyme activity and heterotrophic microbial communities at the forefields of the Tianshan Mountains No. 1 Glacier by investigating soil microbial processes (microbial biomass and nitrogen mineralization), enzyme activity and community-level physiological profiling. Soils deglaciated between 1959 and 2008 (0, 5, 17, 31 and 44 years) were collected. Soils >1,500 years in age were used as a reference (alpine meadow soils). Soil enzyme activity and carbon-source utilization ability significantly increased with successional time. Amino-acid utilization rates were relatively higher in early, unvegetated soils (0 and 5 years), but carbohydrate utilization was higher in later stages (from 31 years to the reference soil). Discriminant analysis, including data on microbial processes and soil enzyme activities, revealed that newly exposed soils (0-5 years) and older soils (17-44 years) were well-separated from each other and obviously different from the reference soil. Correlation analysis revealed that soil organic carbon, was the primary factor influencing soil enzyme activity and heterotrophic microbial community succession. Redundancy analysis suggested that soil pH and available P were also affect microbial activity to a considerable degree. Our results indicated that glacier foreland soils have continued to develop over 44 years and soils were significantly affected by the geographic location of the glacier and the local topography. Soil enzyme activities and heterotrophic microbial communities were also significantly influenced by these variables. PMID:25472706

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

    NASA Astrophysics Data System (ADS)

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

    2014-10-01

    Initial soil development and enhanced nutrient retention are often important underlying environmental factors during primary succession. We quantified the accumulation rates of nitrogen (N) and soil organic matter (SOM) in a 37-year-long chronosequence of Leymus arenarius dunes on the pristine volcanic island Surtsey in order to illuminate the spatiotemporal patterns in their build-up. 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 a 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: a 1 g m-2 increase in soil N led on average to a 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.

  16. Long-term prognostic value of admission haemoglobin A1c (HbA1c) levels in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

    PubMed Central

    Akgul, Ozgur; Cakmak, Huseyin Altug; Erturk, Mehmet; Surgit, Ozgur; Celik, Omer; Ozturk, Derya; Uzun, Fatih; Akkaya, Emre; Yildirim, Aydın

    2014-01-01

    Introduction Many studies have reported the diagnostic and prognostic value of haemoglobin A1c (HbA1c) levels in patients with acute coronary syndrome. However, the short- and long-term prognostic value of HbA1c level in patients with ST elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is controversial. Aim To investigate whether admission HbA1c level has a prognostic value for in-hospital, short-, and long-term cardiovascular (CV) mortality and major adverse cardiovascular events in patients with STEMI undergoing primary PCI. Material and methods This prospective study included 443 consecutive patients with STEMI who underwent primary PCI between September 2010 and July 2012. The patients were divided into three groups based on admission HbA1c levels: group I (HbA1c ≤ 5.6%), group II (HbA1c 5.7–6.4%), and group III (HbA1c ≥ 6.5%). The in-hospital, 1-month, and 1-year CV events of all 3 patient groups were followed up. Results A significant association was found between HbA1c level and 1-year primary clinical outcomes, including CV mortality, non-fatal reinfarction, and stroke (p = 0.037). In addition, age, Killip class > 1, and left ventricular ejection fraction were found to be independent predictors of long-term CV mortality in multivariate analysis (hazard ratios (95% confidence interval) 1.081 (1.020–1.146), 4.182 (1.171–14.935), and 0.832 (0.752–0.920); p = 0.009, p = 0.028, and p < 0.001, respectively). Conclusions In this study, we demonstrated that increased admission HbA1c levels were associated with higher rates of major adverse CV events, including mortality, non-fatal reinfarction, and stroke, in patients with STEMI who underwent primary PCI. PMID:25489302

  17. Successful Chemo-Radiotherapy for Primary Anaplastic Large Cell Lymphoma of the Lung: A Case Report and Literature Review.

    PubMed

    Zhao, Qian; Liu, Yongmei; Chen, Huijiao; Zhang, Yan; Du, Zedong; Wang, Jin; Wang, Yongsheng

    2016-01-01

    BACKGROUND Primary anaplastic large cell lymphoma (ALCL) of the lung is an extremely rare disease. This disease is a great challenge for pneumologists due to its nonspecific clinical presentations and radiological findings. Appropriate invasive biopsy and immunohistochemistry are important for diagnosis. There is currently no standard treatment. CASE REPORT We report a very rare case of primary pulmonary ALCL in a 39-year-old man. The clinical features, imaging, pathological findings, treatment outcomes, and prognosis, are described. Successful treatment outcomes were achieved after 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy followed by involved field radiotherapy of 54Gy/27f. The patient was disease-free after follow-up for 65 months. CONCLUSIONS Our study found that chemotherapy (such as CHOP) is recognized as the first-line regimen for primary ALCL of the lung. For patients with dyspnea caused by a mass blocking the main bronchus, chemo-radiotherapy may be a reasonable therapeutic option. The prognosis is better for patients with positive ALK staining. CD56(+), age older than 60 years, Ann Arbor stage III or IV, survivin expression, PS>2, and high serum LDH level and IPI scores are the poor prognostic factors of ALCL. PMID:26852792

  18. Total Percutaneous Aortic Repair: Midterm Outcomes

    SciTech Connect

    Bent, Clare L. Fotiadis, Nikolas; Renfrew, Ian; Walsh, Michael; Brohi, Karim; Kyriakides, Constantinos; Matson, Matthew

    2009-05-15

    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.

  19. Percutaneous lumbar disc decompression.

    PubMed

    Singh, Vijay; Derby, Richard

    2006-04-01

    Chronic low back pain is a major social, economic, and healthcare issue in the United States. Various techniques are utilized in managing discogenic pain, with or without disc herniation. Percutaneous techniques are rapidly replacing traditional open surgery in operations requiring discectomy, decompression, and fusion. The percutaneous access to the disc was first used in the 1950s to biopsy the disc with needles. Percutaneous access to the disc using endoscopic techniques was developed in the 1970s. Technical advances in the use of intradiscal therapies led to the development of intradiscal electrothermal annuloplasty (IDET), DISC Nucleoplasty, and DeKompressor, along with laser-assisted, endoscopic, and Nucleotome disc decompressions. The indications for percutaneous lumbar disc decompression include low back and lower extremity pain caused by a symptomatic disc. Internal disc disruptions and disc herniations are common causes of low back and/or lower extremity pain which may become chronic, if not diagnosed and treated. Annular tears lead to migration of the nuclear material and deranged internal architecture. In the chronically damaged intervertebral disc, leakage of nuclear material from annular tears can initiate, promote, and continue the inflammatory process and delay or stop recovery of vital remaining intradiscal tissue. The most often stated goal of central nuclear decompression is to lower the pressure in the nucleus and to allow room for the herniated fragment to implode inward. Provocative discography prior to percutaneous lumbar disc decompression is recommended. Percutaneous disc decompression may result in a small number of complications but occasionally, these could be serious. PMID:16703975

  20. Minimally Invasive Management of Biliary Tract Injury Following Percutaneous Nephrolithotomy

    PubMed Central

    Rahnemai-Azar, Ata A; Rahnemaiazar, Amir A; Naghshizadian, Rozhin; Cohen, Jacob H; Naghshizadian, Iman; Gilchrist, Brian F; Farkas, Daniel T

    2014-01-01

    Introduction: Percutaneous nephrolithotomy is generally considered a safe option for the management of large complex or infectious upper urinary tract calculi. Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality, especially in cases where biliary peritonitis develops. All reported cases of biliary tract injury have been managed by either open or laparoscopic cholecystectomy. Case Presentation: Herein for the first time, we report a 39-year old woman with biliary tract injury following percutaneous nephrolithotomy who was managed less invasively by insertion of a percutaneous cholecystostomy tube. The patient was discharged home shortly thereafter, and the tube was later removed at a follow up visit after a normal cholangiogram. Conclusions: Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality. If a biliary tract injury is suspected during percutaneous renal procedures, diverting the bile away from the leak may resolve the problem without the need for a cholecystectomy. Ideally this can be done with ERCP and a stent, but in cases where this is not technically feasible; a percutaneous cholecystostomy can be successful at accomplishing the same result. PMID:25695033

  1. Primary Percutaneous Coronary Intervention by a Stentless Technique for Acute Myocardial Infarction with Idiopathic Thrombocytopenic Purpura: A Case Report and Review of the Literature.

    PubMed

    Fujino, Susumu; Niwa, Satoru; Fujioka, Kensuke; Mabuchi, Tomohito; Noji, Yoshihiro; Yamaguchi, Masato; Aoyama, Takahiko

    2016-01-01

    A 78-year-old man who had been diagnosed with idiopathic thrombocytopenic purpura (ITP) was admitted to our hospital with chest pain, cold sweating and nausea. An electrocardiogram and echocardiogram revealed an ST elevated acute lateral myocardial infarction. He underwent an immediate cardiac catheterization. An occluded left circumflex artery was detected by coronary angiography. Reperfusion was performed successfully by non-slip element balloon angioplasty alone, without stenting, to avoid prolonged dual anti-platelet therapy. In this report we discussed the management strategies of acute myocardial infarction in a patient with concomitant ITP. PMID:26781014

  2. Percutaneous endoscopic gastrostomy in children: a single center experience

    PubMed Central

    Koca, Tuğba; Sivrice, Ayşe Çiğdem; Dereci, Selim; Duman, Levent; Akçam, Mustafa

    2015-01-01

    Aim: The aim of this study was to evaluate the demographic data and complication rates in children who had undergone percutaneous endoscopic gastrostomy in a three-year period in our Division of Pediatric Gastroenterology and to interrogate parental satisfaction. Material and Methods: The demographic data, complications and follow-up findings of the patients who had undergone percutaneous endoscopic gastrostomy between March 2011 and March 2014 were examined retrospectively using medical files. Results: Forty seven percutaneous endoscopic gastrostomy and percutaneous endoscopic gastrostomy related procedures were performed in 34 children during a three-year period. The median age of the patients was 2.25 years (3 months-16 years, first and third quartiles=1.0–6.0) and the mean body weight was 13.07±8.6 kg (3 kg-47 kg). Before percutaneous endoscopic gastrostomy procedure, the mean weight z score was −2.26±1.2 (−5–0) and the mean height z score was −2.25±0.96 (−3.85–0.98). The follow-up mean height and weight Z scores at the 12th month after the percutaneous endoscopic gastrostomy procedure could be reached in 24 patients. A significant increase in the mean weight Z score from −2.41 to −1,07 (p=0.000) and in the mean height Z score from −2.29 to −1.99 (p=0.000) was found one year after percutaneous endoscopic gastrostomy catheter was placed in these 24 patients. Patients with neurological and metabolic diseases constituted the majority (64.7% and 26.5% respectively). Peritoneal leakage of food was detected in one patient and local stoma infections were detected in three patients after the procedure. During the follow up period, “Buried bumper syndrome” was observed in one patient. Following percutaneous endoscopic gastrostomy, the number of patients using anti-reflux medication increased from 16 (47.1%) to 18 (52.9%) (p=0.62). One patient with cerebral palsy who had aspiration pneumonia after percutaneous endoscopic gastrostomy insertion had undergone Nissen fundoplication. Percutaneous endoscopic gastrostomy tube was removed in a patient. The parents had positive views related with percutaneous endoscopic gastrostomy after the procedure. Conclusions: Percutaneous endoscopic gastrostomy is a substantially successful and reliable method in infants as well as in children and adolescents. The parents had positive views related with percutaneous endoscopic gastrostomy after the procedure. PMID:26884690

  3. [Robotic-enhanced percutaneous coronary revascularization].

    PubMed

    Weisz, Giora

    2014-12-01

    Percutaneous revascularization (PCI) has made significant technological progress in the last four decades. Despite advances in the safety and efficacy of the coronary revascularization, interventional cardiologists have to cope with occupational hazards including exposure to radiation, cataract, and orthopedic problems. Robotic systems that enable distant navigation were developed to address the risks and challenges that are associated with percutaneous revascularization. The PRECISE multi-center study with robotic-enhanced PCI demonstrated technical success of 98.7% and clinical success of 97.5%. The use of the robotic-enhanced PCI system reduced operator radiation exposure by 95%. Patient benefits include precise segment measurements, improved stability of the intracoronary devices, and reduction of contrast media volume. Robotic-enhanced PCI is a promising advancement in interventional cardiology. PMID:25654916

  4. Embolic protection devices in percutaneous coronary intervention.

    PubMed

    Meneguz Moreno, Rafael A; Costa, José R; Costa, Ricardo A; Abizaid, Alexandre

    2016-06-01

    Clinical benefit of percutaneous coronary intervention (PCI) depends on both angiographic success at lesion site as well as the restoration of adequate macro and microvascular perfusion. The pathophysiology of embolization from coronary lesions during PCI is multifactorial, being more frequently observed in patients with acute coronary syndrome and in those with lesions at saphenous vein graft (SVG). In this population, despite successful epicardial intervention, distal tissue perfusion may still be absent in up to a quarter of all PCI. Multiple devices and pharmacologic regimens have been developed and refined in an attempt to protect the microvascular circulation during PCI. Among them, embolic protection devices have raised as an attractive adjunctive toll due to their ability to retain debris and potentially prevent distal embolization, reducing major adverse cardiac events. Currently, their use has been validated for the treatment of SVG lesions but failed to show effectiveness in the percutaneous approach of acute coronary syndrome patients, including those with ST elevation myocardial infarction. PMID:27007782

  5. Microcatheter use for difficult percutaneous biliary procedures.

    PubMed

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

    2008-01-01

    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

  6. 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

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

    2010-01-01

    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. PMID:21049006

  7. Percutaneous needle decompression in treatment of malignant small bowel obstruction

    PubMed Central

    Jiang, Ting-Hui; Sun, Xian-Jun; Chen, Yue; Cheng, Hui-Qin; Fang, Shi-Ming; Jiang, Hao-Sheng; Cao, Yan; Liu, Bing-Yan; Wu, Shao-Qiu; Mao, Ai-Wu

    2015-01-01

    AIM: To investigate the efficacy and safety of percutaneous needle decompression in the treatment of malignant small bowel obstruction (MSBO). METHODS: A prospective analysis of the clinical data of 52 MSBO patients undergoing percutaneous needle decompression was performed. RESULTS: Percutaneous needle decompression was successful in all 52 patients. Statistically significant differences were observed in symptoms such as vomiting, abdominal distension and abdominal pain before and after treatment (81.6% vs 26.5%, 100% vs 8.2%, and 85.7% vs 46.9%, respectively; all P < 0.05). The overall significantly improved rate was 19.2% (11/52) and the response rate was 94.2% (49/52) using decompression combined with nasal tube placement, local arterial infusion of chemotherapy and nutritional support. During the one-month follow-up period, puncture-related complications were acceptable. CONCLUSION: Percutaneous needle intestinal decompression is a safe and effective palliative treatment for MSBO. PMID:25741156

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

    PubMed Central

    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

    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. PMID:24771886

  9. Primary hepatic actinomycosis presenting as purulent pericarditis with cardiac tamponade.

    PubMed

    Llenas-García, J; Lalueza-Blanco, A; Fernández-Ruiz, M; Villar-Silva, J; Ochoa, M; Lozano, F; Lizasoain, M; Aguado, J M

    2012-06-01

    Cardiac tamponade constitutes an exceptional form of actinomycosis. We describe a case of primary hepatic actinomycosis presenting as purulent pericarditis with cardiac tamponade in a 20-year-old patient with previous esophagectomy and colonic interposition, successfully managed by computed tomography-guided percutaneous drainage and a prolonged course of antibiotic treatment. Actinomyces israelii was identified in the pericardial fluid by 16S rRNA gene sequencing. The literature on the simultaneous presentation of cardiac and hepatic actinomycosis is reviewed. PMID:22002733

  10. Relationship between ST-segment resolution and anterior infarct size after primary percutaneous coronary intervention: analysis from the INFUSE-AMI trial

    PubMed Central

    Brener, Sorin J; Maehara, Akiko; Witzenbichler, Bernard; Biviano, Angelo; Godlewski, Jacek; Parise, Helen; Dambrink, Jan-Henk; Mehran, Roxana; Gibson, C Michael; Stone, Gregg W

    2014-01-01

    Aims: ST-segment resolution (STR) after reperfusion therapy has been shown to correlate with prognosis in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether acute ECG measurements also correlate with ultimate infarct size. Methods and Results: The INFUSE-AMI trial randomized 452 patients with anterior STEMI to intracoronary bolus abciximab vs. no abciximab, and to thrombus aspiration vs. no aspiration. Infarct size as percentage of total LV mass was calculated by cardiac magnetic resonance imaging (MRI) 30 days post intervention. Five ECG methods were analysed for their ability to predict MRI infarct mass: (1) summed STR across all infarct-related ECG leads (ΣSTR); (2) STR in the single lead with maximum baseline ST-segment elevation (maxSTR); (3) summed residual ST-segment elevation across all infarct-related leads at 60 min post intervention (ΣST residual); (4) maximum residual ST-segment elevation in the worst single lead at 60 min post intervention (maxST residual); (5) number of new significant Q-waves (Qwave) at 60 min. All ECG methods strongly correlated with 30-day MRI infarct mass (all p<0.003). Simpler ECG measurements such as maxSTresidual and Qwave were as predictive as more complex measurements. A subset analysis of 158 patients who had microvascular obstruction (MVO) determined by MRI 5 days post intervention also showed strong correlations of MVO with the ECG measures. Conclusions: ST-segment and Q-wave changes after primary PCI in anterior STEMI strongly correlated with 30-day infarct size by MRI. In particular, maxST residual and Qwave at 60 min are simple ECG parameters that offer rapid analysis for prognostication. PMID:24562806

  11. [Infections of the urinary tract persisting in successful outcome of vesico-ureteral reimplants for primary reflux].

    PubMed

    Manzoni, G A; Giacomoni, M A; Cucchi, L; Contorni, L

    1988-01-01

    Persistence of urinary tract infections after successful ureteric reimplantation for vesico-ureteric reflux has been reported with an incidence varying between 20-30% according to different series. The Authors analyze their own experience with 99 patients successfully operated for primary VUR during a five year period. In 22 patients (22.2%) there was evidence of persistent UTI, which were almost exclusively low and asymptomatic (91%) and occurring within 6-12 months after the antireflux surgery. A single UTI was documented in over 60% of the patients. There was strong female prevalence (21 patients) and 50% were more than 6 years old. No significant relationship was found between grade of VUR, renal scarring, type of germ and number of preoperative infections and incidence of post-operative UTI. On the other end, voiding and continence disorders and cystoscopic evidence of cystitis cystica would both indicate to be predisposing factors. In these specific cases it is mandatory an accurate pre-operative evaluation of the voiding habits, in order to better define the treatment strategy, not only limited to the surgical correction of the associated reflux. PMID:3375130

  12. Percutaneous Implantation of a Catheter with Subcutaneous Reservoir for Intraarterial Regional Chemotherapy: Technique and Preliminary Results

    SciTech Connect

    Grosso, Maurizio; Zanon, Claudio; Mancini, Andrea; Garruso, Matteo; Gazzera, Carlo; Anselmetti, Giovanni Carlo; Veglia, Simona; Gandini, Giovanni

    2000-03-15

    Purpose: We present the technique and the preliminary results of percutaneous implantation of intraarterial catheters connected to a subcutaneous infusion reservoir for prolonged regional chemotherapy of hepatic and extrahepatic tumors.Methods: Two hundred patients with primary or secondary hepatic neoplasms, pelvic, pancreatic, renal, lingual, and breast cancer underwent the procedure. The access was the left axillary artery (188 patients) and the femoral artery (12 patients). The catheter tip was placed in the hepatic (170 patients), hypogastric (18), splenic (4), internal thoracic (2), gastroduodenal (3), renal (2) or the external carotid artery (1). The catheter was connected to a subcutaneous reservoir and filled with heparin; chemotherapeutic infusion was subsequently started.Results: One hundred percent immediate technical success was obtained. Forty-three of 200 (21.5%) patients had a complication: 29 patients had a catheter dislodgment, nine had arterial thrombosis, three had a pseudoaneurysm of the left axillary artery and two had a port pocket hematoma. Most complications (37/43, 86%) were treated percutaneously without interruption of chemotherapy. In only six cases (3% of the total population) was chemotherapy discontinued due to the complication itself. The mean duration of catheter patency was 7.2 months.Conclusion: Percutaneous placement of an intraarterial catheter is feasible and causes less discomfort to the patient than the surgical approach. The technique has an acceptable complication rate (21.5%), similar to that for surgical implantation (17.8%), with the advantage that in most cases the complications can be resolved percutaneously. This technique represents an alternative to surgical implantation in the treatment of liver metastases from colorectal cancer and opens new therapeutic possibilities for the local prolonged treatment of other kinds of tumor, though its clinical efficacy must be assessed in selected trials.

  13. Isolated Spontaneous Dissection of the Common Iliac Artery: Percutaneous Stent Placement in Two Patients

    SciTech Connect

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

    2006-10-15

    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.

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

    SciTech Connect

    Deschamps, F.; Elias, D. Goere, D.; Malka, D. Ducreux, M. Boige, V.; Auperin, A.; Baere, T. de

    2011-10-15

    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.

  15. Percutaneous endoscopic gastrostomy, duodenostomy and jejunostomy.

    PubMed

    Nishiguchi, Y; Fuyuhiro, Y; Lee, J T; Kang, S M; Baba, M; Arimoto, Y; Takeuchi, K; Yamashita, Y; Shigesawa, A; Yoshikawa, K; Sowa, M

    1994-01-01

    Although enteral feeding by nasal gastric tube is popular for the patients who have a swallowing disability and require long-term nutritional support, but have intact gut, this tube sometimes causes aspiration pneumonia or esophageal ulcer. For these patients, conventional techniques for performance of a feeding gastrostomy made by surgical laparotomy have been used so far. However, these patients are frequently poor anesthetic and operative risks. Percutaneous endoscopic gastrostomy (PEG) which can be accomplished with local anesthesia and without the necessity for laparotomy has become popular in the clinical treatment for these patients. PEG was performed in 31 cases, percutaneous endoscopic duodenostomy (PED) in 1 case, and percutaneous endoscopic jejunostomy (PEJ) in 2 cases. All patients were successfully placed, and no major complication and few minor complications (9%) were experienced in this procedure. After this procedure, some patients could discharge their sputa easily and their pneumonia subsided. PED and PEJ for the patients who had previously received gastrostomy could also be done successfully with great care. Our experience suggests that PEG, PED, and PEJ are rapid, safe, and useful procedures for the patients who have poor anesthetic or poor operative risks. PMID:18493339

  16. Percutaneous Endoscopic Gastrostomy, Duodenostomy and Jejunostomy

    PubMed Central

    Fuyuhiro, Yuichi; Lee, Jae-To; Kang, Soon-Myoung; Baba, Mitsuru; Arimoto, Yuichi; Takeuchi, Kazuhiro; Yamashita, Yoshito; Shigesawa, Akira; Yoshikawa, Kazuhiko; Sowa, Michio

    1994-01-01

    Although enteral feeding by nasal gastric tube is popular for the patients who have a swallowing disability and require long-term nutritional support, but have intact gut, this tube sometimes causes aspiration pneumonia or esophageal ulcer. For these patients, conventional techniques for performance of a feeding gastrostomy made by surgical laparotomy have been used so far. However, these patients are frequently poor anesthetic and operative risks. Percutaneous endoscopic gastrostomy (PEG) which can be accomplished with local anesthesia and without the necessity for laparotomy has become popular in the clinical treatment for these patients. PEG was performed in 31 cases, percutaneous endoscopic duodenostomy (PED) in 1 case, and percutaneous endoscopic jejunostomy (PEJ) in 2 cases. All patients were successfully placed, and no major complication and few minor complications (9%) were experienced in this procedure. After this procedure, some patients could discharge their sputa easily and their pneumonia subsided. PED and PEJ for the patients who had previously received gastrostomy could also be done successfully with great care. Our experience suggests that PEG, PED, and PEJ are rapid, safe, and useful procedures for the patients who have poor anesthetic or poor operative risks. PMID:18493339

  17. Percutaneous placement of inferior vena cava filters.

    PubMed

    Pisco, J M; Santiago, M J; Basto, I

    1992-11-01

    Pulmonary embolism is a serious and difficult problem. Many approaches for the prevention of recurrent pulmonary embolism have been tried. Percutaneous placement of inferior vena cava filters is an easy, safe, available and well established procedure for the prevention of pulmonary embolism. The authors review the indications for use of IVC filters, and they review the main filters available in terms of ease of use, the physical characteristics, the technique of introduction, the efficacy and morbidity, and the potential complications associated with their use. Insertion of IVC filters by percutaneous approach was successfully performed in 6 patients with recurrent pulmonary embolism. Following the intervention procedure without complication there were no further pulmonary emboli. PMID:1492602

  18. Changes in the root-associated fungal communities along a primary succession gradient analysed by 454 pyrosequencing.

    PubMed

    Blaalid, Rakel; Carlsen, Tor; Kumar, Surendra; Halvorsen, Rune; Ugland, Karl Inne; Fontana, Giovanni; Kauserud, Håvard

    2012-04-01

    We investigated changes in the root-associated fungal communities associated with the ectomycorrhizal herb Bistorta vivipara along a primary succession gradient using 454 amplicon sequencing. Our main objective was to assess the degree of variation in fungal richness and community composition as vegetation cover increases along the chronosequence. Sixty root systems of B. vivipara were sampled in vegetation zones delimited by dated moraines in front of a retreating glacier in Norway. We extracted DNA from rinsed root systems, amplified the ITS1 region using fungal-specific primers and analysed the amplicons using 454 sequencing. Between 437 and 5063 sequences were obtained from each root system. Clustering analyses using a 98.5% sequence similarity cut-off yielded a total of 470 operational taxonomic units (OTUs), excluding singletons. Between eight and 41 fungal OTUs were detected within each root system. Already in the first stage of succession, a high fungal diversity was present in the B. vivipara root systems. Total number of OTUs increased significantly along the gradient towards climax vegetation, but the average number of OTUs per root system stayed unchanged. There was a high patchiness in distribution of fungal OTUs across root systems, indicating that stochastic processes to a large extent structure the fungal communities. However, time since deglaciation had impact on the fungal community structure, as a systematic shift in the community composition was observed along the chronosequence. Ectomycorrhizal basidiomycetes were the dominant fungi in the roots of B. vivipara, when it comes to both number of OTUs and number of sequences. PMID:22590726

  19. Renal artery angioplasty: Increased technical success and decreased complications in the second 100 patients

    SciTech Connect

    Martin, L.G.; Casarella, W.J.; Alspaugh, J.P.; Chuang, V.P.

    1986-06-01

    In 200 consecutive patients undergoing percutaneous transluminal percutaneous transluminal renal angioplasty (PTRA), a significant increase in primary success rate and a concomitant decrease in complications were noted in the second 100 patients. The primary success rate increased from 93% to 97%, and the incidence of total complications fell from 20% to 13%. The incidence of complications requiring surgery fell from 5% to 2%, and the incidence of renal failure declined from 10% to 5% of the patient population. Variables that contributed to improvement in the procedure included new approaches to crossing arterial stenoses, increased use of digital imaging, less contrast material used in each case, better hydration of patients, and increased use of vascular sheaths at the puncture site.

  20. Percutaneous transmyocardial revascularization.

    PubMed

    Kim, C B; Oesterle, S N

    1997-12-01

    Transmyocardial revascularization (TMR) is a potential therapy for patients with severe angina pectoris and coronary anatomy deemed unsuitable for traditional revascularization techniques. Investigations of TMR are reviewed with emphasis on studies relevant to the development of a percutaneous, catheter-based transmyocardial revascularization procedure (PMR). The results of the preliminary animal studies and description of the PMR procedure are discussed. The recently initiated human PMR protocol is summarized and possible future investigative directions are outlined. PMID:9641086

  1. Percutaneous pulmonary and tricuspid valve implantations: An update

    PubMed Central

    Wagner, Robert; Daehnert, Ingo; Lurz, Philipp

    2015-01-01

    The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology. Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status. Although techniques of percutaneous pulmonary valve implantation have been described just a decade ago, two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide. In contrast, percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status. Taking into account that an “interdisciplinary challenging”, heterogeneous population of patients previously treated by corrective, semi-corrective or palliative surgical procedures is growing inexorably, there is a rapidly increasing need of treatment options besides redo-surgery. Therefore, the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures, to update on current devices, to discuss indications and patient selection criteria, to report on clinical results and finally to consider future directions. PMID:25914786

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

    PubMed Central

    2013-01-01

    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. PMID:23410500

  3. [Percutaneous lumber nucleoplasty].

    PubMed

    Erdine, Serdar; Ozyalçin, Nuri Süleyman; Cimen, Ali

    2005-04-01

    Low-back pain is one of the most common causes for seeking professional medical assistance and the most frequent cause of absence from work. It is not rare that the intervertebral discs are the etiological factor. Degenerated discs with internal disruptions may cause axial back pain whereas protrusion or herniation of a disc may result in radicular pain. Open surgical procedures targeting the intervertebral discs are carried out frequently for years. But especially because of its lack of superiority over the conventional therapies in the long-term and the risk of development of failed back surgery syndrome, the investigators are forced to develop minimally invasive techniques of disc decompression. In the last two decades, better understanding of the spinal anatomy, function and pain generating mechanisms along with the technological achievements, has accelerated the development of many modalities for the treatment of low back pain. Chemonucleolysis, automated percutaneous lumbar discectomy (APLD), intradiscal laser discectomy, intradiscal electrothermal therapy (IDET) and most recently percutaneous nucleoplasty are the minimally invasive techniques developed for this aim. Percutaneous nucleoplasty is a minimally invasive technique which uses radiofrequency energy to ablate the nucleus pulposus in a controlled manner for disc decompression. The current data about this new technique is insufficient yet, but the preliminary reports indicate that the technique is relatively safe and the outcomes are encouraging. PMID:15977089

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

    PubMed Central

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

    1997-01-01

    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. PMID:16535576

  5. N-Terminal Fragment of Pro B-type Natriuretic Peptide as a Marker of Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction.

    PubMed

    Goussot, Samuel; Mousson, Christiane; Guenancia, Charles; Stamboul, Karim; Brunel, Philippe; Brunet, Damien; Touzery, Claude; Cottin, Yves; Zeller, Marianne

    2015-09-15

    Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is frequent and associated with long-term renal impairment and mortality. Early markers of CIN are needed to improve risk stratification. We aimed to assess whether N-terminal fragment of pro B-type natriuretic peptide (Nt-proBNP) could be associated with CIN. From the French regional RICO survey, all the consecutive patients who underwent primary PCI for STEMI, from January 1, 2001, to December 3, 2013, were included. Nt-proBNP circulating levels were assessed on admission. CIN was defined as an increase in serum creatinine >26.5 μmol/L or >50% within 48 to 72 hours after PCI (KDIGO criteria). Of the 1,243 patients included, CIN occurred in 130 patients (10.4%). Nt-proBNP levels were 5 times greater in patients who developed CIN than without CIN (1,275 [435 to 4,022] vs 247 [79 to 986] pg/mL, p <0.001). Hospital mortality rate was markedly higher in patients with CIN (6.9% vs 1.1%, p <0.001). Nt-proBNP levels were univariate predictors for CIN as were age, hypertension, diabetes, smoking, previous stroke, heart rate, impaired left ventricular ejection fraction C-reactive protein, history of renal failure, anemia, and estimated glomerular filtration rate <30 ml/min/1.73 m(2) at baseline. Nt-proBNP levels remained strongly associated with the occurrence of CIN even after adjustment for risk factors, treatments, clinical and biological variables (odds ratio 1.99, 95% confidence interval 1.49 to 2.66). Net reclassification improvement was achieved by the addition of Nt-proBNP to the risk model (p = 0.003). In conclusion, from this large contemporary prospective study in nonselected population, our work suggests that Nt-proBNP levels at admission could help to identify patients at risk of CIN beyond traditional risk factors. PMID:26183794

  6. Percutaneous Extracorporeal Membrane Oxygenation for Graft Dysfunction after Heart Transplantation

    PubMed Central

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

    2014-01-01

    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. PMID:24782957

  7. Percutaneous Zenith endografting for abdominal aortic aneurysms.

    PubMed

    Heyer, Kamaldeep S; Resnick, Scott A; Matsumura, Jon S; Amaranto, Daniel; Eskandari, Mark K

    2009-03-01

    A completely percutaneous approach to infrarenal abdominal aortic aneurysm (AAA) endografting has the theoretic benefits of being minimally invasive and more expedient. Our goal was to demonstrate the utility of this approach using a suprarenal fixation device and a suture-mediated closure system. We conducted a single-institution, retrospective review of 14 patients who underwent percutaneous AAA repair with the Zenith device between August 2003 and March 2007. Immediate and delayed access-related outcomes were examined over a mean follow-up of 12.1+/-2.0 months. Mean AAA size was 5.6 cm. Immediate arterial closure and technical success rate was 96% (27/28 vessels). One immediate hemostatic failure required open surgical repair. Over follow-up, one vessel required operative repair for new-onset claudication. No other immediate or delayed complications (thrombosis, pseudoaneurysm, infection, or deep venous thrombosis) were detected. A percutaneous approach for the treatment of AAA has several advantages over femoral artery cutdown but also has its own unique set of risks in the immediate and late postoperative period. Ultimately, the "preclose technique" can be safely applied for the Zenith device despite its large-bore delivery system. PMID:18774684

  8. Percutaneous Pulmonary Valve Placement

    PubMed Central

    Prieto, Lourdes R.

    2015-01-01

    Patients with congenital heart disease and pulmonary valve disease need multiple procedures over their lifetimes to replace their pulmonary valves. Chronic pulmonary stenosis, regurgitation, or both have untoward effects on ventricular function and on the clinical status of these patients. To date, all right ventricle–pulmonary artery conduits have had relatively short lifespans. Percutaneous pulmonary valve implantation, although relatively new, will probably reduce the number of operative procedures that these patients will have to undergo over a lifetime. Refinement and further development of this procedure holds promise for the extension of this technology to other patient populations. PMID:26175629

  9. Percutaneous left ventricular restoration.

    PubMed

    Ige, Mobolaji; Al-Kindi, Sadeer G; Attizzani, Guilherme; Costa, Marco; Oliveira, Guilherme H

    2015-04-01

    The ventricular partitioning device known as Parachute is the first and only percutaneously implantable device aimed at restoration of normal left ventricular geometry in humans. Since its conception, this technology has undergone extensive animal and human testing, with proved feasibility and safety, and is currently being studied in a pivotal randomized clinical trial. This article discusses ventricular remodeling and therapies attempted in the past, details the components of the ventricular partitioning device, describes the implanting technique, and reviews the most current experience of this device in humans. PMID:25834974

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

    SciTech Connect

    Maruzzelli, Luigi; Miraglia, Roberto Caruso, Settimo; Milazzo, Mariapina; Mamone, Giuseppe; Gruttadauria, Salvatore; Spada, Marco; Luca, Angelo; Gridelli, Bruno

    2010-12-15

    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.

  11. Percutaneous Creation of Bare Intervascular Tunnels for Salvage of Thrombosed Hemodialysis Fistulas Without Recanalizable Outflow

    SciTech Connect

    Chen, Matt Chiung-Yu; Wang, Yen-Chi; Weng, Mei-Jui

    2015-08-15

    PurposeThis study aimed to retrospectively assess the efficacy of a bare intervascular tunnel for salvage of a thrombosed hemodialysis fistula. We examined the clinical outcomes and provided follow-up images of the bare intervascular tunnel.Materials and MethodsEight thrombosed fistulas lacked available recanalizable outflow veins were included in this study. These fistulas were salvaged by re-directing access site flow to a new outflow vein through a percutaneously created intervascular tunnel without stent graft placement. The post-intervention primary and secondary access patency rates were calculated using the Kaplan–Meier method.ResultsThe procedural and clinical success rates were 100 %. Post-intervention primary and secondary access patency at 300 days were 18.7 ± 15.8 and 87.5 ± 11.7 %, respectively. The mean follow-up period was 218.7 days (range 10–368 days). One patient died of acute myocardial infarction 10 days after the procedure. No other major complications were observed. Minor complications, such as swelling, ecchymosis, and pain around the tunnel, occurred in all of the patients.ConclusionsPercutaneous creation of a bare intervascular tunnel is a treatment option for thrombosed hemodialysis fistulas without recanalizable outflow in selected patients.

  12. Percutaneous Sclerotherapy Using Acetic Acid After Failure of Alcohol Ablation in an Intra-abdominal Lymphangioma

    SciTech Connect

    Park, Sang Woo Cha, In Ho; Kim, Kyeong Ah; Hong, Suk Joo; Park, Cheol Min; Chung, Hwan Hoon

    2004-09-15

    We report a case of percutaneous sclerotherapy using acetic acid in a 22-year-old woman with an intra-abdominal cystic lymphangioma who was not successfully treated with ethanol despite multiple trials.

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

    SciTech Connect

    Gemmete, Joseph J. Arabi, Mohammad; Cwikiel, Wojciech B.

    2011-02-15

    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.

  14. The Identification, Development, Succession and Retention of Leadership Talent in Contextually Different Primary Schools: A Case Study Located within the English West Midlands

    ERIC Educational Resources Information Center

    Rhodes, Christopher; Brundrett, Mark

    2006-01-01

    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…

  15. 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

    Kesan, Cenk; Caliskan, Sevdane

    2013-01-01

    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…

  16. 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

    Buyuktaskapu, Sema

    2012-01-01

    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…

  17. An Investigation into the Need for Effective Leadership Mechanisms in the Management of a Successful Inclusive Programme in the Primary School System

    ERIC Educational Resources Information Center

    McClean, Wilma A.

    2007-01-01

    This research project aims to highlight the need for effective leadership mechanisms to be put in place for the management of a successful inclusive program in the Primary School System in Barbados. The outcomes of the research findings show evidence of the need for strong instructional leadership by the principals in order to implement workable…

  18. [Percutaneous transhepatic biliary manometry].

    PubMed

    Kim, Jin Hong

    2007-03-01

    Perendoscopic biliary manometry may not represent the overall sphincter of Oddi (SO) motility, as the recording time is relatively short and it is possibly influenced by the presence of an endoscope in duodenum and air inflation. Percutaneous transhepatic biliary manometry of SO permits long-term recordings without patient discomfort and risk of complications. We investigated the change of human SO motility and the correlation between SO motility and migrating motor complex (MMC) of the small bowel in a fasting state by long-term simultaneous manometric examination of SO and small bowel. During long-term manometry, MMC-like cyclic activities of SO were observed, which considered to be MMC of SO. It coordinated well with MMC of the small bowel, except that SO was not quiescent during phase I MMC of the small bowel. In addition, the basal pressure of SO changed in accordance with the phases of SO motility. Percutaneous transhepatic biliary manometry also permits prolonged manometric studies to investigate normal physiologic reflexes such as gastroduodeno-sphincteric, cholecysto-sphincteric and choledocho-sphincteric reflexes, and the influence of cholecystectomy on SO motility in humans. PMID:18172340

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

    NASA Astrophysics Data System (ADS)

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

    2011-12-01

    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.

  20. Direct Percutaneous Embolization of Bleeding Stomal Varices

    SciTech Connect

    Naidu, Sailen G.; Castle, Erik P.; Kriegshauser, J. Scott; Huettl, Eric A.

    2010-02-15

    Stomal variceal bleeding can develop in patients with underlying cirrhosis and portal hypertension. Most patients are best treated with transjugular intrahepatic portosystemic shunt (TIPS) creation because this addresses the underlying problem of portal hypertension. However, some patients are not good candidates for TIPS creation because they have end-stage liver disease or encephalopathy. We describe such a patient who presented with recurrent bleeding stomal varices, which was successfully treated with percutaneous coil embolization. The patient had bleeding-free survival for 1 month before death from unrelated causes.

  1. Percutaneous mitral valve repair: potential in heart failure management.

    PubMed

    Hussaini, Asma; Kar, Saibal

    2010-03-01

    As a large portion of the US demographic advances into the later decades of life, the incidence of valvular heart disease is expected to increase. Mitral regurgitation (MR) caused by primary valve abnormality (degenerative) or secondary to cardiomyopathy (functional) is an important cause of heart failure. Management of valvular heart disease is expected to account for a large segment of services provided to heart failure patients. Recent years have seen a transition from surgical therapy to minimally invasive techniques, specifically percutaneous approaches for the correction of heart valve disease. The double orifice technique of mitral valve repair using the MitraClip System (Abbott Vascular, Menlo Park, CA) is one of many percutaneous approaches to treat significant MR. This technique is effective in patients with both degenerative and functional MR, reducing MR severity and improving heart failure symptoms. Broad acceptance of this percutaneous technology requires collaboration among cardiologists and cardiac surgeons in centers with superior catheter experience and knowledge of echocardiography. PMID:20425493

  2. Percutaneous venography and occlusion in the management of spermatic varicoceles

    SciTech Connect

    Morag, B.; Rubinstein, Z.J.; Goldwasser, B.; Yerushalmi, A.; Lunnenfeld, B.

    1984-09-01

    Spermatic venography was performed in 140 patients; the main indications were subfertility and abnormal spermatogenesis. Of these 140 patients, 113 had positive examinations, with 33 of them having bilateral varicoceles. Of 146 total varicoceles demonstrated, 42 were found on the right side; the advantage of using the jugular vein approach in both the diagnosis and percutaneous treatment of these cases is stressed. Of the 146 varicoceles, 128 were successfully occluded using spring coils. Because of the frequency of bilateral subclinical varicoceles, spermatic venography and percutaneous embolizaiton is recommended in all men with subfertility and oligoteratoasthenospermia.

  3. [Pancreatic tail pseudoaneurysm: percutaneous treatment by thrombin injection].

    PubMed

    Pacheco Jiménez, M; Moreno Sánchez, T; Moreno Rodríguez, F; Guillén Rico, M

    2014-01-01

    Visceral artery pseudoaneurysms secondary to acute and/or chronic pancreatitis are a relatively common and potentially serious complication. Endovascular techniques are the most currently accepted techniques, given the higher morbidity-mortality of surgery. The thrombosis of the pseudoaneurysm using an ultrasound-guided percutaneous thrombin injection is emerging as a useful option in those cases in which endovascular embolisation is not possible. We present the case of a patient with a pseudoaneurysm of the transverse pancreatic artery secondary to chronic pancreatitis, and successfully treated by administering percutaneous thrombin. PMID:21944714

  4. Selective Coronary Angiography Using a Percutaneous Femoral Technique

    PubMed Central

    Bourassa, M. G.; Lespérance, J.; Campeau, L.; Bois, M. A.; Saltiel, J.

    1970-01-01

    Successful use, in 650 patients over a period of two years, of a percutaneous femoral technique of selective coronary angiography is described. This technique is carried out with the use of mouldable, manually preshaped polyethylene catheters. Preparation of the material and the different steps of the technique are discussed. Excellent flexibility and plastic memory of this catheter material allow easy, rapid and consistent percutaneous insertion and removal of catheters and intubation of the coronary arteries. ImagesFIG. 3FIG. 4FIG. 5FIG. 6 PMID:20311550

  5. Atlantoaxial Joint Synovial Cyst: Diagnosis and Percutaneous Treatment

    SciTech Connect

    Velan, Osvaldo; Rabadan, Alejandra; Paganini, Lisandro; Langhi, Luciano

    2008-11-15

    Synovial cysts at the atlantoaxial level are found uncommonly. Lumbar symptomatic cases are treated by percutaneous cyst aspiration with or without corticoid injection or by surgical resection, but synovial cysts at the C1-C2 level are usually treated by surgery. We report here a 92-year-old woman with a retro-odontoid synovial cyst producing spinal cord compression that was treated by percutaneous aspiration of the cyst under CT guidance. To our knowledge, this is the first reported case of an atlantoaxial synovial cyst successfully treated with a minimally invasive procedure.

  6. Percutaneous coronary intervention in a patient with single coronary artery

    PubMed Central

    Mishra, T.K.; Mishra, C.K.; Das, B.

    2014-01-01

    Coronary artery anomalies are found in 1–5% of all coronary angiograms. Single coronary artery is a rare congenital anomaly. The prevalence of the anomaly is 0.024–0.066% of the general population and percutaneous coronary intervention in this anomaly is performed infrequently. The highest incidence of this condition is reported from India. We report a case of a 55 year old patient of anterior wall ST elevation myocardial infarction with L1 group of single coronary artery who underwent successful angioplasty and stenting to left anterior descending artery. The unique features and inherent risks of percutaneous coronary intervention to single coronary artery are discussed. PMID:24973852

  7. Percutaneous endoscopic gastrostomy in children

    PubMed Central

    El-Matary, Wael

    2008-01-01

    Percutaneous endoscopic gastrostomy has been a valuable tool in nutritional rehabilitation since its inception in 1980. Although it was originally described in children, a large sector of the adult population is dependant on it for nutritional support. Percutaneous endoscopic gastrostomy tube insertion is generally a safe procedure. Nevertheless, variable incidence rates of complications have been reported. The present review highlights the up-to-date indications, contraindications and complications of percutaneous endoscopic gastrostomy in children, along with a discussion of issues that need further exploring through future research. PMID:19096739

  8. Perivascular Inflammatory Reaction After Percutaneous Placement of Covered Stents

    SciTech Connect

    Link, Johann; Mueller-Huelsbeck, Stefan; Brossmann, Joachim; Steffens, Johann C.; Heller, Martin

    1996-09-15

    A 52-year-old woman with an extensive superficial femoral artery occlusion was treated with percutaneous transluminal angioplasty. Because of extensive dissections, two covered stents were placed percutaneously. The intervention was successful with respect to vessel patency, but local pain and fever developed 5 hr after the intervention. Swelling of the thigh occurred, but deep venous thrombosis was excluded. MRI revealed pronounced soft-tissue edema in the adductor canal that persisted for 4 weeks. The fever responded to antiinflammatory medication, but the pain remained for 4 weeks. The vessel was patent at the last follow-up, 8 weeks after graft placement. Soft-tissue edema after percutaneous placement of covered stents has been reported previously. The cause of the inflammatory reaction is unclear.

  9. Computer-Assisted Percutaneous Scaphoid Fixation: Concepts and Evolution

    PubMed Central

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

    2013-01-01

    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

  10. Percutaneous Cystgastrostomy as a Single-Step Procedure

    SciTech Connect

    Curry, L. Sookur, P.; Low, D.; Bhattacharya, S.; Fotheringham, T.

    2009-03-15

    The purpose of this study was to evaluate the success of percutaneous transgastric cystgastrostomy as a single-step procedure. We performed a retrospective analysis of single-step percutaneous transgastric cystgastrostomy carried out in 12 patients (8 male, 4 female; mean age 44 years; range 21-70 years), between 2002 and 2007, with large symptomatic pancreatic pseudocysts for whom up to 1-year follow-up data (mean 10 months) were available. All pseudocysts were drained by single-step percutaneous cystgastrostomy with the placement of either one or two stents. The procedure was completed successfully in all 12 patients. The pseudocysts showed complete resolution on further imaging in 7 of 12 patients with either enteric passage of the stent or stent removal by endoscopy. In 2 of 12 patients, the pseudocysts showed complete resolution on imaging, with the stents still noted in situ. In 2 of 12 patients, the pseudocysts became infected after 1 month and required surgical intervention. In 1 of 12 patients, the pseudocyst showed partial resolution on imaging, but subsequently reaccumulated and later required external drainage. In our experience, percutaneous cystgastrostomy as a single-step procedure has a high success rate and good short-term outcomes over 1-year follow-up and should be considered in the treatment of large symptomatic cysts.

  11. Percutaneous transluminal coronary angioplasty (PTCA)

    MedlinePlus Videos and Cool Tools

    Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. The procedure begins with ...

  12. Percutaneously inserted central catheter - infants

    MedlinePlus

    PICC - infants; PQC - infants; Pic line - infants; Per-Q cath - infants ... A percutaneously inserted central catheter (PICC) is a long, very thin, soft plastic tube that is put into a small blood vessel. This article addresses PICCs in ...

  13. Percutaneous Versus Surgical Tracheostomy

    PubMed Central

    Gysin, Claudine; Dulguerov, Pavel; Guyot, Jean-Philippe; Perneger, Thomas V.; Abajo, Blanca; Chevrolet, Jean-Claude

    1999-01-01

    Objective To compare surgical (SgT) and percutaneous (PcT) tracheostomies. Background Percutaneous tracheostomy has been said to provide numerous advantages over classical SgT. Methods A prospective randomized trial with a double-blind evaluation was used to compare SgT and PcT. SgT and PcT were performed according to established techniques (n = 70). The procedure was performed at the bedside in the intensive care unit in 21 cases (30%). The outcome measures were divided into procedure-related variables, perioperative complications, and postoperative complications. The procedure-related variables (location, duration, and difficulty) were evaluated by the surgeon. The perioperative and postoperative complications were divided into serious, intermediate, and minor. Perioperative and early postoperative (14 days) complications were evaluated daily by an intensive care unit nurse blinded to the technique used. Long-term postoperative complications were evaluated 3 months after decannulation by a surgeon blinded to the surgical technique. Results There were no major complications in either group. Most variables studied were not statistically different between the PcT and SgT groups. The only variables to reach statistical significance were the size of the incision (smaller with PcT, p < 0.0001), minor perioperative complications (greater with PcT, p = 0.02), and difficult cannula changes (greater with PcT; p < 0.05). Among nonsignificant differences, difficult procedures and false passages were more frequent with PcT, whereas long-term unesthetic scars were more frequent with SgT. Conclusions Both techniques are associated with a low rate of serious or intermediate complications when performed by experienced surgeons. There were more minor perioperative complications with PcT and more minor long-term complications with SgT. PMID:10561096

  14. Update on percutaneous mitral commissurotomy.

    PubMed

    Nunes, Maria Carmo P; Nascimento, Bruno Ramos; Lodi-Junqueira, Lucas; Tan, Timothy C; Athayde, Guilherme Rafael Sant'Anna; Hung, Judy

    2016-04-01

    Percutaneous mitral commissurotomy (PMC) is the first-line therapy for managing rheumatic mitral stenosis. Over the past two decades, the indications of the procedure have expanded to include patients with unfavourable valve anatomy as a consequence of epidemiological changes in patient population. The procedure is increasingly being performed in patients with increased age, more deformed valves and associated comorbidities. Echocardiography plays a crucial role in patient selection and to guide a more efficient procedure. The main echocardiographic predictors of immediate results after PMC are mitral valve area, subvalvular thickening and valve calcification, especially at the commissural level. However, procedural success rate is not only dependent on valve anatomy, but a number of other factors including patient characteristics, interventional management strategies and operator expertise. Severe mitral regurgitation continues to be the most common immediate procedural complication with unchanged incidence rates over time. The long-term outcome after PMC is mainly determined by the immediate procedural results. Postprocedural parameters associated with late adverse events include mitral valve area, mitral regurgitation severity, mean gradient and pulmonary artery pressure. Mitral restenosis is an important predictor of event-free survival rates after successful PMC, and repeat procedure can be considered in cases with commissural refusion. PMC can be performed in special situations, which include high-risk patients, during pregnancy and in the presence of left atrial thrombus, especially in centres with specialised expertise. Therefore, procedural decision-making should take into account the several determinant factors of PMC outcomes. This paper provides an overview and update of PMC techniques, complications, immediate and long-term results over time, and assessment of suitability for the procedure. PMID:26743926

  15. Occlusion of an Intraosseous Arteriovenous Malformation With Percutaneous Injection of Polymethylmethacrylate

    SciTech Connect

    Ierardi, Anna Maria; Mangini, Monica; Vaghi, Massimo; Cazzulani, Alberto; Mattassi, Raul; Carrafiello, Gianpaolo

    2011-02-15

    Primary intraosseous arteriovenous malformations are rare. Many minimally invasive procedures can be considered preoperative steps and/or definitive treatment. The case reported regards a young woman with a voluminous arteriovenous extratroncular infiltrating malformation of the humerus. She underwent several treatments, but none of them was completely occlusive. The last treatment consisted of direct percutaneous puncture of the intraosseous alteration and injection of polymethylmethacrylate (PMMA), which is normally used in percutaneous vertebroplasty. We obtained complete occlusion of the humerus lytic lesion. To the best of our knowledge, this represents the first case of intraosseous AVM treated by percutaneous injection of PMMA.

  16. Barriers to the successful practice of chronic kidney diseases at the primary health care level; a systematic review

    PubMed Central

    Junaid Nazar, Chaudhary Muhammad; Kindratt, Tiffany Billmeier; Ahmad, Syed Muhammad Ahtizaz; Ahmed, Manzoor; Anderson, John

    2014-01-01

    Background: Chronic kidney disease (CKD), a major global public health problem, has been recognized as one of the eleven important causes of death. This review explores a wide range of barriers related to patients and health systems involved in controlling the prevalence of CKD at the primary health care level. Patients and Method: Electronic databases including PubMed/Medline, Cumulative Index to Nursing and Allied Health (CINAHL), Entrez, British Medical Journal (BMJ), EBSCO host, Cochrane and Google scholar were searched for the data published from 2000 to 2010 using MeSH terms such as ‘chronic kidney diseases’, ‘renal transplantation’, ‘complications’, ‘health care services’, ‘acute renal failure’. After screening 587 abstracts, a total of 10 studies were selected for systematic review. Developed countries such as the United Kingdom, the USA and other European countries were reviewed in order to identify the barriers associated with CKD practice at the primary health care level. The reasons for the failure of services at the primary health care level were categorized. A pre-defined protocol was used for data extraction and content appraisal. Results: At the primary health care level, the major barriers associated with CKD include the late referral of patients to nephrologists, old age, presence of several co-morbidities, lack of education and awareness among ethnic minorities, difficulty in communication between primary health care professionals, and the shortage of multi-disciplinary care team at dialysis centers. Additionally, factors such as drug-drug interaction during treatment, lack of anemia-management during dialysis, hypertension, and depression in CKD patients also act as important barriers in CKD care at the primary health care level. Conclusion: The knowledge and awareness about CKD management is lacking. Therefore, educational intervention is essential for patients as well medical personnel. Also, a multidisciplinary care team is essential for the complex management of CKD due to associated co-morbidities. PMID:25340171

  17. Percutaneous Radiologic Gastrostomy: A 12-Year Series

    PubMed Central

    Castellazzi, Giorgio; De Iuliis, Alessandro; Rizzo, Laura

    2010-01-01

    Background/Aims Interventional radiologists have played a main role in the technical evolution of gastrostomy, from the first surgical/endoscopical approaches to percutaneous interventional procedures. This study evaluated the results obtained in a 12-year series. Methods During the period December 1996 to December 2008, 254 new consecutive gastrostomies and 275 replacement procedures were performed in selected patients. All of the cases were treated by a T-fastener gastropexy and tube placement. The procedures were assessed by analyzing indications, patient selection, duration of the procedures, and mortality. Results All 254 first gastrostomies were successful; replacement procedures were also successfully performed. One (0.2%) patient with severe neurologic disorders died after the procedure without signs of procedure-related complications, and seven (1.3%) major complications occurred (four duodenal lesions with peritoneal leakage, two gastric bleedings, and one gastric lesion). Minor complications were easily managed; three tube ruptures were resolved. Conclusions This long-term series and follow-up showed that a group of interventional radiologist can effectively provide gastrostomy placement and long-term tube management. Percutaneous gastrostomy is less invasive than other approaches and it satisfies the needs even of high-risk patients. PMID:21103294

  18. Interstitial cystitis associated with primary Sjögren's syndrome successfully treated with a combination of tacrolimus and corticosteroid: A case report and literature review.

    PubMed

    Ueda, Yo; Tomoe, Hikaru; Takahashi, Hiroyuki; Takahashi, Yuko; Yamashita, Hiroyuki; Kaneko, Hiroshi; Kano, Toshikazu; Mimori, Akio

    2016-05-01

    We report a case of interstitial cystitis (IC) associated with primary Sjögren's syndrome (SS) successfully controlled with combination therapy of tacrolimus and a corticosteroid. In 2011, a 69-year-old female, who had been diagnosed with primary SS 23 years ago, developed IC and was successfully treated with tacrolimus and prednisolone combination therapy. The mechanism of IC, including the involved autoimmunity, has not been elucidated. Clinical observation studies suggest a potential association between SS and IC. However, IC is currently thought to be underdiagnosed in patients with SS as well as in the general population. Based on our case and others reported previously, IC associated with SS responds well to immunosuppressive therapy. In particular, a combination of a calcineurin inhibitor (tacrolimus or cyclosporine) with a corticosteroid seems to be highly effective. The possibility of IC in patients with SS complaining of lower urinary tract symptoms without features of infection or other identifiable causes should be given attention. PMID:24720552

  19. Investigating Fresh Water--Some Ideas That Have Been Used Successfully in Primary Schools in the ACT.

    ERIC Educational Resources Information Center

    Shoring, Nola

    2003-01-01

    Outlines some strategies used in primary schools in the Australian Capital Territory (ACT) to teach science. Teachers wanting to investigate freshwater conducted experiments and drew concepts for reuse, recycling, and conservation. Presents two case studies using these activities to show how this theme can be used to introduce and consolidate a…

  20. Success or Failure of Primary Second/Foreign Language Programmes in Asia: What Do the Data Tell Us?

    ERIC Educational Resources Information Center

    Baldauf, Richard B., Jr.; Kaplan, Robert B.; Kamwangamalu, Nkonko; Bryant, Pauline

    2011-01-01

    Primary school second/foreign language (SL/FL) programmes in Asia, as well as in other parts of the world, are becoming more common, with many targeting English as the SL or FL. The pressures for such English language programmes come from top-down notions that in a globalised world English is required for societies to be competitive, especially…

  1. Chronicling Innovative Learning in Primary Classrooms: Conceptualizing a Theatrical Pedagogy to Successfully Engage Young Children Learning Science

    ERIC Educational Resources Information Center

    McGregor, Debra

    2014-01-01

    This article reports on an innovative pedagogical approach devised to re-envigorate primary (elementary) teachers' practice in the United Kingdom for older children. Learning science in elementary schools for 8-11 year olds (Key Stage 2 in England) has been constrained for several decades while teachers prepared them for national tests. The recent…

  2. Clinical efficacy and scintigraphic evaluation of post-coronary bypass patients undergoing percutaneous transluminal coronary angioplasty for recurrent angina pectoris

    SciTech Connect

    Reed, D.C.; Beller, G.A.; Nygaard, T.W.; Tedesco, C.; Watson, D.D.; Burwell, L.R.

    1989-01-01

    The efficacy of percutaneous transluminal angioplasty in improving recurrent anginal symptoms and myocardial perfusion after coronary artery bypass graft surgery was assessed prospectively in 55 patients, of whom 50 had an initial angiographic and clinical success. Although 80% of those successfully dilated were initially free of angina at 23 +/- 11 months of follow-up, one half of these patients had recurrent angina. Although only 48% of the patient cohort had complete relief of angina, 94% had less angina than before dilatation and 86% were able to decrease antianginal medications. Fifteen patients with persistent or recurrent angina had from one to five repeat dilatations. After angioplasty, lung thallium uptake, the extent of abnormal scan segments, and the magnitude of redistribution in dilated lesions were significantly reduced (n = 24 patients). Redistribution defects were seen in 38% of patients on postangioplasty scans. All were associated with subsequent angina. Of various clinical, angiographic, exercise, and thallium-201 scan variables, only the presence of delayed redistribution was an independent predictor of recurrent angina. Restenosis was the most common underlying cause for this exercise-induced perfusion defect. Thus percutaneous coronary angioplasty performed as primary therapy for recurrent angina after bypass surgery is moderately successful in long-term follow-up for the amelioration of symptoms and enhancement of regional myocardial perfusion.

  3. Percutaneous Gastrostomy in Patients Who Fail or Are Unsuitable for Endoscopic Gastrostomy

    SciTech Connect

    Thornton, Frank J.; Varghese, Jose C.; Haslam, Philip J.; McGrath, Frank P.; Keeling, Frank; Lee, Michael J.

    2000-07-15

    Purpose: Percutaneous endoscopic gastrostomy (PEG) is not possible or fails in some patients. We aimed to categorize the reasons for PEG failure, to study the success of percutaneous radiologic gastrostomy (PRG) in these patients, and to highlight the associated technical difficulties and complications.Methods: Forty-two patients (28 men, 14 women; mean age 60 years, range 18-93 years) in whom PEG failed or was not possible, underwent PRG. PEG failure or unsuitability was due to upper gastrointestinal tract obstruction or other pathology precluding PEG in 15 of the 42 patients, suboptimal transillumination in 22 of 42 patients, and advanced cardiorespiratory decompensation precluding endoscopy in five of 42 patients. T-fastener gastropexy was used in all patients and 14-18 Fr catheters were inserted.Results: PRG was successful in 41 of 42 patients (98%). CT guidance was required in four patients with altered upper gastrointestinal anatomy. PRG failed in one patient despite CT guidance. In the 16 patients with high subcostal stomachs who failed PEG because of inadequate transillumination, intercostal tube placement was required in three and cephalad angulation under the costal margin in six patients. Major complications included inadvertent placement of the tube in the peritoneal cavity. There was one case of hemorrhage at the gastrostomy site requiring transfusion and one case of superficial gastrostomy site infection requiring tube removal. Minor complications included superficial wound infection in six patients, successfully treated with routine wound toilette.Conclusion: We conclude that PRG is a safe, well-tolerated and successful method of gastrostomy and gastrojejunostomy insertion in the technically difficult group of patients who have undergone an unsuccessful PEG. In many such cases optimal clinical evaluation will suggest primary referral for PRG as the preferred option.

  4. Delayed Union of a Sacral Fracture: Percutaneous Navigated Autologous Cancellous Bone Grafting and Screw Fixation

    SciTech Connect

    Huegli, R. W. Messmer, P.; Jacob, A. L.; Regazzoni, P.; Styger, S.; Gross, T.

    2003-09-15

    Delayed or non-union of a sacral fracture is a serious clinical condition that may include chronic pain, sitting discomfort, gait disturbances, neurological problems, and inability to work. It is also a difficult reconstruction problem. Late correction of the deformity is technically more demanding than the primary treatment of acute pelvic injuries. Open reduction, internal fixation (ORIF), excision of scar tissue, and bone grafting often in a multi-step approach are considered to be the treatment of choice in delayed unions of the pelvic ring. This procedure implies the risk of neurological and vascular injuries, infection, repeated failure of union, incomplete correction of the deformity, and incomplete pain relief as the most important complications. We report a new approach for minimally invasive treatment of a delayed union of the sacrum without vertical displacement. A patient who suffered a Malgaigne fracture (Tile C1.3) was initially treated with closed reduction and percutaneous screw fixation (CRPF) of the posterior pelvic ring under CT navigation and plating of the anterior pelvic ring. Three months after surgery he presented with increasing hip pain caused by a delayed union of the sacral fracture. The lesion was successfully treated percutaneously in a single step procedure using CT navigation for drilling of the delayed union, autologous bone grafting, and screw fixation.

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

    ERIC Educational Resources Information Center

    Twigg, Vani Veikoso

    2010-01-01

    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…

  6. Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

    SciTech Connect

    Pabon-Ramos, Waleska M.; Niemeyer, Matthew M.; Dasika, Narasimham L.

    2013-10-15

    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.

  7. Percutaneous ventricular septal defect closure with Amplatzer devices resulting in severe tricuspid regurgitation.

    PubMed

    Matyal, Robina; Wang, Angela; Mahmood, Feroze

    2013-11-15

    While percutaneous intervention is an alternative for patients who are not surgical candidates, the rate of morbidity and mortality is comparable to open repair. Appending the reported complications associated with percutaneous intervention (device mal-positioning, dislodgement, and entrapment in the sub-valvular apparatus), we report mechanical damage to the tricuspid valve (TV). Percutaneous closure with an Amplatzer septal occluder device was attempted on three patients who developed a ventricular septal defects (VSD) after myocardial infarction. In all three cases, damage to the tricuspid leaflet was noted post-procedure. The accompanying severe tricuspid regurgitation led to right ventricular failure, even in the patients where the VSD was considered successfully occluded. Despite successful deployment of the Amplatzer device, complications with catheter manipulation may still arise. Damage to the TV can occur during percutaneous VSD closure with Amplatzer device. Periprocedure TEE monitoring can detect damage to the tricuspid leaflets. PMID:23553968

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

    PubMed Central

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

    2013-01-01

    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. PMID:23888182

  9. Percutaneous perirenal thrombin injection for the treatment of acute hemorrhage after renal biopsy

    PubMed Central

    Mafeld, Sebastian; McNeill, Michael; Haslam, Philip

    2016-01-01

    Percutaneous renal biopsy is a valuable diagnostic approach. While commonly safe, it is not without risk and the most feared vascular complications include hemorrhage, pseudoaneurysm, and arteriovenous fistula formation. We report a case of acute hemorrhage after renal biopsy that was immediately identified by ultrasonography and successfully treated with percutaneous perirenal thrombin injection. This technique may prove a useful addition to the armamentarium of any operator performing renal biopsies. PMID:26809832

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

    NASA Technical Reports Server (NTRS)

    Orr, James K.

    2010-01-01

    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.

  11. Laparoscopic-Assisted Percutaneous Endoscopic Transgastrostomy Jejunostomy

    PubMed Central

    Dimofte, Mihail-Gabriel; Nicolescu, Simona; Ristescu, Irina; Lunca, Sorinel

    2014-01-01

    Background and Objectives: New therapeutic protocols for patients with end-stage Parkinson disease include a carbidopa/levodopa combination using continuous, modulated enteral administration via a portable pump. The typical approach involves a percutaneous endoscopic transgastrostomy jejunostomy (PEG-J), which requires a combination of procedures designed to ensure that no organ is interposed between the abdominal wall and the gastric surface. Lack of transillumination in maximal endoscopic light settings is a major contraindication for PEG-J, and we decided to use a different approach to establish enteric access for long-term medication delivery via pump, using a minimally invasive procedure. Methods: In all patients, we performed a laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J) after an unsuccessful endoscopic transillumination. Results: Five patients with end-stage Parkinson disease were referred to our department after successful therapeutic testing with administration of levodopa/carbidopa via naso-jejunal tube. All patients failed the endoscopic transillumination during the endoscopic procedure and were considered for LAPEG-J. In all patients, the LAPEG-J procedure was uneventful. The most common reason identified for failed transillumination was a high position of the stomach, followed by interposition of the liver or colon between the stomach and anterior abdominal wall. There were no complications regarding the LAPEG-J procedure, and all patients were discharged during the second postprocedural day. Conclusions: LAPEG-J provides a simple and safe option for placing a jejunostomy after an unsuccessful PEG-J attempt. PMID:25489214

  12. Percutaneous needle biopsy and synovial histology.

    PubMed

    Saaibi, D L; Schumacher, H R

    1996-08-01

    Percutaneous needle biopsies of synovium are successfully used for diagnosis and investigation of joint disease by an increasing number of groups around the world. This procedure can be done in the office with little morbidity; a large number of samples can minimize the potential limitation of sampling error. Clinical indications for 'imaging the joint' by looking at morphological and other features of the actual tissue include undiagnosed acute or chronic mono- or oligoarthritis, haemarthrosis, suspected deposition diseases, new developments in previous stable disease and less often unexplained polyarthritis. Research into any joint disease can be helped by study of synovium especially using newer immunohistochemical, EM and molecular techniques. This report has reviewed other methods used for obtaining synovium, described the different percutaneous biopsy needles, detailed the methods used for biopsy with the Parker-Pearson needle and described how our group handles tissue so as to obtain maximal impact. The very few side effects of needle biopsy include haemarthrosis and, rarely, needle breakage. Finally, we have provided a brief overview of normal synovium and some aspects of synovium in a variety of joint diseases. PMID:8876958

  13. Clinical Evaluation of Success of Primary Teeth Pulpotomy Using Mineral Trioxide Aggregate®, Laser and BiodentineTM- an In Vivo Study

    PubMed Central

    Prasad, Madhu Ghanshyam; Vasa, Aron Arun Kumar; Divya, Gaddam; Thakur, Mukesh Singh; Saujanya, Kanithi

    2015-01-01

    Introduction Pulpotomy technique basically consists of removing the coronal pulp and fixing the radicular pulp with a medicament. It is the most widely accepted clinical procedure for treating primary teeth with coronal pulp inflammation caused by caries with no involvement of the radicular pulp. Aim To evaluate the success and efficacy of Mineral Trioxide Aggregate (MTA), Lasers and Biodentine as pulpotomy agents both clinically and radiographically. Materials and Methods In the present study, 60 primary molars in children whose pulpal status warranted pulpotomy were selected and randomly assigned into three groups that included MTA, Laser and Biodentine allocating 20 teeth to each group. The pulpotomy procedure was then performed on all selected teeth followed by restoration with stainless steel crowns. Later the patients were recalled for 3 months and 6 months for clinical and radiographic evaluation. Results Statistical analysis was done using Fisher exact test to determine pair wise comparison of three agents with respect to clinical and radiographic criteria. Kruskal-Wallis ANOVA, Mc Nemars test was applied to evaluate the efficacy of each agent between 3 months and 6 months. The results showed that maximum success rate was found in MTA group. However, the comparison between three groups was statistically not significant (p<0.05). Conclusion Pulpotomies performed with either MTA, Laser or Biodentine are equally efficient with similar clinical/radiographic success and hence can be considered as alternatives to Formocresol. PMID:26023640

  14. Direct Percutaneous Jejunostomy-An Underutilized Interventional Technique?

    SciTech Connect

    Sparrow, Patrick David, Elizabeth; Pugash, Robyn

    2008-03-15

    Our aim in this study was to report our single-center experience with direct percutaneous jejunostomy over a 4-year period with regard to technical success rate, immediate and late complications, and patient tolerance of the procedure. Institutional records of 22 consecutive patients who underwent radiological insertion of a percutaneous jejunostomy for a variety of indications were reviewed. The proximal jejunum was punctured under either fluoroscopic or ultrasonic guidance, and following placement of retention sutures, a 10- to 12-Fr catheter inserted. There was a 100% technical success rate in placement involving a total of seven operators. The indications for placement were prior gastric resection, newly diagnosed resectable esophageal or gastric carcinoma, unresectable gastric carcinoma with outlet obstruction, and palliative drainage of bowel obstruction. Mean duration of follow-up was 100 days, and catheter placement 57.7 days. There were six minor early complications, consisting of loss of two retention anchors requiring repuncture, three cases of localized excessive postprocedural pain, and one failed relief of symptoms of small bowel obstruction. Four tubes developed late complications (two blocked, one catheter cracked, and one inadvertently pulled out). Three of the four were successfully replaced through the existing tracts. One patient subsequently developed a minor skin infection, while another developed late pericatheter leakage from ascites. We conclude that direct percutaneous jejunostomy is a valuable treatment modality applicable to a number of clinical scenarios, with a high technical success rate and low serious complication rate.

  15. Single-Institution Results of Image-Guided Nonplugged Percutaneous Versus Transjugular Liver Biopsy

    SciTech Connect

    Hardman, Rulon L.; Perrich, Kiley D.; Silas, Anne M.

    2011-04-15

    Purpose: To retrospectively review patients who underwent transjugular and image-guided percutaneous biopsy and compare the relative risk of ascites, thrombocytopenia, and coagulopathy. Materials and Methods: From August 2001 through February 2006, a total of 238 liver biopsies were performed. The radiologist reviewed all patient referrals for transjugular biopsy. These patients either underwent transjugular biopsy or were reassigned to percutaneous biopsy (crossover group). Patients referred to percutaneous image-guided liver biopsy underwent this same procedure. Biopsies were considered successful if a tissue diagnosis could be made from the samples obtained. Results: A total of 36 transjugular biopsies were performed with 3 total (8.3%) and 1 major (2.8%) complications. A total of 171 percutaneous biopsies were performed with 10 (5.8%) total and 3 (1.8%) major complications. The crossover group showed a total of 4 (12.9%) complications with 1 (3.2%) major complication. Sample adequacy was 91.9% for transjugular and 99.5% for percutaneous biopsy. Conclusion: Both transjugular and percutaneous liver biopsy techniques are efficacious and safe. Contraindications such as thrombocytopenia, coagulopathy, and ascites are indicators of greater complications but are not necessarily prevented by transjugular biopsy. Percutaneous biopsy more frequently yields a diagnostic specimen than transjugular biopsy.

  16. Percutaneous Transluminal Angioplasty and Stenting for Hepatic Vessel Stenosis after Orthotopic Liver Transplantation

    PubMed Central

    Luo, Ming-Yuan; Wu, Yi-Ju; Lin, Tung-Chao; Shen, Thau-Yun; Yang, Ho-Pang; Chen, Chien-Cheng; Chen, Fu-Chung

    2015-01-01

    Background This study aimed to evaluate the efficacy of vascular intervention in percutaneous transluminal angioplasty (PTA) for the treatment of hepatic artery and hepatic vein stenosis after liver transplantation (LT), including thrombotic total occluded lesions. Methods Percutaneous transluminal angioplasty after orthotopic liver transplantation was performed to re-open hepatic vessel lesions. We daily used routine Doppler ultrasound during admission for early detection of graft hepatic vessel lesions, including hepatic artery and vein lesions. In outpatients, Doppler ultrasound was performed every month. Urokinase was delivered with a dose of 150,000-300,000 IU by catheter before PTA for thrombotic total occlusion of the graft for hepatic artery patients. Laboratory data were collected to evaluate the effects of the PTA procedure. Results The study involved a total of seven patients, six of whom were successfully treated by a first PTA procedure. Thrombolysis use of urokinase in totally occluded donor hepatic arteries post-LT following stenting was successful in three patients. One complication occurred, an arterial dissection and perforation, finalizing the success rate at ~86% and the complication rate at ~14%. Therefore, our study has a primary patency rate of 100% at 1 and 3 months. Also, the graft survival rate was 100 % and 86 % in the first and third months, respectively. Conclusions PTA with stenting is an effective treatment for hepatic vessel stenosis, including hepatic arteries and hepatic veins, after a liver transplantation without an increase in the complication rate. In addition, thrombolysis using urokinase intra-artery infusion in graft thrombotic total occluded patients is a good treatment strategy as well. PMID:27122863

  17. Biotechnological reduction of sulfide in an industrial primary wastewater treatment system: A sustainable and successful case study

    SciTech Connect

    Rajamani, S.

    1996-12-31

    The leather industry is an important export-oriented industry in India, with more than 3,000 tanneries located in different clusters. Sodium sulfide, a toxic chemical, is used in large quantities to remove hair and excess flesh from hides and skins. Most of the sodium sulfide used in the process is discharged as waste in the effluent, which causes serious environmental problems. Reduction of sulfide in the effluent is generally achieved by means of chemicals in the pretreatment system, which involves aerobic mixing using large amounts of chemicals and high energy, and generating large volumes of sludge. A simple biotechnological system that uses the residual biosludge from the secondary settling tank was developed, and the commercial-scale application established that more than 90% of the sulfide could be reduced in the primary treatment system. In addition to the reduction of sulfide, foul smells, BOD and COD are reduced to a considerable level. 3 refs., 2 figs., 1 tab.

  18. Percutaneous mitral valve repair with the MitraClip system: acute results from a real world setting

    PubMed Central

    Tamburino, Corrado; Ussia, Gian Paolo; Maisano, Francesco; Capodanno, Davide; La Canna, Giovanni; Scandura, Salvatore; Colombo, Antonio; Giacomini, Andrea; Michev, Iassen; Mangiafico, Sarah; Cammalleri, Valeria; Barbanti, Marco; Alfieri, Ottavio

    2010-01-01

    Aims This study sought to evaluate the feasibility and early outcomes of a percutaneous edge-to-edge repair approach for mitral valve regurgitation with the MitraClip® system (Evalve, Inc., Menlo Park, CA, USA). Methods and results Patients were selected for the procedure based on the consensus of a multidisciplinary team. The primary efficacy endpoint was acute device success defined as clip placement with reduction of mitral regurgitation to ≤2+. The primary acute safety endpoint was 30-day freedom from major adverse events, defined as the composite of death, myocardial infarction, non-elective cardiac surgery for adverse events, renal failure, transfusion of >2 units of blood, ventilation for >48 h, deep wound infection, septicaemia, and new onset of atrial fibrillation. Thirty-one patients (median age 71, male 81%) were treated between August 2008 and July 2009. Eighteen patients (58%) presented with functional disease and 13 patients (42%) presented with organic degenerative disease. A clip was successfully implanted in 19 patients (61%) and two clips in 12 patients (39%). The median device implantation time was 80 min. At 30 days, there was an intra-procedural cardiac tamponade and a non-cardiac death, resulting in a primary safety endpoint of 93.6% [95% confidence interval (CI) 77.2–98.9]. Acute device success was observed in 96.8% of patients (95% CI 81.5–99.8). Compared with baseline, left ventricular diameters, diastolic left ventricular volume, diastolic annular septal–lateral dimension, and mitral valve area significantly diminished at 30 days. Conclusion Our initial results with the MitraClip device in a very small number of patients indicate that percutaneous edge-to-edge mitral valve repair is feasible and may be accomplished with favourable short-term safety and efficacy results. PMID:20299349

  19. Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

    SciTech Connect

    Oh, Jung Suk Lee, Hae Giu Chun, Ho Jong; Choi, Byung Gil; Lee, Sang Hoon; Hahn, Seong Tai; Ohm, Joon Young

    2013-10-15

    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.

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

    PubMed

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

    2005-09-01

    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

  1. Design and Testing of a Percutaneously Implantable Fetal Pacemaker

    PubMed Central

    Loeb, Gerald E.; Zhou, Li; Zheng, Kaihui; Nicholson, Adriana; Peck, Raymond A.; Krishnan, Anjana; Silka, Michael; Pruetz, Jay; Chmait, Ramen; Bar-Cohen, Yaniv

    2012-01-01

    We are developing a cardiac pacemaker with a small, cylindrical shape that permits percutaneous implantation into a fetus to treat complete heart block and consequent hydrops fetalis, which can otherwise be fatal. The device uses off-the-shelf components including a rechargeable lithium cell and a highly efficient relaxation oscillator encapsulated in epoxy and glass. A corkscrew electrode made from activated iridium can be screwed into the myocardium, followed by release of the pacemaker and a short, flexible lead entirely within the chest of the fetus to avoid dislodgement from fetal movement. Acute tests in adult rabbits demonstrated the range of electrical parameters required for successful pacing and the feasibility of successfully implanting the device percutaneously under ultrasonic imaging guidance. The lithium cell can be recharged inductively as needed, as indicated by a small decline in the pulsing rate. PMID:22855119

  2. Treatment of Kidney Stone in a Kidney-Transplanted Patient with Mini-Percutaneous Laser Lithotripsy: A Case Report

    PubMed Central

    Markić, Dean; Krpina, Kristian; Ahel, Juraj; Gršković, Antun; Španjol, Josip; Rubinić, Nino; Materljan, Mauro; Mikolašević, Ivana; Orlić, Lidija; Rački, Sanjin

    2016-01-01

    We report a case of a kidney-transplanted patient with urolithiasis treated with mini-percutaneous laser lithotripsy. The patient presented with renal dysfunction and graft hydronephrosis. Diagnostic procedures revealed ureterolithiasis as a cause of obstruction, and percutaneous nephrostomy was inserted as a temporary solution. Before surgery, the stone migrated to the renal pelvis. Mini-percutaneous laser lithotripsy was successfully performed, and during surgery, all stone fragments were removed. Six months after successful treatment, the patient has good functioning and stone-free graft. PMID:27066492

  3. Academic success across the transition from primary to secondary schooling among lower-income adolescents: understanding the effects of family resources and gender.

    PubMed

    Serbin, Lisa A; Stack, Dale M; Kingdon, Danielle

    2013-09-01

    Successful academic performance during adolescence is a key predictor of lifetime achievement, including occupational and social success. The present study investigated the important transition from primary to secondary schooling during early adolescence, when academic performance among youth often declines. The goal of the study was to understand how risk factors, specifically lower family resources and male gender, threaten academic success following this "critical transition" in schooling. The study involved a longitudinal examination of the predictors of academic performance in grades 7-8 among 127 (56 % girls) French-speaking Quebec (Canada) adolescents from lower-income backgrounds. As hypothesized based on transition theory, hierarchical regression analyses showed that supportive parenting and specific academic, social and behavioral competencies (including spelling ability, social skills, and lower levels of attention problems) predicted success across this transition among at-risk youth. Multiple-mediation procedures demonstrated that the set of compensatory factors fully mediated the negative impact of lower family resources on academic success in grades 7-8. Unique mediators (social skills, spelling ability, supportive parenting) also were identified. In addition, the "gender gap" in performance across the transition could be attributed statistically to differences between boys and girls in specific competencies observed prior to the transition, as well as differential parenting (i.e., support from mother) towards girls and boys. The present results contribute to our understanding of the processes by which established risk factors, such as low family income and gender impact development and academic performance during early adolescence. These "transitional" processes and subsequent academic performance may have consequences across adolescence and beyond, with an impact on lifetime patterns of achievement and occupational success. PMID:23904002

  4. Percutaneous transluminal alcohol septal myocardial ablation after aortic valve replacement

    NASA Technical Reports Server (NTRS)

    Sitges, M.; Kapadia, S.; Rubin, D. N.; Thomas, J. D.; Tuzcu, M. E.; Lever, H. M.

    2001-01-01

    When left ventricular outflow tract obstruction develops after aortic valve replacement, few treatment choices have been available until now. We present a patient with prior aortic valve replacement who developed left ventricle outflow tract obstruction that was successfully treated with a percutaneous transcoronary myocardial septal alcohol ablation. This technique is a useful tool for the treatment of obstructive hypertrophic cardiomyopathy, especially in those patients with prior heart surgery. Copyright 2001 Wiley-Liss, Inc.

  5. Percutaneous upsizing of a Blalock-Taussig shunt.

    PubMed

    Tzifa, Aphrodite; Rosenthal, Eric; Qureshi, Shakeel

    2012-04-01

    Percutaneous upsizing of surgically placed Blalock-Taussig shunts is an uncommon practice. We report the case of an 8-month-old infant with single-ventricle physiology, who - due to comorbidities - was deemed unsuitable to proceed with Glenn operation. The 3.5-millimetre Blalock-Taussig shunt was stented successfully with a 5-millimetre pre-mounted stent, resulting in an increase in shunt diameter and oxygen saturation by nearly 30% and 10%, respectively. PMID:21920058

  6. Percutaneous balloon occlusion of surgical arteriovenous fistulae following venous thrombectomy.

    PubMed

    Endrys, J; Eklöf, B; Neglén, P; Zýka, I; Peregrin, J

    1989-01-01

    We describe a percutaneous method of balloon occlusion of surgically created femoral arteriovenous fistulae (AVF) after thrombectomy for acute iliofemoral venous thrombosis. The technique was successful in permanent obliteration of the AVF in 25 of 27 patients. Complications were few, minor, and limited to the developmental period of the procedure. No patient required surgical intervention. The procedure provides an opportunity to angiographically evaluate the results of previous thrombectomy. PMID:2513121

  7. Percutaneous corrective osteotomy for Kirner's deformity: a case report.

    PubMed

    Gamo, Kazushige; Kuriyama, Kohji; Uesugi, Ayako; Nakase, Takanobu; Hamada, Masayuki; Kawai, Hideo

    2014-05-01

    Kirner's deformity is a rare skeletal deformity first described in Germany in 1927. It is characterized by progressive palmar-radial curvature of the distal phalanx of the small finger. Here, we present the case of a 15-year-old boy with Kirner's deformity in both little fingers, who was treated with percutaneous corrective osteotomy. This was followed by a successful outcome after 36 months. PMID:24590256

  8. The value of percutaneous cholangiography

    PubMed Central

    Evison, Gordon; McNulty, Myles; Thomson, Colin

    1973-01-01

    Percutaneous cholangiograms performed on fifty patients in a district general hospital have been reviewed, and the advantages and limitations of the examination are described. The investigation is considered to have sufficient diagnostic value to warrant its inclusion in the diagnostic armamentarium of every general radiological department. ImagesFig. 1Fig. 2Fig. 3Fig. 4 PMID:4788917

  9. Recent Advances in Percutaneous Cardioscopy.

    PubMed

    Uchida, Yasumi

    2011-08-01

    Percutaneous cardioscopy, using high-resolution fiberoptic imaging, enables direct visualization of the cardiac interior, thereby enabling macroscopic pathological diagnosis. Percutaneous cardioscopy has demonstrated that the endocardial surface exhibits various colors characteristic of different heart diseases. This imaging modality can now be used for evaluation of the severity of myocardial ischemia, and staging of myocarditis. Myocardial blood flow recovery induced by vasodilating agents or percutaneous coronary interventions can be clearly visualized. Morphological and functional changes in the cardiac valves can also be evaluated. Cardioscope-guided endomyocardial biopsy enables pin-point biopsy of the diseased myocardium. Recently, dye-image cardioscopy and fluorescence cardioscopy were developed for evaluation of the subendocardial microcirculation. Cardioscope-guided intracardiac therapies such as myotomy, myectomy, valvulotomy, and transendocardial angiogenic and myogenic therapy have been trialed using animal models in anticipation of future clinical applications. Percutaneous cardioscopy has the potential to contribute to our understanding of heart disease, and to assist in guidance for intracardiac therapies. PMID:21841961

  10. Percutaneous Management of Caliceal Diverticuli

    PubMed Central

    Krambeck, Amy E.

    2009-01-01

    Abstract Background and Purpose Caliceal diverticula are rare congenital abnormalities that can become symptomatic if associated with a calculus or infection. We review percutaneous management of caliceal diverticula. Methods Pathogenesis, clinical evaluation, management options, and recommended follow-up for symptomatic caliceal diverticula are reviewed. We present our single-stage and prepercutaneous nephrolithotomy opacification techniques for the management of caliceal diverticula. This involves complete extraction of all stone particles and ablation of the diverticular cavity without infundibular identification or dilation. Comparison of outcomes between our current ablative technique and our previous dilation technique is evaluated. Results Percutaneous management of caliceal diverticula offers the highest symptomatic relief and stone-free rate of available management options. We identified 106 patients with caliceal diverticula who were treated with a percutaneous approach. Review of 85 of these patients demonstrated that most procedures can be performed with a small nephrostomy tube in place for 24 hours and an overnight hospital stay. Minimal complication and stone recurrence rates were observed. Patients treated with caliceal diverticular ablation experienced a shorter hospital stay, fewer complications, and a higher stone-free status than those patients who were treated with dilation of the diverticular infundibulum. Conclusions Percutaneous management of caliceal diverticula using cavity ablation is a minimally invasive technique that offers long-term symptomatic relief with minimal complications. PMID:19814580

  11. Percutaneous Image-guided Laser Photocoagulation of Spinal Osteoid Osteoma: A Single-Institution Series.

    PubMed

    Tsoumakidou, Georgia; Thnint, Marie-Aude; Garnon, Julien; Buy, Xavier; Steib, Jean-Paul; Gangi, Afshin

    2016-03-01

    Purpose To retrospectively evaluate the safety and efficacy of percutaneous image-guided laser photocoagulation for the treatment of spinal osteoid osteoma (OO) in proximity to neural structures. Materials and Methods This study was institutional review board-approved with waivers of informed consent. From January 1994 until October 2014, 58 patients with spinal OO (mean age, 25 years; 40 men, 17 women) were treated in one institution by using laser photocoagulation with combined computed tomographic (CT) and fluoroscopic guidance. One patient was excluded because of less than 3 months of follow-up. All patients had typical clinical and imaging findings. Clinical features, radiologic data, and procedure-related data were reviewed, and limitations, complications, and failure rate were evaluated. All data were expressed as means standard deviation. P values of less than .05 were indicative of statistical significance. Results OO was in the vertebral body for 18 of 57 patients, the neural arch for 21 of 57 patients, and the articular process for 18 of 57 patients. Mean nidal diameter was 8 mm, and the mean distance from the closest neural structure was 6.6 mm (minimum distance, ?5 mm in 35 of 57 patients). In 35 of 57 patients, no cortical coverage was present between the nidus and neural structure in danger. Mean total energy delivered was 1271 J (2-watt continuous power mode). Thermal insulation (carbon dioxide and/or hydrodissection), temperature monitoring, and electrostimulation were used in 42, 24, and one patient, respectively. Primary clinical success at 1 month was 98.2%. Total recurrence rate was 5.3%. All recurrences were addressed percutaneously. Secondary success rate was 100%. One-year follow-up is available in 54 of 57 patients. No major complications were noted. Conclusion Spinal OO can be safely and effectively treated with percutaneous laser photocoagulation. In cases that are less than 8 mm to 10 mm distance and in the absence of cortical coverage, thermal protection techniques of the neural structures should be used. () RSNA, 2015. PMID:26383230

  12. Primary renal MALToma: A rare differential diagnosis for a recurrent renal mass after primary ablative therapy

    PubMed Central

    Vedovo, Francesca; Pavan, Nicola; Liguori, Giovanni; Siracusano, Salvatore; Bussani, Rossana; Trombetta, Carlo

    2014-01-01

    We report a case of primary renal lymphoma of mucosa-associated lymphoid tissue in an 82-year-old woman. She presented with a history of renal mass previously treated with kidney percutaneous cryoablation at another centre. PMID:25024802

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

    PubMed Central

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

    2014-01-01

    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

  14. Congenital Splenic Cyst Treated with Percutaneous Sclerosis Using Alcohol

    SciTech Connect

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

    2006-08-15

    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.

  15. Percutaneous vertebroplasty: technique and results in 192 procedures.

    PubMed

    Cohen, José E; Lylyk, Pedro; Ceratto, Rosana; Kaplan, Leonid; Umanskyt, Felix; Gomori, John Moshe

    2004-01-01

    Percutaneous vertebroplasty with acrylic cement (usually polymethylmethacrylate) consists of injecting cement into vertebral bodies weakened by osseous lesions. The objective of this procedure is to obtain an analgesic effect by mechanical stabilization in destructive lesions of the spine. The three major indications are aggressive vertebral hemangiomas, severe or refractory pain related to osteoporotic vertebral fractures, and malignant vertebral tumors. Complications are infrequent, but occur essentially in patients with vertebral malignant tumors. We present our experience with 148 patients that underwent 192 percutaneous PMMA vertebroplasties for the treatment of painful osteoporotic compression fractures (76 patients, 105 vertebral levels), hemangiomas (31 patients, 43 vertebral levels) and neoplasms (31 patients, 43 vertebral levels). In a vast majority of appropriately selected cases and especially in osteoporotic cases, vertebroplasty constitutes a relatively simple procedure with a very high rate of success. PMID:14977056

  16. Percutaneous Ablation in the Kidney

    PubMed Central

    Wood, Bradford J.; Gervais, Debra A.

    2011-01-01

    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 PMID:22012904

  17. Successful treatment of relapsing autoimmune pancreatitis in primary Sjögren's syndrome with rituximab: report of a case and review of the literature.

    PubMed

    Rueda, Juan C; Duarte-Rey, Carolina; Casas, Nohemi

    2009-10-01

    Autoimmune pancreatitis (AIP) is a rare disorder often associated with multiple autoimmune diseases like rheumatoid arthritis, inflammatory bowel disease and Sjögren's syndrome (SS). Although knowledge of AIP has grown over the last few years, little is certain about its cause and pathogenesis. Positive immunologic markers like antinuclear antibodies (ANA) or elevated serum levels of IgG4, systemic autoimmune disease association and positive response to oral steroid therapy strongly supports the idea of autoimmune mechanisms involved in the pathogenesis of AIP. We describe the first case reported on the literature of a patient with primary SS who developed relapsing AIP to steroids but responded successfully to Rituximab (RTX) therapy. New theories about the role of B-cells activity in SS and other autoimmune diseases has encourage the use of RTX, proving tolerance and efficacy especially in extra-glandular manifestations. PMID:19137434

  18. Percutaneous Endoluminal Bypass of Iliac Aneurysms with a Covered Stent

    SciTech Connect

    Ruebben, Alexander; Tettoni, Serena; Muratore, Pierluigi; Rossato, Dennis; Savio, Daniele; Rabbia, Claudio

    1998-07-15

    To evaluate the feasibility of percutaneous treatment of iliac aneurysms, a covered stent was inserted in nine men suffering from common iliac artery aneurysms (six cases), external iliac aneurysms (one case), or pseudoaneurysms (two cases). Placement of the stent was successful in all patients. In one patient, an endoprosthesis thrombosed after 15 days, but was successfully treated by thrombolysis and additional stent placement. At the follow-up examinations (mean period 22 months) all stent-grafts had remained patent. No late leakage or stenosis was observed.

  19. Percutaneous Therapy of Ureteral Obstructions and Leak After Renal Transplantation: Long-Term Results

    SciTech Connect

    Aytekin, Cueneyt Boyvat, Fatih; Harman, Ali; Ozyer, Umut; Colak, Turan; Haberal, Mehmet

    2007-11-15

    The purpose of this study was to evaluate the long-term outcome of percutaneous therapy of ureteral complications after renal transplantation. Between January 2000 and June 2006 we percutaneously treated 26 renal transplant patients with ureteral obstruction (n=19) and leak (n=7). Obstructions were classified as early (<2 months after transplantation) or late (>2 months). Patients with leak were treated with nephro-ureteral catheter placement and subsequent double-J stenting. Balloon dilatation, stent placement, and basket extraction were used to treat ureteral obstructions. Patients were followed with ultrasonography. No major procedure-related complication occurred. The mean follow-up time was 34.3 months (range: 6 to 74 months). Initial clinical success was achieved in all 19 patients with obstruction and 6 of 7 patients with leak. Four of 9 early obstructions and 4 of 10 late obstructions recurred during the follow-up. All recurrences were initially managed again with percutaneous methods, including cutting balloon technique and metallic stent placement. Although there was no recurrence in patients with successfully treated leak, stricture was seen at the previous leak site in two patients. These strictures were also successfully managed percutaneously. We conclude that in the treatment of ureteral obstruction and leak following renal transplantation, percutaneous therapy is an effective alternative to surgery. However, further interventions are usually needed to maintain long-term patency.

  20. Percutaneous Transpedicular Fixation: Technical tips and Pitfalls of Sextant and Pathfinder Systems

    PubMed Central

    Hassan, Ahmed Salah Aldin

    2016-01-01

    Study Design The efficacy of the operative techniques, possible benefits as well as pitfalls and limitations of the techniques are discussed. Potential drawbacks are also detected. Purpose This study aims to report indications, techniques, and our experience with the use of the Sextant and PathFinder percutaneous transpedicular screw fixation systems. Overview of Literature Percutaneous pedicle screw insertion is a novel technique. Successful percutaneous placement of pedicle screws requires surgical skill and experience because of lack of anatomic surface landmarks. Fluoroscopy-guided percutaneous placement of pedicle screws is effective. Many systems are now available. Methods We conducted a prospective operative and postoperative analysis of 40 patients with absolute indication for thoracic or lumbar instability between January 2009 and June 2013. All procedures were performed with the Sextant (group A) and PathFinder (group B) systems under fluoroscopic guidance. Operative techniques are discussed and the results compared. Results Percutaneous transpedicular screw fixation minimizes the morbidity associated with open techniques without compromising the quality of fixation. A total of 190 screws were inserted. There was no additional morbidity. Postoperative computed tomography images and plain X-rays were analyzed. Reduction of visual analog scale scores of back pain was evident. Conclusions Fluoroscopy-guided percutaneous pedicular screws are feasible and can be safely done. Current systems allow multi-segmental fixation with significantly less difficulties. The described techniques have acceptable intra- and postoperative complication rates, and overall sufficient pain control with early mobilization of patients. PMID:26949466

  1. Balloon-Assisted Tracking: A Solution to Severe Subclavian Tortuosity Encountered During Transradial Primary PCI.

    PubMed

    Dharma, Surya; Gilchrist, Ian C; Patel, Tejas

    2016-06-01

    Radial artery access is preferred over femoral access for primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction because of the reduction in access site complications and mortality associated with the radial artery access. Successful transradial primary PCI requires knowledge of techniques to handle unexpected severe subclavian artery tortuosity. Balloon-assisted tracking (BAT) is one technique developed to negotiate the tortuosity and loops in the upper extremity. However, the use of BAT in dealing with a severe subclavian loop during a transradial primary PCI procedure has never been reported. We described a case of transradial primary PCI with severe subclavian artery loop that was negotiated successfully by the BAT technique. PMID:27231432

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

    NASA Astrophysics Data System (ADS)

    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

    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.

  3. The prognosis of periprocedural myocardial infarction after percutaneous coronary interventions.

    PubMed

    Zimarino, Marco; Affinito, Vincenzo

    2013-01-01

    An increase of biomarkers of myocardial necrosis is observed frequently after percutaneous coronary interventions (PCI) even when the procedure seems angiographically successful and otherwise uncomplicated. The recently updated Universal Definition of Myocardial infarction (MI) arbitrarily defined periprocedural MI (type 4a) by elevation of cardiac troponin (cTn) values >5 the upper reference limit (URL) in patients with normal baseline values or a rise of cTn values >20% if the baseline values are elevated, together with either angina or new ECG changes or angiographic loss of patency of a coronary artery or a side branch or persistent slow or no-flow or embolization, or imaging demonstration of new loss of viable myocardium. Most frequent causes of such event are side-branch closure and/or plaque microembolization. The present review is focused on the prognostic implication of periprocedural necrosis. The risk related to a PCI-induced MI is significantly lower as compared to a spontaneous event where a similar increase of biomarkers is detected. Moreover, although an association between CK-MB elevations and adverse prognosis after PCI has been documented, existing data do not support the statement that an isolated elevation of troponins after PCI is associated with an adverse prognosis after PCI; increased troponin levels before PCI seem far more predictive of future events than a peri-procedural itself. Caution should be paid in the interpretation of clinical trials using type 4a MI as a primary endpoint. Nevertheless, patients with periprocedural myocardial damage should be treated as a higher-risk cohort, carefully monitored and receive an intensified secondary prevention program. PMID:23164601

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

    SciTech Connect

    Kim, Soo Chin; Kim, Hyo-Cheol Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung

    2011-02-15

    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.

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

    SciTech Connect

    Chu, Hee Ho; Kim, Hyo-Cheol Jae, Hwan Jun; Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk; Chung, Jin Wook; Park, Jae Hyung

    2012-12-15

    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.

  6. Coupling of primary producers, detritus, decomposer organisms and nitrogen availability during secondary succession: Progress report for period September 28, 1987-September 27, 1988

    SciTech Connect

    Redente, E.F.

    1988-06-01

    Secondary succession is a consequence of the interactions among primary producers, decomposers, detritus and abiotic components of the system over time. This study focuses on the interrelationships among above- and below-ground processes involved in semiarid ecosystem development. We found that the addition of nitrogen and phosphorus significantly reduced the production of perennial species while significantly increasing the production of annual and biennial plants. Three years of N addition have altered plant community composition, slowed the rate of secondary succession, and reduced the fungal component, of the microbial community. Early- and late-successional plant species differ in their maintenance of rhizosphere microbial communities. Under nutrient-limited conditions, early-successional species maintain larger microbial biomasses than late-successional species. This strategy may cause early-successional species to be less competitive than late-successional species under nutrient poor conditions because of the need for a greater amount of carbon to be released by early-successional species to maintain a rhizosphere community. Using P/N ratios we have demonstrated that mycorrhizal grasses in the field have enriched relative P nutrition. 52 refs., 2 figs., 3 tabs.

  7. 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)

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

    2014-11-01

    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 relationship between N accumulation and biomass and ecosystem carbon (C) stocks in a 50-year-old volcanic island, Surtsey, Iceland, where N stocks are still exceptionally low. However, a 28-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 had accumulated 0.7 kg N ha-1 yr-1, which was ca. 50-60% of the estimated N input rate from wet deposition. This approximates values for systems under low N input and bare dune habitats. 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 ton C ha-1) had reached normal values for grasslands, while the soil organic carbon (SOC) stocks (4-10 ton 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.

  8. 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)

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

    2014-05-01

    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.

  9. Successful Tuberculosis Treatment Outcomes among HIV/TB Coinfected Patients Down-Referred from a District Hospital to Primary Health Clinics in Rural South Africa

    PubMed Central

    Jacobson, Karen B.; Moll, Anthony P.; Friedland, Gerald H.; Shenoi, Sheela V.

    2015-01-01

    Background HIV and tuberculosis (TB) coinfection remains a major public health threat in sub-Saharan Africa. Integration and decentralization of HIV and TB treatment services are being implemented, but data on outcomes of this strategy are lacking in rural, resource-limited settings. We evaluated TB treatment outcomes in TB/HIV coinfected patients in an integrated and decentralized system in rural KwaZulu-Natal, South Africa. Methods We retrospectively studied a cohort of HIV/TB coinfected patients initiating treatment for drug-susceptible TB at a district hospital HIV clinic from January 2012-June 2013. Patients were eligible for down-referral to primary health clinics(PHCs) for TB treatment completion if they met specific clinical criteria. Records were reviewed for patients’ demographic, baseline clinical and laboratory information, past HIV and TB history, and TB treatment outcomes. Results Of 657(88.7%) patients, 322(49.0%) were female, 558(84.9%) were new TB cases, and 572(87.1%) had pulmonary TB. After TB treatment initiation, 280(42.6%) were down-referred from the district level HIV clinic to PHCs for treatment completion; 377(57.4%) remained at the district hospital. Retained patients possessed characteristics indicative of more severe disease. In total, 540(82.2%) patients experienced treatment success, 69(10.5%) died, and 46(7.0%) defaulted. Down-referred patients experienced higher treatment success, and lower mortality, but were more likely to default, primarily at the time of transfer to PHC. Conclusion Decentralization of TB treatment to the primary care level is feasible in rural South Africa. Treatment outcomes are favorable when patients are carefully chosen for down-referral. Higher mortality in retained patients reflects increased baseline disease severity while higher default among down-referred patients reflects failed linkage of care. Better linkage mechanisms are needed including improved identification of potential defaulters, increased patient education, active communication between hospitals and PHCs, and tracing of patients lost to follow up. Decentralized and integrated care is successful for carefully selected TB/HIV coinfected patients and should be expanded. PMID:25993636

  10. [Percutaneous treatment of chronic total occlusions: state of the art and future perspectives].

    PubMed

    Garbo, Roberto; Gagnor, Andrea; Colombo, Francesco

    2015-10-01

    Coronary chronic total occlusions (CTO) are a frequent finding in patients undergoing coronary angiography. However, a low percentage of patients is still referred for percutaneous coronary intervention. The main reasons lie in the skepticism concerning the real benefit and high technical complexity of these interventions. In recent years, thanks to the growing operators' experience and the introduction of new techniques and materials, the procedural success has increased with relatively low complication rates. There is growing evidence in recent literature that percutaneous recanalization improves symptoms and quality of life, increases ejection fraction and prolongs survival. Appropriate patient selection alone may involve a real clinical benefit in case of percutaneous CTO treatment. The key to procedural success is to use the right method and the knowledge of dedicated techniques and devices: CTO recanalization should be performed by experienced operators, and non-CTO interventionalists should approach these procedures only after specific training. PMID:26444214

  11. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1250 Percutaneous...

  12. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1250 Percutaneous...

  13. Mediastinitis complicating a percutaneous endoscopic gastrostomy: a case report

    PubMed Central

    Papakonstantinou, Kalliopi; Karagiannis, Athanasios; Tsirantonaki, Maria; Konstantinidis, Anastasios; Spirou, Spiros; Skottis, Ion; Karabinis, Andreas

    2003-01-01

    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. PMID:12791167

  14. Fluoroscopy guided percutaneous renal access in prone position.

    PubMed

    Sharma, Gyanendra R; Maheshwari, Pankaj N; Sharma, Anshu G; Maheshwari, Reeta P; Heda, Ritwik S; Maheshwari, Sakshi P

    2015-03-16

    Percutaneous nephrolithotomy is a very commonly done procedure for management of renal calculus disease. Establishing a good access is the first and probably the most crucial step of this procedure. A proper access is the gateway to success. However, this crucial step has the steepest learning curve for, in a fluoroscopy guided access, it involves visualizing a three dimensional anatomy on a two dimensional fluoroscopy screen. This review describes the anatomical basis of the renal access. It provides a literature review of all aspects of percutaneous renal access along with the advances that have taken place in this field over the years. The article describes a technique to determine the site of skin puncture, the angle and depth of puncture using a simple mathematical principle. It also reviews the common problems faced during the process of puncture and dilatation and describes the ways to overcome them. The aim of this article is to provide the reader a step by step guide for percutaneous renal access. PMID:25789297

  15. Management of pediatric pyocele using percutaneous imaging-guided aspiration

    PubMed Central

    Oberlin, Daniel T.; Cheng, Earl Y.

    2015-01-01

    Introduction Pyocele of the scrotum is a rare clinical entity not well-described in the pediatric literature. With the exception of those patients who cannot undergo surgery, all published cases have been treated definitely with surgical drainage with severe cases leading to orchiectomy. Presentation of case A 12 day-old full-term boy with no significant medical history presented to the emergency department with a two-day history of fever, right hemiscrotal redness, swelling and discomfort. Scrotal ultrasound revealed findings consistent with an acute pyocele of the tunica vaginalis also known as an infected hydrocele. The infection was successfully managed with ultrasound-guided transcutaneous aspiration under local anesthesia. Discussion To the best of our knowledge, this is the first description of percutaneous aspiration of infant pyocele Pediatric patients diagnosed with acute pyocele require immediate urologic evaluation, with a consideration for surgical exploration and drainage. Unfortunately, orchiectomy may be required at the time of surgical exploration in severe cases. Percutaneous drainage is a non-operative, minimally invasive treatment modality that avoids orchiectomy and the risks of general anesthesia. Conclusion Percutaneous drainage avoids open surgical exploration, expedites recovery, and is performed in the absence of general anesthesia in select cases. PMID:26453938

  16. Fluoroscopy guided percutaneous renal access in prone position

    PubMed Central

    Sharma, Gyanendra R; Maheshwari, Pankaj N; Sharma, Anshu G; Maheshwari, Reeta P; Heda, Ritwik S; Maheshwari, Sakshi P

    2015-01-01

    Percutaneous nephrolithotomy is a very commonly done procedure for management of renal calculus disease. Establishing a good access is the first and probably the most crucial step of this procedure. A proper access is the gateway to success. However, this crucial step has the steepest learning curve for, in a fluoroscopy guided access, it involves visualizing a three dimensional anatomy on a two dimensional fluoroscopy screen. This review describes the anatomical basis of the renal access. It provides a literature review of all aspects of percutaneous renal access along with the advances that have taken place in this field over the years. The article describes a technique to determine the site of skin puncture, the angle and depth of puncture using a simple mathematical principle. It also reviews the common problems faced during the process of puncture and dilatation and describes the ways to overcome them. The aim of this article is to provide the reader a step by step guide for percutaneous renal access. PMID:25789297

  17. Percutaneous aspiration of fluid for management of peritonitis in space

    NASA Technical Reports Server (NTRS)

    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

    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.

  18. Implementing a successful tuberculosis programme within primary care services in a conflict area using the stop TB strategy: Afghanistan case study

    PubMed Central

    2014-01-01

    Introduction Afghanistan has faced health consequences of war including those due to displacement of populations, breakdown of health and social services, and increased risks of disease transmission for over three decades. Yet it was able to restructure its National Tuberculosis Control Programme (NTP), integrate tuberculosis treatment into primary health care and achieve most of its targets by the year 2011. What were the processes that enabled the programme to achieve its targets? More importantly, what were the underpinning factors that made this success possible? We addressed these important questions through a case study. Case description We adopted a processes and outcomes framework for this study, which began with examining the change in key programme indicators, followed by backwards tracing of the processes and underlying factors, responsible for this change. Methods included review of the published and grey literature along with in-depth interviews of 15 key informants involved with the care of tuberculosis patients in Afghanistan. Discussion and evaluation TB incidence and mortality per 100,000 decreased from 325 and 92 to 189 and 39 respectively, while case notification and treatment success improved during the decade under study. Efficient programme structures were enabled through high political commitment from the Government, strong leadership from the programme, effective partnership and coordination among stakeholders, and adequate technical and financial support from the development partners. Conclusions The NTP Afghanistan is an example that public health programmes can be effectively implemented in fragile states. High political commitment and strong local leadership are essential factors for such programmes. To ensure long-term effectiveness of the NTP, the international support should be withdrawn in a phased manner, coupled with a sequential increase in resources allocated to the NTP by the Government of Afghanistan. PMID:24507446

  19. The Use of Below-Knee Percutaneous Transluminal Angioplasty in Arterial Occlusive Disease Causing Chronic Critical Limb Ischemia

    SciTech Connect

    Loefberg, Ann-Marie; Loerelius, Lars-Erik; Karacagil, Sadettin; Westman, Bo; Almgren, Bo; Berqgvist, David

    1996-09-15

    Purpose: To determine the efficacy, safety and long-term results of crural artery percutaneous transluminal angioplasty (PTA) in limbs with chronic critical limb ischemia (CLI). Methods: Patients undergoing crural artery PTA due to CLI were followed at regular clinic visits with ankle brachial pressure index (ABPI) measurements. PTA of the crural arteries was attempted either alone (n= 39) or in combination with PTA of the superficial and/or popliteal artery (n= 55) in 86 limbs (82 patients and 94 procedures) presenting with CLI. The ages of patients ranged from 37 to 94 years (mean 72 years). The indications for PTA were rest pain in 10 and ulcer/gangrene in 84 limbs.Results: A technically successful PTA with at least one crural level was achieved in 88% of cases (n= 83). Cumulative primary clinical success rates at 6, 12, 24, and 36 months were 55%, 51%, 36%, and 36%, respectively. Cumulative secondary clinical success and limb salvage rates at 36 months were 44% and 72%, respectively. Conclusion: PTA of the crural arteries might be considered the primary choice of treatment in patients with CLI and distal lesions with localized stenosis or segmental short occlusions.

  20. Current status of percutaneous vertebroplasty and percutaneous kyphoplasty a review

    PubMed Central

    Yimin, Yang; Zhiwei, Ren; Wei, Ma; Jha, Rajiv

    2013-01-01

    Percutaneous vertebroplasty (PV) and kyphoplasty (PK) are the 2 vertebral augmentation procedures that have emerged as minimally invasive surgical options to treat painful vertebral compression fractures (VCF) during the last 2 decades. VCF may either be osteoporotic or tumor-associated. Two hundred million women are affected by osteoporosis globally. Vertebral fracture may result in acute pain around the fracture site, loss of vertebral height due to vertebral collapse, spinal instability, and kyphotic deformity. The main goal of the PV and PK procedures is to give immediate pain relief to patients and restore the vertebral height lost due to fracture. In percutaneous vertebroplasty, bone cement is injected through a minimal incision into the fractured site. Kyphoplasty involves insertion of a balloon into the fractured site, followed by inflation-deflation to create a cavity into which the filler material is injected, and the balloon is taken out prior to cement injection. This literature review presents a qualitative overview on the current status of vertebral augmentation procedures, especially PV and PK, and compares the efficacy and safety of these 2 procedures. The review consists of a brief history of the development of these 2 techniques, a discussion on the current research on the bone cement, clinical outcome of the 2 procedures, and it also sheds light on ongoing and future research to maximize the efficacy and safety of vertebral augmentation procedures. PMID:24097261

  1. Clinical review: Percutaneous dilatational tracheostomy

    PubMed Central

    Al-Ansari, Mariam A; Hijazi, Mohammed H

    2006-01-01

    As the number of critically ill patients requiring tracheotomy for prolonged ventilation has increased, the demand for a procedural alternative to the surgical tracheostomy (ST) has also emerged. Since its introduction, percutaneous dilatational tracheostomies (PDT) have gained increasing popularity. The most commonly cited advantages are the ease of the familiar technique and the ability to perform the procedure at the bedside. It is now considered a viable alternative to (ST) in the intensive care unit. Evaluation of PDT procedural modifications will require evaluation in randomized clinical trials. Regardless of the PDT technique, meticulous preoperative and postoperative management are necessary to maintain the excellent safety record of PDT. PMID:16356203

  2. Efficacy and Safety of Augmenting the Preclose Technique with a Collagen-Based Closure Device for Percutaneous Endovascular Aneurysm Repair

    SciTech Connect

    Patel, Rafiuddin; Juszczak, Maciej T.; Bratby, Mark J.; Sideso, Ediri; Anthony, Susan; Tapping, Charles R.; Handa, Ashok; Darby, Christopher R.; Perkins, Jeremy; Uberoi, Raman

    2015-08-15

    PurposeTo report our experience of selectively augmenting the preclose technique for percutaneous endovascular aneurysm repair (p-EVAR) with an Angio-Seal device as a haemostatic adjunct in cases of significant bleeding after tensioning the sutures of the suture-mediated closure devices.Materials and MethodsProspectively collected data for p-EVAR patients at our institute were analysed. Outcomes included technical success and access site complications. A logistic regression model was used to analyse the effects of sheath size, CFA features and stent graft type on primary failure of the preclose technique necessitating augmentation and also on the development of complications.Resultsp-EVAR was attempted via 122 CFA access sites with a median sheath size of 18-French (range 12- to 28-French). Primary success of the preclose technique was 75.4 % (92/122). Angio-Seal augmentation was utilised as an adjunct to the preclose technique in 20.5 % (25/122). The overall p-EVAR success rate was 95.1 % (116/122). There was a statistically significant relationship (p = 0.0093) between depth of CFA and primary failure of preclose technique. CFA diameter, calcification, type of stent graft and sheath size did not have significant effects on primary preclose technique failure. Overall 4.9 % (6/122) required surgical conversion but otherwise there were no major complications.ConclusionAugmentation with an Angio-Seal device is a safe and effective adjunct to increase the success rate of the preclose technique in p-EVAR.

  3. Successful treatment of chronic lower respiratory tract infection by macrolide administration in a patient with intralobar pulmonary sequestration and primary ciliary dyskinesia.

    PubMed

    Tsubouchi, Hironobu; Matsumoto, Nobuhiro; Yanagi, Shigehisa; Ashitani, Jun-Ichi; Nakazato, Masamitsu

    2015-01-01

    Primary ciliary dyskinesia (PCD) is a genetic disease associated with abnormalities in ciliary structure and function. Although recurrent respiratory infection associated with ciliary dysfunction is a common clinical feature, there is no standardized treatment or management of respiratory infection in PCD patients. Here, we report that respiratory infection with PCD and intralobar sequestration (ILS) were treated successfully with clarithromycin before the surgical resection of ILS. A 15-year-old non-smoking Japanese woman was admitted for productive cough and dyspnea on exertion. Chest CT scan on admission showed complex cystic LESIONS with air-fluid level in the right lower lobe, and diffuse nodular shadows in the whole lobe of the lung. On flexible bronchoscopy examination, sputum and bronchiolar fluid cultures revealed Staphylococcus aureus (S. aureus). An electron microscopic examination of the cilia showed inner dynein arm deficiency. Administration of clarithromycin improved the lower respiratory tract infection associated with S. aureus. CT angiography after clarithromycin treatment demonstrated an aberrant systemic artery arising from the celiac trunk and supplying the cystic mass lesions that were incorporated into the normal pulmonary parenchyma without their own pleural covering. Based on these results, the patient was diagnosed with PCD and ILS. Because of the clarithromycin treatment, resection of the ILS was performed safely without any complications. Although further observation of clarithromycin treatment is needed, we believe that clarithromycin may be considered one of the agents for treating PCD. PMID:26236606

  4. Percutaneous coronary intervention in the elderly with ST-segment elevation myocardial infarction

    PubMed Central

    Gao, Lei; Hu, Xin; Liu, Yu-Qi; Xue, Qiao; Feng, Quan-Zhou

    2014-01-01

    As a result of increased life expectancy, octogenarians constitute an increasing proportion of patients admitted to hospital for ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention is currently the treatment of choice for octogenarians presenting with STEMI. The recent literature on this topic has yielded controversial results, even though advances in drug-eluting stents and new types of antithrombotic agents are improving the management of STEMI and postoperative care. In this paper, we review the current status of percutaneous coronary intervention in the elderly with STEMI, including the reasons for their high mortality and morbidity, predictors of mortality, and strategies to improve outcomes. PMID:25114518

  5. Sclerotic Vertebral Metastases: Pain Palliation Using Percutaneous Image-Guided Cryoablation

    SciTech Connect

    Costa de Freitas, Ricardo Miguel Menezes, Marcos Roberto de; Cerri, Giovanni Guido; Gangi, Afshin

    2011-02-15

    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.

  6. Percutaneous Endoscopic Retrieval and Replacement of a Knitted (Ultraflex) Biliary Stent

    SciTech Connect

    Sawada, Satoshi; Kobayashi, Masami; Tanigawa, Noboru; Okuda, Yoshikazu; Mishima, Kazuya; Ohmura, Naoto; Kobayashi, Midori

    1997-09-15

    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.

  7. Percutaneous transluminal angioplasty for carotid artery stenosis in Takayasu arteritis: Persistent benefit over 10 years

    SciTech Connect

    Murakami, Ryuji; Korogi, Yukunori; Matsuno, Yasuji; Matsukawa, Tetsuya; Hirai, Toshinori; Takahashi, Mutsumasa

    1997-05-15

    A 66-year-old man was admitted to our hospital with right hemiplegia due to a cerebral infarction associated with Takayasu arteritis. We successfully performed percutaneous transluminal angioplasty for stenoses of the innominate and right common carotid arteries. Improvement of the stenotic lesions persisted over 10 years.

  8. Retrieval of Cement Embolus from Inferior Vena Cava After Percutaneous Vertebroplasty

    SciTech Connect

    Athreya, S.; Mathias, N.; Rogers, P.; Edwards, R.

    2009-07-15

    Percutaneous vertebroplasty is an accepted treatment for painful vertebral compression fractures caused by osteoporosis and malignant disease. Venous leakage of cement and pulmonary cement embolism have been reported complications. We describe a paravertebral venous cement leak resulting in the deposition of a cement cast in the inferior vena cava and successful retrieval of the cement embolus.

  9. Percutaneous Endovascular Stent-Graft for Iliac Pseudoaneurysm Following Lumbar Discectomy

    SciTech Connect

    Hong, Seong J.; Oh, Joo H.; Yoon, Yup

    2000-11-15

    In a 24-year-old woman, an iliac pseudoaneurysm following lumbar discectomy was successfully treated by percutaneous placement of a self-expanding stent-graft. A postprocedural angiogram demonstrated complete exclusion of the pseudoaneurysm without leakage of contrast agent.

  10. Percutaneous Transthoracic Computed Tomography-Guided AICD Insertion in a Patient with Extracardiac Fontan Conduit

    SciTech Connect

    Murphy, Darra T. Moynagh, Michael R.; Walsh, Kevin P.; Noelke, Lars; Murray, John G.

    2011-02-15

    Percutaneous pulmonary venous atrial puncture was performed under computed tomography guidance to successfully place an automated implantable cardiac defibrillator into a 26-year-old patient with extracardiac Fontan conduit who had presented with two out-of-hospital cardiac arrests. The procedure avoided the need for lead placement at thoracotomy.

  11. Percutaneous ablation of liver tumours.

    PubMed

    Tranberg, K-G

    2004-02-01

    The goal of local ablation treatment of hepatic disease is to prolong survival for patients with unresectable tumours. Presently, influence on survival is difficult to estimate because of the heterogeneity of indications and treatments and short follow-up. This chapter therefore focuses on potential benefits and limitations, complications and solutions for improvement. The main problems with in situ ablation are the lack of good imaging techniques to determine the extent of disease and the lack of a method for real-time monitoring of irreversible tissue effect. With one exception, there are no prospective, randomized studies comparing local destruction methods. It appears that percutaneous ethanol injection and cryotherapy should be replaced by radiofrequency ablation (RFA) or interstitial laser thermotherapy (ILT) and that there is little difference in outcome between RFA and ILT. Intraoperative RFA or ILT is valuable as an adjunct to hepatic resection in order to increase the rate of resectability. The percutaneous approach needs further development. It might be valuable in a few truly unresectable or inoperable patients or in selected patients with neuroendocrine liver metastases. In the large majority of unresectable patients it should, however, presently be used and evaluated only in prospective, randomized studies. PMID:15123088

  12. Percutaneous Transcatheter Ethanol Sclerotherapy and Catheter Drainage of Postoperative Pelvic Lymphoceles

    SciTech Connect

    Akhan, Okan Karcaaltincaba, Musturay; Ozmen, Mustafa N.; Akinci, Devrim; Karcaaltincaba, Deniz; Ayhan, Ali

    2007-04-15

    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.

  13. Tumor seeding from percutaneous biliary catheters.

    PubMed Central

    Chapman, W C; Sharp, K W; Weaver, F; Sawyers, J L

    1989-01-01

    Percutaneous transhepatic biliary decompression has been used since 1973 as a preoperative surgical adjunct in patients with obstructive jaundice. Tumor seeding along the catheter tract is an unusual complication but it occurred recently in one of our patients who had preoperative biliary drainage for four days. Four months after his pancreaticoduodenectomy, a 2-cm nodule developed at the catheter exit site. This nodule was a metastatic focus of adenocarcinoma similar to his pancreatic tumor. He died 1 month later and at autopsy was found to have numerous metastases along the catheter tract. A review of the world literature found 17 other patients with this complication. Thirteen of the 18 total patients had catheters placed for palliation, while 5 patients underwent preoperative drainage before definitive procedures, and 4 of these patients had undergone "curative" resections. Nine of the 18 patients had biliary obstruction from cholangiocarcinoma, while seven patients had primary pancreatic carcinoma. Positioning of the catheter tip above the obstructing tumor and maintaining the catheter for only a short duration before operation (mean 8 days for resected patients, range 2 to 16 days) did not protect against catheter-related tumor seeding. Patients with suspected malignant obstruction of the biliary tract who may have resectable tumors should not undergo routine preoperative biliary decompression. If, on exploration, the tumor is found to be unresectable, then a palliative bypass may be performed. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. PMID:2658881

  14. Current status of percutaneous coronary intervention of chronic total occlusion

    PubMed Central

    Ge, Jun-bo

    2012-01-01

    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 patients 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. PMID:22843178

  15. [Echographic localization for percutaneous internal jugular vein catheterization].

    PubMed

    Jean, G; Megri, K; Adesina, K; François, B

    1994-01-01

    The standard internal jugular vein access is an anatomical-landmark method and the individual variations causes technical difficulty and sometimes morbidity. Ultrasound guidance for percutaneous puncture of internal jugular vein is used in 20 patients for hemodialysis catheter insertion. This method allow the visualization of jugular permeability and needle progression during puncture. A control historical group comparison emphasized the advantage of this technique with lower access time (20 s vs 90 s), more first needle pass success (90% vs 50%) and reduced morbidity (carotid puncture, hematomas). The ultrasound guidance is very simple and safe but major disadvantage is the cost of the equipment. PMID:8047198

  16. Imaging and Percutaneous Management of Acute Complicated Pancreatitis

    SciTech Connect

    Shankar, Sridhar; Sonnenberg, Eric van; Silverman, Stuart G.; Tuncali, Kemal; Banks, Peter A.

    2004-11-15

    Acute pancreatitis varies from a mild, self-limited disease to one with significant morbidity and mortality in its most severe forms. While clinical criteria abound, imaging has become indispensable to diagnose the extent of the disease and its complications, as well as to guide and monitor therapy. Percutaneous interventional techniques offer options that can be life-saving, surgery-sparing or important adjuncts to operation. Close cooperation and communication between the surgeon, gastroenterologist and interventional radiologist enhance the likelihood of successful patient care.

  17. Percutaneous Salvage of Crushed Bilateral Aorto-Iliac Stents: Case Report

    SciTech Connect

    Soares, Gregory M.; Coiner, Leonard G.; Gunlock, Michael G.; Hagino, Ryan T.

    2002-12-15

    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.

  18. Traumatic axillary artery pseudoaneurysm treated with intravascular balloon occlusion and percutaneous thrombin injection

    PubMed Central

    Carratola, Maria; Parikh, Priti; Tchorz, Kathryn; Kauffman, Shannon

    2015-01-01

    Axillary artery pseudoaneurysms are relatively rare, with few reported cases found in the literature. Furthermore, treatment with percutaneous thrombin injection has not yet been reported. We report the case of a 59-year-old man with a large (10 cm) post-traumatic pseudoaneurysm of the left axillary artery found five weeks after a motorcycle crash. The patient sustained multiple injuries, including fractures of the left scapula and clavicle. Edema was observed at the time of diagnosis. Arteriography with successful ultrasound-guided percutaneous thrombin injection was undertaken. The patient experienced no complications after the procedure. PMID:27141239

  19. Percutaneous pulmonary valve implantation in a single artery branch: A preliminary experience

    PubMed Central

    Chessa, Massimo; Butera, Gianfranco; Giugno, Luca; Micheletti, Angelo; Negura, Diana G; Carminati, Mario

    2015-01-01

    To describe preliminary experience of percutaneous pulmonary valve implantation, in a single pulmonary branch position. Two procedures in 2 patients from a single center are described, where implantation of percutaneous valves within a single pulmonary artery branch was technically successful. The procedural indication was pulmonary valve regurgitation and/or residual stenosis. The 2 patients were symptomatic. An Edwards Sapien™ valve (Patient 1), and a Medtronic Melody™ valve (Patient 2) were implanted. Both pts were discharged with an excellent valve function. In this report it is underlined that this modality is technically feasible and may be considered an option in patients with congenital heart defect under special circumstances. PMID:26516424

  20. Early experience with percutaneous lateral discectomy.

    PubMed

    Stern, M B

    1989-01-01

    Seventeen patients were treated by percutaneous lumbar discectomy for a herniated disc and sciatica. The criteria for inclusion in this series included: (1) a protruding disc in the lumbar area causing neural compression; (2) persistent sciatica; (3) failure of conservative treatment; (4) magnetic resonance imaging, computer tomographic, or myelographic confirmation of the protrusion; and (5) chronic low-back pain with definite evidence of a protruding disc at the appropriate level. The only contraindication to the procedure is the presence of an extruded fragment. There were ten male and seven female patients, with an average age of 40 years. The operation was performed under local anesthesia and by the method of Hijikata. Six cases were at L5-S1, nine at L4-L5, four at L3-L4, and one at L2-L3. Fourteen of 16 patients were relieved of their symptoms. One operation was aborted due to the inability to pass the cannula beneath arthritic facet joints. One complication occurred early while using general anesthetic. An L5 nerve root was injured, causing a permanent drop foot. Major possible complications include infection, nerve root injury, and vascular injury. The success rate with an average follow-up period of six and one-half months was 87.5%. PMID:2910618

  1. Minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy for calculus in bladder diverticula

    PubMed Central

    GU, SI-PING; YOU, ZHI-YUAN; HUANG, YUNTENG; LU, YI-JIN; HE, CAOHUI; CAI, XIAO-DONG; ZHOU, XIAO-MING

    2013-01-01

    The aim of this study was to investigate the effectiveness of minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy for treating calculus in bladder diverticula. Percutaneous cystostomy with ureteroscopic pneumatic lithotripsy was performed on six elderly male patients with calculi in bladder diverticula, who could not be treated with transurethral ureteroscopic lithotripsy. The stones were successfully removed from all patients, with no complications such as bladder perforation, rupture, urethritis or cystitis. The surgery time was 15–60 min, with an average time of 32 min. Postoperative ultrasound or X-ray examination showed no stone residues and the bladder stoma healed well. No recurrent stones were detected in the follow-up of 3–24 months (average, 16 months). Minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy is a safe, efficient and easy treatment for calculus in bladder diverticula. This method provides a new clinical approach for lithotripsy and we suggest that it is worthy of wider use. PMID:23837044

  2. A novel vacuum assisted closure therapy model for use with percutaneous devices.

    PubMed

    Cook, Saranne J; Nichols, Francesca R; Brunker, Lucille B; Bachus, Kent N

    2014-06-01

    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

  3. A novel vacuum assisted closure therapy model for use with percutaneous devices

    PubMed Central

    Cook, Saranne J.; Nichols, Francesca R.; Brunker, Lucille B.; Bachus, Kent N.

    2016-01-01

    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

  4. Percutaneous Retrieval of Misplaced Intravascular Foreign Objects with the Dormia Basket: An Effective Solution

    SciTech Connect

    Sheth, Rahul Someshwar, Vimal; Warawdekar, Gireesh

    2007-02-15

    Purpose. We report our experience of the retrieval of intravascular foreign body objects by the percutaneous use of the Gemini Dormia basket. Methods. Over a period of 2 years we attempted the percutaneous removal of intravascular foreign bodies in 26 patients. Twenty-six foreign bodies were removed: 8 intravascular stents, 4 embolization coils, 9 guidewires, 1 pacemaker lead, and 4 catheter fragments. The percutaneous retrieval was achieved with a combination of guide catheters and the Gemini Dormia basket. Results. Percutaneous retrieval was successful in 25 of 26 patients (96.2%). It was possible to remove all the intravascular foreign bodies with a combination of guide catheters and the Dormia basket. No complication occurred during the procedure, and no long-term complications were registered during the follow-up period, which ranged from 6 months to 32 months (mean 22.4 months overall). Conclusion. Percutaneous retrieval is an effective and safe technique that should be the first choice for removal of an intravascular foreign body.

  5. Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy.

    PubMed

    Tepeler, Abdulkadir; Akman, Tolga; Silay, Mesrur Selcuk; Akcay, Muzaffer; Ersoz, Cevper; Kalkan, Senad; Armagan, Abdullah; Sarica, Kemal

    2014-06-01

    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

  6. Single-lead Percutaneous Peripheral Nerve Stimulation for the Treatment of Hemiplegic Shoulder Pain: A Case Series

    PubMed Central

    Chae, John; Wilson, Richard D.; Bennett, Maria E.; Lechman, Tina E.; Stager, Kathryn W.

    2012-01-01

    Objective Previous studies demonstrated the efficacy of Intramuscular Nerve therapy with a 4-lead percutaneous, peripheral nerve stimulation system in reducing hemiplegic shoulder pain. This case series investigates the feasibility of a less complex, single-lead approach in reducing hemiplegic shoulder pain. Methods Eight participants received one percutaneous intramuscular lead in the hemiparetic deltoid muscle and were then treated 6-hours/day for three weeks. The primary outcome measure was the Brief Pain Inventory (Short-Form) Question 3 (BPI3), which queries worst pain in the last week on a 0–10 numeric rating scale. Secondary outcomes included pain interference (BPI9) and Medical Outcomes Study Short-Form 36 (SF-36v2). Primary and secondary outcomes were assessed at end of treatment and 1 and 4-wks after end of treatment. Results All participants tolerated the treatment well with 96% compliance. All leads remained infection free and were removed intact at end of treatment. On average, participants exhibited 70% reduction in BPI3 at end of treatment and 61% reduction at 4-weeks after end of treatment. All participants satisfied the success criterion of at least a 2-point reduction in BPI3 at end of treatment. Longitudinal analysis revealed significant treatment effect for BPI3 (F=14.0, p<0.001), BPI9 (F=5.9, p<0.01) and the bodily pain domain of SF-36v2 (F=12.8, p<0.001). Conclusion This case series demonstrates the feasibility of a single-lead, 3-week Intramuscular Nerve therapy for the treatment of chronic hemiplegic shoulder pain. Additional studies are needed to further demonstrate safety, efficacy and long-term benefit, define optimal prescriptive parameters and dose, and expand clinical indications. PMID:22448759

  7. Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

    PubMed Central

    TAN, YONG; ZHU, JIAN-YONG; QIU, BAO-AN; XIA, NIAN-XIN; WANG, JING-HAN

    2015-01-01

    Hilar cholangiocarcinoma is often unresectable at the time of the initial diagnosis, and the provision of a definite palliative benefit is important in patients with unresectable hilar cholangiocarcinoma. The aim of the present study was to evaluate the safety of percutaneous biliary stenting and to analyze whether percutaneous biliary stenting combined with radiotherapy (RT) prolonged the stent patency and survival time of patients. In total, the cases of 38 patients with unresectable hilar cholangiocarcinoma that underwent percutaneous biliary stenting at the Navy General Hospital were retrospectively reviewed in the present study. Uncovered metallic stenting (UMS) combined with RT was administered to 25 patients, and UMS alone was administered to 13 patients. The records of early complications subsequent to percutaneous biliary stenting were collected, and the stent patency and survival times of patients were analyzed and compared between the two groups. The technical success rate of the procedure was 100% and the successful drainage rate was 86.8%. The overall early complication rate was 15.8% and the procedure-associated mortality rate was 2.6%. The median stent patency was 326 days in the UMS+RT group and 196 days in the UMS group (P=0.022). The UMS+RT group (median, 367 days) demonstrated a longer survival time compared with the UMS group (median, 267 days; P=0.025). Percutaneous biliary stenting offers a safe and effective method for the palliative treatment of patients with unresectable hilar cholangiocarcinoma, and percutaneous biliary stenting combined with RT may prolong stent patency and patient survival time. PMID:26622885

  8. Replacement of Mushroom Cage Gastrostomy Tube Using a Modified Technique to Allow Percutaneous Replacement with an Endoscopic Tube in Patients with Amyotrophic Lateral Sclerosis

    SciTech Connect

    Ammar, Thoraya; Rio, Alan; Ampong, Mary Ann; Sidhu, Paul S.

    2010-06-15

    Radiologic inserted gastrostomy (RIG) is the preferred method in our institution for enteral feeding in amyotrophic lateral sclerosis (ALS). Skin-level primary-placed mushroom cage gastrostomy tubes become tight with weight gain. We describe a minimally invasive radiologic technique for replacing mushroom gastrostomy tubes with endoscopic mushroom cage tubes in ALS. All patients with ALS who underwent replacement of a RIG tube were included. Patients were selected for a modified replacement when the tube length of the primary placed RIG tube was insufficient to allow like-for-like replacement. Replacement was performed under local anesthetic and fluoroscopic guidance according to a preset technique, with modification of an endoscopic mushroom cage gastrostomy tube to allow percutaneous placement. Assessment of the success, safety, and durability of the modified technique was undertaken. Over a 60-month period, 104 primary placement mushroom cage tubes in ALS were performed. A total of 20 (19.2%) of 104 patients had a replacement tube positioned, 10 (9.6%) of 104 with the modified technique (male n = 4, female n = 6, mean age 65.5 years, range 48-85 years). All tubes were successfully replaced using this modified technique, with two minor complications (superficial wound infection and minor hemorrhage). The mean length of time of tube durability was 158.5 days (range 6-471 days), with all but one patient dying with a functional tube in place. We have devised a modification to allow percutaneous replacement of mushroom cage gastrostomy feeding tubes with minimal compromise to ALS patients. This technique allows tube replacement under local anesthetic, without the need for sedation, an important consideration in ALS.

  9. Percutaneous absorption of disopyramide, lidocaine and trimecaine.

    PubMed

    Príborský, J; Kikuchi, K; Takayama, K; Nagai, T

    1998-01-01

    Promoting effect of cyclic monoterpenes on percutaneous absorption of antiarrythmics drugs disopyramide, lidocaine and trimecaine was investigated in the rats. Laurocapram (Azone) was used as a standard comparator of penetration enhancement. The absorption of trimecaine was significantly enhanced by addition of limonene, trans-p-menthane and Azone in 1% concentration. Lidocaine and disopyramide penetrated across the skin only when 1% of limonene was used. Other cyclic monoterpenes showed no effect on percutaneous absorption of examined drugs. PMID:9684478

  10. Percutaneous transcatheter snare vegetectomy in a child.

    PubMed

    Saltık, I Levent; Atik, Sezen U; Eroglu, Ayşe G

    2016-04-01

    Surgical vegetectomy may be indicated in patients with unresolving sepsis, heart failure, recurrent embolism, or the presence of large vegetations >10 mm in size. Percutaneous vegetectomy using a snare may be a reasonable option instead of open-heart surgery in selected patients. We describe the case of a patient with operated tetralogy of Fallot and infective endocarditis who underwent vegetectomy via a percutaneous approach. PMID:26817598

  11. Percutaneous needle biopsy of the irradiated skeleton

    SciTech Connect

    Edeiken, B.; deSantos, L.A.

    1983-03-01

    Percutaneous needle biopsy was performed in 20 patients who had radiologic abnormalities after irradiation of the skeleton. The biopsies were performed to determine the nature of the bone changes and to differentiate radiation necrosis from metastases or local tumor extension. Eleven patients had tumors, two of which were radiation-induced sarcomas; nine patients did not show evidence of tumor. One patient had osteomyelitis rather than the suspected tumor. The value of percutaneous needle biopsy in the postirradiated skeleton is discussed.

  12. [Percutaneous absorption of venenum bufonis in vitro].

    PubMed

    Yu, J; Cheng, Y; Feng, Q; Jin, K

    1995-09-01

    V-C horizontal diffusion cell and HPLC determination have been used to study the effect of 1,2-propanediol and azone on the percutaneous absorption Venenum Bufonis. The contents of resibufogenin have been determined through mouse skin in vitro by HPLC. The results indicate that the contents get increased when 1,2-propanediol is added and that azone can shorten the lag time of percutaneous absorption of resibufogenin through mouse skin in vitro. PMID:8679090

  13. Intraoperative Patient Selection for Tubeless Percutaneous Nephrolithotomy

    PubMed Central

    Lee, Joo Yong; Kim, Kyu Hyun; Kim, Man Deuk; Chung, Doo Yong; Cho, Kang Su

    2014-01-01

    This study was conducted to report our experience of intraoperative patient selection for tubeless percutaneous nephrolithotomy (PCNL) based on a tentative decision-making algorithm. Thirty-four consecutive patients who were scheduled to undergo tubeless PCNL were included and medical records were obtained from a prospectively maintained database for these patients. After completion of PCNL, the nephrostomy site was observed with a safety guidewire in place. If there was no significant bleeding through the tract, tubeless PCNL was performed, and in cases with significant bleeding or other complications, nephrostomy catheter insertion was performed as usual. In 29 cases (85.3%), tubeless PCNL was performed according to our decision-making protocol. Mean stone size was 7.33 9.35 cm2. Mean hospital stay was 2.61 1.01 days. The difference between preoperative and postoperative hemoglobin was 0.68 1.22 g/dL (p > 0.05). Visual analog pain scale scores immediately post-operation, on postoperative day one and on the day of discharge were 4.62 1.80, 3.25 1.68 (postoperative day one vs. operative day; p = 0.001), and 1.87 0.83 (the day of discharge vs. operative day; p = 0.001), respectively. The success rate with insignificant remnant stones was 85.2% and complete stone-free rate was 76.5%. In conclusion, tubeless PCNL was performed successfully with low complication rate and reduced pain score through our decision-making algorithm. PMID:25216439

  14. Gortex graft-external carotid artery anastomotic stricture treated by percutaneous transluminal angioplasty.

    PubMed

    Dacie, J E; Lumley, J S

    1985-01-01

    We describe successful percutaneous transluminal angioplasty (PTA) of a gortex-right external carotid artery anastomotic stricture in a 49-year-old man with amaurosis fugax and occlusion of the right internal carotid artery. No neurological complications occurred during the procedure. The patient had had three previous carotid operations, and PTA enabled successful transcranial arterial bypass surgery to be carried out, with complete relief of symptoms. PMID:2934132

  15. Subclavian Vein Cannulation Success Rate in Neonates and Children

    PubMed Central

    Aminnejad, Reza; Razavi, Seyed Sajjad; Mohajerani, Seyed Amir; Mahdavi, Seyed Alireza

    2015-01-01

    Background: Central vein cannulation allows the administration of large volumes of fluids in short times and at high osmolarities for rehydration, volume replacement, chemotherapy, and parenteral nutrition. Percutaneous central venous line insertion has replaced peripheral venous cut-down as the primary mode of short-term venous access in children. Objectives: The aim of our study was to delineate some aspects of this procedure as well as its success rate and relative risk in pediatrics. Patients and Methods: Totally, 3264 subclavian vein cannulations in neonates and children were analyzed regarding successful catheterization attempts and early complication rates after the procedure retrospectively in Mofid Hospital (Tehran, Iran). Results: There were 1340 newborn patients (first 28 days of life) in our study population. In these newborns, only 55 cannulations failed; one patient was complicated with pneumothorax; guide wires malfunctioned in 21 cases; and first- attempt cannulation success was reported in only 981 cases. In the remaining 1924 patients, between one month and 8 years old, only 14 attempts at the cannulation of the subclavian vein failed and 1655 cases had first-attempt cannulation success. Conclusions: The cannulation of the central vein in neonates and children in a skilled hand would be performed with great success rate and low complications. PMID:26161322

  16. Preoperative trajectory planning for percutaneous procedures in deformable environments.

    PubMed

    Hamzé, Noura; Peterlík, Igor; Cotin, Stéphane; Essert, Caroline

    2016-01-01

    In image-guided percutaneous interventions, a precise planning of the needle path is a key factor to a successful intervention. In this paper we propose a novel method for computing a patient-specific optimal path for such interventions, accounting for both the deformation of the needle and soft tissues due to the insertion of the needle in the body. To achieve this objective, we propose an optimization method for estimating preoperatively a curved trajectory allowing to reach a target even in the case of tissue motion and needle bending. Needle insertions are simulated and regarded as evaluations of the objective function by the iterative planning process. In order to test the planning algorithm, it is coupled with a fast needle insertion simulation involving a flexible needle model and soft tissue finite element modeling, and experimented on the use-case of thermal ablation of liver tumors. Our algorithm has been successfully tested on twelve datasets of patient-specific geometries. Fast convergence to the actual optimal solution has been shown. This method is designed to be adapted to a wide range of percutaneous interventions. PMID:26629592

  17. Chronic Support with an Ambulatory Percutaneous Paracorporeal Artificial Lung

    PubMed Central

    Zhou, Xiaoqin; Wang, Dongfang; Sumpter, Ryan; Pattison, Gary; Croft, Cherry; Zwischenberger, Joseph B.

    2016-01-01

    Background Conventional ECMO is bulky/non-ambulatory and requires multiple blood transfusions. We hypothesized that a percutaneous, paracorporeal artificial lung (PAL) could be established through a single venous cannulation to provide long-term ambulatory respiratory support. Methods Our PAL system was tested in 11 healthy sheep. Avalon Elite™ DLC, inserted through right jugular vein into SVC, RA and IVC, was connected to a CentriMag pump and compact hollow fiber gas exchanger, forming a short circuit PAL system. All sheep were moved to ICU and were ambulatory following anesthesia recovery. Hemodynamics and device performance were measured daily. Results The ambulatory PALs were successfully established in all 11 sheep. The sheep were awake, ate and moved freely in the metabolic cage with no need of artificial nutrition and blood transfusion. All sheep had stable hemodynamics with 2 L/min of average circuit flow, above 9.2 g/dl of Hgb levels throughout the experiment. A progressive decrease of O2 transfer and CO2 removal capacity was observed. The sheep were euthanized between 10–24 days for the reasons of bleeding (n=2), gas exchanger failure (n=6), and DLC issues (n=3). Conclusions We successfully established up to 24 days long-term ambulatory PAL in 11 animals using our patented DLC through a single-site percutaneous venous cannulation. However, critical bleeding/thrombosis formation and gas exchanger durability remain two major challenges for long term ambulatory PAL. PMID:22445195

  18. Image-Guided Percutaneous Ablation of Hepatic Malignancies

    PubMed Central

    Foltz, Gretchen

    2014-01-01

    The liver is a common site of primary and secondary malignancies, often resulting in significant morbidity and mortality. Evaluating these patients in a multidisciplinary setting allows for optimal utilization of all oncologic therapies including surgery, radiation, systemic chemotherapy, transarterial therapies, and ablation. While surgical intervention often provides the best outcomes when treating most hepatic tumors, many patients are not surgical candidates due to extensive tumor burden, underlying liver disease, or other comorbid conditions. The evolution of imaging and ablation devices has allowed for the increased utilization of percutaneous ablation as definitive and palliative treatment of primary and metastatic hepatic malignancies. Ablation induces tumor necrosis by injection of chemicals (chemical ablation) or temperature modification (thermal ablation). The goal of this review is to provide an overview of different ablation techniques commonly used for hepatic malignancies, discuss the oncologic outcomes of these interventions, and outline the current indications, contraindications, and reported complications of these therapies. PMID:25071304

  19. Balloon dilator versus telescopic metal dilators for tract dilatation during percutaneous nephrolithotomy for staghorn stones and calyceal stones

    PubMed Central

    El-Shazly, Mohamed; Salem, Shady; Allam, Adel; Hathout, Badawy

    2015-01-01

    Objective To compare the results of balloon dilatation (BD) vs. telescopic metal dilators (TMDs) in establishing the tract for percutaneous nephrolithotomy (PCNL) in patients with calyceal stones or staghorn stones, but with no hydronephrosis. Patients and methods Data from selected patients over 4years were recorded retrospectively. Patients with complex staghorn stones, an undilated targeted calyx, or the stone filling the targeted calyx, were included in the study. In all, 97 patients were included, of 235 undergoing PCNL between March 2010 and March 2014, and were divided into two groups according to the technique of primary tract dilatation. Group A included patients who had BD and group B those treated using TMDs. Results In group A (BD, 55 patients) dilatation was successful in 34 (62%). The dilatation failed or there was a need for re-dilatation using TMD in 21 patients (38%). In one of these 21 patients the dilatation failed due to extravasation. In group B (TMD, 42 patients) dilatation was successful in 38 (90%) patients, with incomplete dilatation and a need for re-dilatation in four (10%) patients, and no failed procedures. Group A had a significantly higher failure rate than group B (P<0.001). Differences in operative duration, blood loss, stone-removal success rate and complication rate were statistically insignificant. Conclusion BD has a higher failure rate than TMD when establishing access for calyceal stones or staghorn stones that have little space around them. PMID:26413325

  20. Determinants of Outstanding Success in Education: An Investigation among Finalists of Competitions in Polish Language and Mathematics for Pupils in Polish Primary Education.

    ERIC Educational Resources Information Center

    Nakielska-Cremers, Z.

    This two-part volume provides a theoretical study of determinants of success in education and reports on an empirical study of competition in language and mathematics for students in the highest grades of Polish grade schools in 1976-77. The empirical study investigated factors associated with outstanding success in educational endeavors. Of…

  1. [Shock wave lithotripsy, retrograde intrarenal surgery or percutaneous nephrolithotomy for lower pole renal stones?].

    PubMed

    Rojas, Alejandro; Gallegos, Héctor; Salvadó, José A

    2015-01-01

    Among the therapeutic alternatives available for the treatment of lower pole renal calculi are extracorporeal lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery. There is controversy about which of these techniques is more effective, especially for stones smaller than 20 mm. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified four systematic reviews including 11 pertinent randomized controlled trials overall. We combined the evidence and generated a summary of findings following the GRADE approach. We concluded percutaneous nephrolithotomy probably increases success rate, but it is not clear if it decreases the need of retreatment compared to extracorporeal shock wave lithotripsy. In comparison to retrograde intrarenal surgery, it may increase success rate, but it is not clear if it decreases the need of retreatment. Retrograde intrarenal surgery may increase success rate, and probably decreases need of retreatment compared to extracorporeal shock wave lithotripsy. PMID:26352272

  2. Clinical outcome of angiosome-oriented infrapopliteal percutaneous transluminal angioplasty for isolated infrapopliteal lesions in patients with critical limb ischemia

    PubMed Central

    Jeon, Eui-Yong; Cho, Young Kwon; Yoon, Dae Young; Kim, Dae Jung; Woo, Jeong Joo

    2016-01-01

    PURPOSE We aimed to evaluate the clinical usefulness and outcome of angiosome-oriented percutaneous transluminal angioplasty (IP-PTA) and its clinical outcome for isolated infrapopliteal lesions in diabetic critical limb ischemia. METHODS We retrospectively reviewed 70 patients (82 limbs) with diabetic critical limb ischemia who had localized disease at the level of the infrapopliteal artery. Patients underwent IP-PTA between January 2011 and December 2013 and were followed up for a mean of 13 months. The primary target arterial lesions were chosen according to the angiosome concept. We evaluated clinical findings, technical success, and patients’ clinical outcome. The angiographic outcome of IP-PTA was assessed using the angiosome score. We analyzed the relationship between the angiosome score and the amputation rate. RESULTS There were 69 anterior tibial artery (ATA) lesions, 70 posterior tibial artery (PTA) lesions, and 58 peroneal artery (PA) lesions. The primary target arteries were the ATA (n=43), PTA (n=26), PA (n=2), and ATA + PTA (n=11). We divided the treated limbs into target (n=63) and nontarget (n=19) groups. The overall initial technical success rate was 91.4%. Successful wound healing rates were 87.3% (55/63) and 47.3% (9/19) in the target and nontarget groups, respectively (P < 0.05). CONCLUSION Angiosome-oriented primary targeted IP-PTA shows a highly effective treatment outcome in diabetic critical limb ischemia. In cases with inadequate angioplastic results of the target artery, IP-PTA of the nontarget artery should be recommended to improve the limb salvage rates. PMID:26573976

  3. Foliar and fungal 15N:14N ratios reflect development of mycorrhizae and nitrogen supply during primary succession: testing analytical models.

    PubMed

    Hobbie, Erik A; Jumpponen, Ari; Trappe, Jim

    2005-12-01

    Nitrogen isotopes (15N/14N ratios, expressed as delta15N values) are useful markers of the mycorrhizal role in plant nitrogen supply because discrimination against 15N during creation of transfer compounds within mycorrhizal fungi decreases the 15N/14N in plants (low delta15N) and increases the 15N/14N of the fungi (high delta15N). Analytical models of 15N distribution would be helpful in interpreting delta15N patterns in fungi and plants. To compare different analytical models, we measured nitrogen isotope patterns in soils, saprotrophic fungi, ectomycorrhizal fungi, and plants with different mycorrhizal habits on a glacier foreland exposed during the last 100 years of glacial retreat and on adjacent non-glaciated terrain. Since plants during early primary succession may have only limited access to propagules of mycorrhizal fungi, we hypothesized that mycorrhizal plants would initially be similar to nonmycorrhizal plants in delta15N and then decrease, if mycorrhizal colonization were an important factor influencing plant delta15N. As hypothesized, plants with different mycorrhizal habits initially showed similar delta15N values (-4 to -6 per thousand relative to the standard of atmospheric N2 at 0 per thousand), corresponding to low mycorrhizal colonization in all plant species and an absence of ectomycorrhizal sporocarps. In later successional stages where ectomycorrhizal sporocarps were present, most ectomycorrhizal and ericoid mycorrhizal plants declined by 5-6 per thousand in delta15N, suggesting transfer of 15N-depleted N from fungi to plants. The values recorded (-8 to -11 per thousand) are among the lowest yet observed in vascular plants. In contrast, the delta15N of nonmycorrhizal plants and arbuscular mycorrhizal plants declined only slightly or not at all. On the forefront, most ectomycorrhizal and saprotrophic fungi were similar in delta15N (-1 to -3 per thousand), but the host-specific ectomycorrhizal fungus Cortinarius tenebricus had values of up to 7 per thousand. Plants, fungi and soil were at least 4 per thousand higher in delta15N from the mature site than in recently exposed sites. On both the forefront and the mature site, host-specific ectomycorrhizal fungi had higher delta15N values than ectomycorrhizal fungi with a broad host range. From these isotopic patterns, we conclude: (1) large enrichments in 15N of many ectomycorrhizal fungi relative to co-occurring ectomycorrhizal plants are best explained by treating the plant-fungal-soil system as a closed system with a discrimination against 15N of 8-10 per thousand during transfer from fungi to plants, (2) based on models of 15N mass balance, ericoid and ectomycorrhizal fungi retain up to two-thirds of the N in the plant-mycorrhizal system under the N-limited conditions at forefront sites, (3) sporocarps are probably enriched in 15N by an additional 3 per thousand relative to available nitrogen, and (4) host-specific ectomycorrhizal fungi may transfer more N to plant hosts than non-host-specific ectomycorrhizal fungi. Our study confirms that nitrogen isotopes are a powerful tool for probing nitrogen dynamics between mycorrhizal fungi and associated plants. PMID:16096847

  4. Percutaneous Tumor Ablation with Radiofrequency

    PubMed Central

    Wood, Bradford J.; Ramkaransingh, Jeffrey R.; Fojo, Tito; Walther, McClellan M.; Libutti, Stephen K.

    2008-01-01

    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. PMID:11900230

  5. A heart team and multi-modality imaging approach to percutaneous closure of a post-myocardial infarction ventricular septal defect

    PubMed Central

    Iyer, Sunil; Bauer, Thurston; Yeung, Michael; Ramm, Cassandra; Kiser, Andy C.; Caranasos, Thomas G.

    2016-01-01

    Post-infarction ventricular septal defect (PI-VSD) is a devastating complication that carries a high mortality with or without surgical repair. Percutaneous closure is an attractive alternative in select patients though requires appropriate characterization of the PI-VSD as well as careful device and patient selection. We describe a multidisciplinary and multi-modality imaging approach to successful percutaneous closure of a PI-VSD. PMID:27054108

  6. Advances in percutaneous treatment of mitral regurgitation.

    PubMed

    Nombela-Franco, Luis; Urena, Marina; Ribeiro, Henrique Barbosa; Rodés-Cabau, Josep

    2013-07-01

    Percutaneous techniques for the treatment of mitral regurgitation have aroused much interest in recent years. Percutaneous mitral annuloplasty can be performed indirectly by using devices implanted in the coronary sinus or directly by using a retrograde approach. However, as yet, the results of these techniques are scarce and some devices have a high complications rate. The most frequent percutaneous mitral valve repair technique consists of mitral leaflet plication by implanting 1 or more percutaneous clips (MitraClip) in an imitation of the Alfieri surgical technique. Clinical experience with this device is broader than that with any other. The MitraClip device is associated with improved mitral regurgitation in a high percentage of carefully-selected patients. However, the single randomized study performed to date (EVEREST) showed its efficacy to be less than that of surgical repair and we await the results of new randomized studies that should clarify which patient-type can benefit most from this technique. Other left ventricular remodeling devices, tendinous cord implantation, and leaflet ablation are currently undergoing preclinical development or first-in-human experimentation. Finally, the development of biological prostheses for percutaneous mitral valve replacement is at an early stage. Many promising experiments at the preclinical phase and initial experiments in humans will very probably multiply in the near future. However, the true role of this technique in treating mitral valve disease will have to be evaluated in appropriately designed randomized controlled studies. PMID:24776207

  7. Does percutaneous nephrolithotomy cause elevated cardiac troponins?

    PubMed Central

    Shemirani, Hassan; Khanjani, Reza; Mohammadi-Sichani, Mehrdad; Mozafarpour, Sarah; Rabbani, Majid; Shahabi, Javad

    2014-01-01

    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. PMID:24963313

  8. Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: a randomized, clinical trial

    PubMed Central

    Moosanejad, N.; Firouzian, A.; Hashemi, S.A.; Bahari, M.; Fazli, M.

    2016-01-01

    This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques regarding their rates of success and complications in patients with kidney stones. Patients were randomly assigned to two groups. Forty-four patients (24 men; mean age: 50.40±2.02 years) received totally tubeless percutaneous nephrolithotomy (PCNL; no nephrostomy catheter or ureteral catheter after PCNL) and 40 patients (18 men; mean age: 49.95±13.38 years) underwent standard PCNL (a nephrostomy catheter and ureteral catheter were used after PCNL). All surgeries were performed by one surgeon. Postoperative changes in hemoglobin, the blood transfusion rate, changes in creatinine levels, operation time, analgesic need, hospitalization time, and complication rate were compared between the groups. No significant differences were observed in age, gender, stone size, and surgery side between the groups (P<0.05). The operation time was significantly lower in the totally tubeless PCNL group than in the standard PCNL group (P=0.005). Pethidine requirements were significantly higher in the standard PCNL group than the totally tubeless PCNL group (P=0.007). Hospitalization time was significantly higher in the standard PCNL group than in the totally tubeless PCNL group (P<0.0001). The complication rate was 15% in the standard PCNL group and 9.1% in the totally tubeless PCNL group (P=0.73). The totally tubeless PCNL technique is safe and effective, even for patients with staghorn stones. This technique is associated with decreased pain, analgesic needs, and operative and hospitalization time. We believe that a normal peristaltic ureter is the best drainage tube. PMID:27007650

  9. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vessel dilator for percutaneous catheterization... Vessel dilator for percutaneous catheterization. (a) Identification. A vessel dilator for percutaneous catheterization is a device which is placed over the guide wire to enlarge the opening in the vessel, and which...

  10. Single-Centre Experience with Percutaneous Cryoablation of Breast Cancer in 23 Consecutive Non-surgical Patients

    SciTech Connect

    Cazzato, Roberto Luigi; Lara, Christine Tunon de; Buy, Xavier Ferron, Stéphane Hurtevent, Gabrielle; Fournier, Marion; Debled, Marc; Palussière, Jean

    2015-10-15

    AimTo present our single-centre prospective experience on the use of cryoablation (CA) applied to treat primary breast cancer (BC) in a cohort of patients unsuitable for surgical treatment.Materials and MethodsTwenty-three consecutive post-menopausal female patients (median age 85 years; range 56–96) underwent percutaneous CA of unifocal, biopsy-proven BC, under ultrasound/computed tomography (US/CT) guidance. Clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) follow-ups were systematically scheduled at 3, 12, 18 and 24 months. Local tumour control was assessed by comparing baseline and follow-up DCE-MRI.ResultsTwenty-three BC (median size 14 mm) were treated under local anaesthesia (78.3 %) or local anaesthesia and conscious sedation (21.7 %). Median number of cryo-probes applied per session was 2.0. A “dual-freezing” protocol was applied for the first ten patients and a more aggressive “triple-freezing” protocol for the remaining 13. Median follow-up was 14.6 months. Five patients recurred during follow-up and two were successfully re-treated with CA. Five patients presented immediate CA-related complications: four hematomas evolved uneventfully at 3-month follow-up and one skin burn resulted in skin inflammation and skin retraction at 3 and 12 months, respectively.ConclusionsPercutaneous CA is safe and well tolerated for non-resected elderly BC patients. Procedures can be proposed under local anaesthesia only. Given the insulation properties of the breast gland, aggressive CA protocols are required. Prospective studies are needed to better understand the potential role of CA in the local treatment of early BC.

  11. [Percutaneous cementoplasty for malignant osteolysis of the acetabulum].

    PubMed

    Cotten, A; Duquesnoy, B

    1995-09-30

    The development of malignant lesions in the acetabulum can lead to painful and disabling bone destruction. In carefully selected patients where the cortical still provides a sufficient barrier protecting the joint, percutaneous injection of ciment (10-15 cc) can be a successful mean of countering both pain and functional impairment. This easy-to-perform technique requires only local anaesthesia and can be highly cost-effective. The antalgic effect is rapid. Most patients are able to walk again within 1 to 5 days (an effect which is particularly spectacular in bedridden subjects) probably due to the reduced pain and to better distribution of the mechanical forces. Hospitalization is usually shortened. In our experience with 18 patients, clinical improvement has been maintained for up to 18 months (mean follow-up 7 months) if the osteolytic process remains under control. Secondary effects are not rare but usually temporary. Recurrent pain, fever and/or inflammatory processes have been observed and usually resolve within 1 to 4 days. Intra-articular leakage can be avoided by careful patient selection. In association with radiotherapy, percutaneous injection of ciment appears to be an useful alternative to surgery for patients with destructive malignant lesions of the acetabulum, particularly in those with a poor clinical status and a short life expectancy. This technique has already been shown to be effective in lesions of the vertebral bodies. Several teams have made further attempts in other localizations. PMID:7501624

  12. Small-diameter percutaneous decompression for osteonecrosis of the shoulder.

    PubMed

    Harreld, Kevin L; Marulanda, German A; Ulrich, Slif D; Marker, David R; Seyler, Thorsten M; Mont, Michael A

    2009-07-01

    Core decompression of the humeral head has previously been used as a joint-preserving procedure for treatment of symptomatic osteonecrosis of the shoulder. In this article, we describe a new decompression technique, which involves multiple small-diameter (3-mm) percutaneous perforations. In our study population (early-stage disease), shoulder arthroplasty was avoided in all 15 patients (26 shoulders) for a mean follow-up of 32 months (range, 24-41 months). Of the 26 shoulders, 25 had successful clinical and functional outcomes (University of California Los Angeles shoulder score, >24 points), and 1 showed radiographic progression of the disease but has not needed further operative treatment. We compared our decompression results with those of a nonoperative historical control group, identified through a literature search. There was a 48% (143/299) rate of progression to arthroplasty in the control group at a follow-up ranging from 2 to 4.5 years. This outpatient, percutaneous perforations technique appears to be a low-morbidity method for relieving symptoms and deferring shoulder arthroplasty in patients with symptomatic osteonecrosis of the humeral head. PMID:19714276

  13. Fiber optic bronchoscopy-assisted percutaneous tracheostomy: a decade of experience at a university hospital

    PubMed Central

    Romero, Carlos M.; Cornejo, Rodrigo; Tobar, Eduardo; Gálvez, Ricardo; Luengo, Cecilia; Estuardo, Nivia; Neira, Rodolfo; Navarro, José Luis; Abarca, Osvaldo; Ruiz, Mauricio; Berasaín, María Angélica; Neira, Wilson; Arellano, Daniel; Llanos, Osvaldo

    2015-01-01

    Objective To evaluate the efficacy and safety of percutaneous tracheostomy by means of single-step dilation with fiber optic bronchoscopy assistance in critical care patients under mechanical ventilation. Methods Between the years 2004 and 2014, 512 patients with indication of tracheostomy according to clinical criteria, were prospectively and consecutively included in our study. One-third of them were high-risk patients. Demographic variables, APACHE II score, and days on mechanical ventilation prior to percutaneous tracheostomy were recorded. The efficacy of the procedure was evaluated according to an execution success rate and based on the necessity of switching to an open surgical technique. Safety was evaluated according to post-operative and operative complication rates. Results The mean age of the group was 64 ± 18 years (203 women and 309 males). The mean APACHE II score was 21 ± 3. Patients remained an average of 11 ± 3 days on mechanical ventilation before percutaneous tracheostomy was performed. All procedures were successfully completed without the need to switch to an open surgical technique. Eighteen patients (3.5%) presented procedure complications. Five patients experienced transient desaturation, 4 presented low blood pressure related to sedation, and 9 presented minor bleeding, but none required a transfusion. No serious complications or deaths associated with the procedure were recorded. Eleven patients (2.1%) presented post-operative complications. Seven presented minor and transitory bleeding of the percutaneous tracheostomy stoma, 2 suffered displacement of the tracheostomy cannula, and 2 developed a superficial infection of the stoma. Conclusion Percutaneous tracheostomy using the single-step dilation technique with fiber optic bronchoscopy assistance seems to be effective and safe in critically ill patients under mechanical ventilation when performed by experienced intensive care specialists using a standardized procedure. PMID:26340151

  14. Role of percutaneous needle core biopsy in diagnosis and clinical management of renal masses.

    PubMed

    Hu, Rong; Montemayor-Garcia, Celina; Das, Kasturi

    2015-04-01

    Percutaneous needle core biopsies are routinely performed for renal mass diagnosis in some institutions. Because of limited tissue availability, accurate diagnosis can be challenging, and the role of needle core biopsy (NCB) remains debatable in kidney tumor management. In the present study, we reported our experience in diagnosing renal masses via percutaneous NCB and the role it plays in clinical management of these masses. We studied 301 consecutive cases of percutaneous NCBs performed for 280 renal masses from 269 patients between year 2008 and 2011 by reviewing final pathology diagnosis, hematoxylin and eosin slides, and ancillary studies. Diagnostic accuracy was determined by comparing biopsy and nephrectomy diagnoses in a subset of renal masses. Clinical data including demographic information, clinical presentation, radiographic findings, and treatment information were reviewed subsequently if available. The size of renal masses in our study cohort ranged from 0.5 to 24 cm, and 78% of them were small renal masses. Definite diagnoses were rendered in 89% of the renal masses by NCBs, and 23% of them were benign. Renal mass NCB was 100% accurate in diagnosing primary renal malignancy and 93% accurate in determining histologic subtypes. Clinical management was analyzed for 180 renal masses. There was significant difference in clinical management between different diagnostic groups. We conclude that percutaneous NCB is a powerful tool not only for definite tissue diagnosis of renal masses before treatment but also plays an important role in guiding patient management and obtaining material for future molecular studies for targeted therapies. PMID:25666665

  15. Two Cases of Occupational Contact Urticaria Caused by Percutaneous Sensitization to Parvalbumin

    PubMed Central

    Sano, Akiyo; Yagami, Akiko; Suzuki, Kayoko; Iwata, Yohei; Kobayashi, Tsukane; Arima, Masaru; Kondo, Yasuto; Yoshikawa, Tetsushi; Matsunaga, Kayoko

    2015-01-01

    Background In recent years, it has been proposed that the primary mechanism for the development of food allergies is percutaneous sensitization. Since 2010, in Japan, the number of immediate-type wheat allergy due to hydrolyzed wheat protein has dramatically increased among those who have been using soap containing hydrolyzed wheat. This incidence supports the hypothesis that food allergens arise through percutaneous sensitization. Clinical Summary A 25-year-old man (case 1) and an 18-year-old girl (case 2) with atopic dermatitis visited our Department because of food allergy and hand eczema. After starting their work with fish, severe itchy eczema appeared on their hands. They subsequently started to experience oral allergic symptoms, intraoral itchiness and dyspnea after eating fish. Specific IgE antibodies were detected for many fishes, and skin prick tests showed positive reactions for a variety of fishes in both cases. Furthermore, the fluorescence intensities of specific IgE antibodies against parvalbumin from various types of fish in microarray immunoassay analysis showed positive reactions. We diagnosed them as contact urticaria caused by percutaneous sensitization to parvalbumin through job-related physical contact with fish. Conclusion The patients' histories and findings indicate the possibility of percutaneous sensitization through occupational exposure to parvalbumin, leading to food allergy. PMID:26464568

  16. Percutaneous Cryotherapy of Vascular Malformation: Initial Experience

    SciTech Connect

    Cornelis, F.; Neuville, A.; Labreze, C.; Kind, M.; Bui, B.; Midy, D.; Palussiere, J.; Grenier, N.

    2013-06-15

    The present report describes a case of percutaneous cryotherapy in a 36-year-old woman with a large and painful pectoral venous malformation. Cryoablation was performed in a single session for this 9-cm mass with 24 h hospitalisation. At 2- and 6-month follow-up, the pain had completely disappeared, and magnetic resonance imaging demonstrated a significant decrease in size. Percutaneous cryoablation shows promise as a feasible and apparently safe method for local control in patients with symptomatic venous vascular malformations.

  17. An Evaluation of "Success and Dyslexia"--A Multi Component School-Based Coping Program for Primary School Students with Learning Disabilities: Is It Feasible?

    ERIC Educational Resources Information Center

    Firth, Nola Virginia; Frydenberg, Erica; Bond, Lyndal

    2012-01-01

    A learning disabilities coping program was implemented in the final year of two primary schools within the context of a whole class coping program and whole school learning disabilities professional development. Using data collected over three years from school surveys, reports, interviews, school documents and a field diary, this paper reports on…

  18. Successful ICSI in an azoospermic and kidney transplant man with type 1 primary hyperoxaluria and first histopathological testicular findings described in the literature.

    PubMed

    Balmori, C; Guillén, A; Montans, J; Bronet, F; García-Velasco, J A

    2015-02-01

    In this report, we describe for the first time a pregnancy using sperm retrieved from an azoospermic man with kidney transplant due to type I primary hyperoxaluria. It is the first case that we were able to find in the literature for both male infertility and hystopathologic findings. PMID:24456123

  19. An Evaluation of "Success and Dyslexia"--A Multi Component School-Based Coping Program for Primary School Students with Learning Disabilities: Is It Feasible?

    ERIC Educational Resources Information Center

    Firth, Nola Virginia; Frydenberg, Erica; Bond, Lyndal

    2012-01-01

    A learning disabilities coping program was implemented in the final year of two primary schools within the context of a whole class coping program and whole school learning disabilities professional development. Using data collected over three years from school surveys, reports, interviews, school documents and a field diary, this paper reports on

  20. Percutaneous reduction and flexible intramedullary nailing for monteggia fracture in a skeletally mature patient

    PubMed Central

    Beutel, Bryan G.; Klifto, Christopher S.; Chu, Alice

    2014-01-01

    INTRODUCTION Monteggia lesions are defined as a fracture of the proximal ulna with an associated radial head dislocation. Management of these injuries varies depending upon the patient population, ranging from non-operative treatment with closed reduction and immobilization to surgical fixation. Percutaneous techniques of radial head reduction are often reserved for skeletally immature patients. PRESENTATION OF CASE In this case report, a 14-year-old female presented with left elbow pain three days after a fall. Radiographs and CT images from an outside hospital revealed a displaced left radial head fracture and a non-displaced proximal olecranon fracture, consistent with a Monteggia equivalent fracture. The patient underwent percutaneous reduction and internal fixation of the radial head with a flexible intramedullary nail (Metaizeau technique), and open reduction and internal fixation of the olecranon. She developed a 25 degree left elbow flexion contracture and, five months after her index procedure, underwent arthroscopic release and removal of hardware. The radial head reduction was near anatomic and she regained full extension. DISCUSSION This report demonstrates that percutaneous reduction with intramedullary nailing and fixation techniques can be performed successfully in skeletally mature patients. CONCLUSION Given their less invasive nature, we recommend attempting percutaneous interventions in some skeletally mature individuals for fracture reduction and fixation. PMID:25460489

  1. Percutaneous Laser Disc Decompression (PLDD): Experience and Results From Multiple Centers and 19,880 Procedures

    NASA Astrophysics Data System (ADS)

    Paolo Tassi, Gian; Choy, Daniel S. J.; Hellinger, Johannes; Hellinger, Stefan; Lee, Sang-Ho

    2010-05-01

    In mid-February 1986, Peter Ascher and Daniel Choy performed the first Percutaneous Laser Disc Decompression (PLDD) at the Neurosurgical Department, University of Graz, Graz, Austria. It was planned to deliver 1000 joules with a Nd:YAG laser to a herniated L4-5 disc causing sciatica. At 600 joules the procedure was terminated because the pain was gone. Since then, PLDD has spread all over the world, with procedures being performed in the entire spine except for T1-T4 because these discs do not permit percutaneous access with a needle. The success rate has ranged from 70 to 89%, and the complication rate, chiefly discitis, from 0.3 to 1.0%. When successful, return to normal work averages one week. Long term follow-up to 23 years yields a recurrence rate of 4-5%.

  2. Computed tomography-guided percutaneous core needle biopsy in pancreatic tumor diagnosis

    PubMed Central

    Tyng, Chiang J; Almeida, Maria Fernanda A; Barbosa, Paula NV; Bitencourt, Almir GV; Berg, José Augusto AG; Maciel, Macello S; Coimbra, Felipe JF; Schiavon, Luiz Henrique O; Begnami, Maria Dirlei; Guimarães, Marcos D; Zurstrassen, Charles E; Chojniak, Rubens

    2015-01-01

    AIM: To evaluate the techniques, results, and complications related to computed tomography (CT)-guided percutaneous core needle biopsies of solid pancreatic lesions. METHODS: CT-guided percutaneous biopsies of solid pancreatic lesions performed at a cancer reference center between January 2012 and September 2013 were retrospectively analyzed. Biopsy material was collected with a 16-20 G Tru-Core needle (10-15 cm; Angiotech, Vancouver, CA) using a coaxial system and automatic biopsy gun. When direct access to the lesion was not possible, indirect (transgastric or transhepatic) access or hydrodissection and/or pneumodissection maneuvers were used. Characteristics of the patients, lesions, procedures, and histologic results were recorded using a standardized form. RESULTS: A total of 103 procedures included in the study were performed on patients with a mean age of 64.8 year (range: 39-94 year). The mean size of the pancreatic lesions was 45.5 mm (range: 15-195 mm). Most (75/103, 72.8%) procedures were performed via direct access, though hydrodissection and/or pneumodissection were used in 22.2% (23/103) of cases and indirect transhepatic or transgastric access was used in 4.8% (5/103) of cases. Histologic analysis was performed on all biopsies, and diagnoses were conclusive in 98.1% (101/103) of cases, confirming 3.9% (4/103) of tumors were benign and 94.2% (97/103) were malignant; results were atypical in 1.9% (2/103) of cases, requiring a repeat biopsy to diagnose a neuroendocrine tumor, and surgical resection to confirm a primary adenocarcinoma. Only mild/moderate complications were observed in 9/103 patients (8.7%), and they were more commonly associated with biopsies of lesions located in the head/uncinate process (n = 8), than of those located in the body/tail (n = 1) of the pancreas, but this difference was not significant. CONCLUSION: CT-guided biopsy of a pancreatic lesion is a safe procedure with a high success rate, and is an excellent option for minimally invasive diagnosis. PMID:25834323

  3. Percutaneous Vertebroplasty for Pain Management in Patients with Multiple Myeloma: Is Radiofrequency Ablation Necessary?

    SciTech Connect

    Orgera, Gianluigi; Krokidis, Miltiadis; Matteoli, Marco; Varano, Gianluca Maria; La Verde, Giacinto; David, Vincenzo; Rossi, Michele

    2013-05-08

    PurposeThis study was designed to investigate the added role of radiofrequency ablation (RFA) to vertebroplasty on the pain management of patients with multiple myeloma (MM).MethodsThirty-six patients (51–82 years) with vertebral localization of MM were randomly divided into two groups: 18 patients (group A) who underwent RFA and then vertebroplasty, and 18 patients (group B) who underwent only vertebroplasty. Primary endpoints were technical success and pain relief score rate measured by the visual analogue pain scores (VAS) and Roland–Morris Questionnaire (RMQ); secondary endpoint was the amount of administered analgesia. Survival and complications were compared.ResultsTechnical success was 100 % in both groups. The VAS score (at 24 h and 6 weeks postprocedure) decreased in equal manner for both groups from a mean of 9.1–3.4 and 2.0 for group A and from a mean of 9.3–3.0 and 2.3 for group B; RMQ mean score was 19.8 for group A and 19.9 for group B and decreased to a mean of 9.6 and 8.2 for group A and 9.5 and 8.7 for group B. The amount of medication was equally decreased in the two groups. No statistically significant difference was noted. No major complication occurred and two patients died from other causes.ConclusionsThe use of percutaneous vertebroplasty alone appears to be effective for the pain management of the patients with vertebral involvement of multiple myeloma. The use of RFA that includes cost and time does not offer any clear added benefit on the midterm pain management of such patients.

  4. Percutaneous Injection Therapy for a Peripheral Pulmonary Artery Pseudoaneurysm After Failed Transcatheter Coil Embolization

    SciTech Connect

    Lee, Kyungwoo; Shin, Taebeom; Choi, Jinsu; Kim, Younghwan

    2008-09-15

    Coil embolization to occlude the feeding artery of a pseudoaneurysm is an effective treatment to control hemoptysis. However, a feeding artery of the pseudoaneurysm may not be identified at pulmonary angiography, resulting in a failure to obtain embolization. We describe here two cases of a Rasmussen aneurysm that was successfully treated with percutaneous injection of thrombin (case 1) and N-butyl cyanoacrylate (case 2) under ultrasonographic and fluoroscopic guidance after failed transcatheter coil embolization.

  5. Percutaneous bridge to heart transplantation by venoarterial ECMO and transaortic left ventricular venting.

    PubMed

    Fumagalli, R; Bombino, M; Borelli, M; Rossi, F; Colombo, V; Osculati, G; Ferrazzi, P; Pesenti, A; Gattinoni, L

    2004-05-01

    We report a case in which life support for cardiogenic shock was achieved by a nonpulsatile venoarterial bypass, and left ventricular decompression was obtained by a catheter placed percutaneously through the aortic valve into the left ventricle. The blood drained from the left ventricle was pumped into the femoral artery. The normalization of left heart filling pressures allowed the resolution of pulmonary edema, and the patient underwent a successful heart transplantation following 7 days of mechanical cardiocirculatory support. PMID:15202819

  6. Percutaneous Embolization of a High-Flow Pancreatic Transplant Arteriovenous Fistula

    SciTech Connect

    Angle, J. Fritz; Matsumoto, Alan H.; McGraw, J. Kevin; Hagspiel, Klaus D.; Spinosa, David J.; McCullough, Christopher S.

    1998-03-15

    Percutaneous endovascular techniques were used to treat an arteriovenous fistula (AVF) associated with pancreatic transplantation. A pancreatic transplant superior mesenteric artery-to-superior mesenteric-vein AVF was successfully embolized while flow to the pancreas transplant was preserved. The embolization was aided by the use of Guglielmi detachable coils and a detachable balloon. No complications were encountered. At 23 months follow-up, the patient is doing well with no recurrence.

  7. Percutaneous embolization of a high-flow pancreatic transplant arteriovenous fistula

    SciTech Connect

    Angle, J. Fritz; Matsumoto, Alan H.; McGraw, J. Kevin; Hagspiel, Klaus D.; Spinosa, David J.; McCullough, Christopher S.

    1999-03-15

    Percutaneous endovascular techniques were used to treat an arteriovenous fistula (AVF) associated with pancreatic transplantation. A pancreatic transplant superior mesenteric artery-to-superior mesenteric-vein AVF was successfully embolized while flow to the pancreas transplant was preserved. The embolization was aided by the use of Guglielmi detachable coils and a detachable balloon. No complications were encountered. At 23 months follow-up, the patient is doing well with no recurrence.

  8. [Late complication of selective renal arterial embolization after percutaneous surgery: renal "colic"].

    PubMed

    Savoie, Pierre-Henri; Lafolie, Trévor; Gabaudan, Charline; Biance, Nicolas; Avaro, Jean-Philippe; André, Marc; Bertrand, Serge; Balandraud, Paul

    2007-06-01

    Authors report a case of a 31 years old patient who eliminate a urinary stone which contains a platinium coil. Five years ago, this patient had a percutaneous nephrolithotomy. A persistent hematuria was successfully managed with angioembolization of a lower polar artery branch. One of the coils was deployed too distally. It was not efficient, it rolled itself up in the pseudoaneurysm cavity. Different physio pathological hypothesis are developed to explain this expulsion. PMID:17634005

  9. Percutaneous Repair of Radial Artery Pseudoaneurysm in a Hemodialysis Patient Using Sonographically Guided Thrombin Injection

    SciTech Connect

    Corso, Rocco Rampoldi, Antonio; Vercelli, Ruggero; Leni, Davide; Vanzulli, Angelo

    2006-02-15

    We report a case of a radial artery pseudoaneurysm complicating an incorrect puncture of a Brescia-Cimino hemodialysis fistula that was treated with percutaneous ultrasound-guided thrombin injection. The pseudoaneurysm recurred after the initial successful thrombin injection. With a second injection we obtained permanent pseudoaneurysm occlusion. Our case illustrates that this procedure is an effective treatment in this type of arteriovenous fistula complication. We compare this case with the only similar one we could find in the literature.

  10. Percutaneous Retrieval of an Embolized Central Venous Chemoport in a Patient With Colon Cancer

    PubMed Central

    Kim, Jeong Eun; Kim, Mi Kyoung; Shim, Young Kwang; Kim, Jeong Tae; Kim, Sang Min; Lee, Sang Yeub; Hwang, Kyung-Kuk; Kim, Dong-Woon; Cho, Myeong-Chan

    2012-01-01

    The central access device is commonly used as a route of chemotherapuetic agents in patients with malignant diseases for its convenient and safety for insertion. This report describes a case of 66-year-old man with colon cancer who suffered a rare complication in which a chemoport embolized into the inferior vena cava and it was successfully retrieved by a percutaneous approach using a goose neck snare. PMID:22396701

  11. Percutaneous CT-Guided Treatment of Osteochondritis Dissecans of the Sacroiliac Joint

    SciTech Connect

    Becce, Fabio; Mouhsine, Elyazid; Mosimann, Pascal John; Anaye, Anass; Letovanec, Igor; Theumann, Nicolas

    2012-08-15

    Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography-guided retrograde drilling and debridement.

  12. [Epiperiostal, percutaneous plate osteosynthesis. A new minimally invasive technique with reference to "biological osteosynthesis"].

    PubMed

    Weller, S; Hntzsch, D; Frigg, R

    1998-02-01

    Conservation of bone perfusion, protection of the soft tissue envelope and reduction of systemic stress by strengthening the host defence mechanism are general and essential aspects of a biological osteosynthesis. The minimal invasive operating techniques with the use of technical aids and tricks form the necessary presupposition for successful bone healing with a low complication rate. For an epiperiosteal, percutaneous plate osteosynthesis, the technique using a sliding tip and a manipulation handle is demonstrated. PMID:9553479

  13. Bedside ultrasound-guided percutaneous cystostomy in an infant in the neonatal intensive care unit

    PubMed Central

    Luk, Yiu Shiobhon; Shin, Ji Hoon; Khoo, Jennifer Lai San

    2015-01-01

    We describe a case of an infant born at 39 weeks of gestation who was in the neonatal intensive care unit for postoperative management of congenital heart disease and underwent bedside ultrasound-guided percutaneous cystostomy to treat an iatrogenic urethral injury. The procedure was uneventful, successful, and no complications were noted. This case demonstrates that this procedure is safe and minimally invasive. Indications, contraindications, techniques, potential complications, and the safety of performing this procedure in a bedside setting are discussed. PMID:25754366

  14. The Use of the Whole Primary-Care Team, Including Community Health Workers, to Achieve Success in Increasing Colon Cancer Screening Rate.

    PubMed

    Arsenault, Paul R; John, Laura St; OʼBrien, Liam M

    2016-01-01

    The National Colorectal Cancer Roundtable, an organization cofounded by the American Cancer Society and the Centers for Disease Control and Prevention, has set an aggressive goal to achieve an 80% colon cancer screening rate by the year 2018 to reduce the burden of colon cancer in the United States. This goal is in alignment with the primary care movement to focus on prevention and population health. However, colon cancer screening has been proven as an especially challenging preventive measure to get traction on with patients. Oakland Family Medicine, a medium primary care practice in Maine, has engaged in a quality improvement project to increase the colon cancer screening rates from 28%, when the project started, to 80.3%. To achieve these results, it required a redesign of the primary care team, including the use of team extenders like community health workers. In addition, it requires understanding the data and its flaws, knowing the workflow and working to simplify it, and finally, to be clear what problem you are trying to solve. The Oakland Family Medicine project shows that closing the gaps in care for colon cancer screening is not only possible but that the new national goal is attainable also. PMID:26918810

  15. Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

    PubMed Central

    McAlpine, Kristen; Leveridge, Michael J.; Beiko, Darren

    2015-01-01

    Percutaneous nephrolithotomy (PCNL) is an established safe and effective surgical treatment option for renal calculi in renal allografts. The advent of tubeless PCNL has led to reports of ambulatory or outpatient PCNL. This case report describes the successful outpatient management of a 49-year-old female with a symptomatic renal pelvic calculus in her transplanted kidney. Tubeless PCNL successfully removed the stone, free of complication, and the patient was discharged 2 hours and 17 minutes after the procedure in stable condition with minimal pain. This is, to the best of our knowledge, the first successful case of outpatient tubeless PCNL in a transplanted kidney. PMID:26029308

  16. Outpatient percutaneous nephrolithotomy in a renal transplant patient: World's first case.

    PubMed

    McAlpine, Kristen; Leveridge, Michael J; Beiko, Darren

    2015-01-01

    Percutaneous nephrolithotomy (PCNL) is an established safe and effective surgical treatment option for renal calculi in renal allografts. The advent of tubeless PCNL has led to reports of ambulatory or outpatient PCNL. This case report describes the successful outpatient management of a 49-year-old female with a symptomatic renal pelvic calculus in her transplanted kidney. Tubeless PCNL successfully removed the stone, free of complication, and the patient was discharged 2 hours and 17 minutes after the procedure in stable condition with minimal pain. This is, to the best of our knowledge, the first successful case of outpatient tubeless PCNL in a transplanted kidney. PMID:26029308

  17. Percutaneous Transhepatic Endobiliary Drainage of Hepatic Hydatid Cyst with Rupture into the Biliary System: An Unusual Route for Drainage

    SciTech Connect

    Inal, Mehmet; Soyupak, Suereyya; Akguel, Erol; Ezici, Hueseyin

    2002-10-15

    The most common and serious complication of hydatid cyst of the liver is rupture into the biliary tract causing obstructive jaundice, cholangitis and abscess. The traditional treatment of biliary-cystic fistula is surgery and recently endoscopic sphincterotomy. We report a case of complex heterogeneous cyst rupture into the biliary tract causing biliary obstruction in which the obstruction and cyst were treated successfully by percutaneous transhepatic endobiliary drainage. Our case is the second report of percutaneous transbiliary internal drainage of hydatid cyst with rupture into the biliary duct in which the puncture and drainage were not performed through the cyst cavity.

  18. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class...

  19. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class...

  20. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class...

  1. Brachial Artery Access for Percutaneous Renal Artery Interventions

    SciTech Connect

    Kaukanen, Erkki T.; Manninen, Hannu I.; Matsi, Pekka J.; Soeder, Heini K.

    1997-09-15

    Purpose: To evaluate the suitability of transbrachial access for endovascular renal artery interventions. Methods: During 37 consecutive endovascular renal artery interventions, the transbrachial approach was used on nine patients (mean age 63 years; range 41-76 years) for 11 renal artery procedures on native kidneys and one percutaneous transluminal angioplasty (PTA) on a transplanted kidney. The reason for using transbrachial access was a steep aorta-renal angle in five, and severe aorta-iliac atherosclerosis in the remaining patients. In addition to the intervention catheter in the left brachial artery, an additional nonselective catheter for controlling the procedure was inserted transfemorally (six patients) or via the contralateral brachial artery. Results: Eleven interventions (six PTAs, five stents) were successfully completed. The one failure resulted from impenetrable subclavian artery stenosis. The only major complication was a brachial artery pseudoaneurysm requiring surgical treatment. Conclusion: Transbrachial access is an effective and relatively safe technique for renal artery interventions when transfemoral access is not possible.

  2. Cone-Beam Computed Tomography-Guided Percutaneous Radiologic Gastrostomy

    SciTech Connect

    Moehlenbruch, Markus; Nelles, Michael; Thomas, Daniel; Willinek, Winfried; Gerstner, Andreas; Schild, Hans H.; Wilhelm, Kai

    2010-04-15

    The purpose of this study was to investigate the feasibility of a flat-detector C-arm-guided radiographic technique (cone-beam computed tomography [CBCT]) for percutaneous radiologic gastrostomy (PRG) insertion. Eighteen patients (13 men and 5 women; mean age 62 years) in whom percutaneous endoscopic gastrostomy (PEG) had failed underwent CBCT-guided PRG insertion. PEG failure or unsuitability was caused by upper gastrointestinal tract obstruction in all cases. Indications for gastrostomy were esophageal and head and neck malignancies, respectively. Before the PRG procedure, initial C-arm CBCT scans were acquired. Three- and 2-dimensional soft-tissue reconstructions of the epigastrium region were generated on a dedicated workstation. Subsequently, gastropexy was performed with T-fasteners after CBCT-guided puncture of the stomach bubble, followed by insertion of an 14F balloon-retained catheter through a peel-away introducer. Puncture of the stomach bubble and PRG insertion was technically successful in all patients without alteration of the epigastric region. There was no malpositioning of the tube or other major periprocedural complications. In 2 patients, minor complications occurred during the first 30 days of follow-up (PRG malfunction: n = 1; slight infection: n = 1). Late complications, which were mainly tube disturbances, were observed in 2 patients. The mean follow-up time was 212 days. CBCT-guided PRG is a safe, well-tolerated, and successful method of gastrostomy insertion in patients in whom endoscopic gastrostomy is not feasible. CBCT provides detailed imaging of the soft tissue and surrounding structures of the epigastric region in one diagnostic tour and thus significantly improves the planning of PRG procedures.

  3. Retrieval of Embolized Intracardiac Peripherally Inserted Central Catheter Line: Novel Percutaneous Technique by Utilizing a Flexible Biopsy Forceps

    PubMed Central

    Pande, Arindam; Sarkar, Achyut; Ahmed, Imran; Patil, Shailesh K.

    2015-01-01

    Peripheral catheter embolization to the heart is common but infrequently reported. In view of the hazardous complications of thrombosis, embolism, infection, arrhythmia and even death, percutaneous retrieval of such foreign bodies is usually attempted. Previously reported percutaneous technique of retrieval mainly involved the snaring technique. Herein, we report a novel nonsurgical retrieval technique for successful removal of a 46 cm long embolized intracardiac peripherally inserted central catheter by utilizing a flexible biopsy forceps. To the best of our knowledge, the use of flexible biopsy forceps for retrieval has hitherto been unreported and this case report therefore adds to the repertoire of percutaneous retrieval techniques for safe and easy removal of embolized catheters to the heart. PMID:26900421

  4. Interval Biliary Stent Placement Via Percutaneous Ultrasound Guided Cholecystostomy: Another Approach to Palliative Treatment in Malignant Biliary Tract Obstruction

    SciTech Connect

    Harding, James Mortimer, Alex; Kelly, Michael; Loveday, Eric

    2010-12-15

    Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.

  5. Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

    PubMed Central

    2012-01-01

    Background Continuous quality improvement (CQI) methods are widely used in healthcare; however, the effectiveness of the methods is variable, and evidence about the extent to which contextual and other factors modify effects is limited. Investigating the relationship between these factors and CQI outcomes poses challenges for those evaluating CQI, among the most complex of which relate to the measurement of modifying factors. We aimed to provide guidance to support the selection of measurement instruments by systematically collating, categorising, 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: The scope of the review was determined by a conceptual framework developed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). Papers reporting development or use of an instrument measuring a construct encompassed by the framework were included. 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 summarising and comparing instruments. Instrument content was categorised 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 186 potentially relevant instruments, 152 of which were analysed to develop the taxonomy. Eighty-four instruments measured constructs relevant to primary care, with content measuring CQI implementation and use (19 instruments), organizational context (51 instruments), and individual factors (21 instruments). Forty-one instruments were included for full review. Development methods were often pragmatic, rather than systematic and theory-based, and evidence supporting measurement properties was limited. Conclusions Many instruments are available for evaluating CQI, but most require further use and testing to establish their measurement properties. Further development and use of these measures in evaluations should increase the contribution made by individual studies to our understanding of CQI and enhance our ability to synthesise evidence for informing policy and practice. PMID:23241168

  6. Percutaneous fiducial marker placement prior to stereotactic body radiotherapy for malignant liver tumors: an initial experience

    PubMed Central

    Ohta, Kengo; Shimohira, Masashi; Murai, Taro; Nishimura, Junichi; Iwata, Hiromitsu; Ogino, Hiroyuki; Hashizume, Takuya; Shibamoto, Yuta

    2016-01-01

    The aim of this study was to describe our initial experience with a gold flexible linear fiducial marker and to evaluate the safety and technical and clinical efficacy of stereotactic body radiotherapy using this marker for malignant liver tumors. Between July 2012 and February 2015, 18 patients underwent percutaneous fiducial marker placement before stereotactic body radiotherapy for malignant liver tumors. We evaluated the technical and clinical success rates of the procedure and the associated complications. Technical success was defined as successful placement of the fiducial marker at the target site, and clinical success was defined as the completion of stereotactic body radiotherapy without the marker dropping out of position. All 18 fiducial markers were placed successfully, so the technical success rate was 100% (18/18). All 18 patients were able to undergo stereotactic body radiotherapy without marker migration. Thus, the clinical success rate was 100% (18/18). Slight pneumothorax occurred as a minor complication in one case. No major complications such as coil migration or bleeding were observed. The examined percutaneous fiducial marker was safely placed in the liver and appeared to be useful for stereotactic body radiotherapy for malignant liver tumors. PMID:26826200

  7. Percutaneous fiducial marker placement prior to stereotactic body radiotherapy for malignant liver tumors: an initial experience.

    PubMed

    Ohta, Kengo; Shimohira, Masashi; Murai, Taro; Nishimura, Junichi; Iwata, Hiromitsu; Ogino, Hiroyuki; Hashizume, Takuya; Shibamoto, Yuta

    2016-03-01

    The aim of this study was to describe our initial experience with a gold flexible linear fiducial marker and to evaluate the safety and technical and clinical efficacy of stereotactic body radiotherapy using this marker for malignant liver tumors. Between July 2012 and February 2015, 18 patients underwent percutaneous fiducial marker placement before stereotactic body radiotherapy for malignant liver tumors. We evaluated the technical and clinical success rates of the procedure and the associated complications. Technical success was defined as successful placement of the fiducial marker at the target site, and clinical success was defined as the completion of stereotactic body radiotherapy without the marker dropping out of position. All 18 fiducial markers were placed successfully, so the technical success rate was 100% (18/18). All 18 patients were able to undergo stereotactic body radiotherapy without marker migration. Thus, the clinical success rate was 100% (18/18). Slight pneumothorax occurred as a minor complication in one case. No major complications such as coil migration or bleeding were observed. The examined percutaneous fiducial marker was safely placed in the liver and appeared to be useful for stereotactic body radiotherapy for malignant liver tumors. PMID:26826200

  8. Comparison between computed tomography, fluoroscopy, and ultrasonography for guiding percutaneous injection of the canine intervertebral disc.

    PubMed

    MacKenzie, Shawn D; Caswell, Jeff L; Brisson, Brigitte A; Gaitero, Luis; Chalmers, Heather J

    2014-01-01

    A minimally invasive method for delivering injectable therapeutic agents would be desirable for the treatment of intervertebral disc disease in dogs. The purpose of this study was to compare computed tomography (CT), ultrasonography (US), and fluoroscopy modalities for guiding percutaneous injection into canine intervertebral discs. Intervertebral discs of 14 dog cadavers were injected with a gelified ethanol therapeutic agent. Successful injectate placement and injectate leakage were determined based on necropsy inspection of discs. Injection into the nucleus pulposus was successful in 55 of 78 (71%) of all injected discs. Injections guided using CT and fluoroscopy were significantly more successful than US-guided injections. Odds of successful injection without leakage were greater for CT vs. US (P = 0.0026) but there was no significant difference between CT and fluoroscopy (P = 0.0620). Injection success rates did not differ among vertebral sites or dog cadavers of varying weights. Forty-nine (63%) of injection sites had injectate leakage outside the disc and 10 of these involved structures within the vertebral canal. The highest rate of injection success with the least amount of leakage was achieved with CT guidance. Findings indicated that CT, fluoroscopy, and US are feasible modalities for guiding percutaneous injection of a gelified ethanol therapeutic agent into the canine intervertebral disc, with moderate to high success rates for different regions of the spine. However, a moderately high rate of injectate leakage occurred outside of the disc and this should be taken into consideration for future safety and efficacy studies. PMID:24620815

  9. Percutaneous papillary large balloon dilation during percutaneous cholangioscopic lithotripsy for the treatment of large bile-duct stones: a feasibility study.

    PubMed

    Han, Jee Young; Jeong, Seok; Lee, Don Haeng

    2015-03-01

    When access to a major duodenal papilla or endoscopic retrograde cholangiopancreatography has failed, percutaneous transhepatic cholangioscopic lithotripsy (PTCS-L) may be useful for removing common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) during PTCS-L for the removal of large CBD stones has not been established. We aimed to determine the safety and efficacy of PPLBD for the treatment of large CBD stones. Eleven patients with large CBD stones in whom the access to the major papilla or bile duct had failed were enrolled prospectively. Papillary dilation was performed using a large (12-20 mm) dilation balloon catheter via the percutaneous transhepatic route. Post-procedure adverse events and efficacy of the stone retrieval were measured. The initial success rate of PPLBD was 100%. No patient required a basket to remove a stone after PPLBD. Electrohydraulic lithotripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8 min and no adverse events occurred after PPLBD. Asymptomatic hyperamylasemia was not encountered in any patients. This study indicates that PPLBD is safe and effective for removal of large CBD stones. PMID:25729250

  10. Clinical evaluation of a true percutaneous technique for antegrade femoral nailing.

    PubMed

    Ziran, Bruce H; Smith, Wade R; Zlotolow, D A; Manion, C; Grosskreuz, R; Agudelo, Juan F; Morgan, Steven J

    2005-10-01

    From July 1997 to March 2001, 209 consecutive patients with 215 femoral shaft fractures amenable to antegrade femoral nailing were enrolled. A true percutaneous insertion technique was performed using a stab wound incision. One hundred ninety-seven (92%) fractures achieved primary union with anatomic or near anatomic alignment. Eighteen (8%) healing problems and two deep infections (1%) responded to repeat interventions. There was one iatrogenic complication related to an anterior starting point. External blood loss was minimal (generally <100 cc). Incisions averaged 16 mm and healed uneventfully. At one-year follow-up only 10% of patients had hip abductor pain. The percutaneous technique appears to be a safe and effective alternative to the standard technique. Hip pain at one year appears decreased compared to reports using a traditional approach. PMID:16237882

  11. Rare complications after lung percutaneous radiofrequency ablation: Incidence, risk factors, prevention and management.

    PubMed

    Alberti, Nicolas; Buy, Xavier; Frulio, Nora; Montaudon, Michel; Canella, Mathieu; Gangi, Afshin; Crombe, Amandine; Palussière, Jean

    2016-06-01

    Among image-guided thermo-ablative techniques, percutaneous radiofrequency ablation (PRFA) is the most widely used technique for the treatment of primary and secondary lung malignancies. Tolerance of PRFA in the lung is excellent. However, relatively little is known about potential rare complications. This article presents both the clinical and imaging features of lung PRFA complications as well as their prevention and management. Complications may be classified in four groups: pleuropulmonary (e.g., bronchopleural or bronchial fistula, delayed abscess or aspergilloma inside post-PRFA cavitations, pulmonary artery pseudo aneurysm, gas embolism and interstitial pneumonia); thoracic wall and vertebral (e.g., rib or vertebral fractures and intercostal artery injury); mediastinal and apical (e.g., neural damage); or diaphragmatic. Most complications can be managed with conservative treatment, percutaneous or endoscopic drainage, or surgical repair. PMID:27161069

  12. Similar Success Rates with Bivalirudin and Unfractionated Heparin in Bare-Metal Stent Implantation

    SciTech Connect

    Hallak, Omar; Shams, S. Ali; Broce, Mike; Lavigne, P. Scott; Lucas, B. Daniel; Elhabyan, Abdul-Karim; Reyes, Bernardo J.

    2007-09-15

    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.

  13. Complications of Percutaneous Nephrostomy, Percutaneous Insertion of Ureteral Endoprosthesis, and Replacement Procedures

    SciTech Connect

    Kaskarelis, Ioannis S.; Papadaki, Marina G.; Malliaraki, Niki E.; Robotis, Epaminondas D.; Malagari, Katerina S.; Piperopoulos, Ploutarchos N.

    2001-07-15

    Purpose: The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses.Methods: During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting).Results: There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter.Conclusion: The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures.

  14. Percutaneous Treatment of Pyocystis in Patients with Autosomal Dominant Polycystic Kidney Disease

    SciTech Connect

    Akinci, Devrim Turkbey, Baris; Yilmaz, Rahmi; Akpinar, Erhan; Ozmen, Mustafa N.; Akhan, Okan

    2008-09-15

    The course of autosomal dominant polycystic kidney disease (ADPKD) is frequently complicated by infection of a cyst within a polycystic kidney, which is a diagnostic and therapeutic dilemma damaging the clinical course of patients. The aim of this study was to demonstrate the safety and efficacy of percutaneous drainage in management of infected cysts in ADPKD patients. Between May 2003 and December 2006, percutaneous drainage was performed in 16 infected renal cysts of four kidneys in three patients (two females, one male), with a mean age of 57.3 years. Cyst dimensions, total amount of drained cyst fluid, catheterization duration, isolated microorganisms, and follow-up duration were recorded. Technical, clinical success rates were 100%; the complication rate was 0%. Diameters of cysts ranged between 3 and 8 cm. Average volume of drained fluid and average duration of catheterization for one cyst were 226 ml and 9.8 days. No recurrence was encountered but one patient (no. 3), who had pyocystis in the right kidney and was treated with catheterization, referred with left flank pain due to pyocystis in her left kidney 3 months later. Follow-up durations were 35, 47, and 11 months for patients 1, 2, and 3, respectively. For patient 3, follow-up duration for the second procedure was 7 months. We conclude that percutaneous drainage with antibiotic therapy should be the initial method in management of infected cysts in ADPKD patients, with high success and low complication rates.

  15. Common Bile Duct Stones Detected After Cholecystectomy:Advancement into the Duodenum via the Percutaneous Route

    SciTech Connect

    Ozcan, Nevzat Erdogan, Nuri; Baskol, Mevlut

    2003-04-15

    Purpose: To report our experience in the use of percutaneous extraction of common bile duct stones detected in the post-cholecystectomy period. Methods: Forty-two patients in whom endoscopic cannulation and/or sphincterotomy had failed or could not be done due to several reasons underwent balloon dilatation of the ampulla of Vater and subsequent advancement of the stones via the percutaneous transhepatic route or T-tube tract. Results: The procedure was successful in 42 cases. In three patients, stones were crushed in the common bile duct and pushed as fragments into the duodenum. In all cases transient adverse effects were observed. There were no major complications. All cases were checked with ultrasonography for 6 months after the procedure. Conclusion: Percutaneous extraction of common bile duct stones is an effective method of treatment with a high success rate,low complication rate and shorter hospital stay. It may serve as an alternative method in cases where endoscopic removal of stones fails.

  16. Percutaneous “Y” biliary stent placement in palliative treatment of type 4 malignant hilar stricture

    PubMed Central

    Centore, Luca; Soreca, Emilio; Corvino, Antonio; Farbo, Vincenzo; Bencivenga, Alfonso

    2016-01-01

    Background This study evaluated the technical and clinical efficacy of percutaneous bilateral biliary stent-in-stent (SIS) deployment technique with a “Y” configuration using open-cell-design stents in type 4 Klatskin tumor patients. Methods Retrospective evaluation ten patients with type IV Bismuth malignant hilar stricture (MHS) treated with percutaneous bilateral “Y” SIS deployment technique placement followed in our institution between March of 2012 and November of 2014. Results Bilateral SIS deployment was technically successful in all patients. One patient (10%) had major complications (episode of cholangitis); one patient (10%) had minor complications, including self-limiting hemobilia. Successful internal drainage was achieved in nine (90%) patients. Stent occlusion by tumor overgrowth and sludge formation occurred in two patient (20%). The median survival and stent patency time were 298 and 315 days respectively. Conclusions Percutaneous bilateral metal stenting using a Y-stent is a valid option for the palliative treatment of type 4 Bismuth MHS, improving quality patient’ life. PMID:27034794

  17. Percutaneous assist devices in acute myocardial infarction with cardiogenic shock: Review, meta-analysis

    PubMed Central

    Romeo, Francesco; Acconcia, Maria Cristina; Sergi, Domenico; Romeo, Alessia; Francioni, Simona; Chiarotti, Flavia; Caretta, Quintilio

    2016-01-01

    AIM: To assess the impact of percutaneous cardiac support in cardiogenic shock (CS) complicating acute myocardial infarction (AMI), treated with percutaneous coronary intervention. METHODS: We selected all of the studies published from January 1st, 1997 to May 15st, 2015 that compared the following percutaneous mechanical support in patients with CS due to AMI undergoing myocardial revascularization: (1) intra-aortic balloon pump (IABP) vs Medical therapy; (2) percutaneous left ventricular assist devices (PLVADs) vs IABP; (3) complete extracorporeal life support with extracorporeal membrane oxygenation (ECMO) plus IABP vs IABP alone; and (4) ECMO plus IABP vs ECMO alone, in patients with AMI and CS undergoing myocardial revascularization. We evaluated the impact of the support devices on primary and secondary endpoints. Primary endpoint was the inhospital mortality due to any cause during the same hospital stay and secondary endpoint late mortality at 6-12 mo of follow-up. RESULTS: One thousand two hundred and seventy-two studies met the initial screening criteria. After detailed review, only 30 were selected. There were 6 eligible randomized controlled trials and 24 eligible observational studies totaling 15799 patients. We found that the inhospital mortality was: (1) significantly higher with IABP support vs medical therapy (RR = +15%, P = 0.0002); (2) was higher, although not significantly, with PLVADs compared to IABP (RR = +14%, P = 0.21); and (3) significantly lower in patients treated with ECMO plus IABP vs IABP (RR = -44%, P = 0.0008) or ECMO (RR = -20%, P = 0.006) alone. In addition, Trial Sequential Analysis showed that in the comparison of IABP vs medical therapy, the sample size was adequate to demonstrate a significant increase in risk due to IABP. CONCLUSION: Inhospital mortality was significantly higher with IABP vs medical therapy. PLVADs did not reduce early mortality. ECMO plus IABP significantly reduced inhospital mortality compared to IABP. PMID:26839661

  18. Percutaneous coronary intervention: recommendations for good practice and training

    PubMed Central

    Dawkins, K; Gershlick, T; de Belder, M; Chauhan, A; Venn, G; Schofield, P; Smith, D; Watkins, J; Gray, H; Joint, W

    2005-01-01

    Cardiologists undertaking percutaneous coronary intervention (PCI) are excited by the combination of patient and physician satisfaction and technological advance occurring on the background of the necessary manual dexterity. Progress and applicability of percutaneous techniques since their inception in 1977 have been remarkable; a sound evidence base coupled with the enthusiasm and ingenuity of the medical device industry has resulted in a sea change in the treatment of coronary heart disease (CHD), which continues to evolve at breakneck speed. This is the third set of guidelines produced by the British Cardiovascular Intervention Society and the British Cardiac Society.1,2 Following the last set of guidelines published in 2000, we have seen PCI activity in the UK increase from 33 652 to 62 780 (87% in four years) such that the PCI to coronary artery bypass grafting ratio has increased to 2.5:1. The impact of drug eluting stents has been profound, and the Department of Health is investigating the feasibility of primary PCI for acute myocardial infarction. Nevertheless, the changes in the structure of National Health Service funding are likely to focus our attention on cost effective treatments and will require physician engagement and sensitive handling if we are to continue the rapid and appropriate growth in our chosen field.3 It is important with this burgeoning development now occurring on a broad front (in both regional centres and district general hospitals) that we maintain our vigilance on audit and outcome measures so that standards are maintained for both operators and institutions alike. This set of guidelines includes new sections on training, informed consent, and a core evidence base, which we hope you will find useful and informative. Keith D Dawkins: President, British Cardiovascular Intervention Society (2000–2004) Huon H Gray: President, British Cardiac Society (2003–2005) PMID:16365340

  19. Endovascular management of iliac vein rupture during percutaneous interventions for occlusive lesions.

    PubMed

    Adams, Matthew K; Anaya-Ayala, Javier E; Davies, Mark G; Bismuth, Jean; Peden, Eric K

    2012-05-01

    Iatrogenic Iliac vein rupture is a rare and potentially lethal complication. We present herein two different clinical scenarios of iatrogenic iliac vein rupture that resulted from performing percutaneous endoluminal interventions to treat symptomatic veno-occlusive lesions. The first case was due to the presence of surgical clips from the patient's previous gynecologic surgery, which caused iliac vein compression and eventually led to acute deep vein thrombosis. The second case resulted from central venous outflow obstruction ipsilateral to a lower extremity arteriovenous dialysis access site. Both Iliac vein ruptures were the result of percutaneous attempts to correct the outflow lesion (delayed in the first case and acute in the second case). Hemorrhage was successfully controlled in both cases using a self-expandable Viabahn (W. L. Gore and Associates, Flagstaff, AZ) covered stent while maintaining vessel patency and resolving symptoms related to veno-occlusive disease. PMID:22437071

  20. Ultrasound-Guided Percutaneous Drainage of Neonatal Pyometrocolpos Under Local Anesthesia

    SciTech Connect

    Algin, Oktay; Erdogan, Cuneyt; Kilic, Nizamettin

    2011-02-15

    Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improved clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.

  1. Prevention and treatment of bone cement-related complications in patients receiving percutaneous kyphoplasty

    PubMed Central

    Zhang, Kaining; Shen, Yingchun; Ren, Yanjun; Zou, Debo

    2015-01-01

    Objective: This study is to investigate the complications and preventive measures of bone cement in percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Methods: A retrospective analysis of 134 cases of osteoporotic vertebral compression fracture patients treated with percutaneous kyphoplasty, which involved 182 vertebral fractures, was performed. The bone cement-related complications, the reasons causing these complications, and the preventive measures were investigated. Results: Successful operation was performed in all patients. Operative bone cement toxic reaction occurred in 1 patient. Different degrees of leakage of bone cement were found in 21 patients with 25 fractures and 1 case needed operation treatment. During the long term follow-up, bone necrosis absorption and cement drifted away which needed operation treatment was found in 1 patient with vertebral fracture. Thirteen adjacent vertebral fractures were found in 11 patients and 10 patients underwent operation treatment again. Conclusions: With careful surgery, complications associated with bone cement could be greatly reduced. PMID:25932175

  2. Traumatic Laceration of the Cisterna Chyli Treated by Lymphangiography and Percutaneous Embolization

    SciTech Connect

    Allison, Stephen Rainey, Matthew Aarabi, Shahram Padia, Siddharth A.

    2013-03-09

    Lymphangiography and percutaneous embolization has been described for the treatment of thoracic duct injury, usually occurring in the postsurgical period. We report a case of a traumatic gunshot-induced massive chylothorax. Inguinal lymphangiogram was performed demonstrating the site of injury at the cisterna chyli. The cisterna chyli was successfully accessed via a percutaneous approach, and embolization was performed. Chylothorax immediately resolved after two rounds of embolization. Although lymphangiography has been traditionally challenging and cumbersome, because of the need for pedal lymph access, the recent use of inguinal lymphangiography has made this technique more practical. Techniques used for embolization of the thoracic duct may be applied to the cisterna chyli, which is much more challenging to treat surgically.

  3. [Right patent ductus arteriosus with an ipsilateral aortic arch: percutaneous closure with amplatzer devices].

    PubMed

    Santiago, Justo; Acuña, Manuel; Arispe, Elizabeth; Camargo, Ronaldo; Neves, Juliana; Arnoni, Daniel; Fontes, Valmir F; Pedra, Carlos A

    2007-03-01

    The association of a right aortic arch with an ipsilateral patent ductus arteriosus is rare, especially when there are no other intracardiac anomalies. We report three female patients aged 26, 35 and 9 years with this combination in whom previous attempts at surgical closure by thoracotomy and sternotomy were unsuccessful and who subsequently underwent successful percutaneous closure of the defects using Amplatzer devices. In two patients, although angiography demonstrated the presence of type-A patent ductus arteriosus, it was not possible to determine the minimum diameter accurately and it was necessary to measure it using a sizing balloon. An Amplatzer duct occluder was used in two patients and an Amplatzer muscular ventricular septal defect occluder, in the other. In all patients, full closure was confirmed in the catheterization laboratory and the patients were discharged on the same day with no complications. Percutaneous closure of a right patent ductus arteriosus associated with a right aortic arch is feasible, safe and effective. PMID:17394880

  4. Percutaneous Retrieval of an Embolized Catheter Tip With the Balloon Dilatation Technique

    PubMed Central

    Karaca, Oguz; Cakal, Beytullah; Omaygenc, Onur; Turkmen, Muhsin

    2016-01-01

    Introduction: Increasing numbers of complex percutaneous coronary interventions have been accompanied by various intra-procedural complications. The fracture and embolization of devices or their fragments are potentially life-threatening situations, depending on the site of embolization. Different non-surgical methods to handle embolic complications have been proposed for different clinical situations. Case Presentation: We present a case of a distally embolized catheter fragment that was percutaneously retrieved. The catheter fragment was tightly held by the inflated balloon, moved together with the system, and successfully retrieved out of the circulation via the femoral sheath. Considerable distal embolization of the foreign body and retrieval with the balloon dilatation technique are the unique features of this case. Conclusions: The present case appears to offer a safe and relatively simple method of balloon dilatation inside the lumen of the embolized fragment when the foreign body is too distal to retrieve with conventional snare systems. PMID:26889462

  5. Percutaneous endoscopic decompression for lumbar spinal stenosis.

    PubMed

    Ahn, Yong

    2014-11-01

    Percutaneous endoscopic lumbar discectomy has become a representative minimally invasive spine surgery for lumbar disc herniation. Due to the remarkable evolution in the techniques available, the paradigm of spinal endoscopy is shifting from treatments of soft disc herniation to those of lumbar spinal stenosis. Lumbar spinal stenosis can be classified into three categories according to pathological zone as follows: central stenosis, lateral recess stenosis and foraminal stenosis. Moreover, percutaneous endoscopic decompression (PED) techniques may vary according to the type of lumbar stenosis, including interlaminar PED, transforaminal PED and endoscopic lumbar foraminotomy. However, these techniques are continuously evolving. In the near future, PED for lumbar stenosis may be an efficient alternative to conventional open lumbar decompression surgery. PMID:25033889

  6. Percutaneous Management of Malignant Biliary Obstruction.

    PubMed

    Sutter, Christopher M; Ryu, Robert K

    2015-12-01

    Malignancy resulting in impaired biliary drainage includes a number of diagnoses familiar to the interventional radiologist. Adequate drainage of such a system can significantly improve patient quality of life, and can facilitate the further treatment options and care of such patients. In the setting of prior instrumentation, cholangitis can present as an urgent indication for drainage. Current initial interventional management of malignant biliary duct obstruction frequently includes endoscopic or percutaneous intervention, with local practices and preprocedural imaging guiding interventional approaches and subsequent management. This article addresses the indications for percutaneous drainage, technical considerations in performing such drainage, and specific techniques useful in attempting to achieve clinical end points in patients with malignant biliary duct obstruction. PMID:26615162

  7. Intraplaque therapies for facilitating percutaneous recanalization of chronic total occlusions.

    PubMed

    Fefer, Paul; Carlino, Mauro; Strauss, Bradley H

    2010-03-01

    Chronic total occlusions (CTOs) are found in up to 30% of angiograms performed on patients with coronary disease. The technical difficulty of performing percutaneous coronary interventions (PCIs) in CTOs, primarily because of the inability to cross CTOs with a guide wire, is reflected in low rates of PCI for CTo (approximately 9% of PCI procedures). The main barrier to successful CTO crossing is the dense collagenous extracellular matrix, particularly at the entrance, known as the 'proximal fibrous cap'. Current interventional strategies to overcome this barrier are based primarily on forceful penetration of the CTO plaque by the use of dedicated CTO guide wires. These extra-stiff wires are designed to transfer maximal force to the tip to create a path within the plaque. However, these wires can also cause vascular complications such as dissections; overall procedural success rates remain modest. Several groups are working on new approaches to actually alter the biology and structural characteristics of the CTO plaque to facilitate guide wire crossing. Preliminary data suggest that plaque-directed therapies aimed at 'priming' it for wire crossing may increase PCI success in these challenging cases. New techniques for plaque modification, either by 'softening' the collagenous matrix (collagenase) or by exposing and enlarging existing microvessels (intravascular thrombolysis, contrast injection) or by inducing new microvessels (angiogenic growth factor[s]) are described in the present review. PMID:20386758

  8. The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon

    PubMed Central

    2014-01-01

    Background In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC. Methods The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors. Results The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages. Conclusions To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well. PMID:24568632

  9. Primary nitinol stenting for femoropopliteal disease.

    PubMed

    Mewissen, Mark W

    2009-04-01

    The 1- to 2-year primary patency rates associated with self-expanding nitinol stents for the treatment of symptomatic femoropopliteal disease are superior to those for percutaneous transluminal angioplasty (PTA) and the first-generation stainless steel balloon-expandable stents. The advantages of nitinol stents include improved radial strength and flexibility, the ability to recover from being crushed, reduced foreshortening, and (importantly) deployability without balloon dilation of the stent edge (which may decrease the incidence of the edge stenosis, or "candy-wrap" effect, often observed with balloon-expandable stents). The technical success rate associated with primary deployment of nitinol stents is very high, and acute to 6-month patency results are predictably excellent. Prior to the introduction of nitinol stents, the original guidelines (2000) of the multidisciplinary TransAtlantic Inter-Society Consensus (TASC I) recommended only an adjunctive role for femoropopliteal stents following suboptimal PTA. The abbreviated 2007 TASC II report essentially extended this recommendation to nitinol stents. Here, current trials of nitinol stenting in the femoropopliteal segment are discussed, with emphasis on the advantages of primary (and often direct) deployment in selected circumstances dependent on factors including lesion length, lesion location, indication for treatment (critical limb ischemia or claudication, in-stent restenosis, stent-graft restenosis), and the relative appropriateness of other modalities (e.g., covered stents). Technical considerations in primary nitinol stenting are briefly reviewed. Open questions regarding the factors involved in nitinol stent fracture and the possible association of fracture and restenosis are examined in the context of current clinical trials. A new generation of femoropopliteal nitinol stents combining superior durability and flexibility is expected soon. Development and implementation of uniform reporting and surveillance standards is important for optimizing current and future research. PMID:19624075

  10. Needle track seeding following percutaneous procedures for hepatocellular carcinoma

    PubMed Central

    Cabibbo, Giuseppe; Craxì, Antonio

    2009-01-01

    Neoplastic seeding may arise after diagnostic or therapeutic percutaneous procedures for hepatocellular carcinoma. The true incidence of seeding with hepatocellular carcinoma is difficult to assess precisely, but a significant risk of seeding exists and is greater when performing diagnostic biopsy as compared to therapeutic percutaneous procedures [radiofrequency ablation, radiofrequency ablation (RFA); percutaneous ethanol injection, Percutaneous ethanol injection (PEI)]. Whenever liver transplantation is feasible, diagnostic needle biopsies should be avoided, but RFA and PEI are often needed as “bridge” treatments. The role of adjuvant treatments in reducing the incidence of seeding following RFA or PEI requires further evaluation. PMID:21160966

  11. Percutaneous transhepatic cholangiography in the investigation of the persistent postoperative bile leak.

    PubMed

    Kissin, C M; Grundy, A

    1987-01-01

    Percutaneous transhepatic cholangiography (PTHC) is now a widely available, inexpensive investigation with a low incidence of complications, especially in the nonobstructed system, and a high success rate. Its role in the management of obstructive jaundice is well established but it is only infrequently performed in the investigation of persistent bile leakage following biliary tract surgery. Four cases are reported in which the superior demonstration of biliary anatomy provided by PTHC allowed successful identification of the site of postoperative biliary leakage. We compared PTHC with other diagnostic imaging techniques available and conclude that it is a safe, accurate, and reliable technique. PMID:3596138

  12. Anesthetic management of a patient with hypertrophic cardiomyopathy with atrial flutter posted for percutaneous nephrolithotomy.

    PubMed

    Nama, Rajnish K; Parikh, Geeta P; Patel, Hiren R

    2015-01-01

    Hypertrophic cardiomyopathy (HCM) is a most common genetic cardiovascular disorder, characterized by asymmetric hypertrophy of the interventricular septum that leads to intermittent obstruction of the left ventricular outflow tract (LVOT). Clinical presentation ranges from absence of symptoms to sudden death in the young and disability at any age. Although patients are asymptomatic in basal conditions, but anesthesia and surgical stress can lead to exacerbation of the LVOT obstruction and may complicate the perioperative course. Therefore, complete understanding of the pathophysiology and anesthetic implications is needed for the successful perioperative outcome. We describe the successful management of a case of HCM with atrial flutter posted for percutaneous nephrolithotomy. PMID:26417147

  13. Radiation Therapy-Induced Cardiovascular Disease Treated by a Percutaneous Approach

    PubMed Central

    Fiocca, Luigi; Coccato, Micol; Sirbu, Vasile; Vassileva, Angelina; Guagliumi, Giulio; Musumeci, Giuseppe; Terzi, Amedeo; Canu, Gianluca; Cerchierini, Elisa; Cugola, Diego; Valsecchi, Orazio

    2015-01-01

    We report the case of a 51-year-old woman, treated with radiotherapy at the age of two years, for a pulmonary sarcoma. Subsequently she developed severe aortic stenosis and bilateral ostial coronary artery disease, symptomatic for dyspnea (NYHA III functional class). Due to the prohibitive surgical risk, she underwent successful stenting in the right coronary artery and left main ostia with drug eluting stents and, afterwards, transcatheter aortic valve replacement with transfemoral implantation of a 23?mm Edwards SAPIEN XT valve. The percutaneous treatment was successful without complications and the patient is in NYHA II functional class at 2 years' follow-up, fully carrying out normal daily activities. PMID:26064696

  14. Radiation Therapy-Induced Cardiovascular Disease Treated by a Percutaneous Approach.

    PubMed

    Fiocca, Luigi; Coccato, Micol; Sirbu, Vasile; Vassileva, Angelina; Guagliumi, Giulio; Musumeci, Giuseppe; Terzi, Amedeo; Canu, Gianluca; Cerchierini, Elisa; Cugola, Diego; Valsecchi, Orazio

    2015-01-01

    We report the case of a 51-year-old woman, treated with radiotherapy at the age of two years, for a pulmonary sarcoma. Subsequently she developed severe aortic stenosis and bilateral ostial coronary artery disease, symptomatic for dyspnea (NYHA III functional class). Due to the prohibitive surgical risk, she underwent successful stenting in the right coronary artery and left main ostia with drug eluting stents and, afterwards, transcatheter aortic valve replacement with transfemoral implantation of a 23?mm Edwards SAPIEN XT valve. The percutaneous treatment was successful without complications and the patient is in NYHA II functional class at 2 years' follow-up, fully carrying out normal daily activities. PMID:26064696

  15. Taylor's approach in an ankylosing spondylitis patient posted for percutaneous nephrolithotomy: A challenge for anesthesiologists

    PubMed Central

    Jindal, Parul; Chopra, Gaurav; Chaudhary, Amit; Rizvi, Aslam Aziz; Sharma, J. P.

    2009-01-01

    We describe a patient with long-standing ankylosing spondylitis who underwent percutaneous nephrolithotomy under spinal anesthesia. At preoperative assessment, it was considered that intubation of the trachea was likely to be difficult. Fiberoptic bronchoscopy was attempted, but without success. As the standard technique for spinal anesthesia failed, a variation of the paramedian approach in the lumbosacral approach, also known as Taylor's approach was successfully attempted. This resulted in adequate sensory and motor blockade for the surgical procedure. The patient did not require airway interventions, but equipment and aids to secure airway were available. PMID:20532110

  16. Percutaneous Vertebral Body Augmentation: An Updated Review

    PubMed Central

    Omidi-Kashani, Farzad

    2014-01-01

    There are many medical conditions like osteoporosis, tumor, or osteonecrosis that weaken the structural strength of the vertebral body and prone it to fracture. Percutaneous vertebral augmentation that is usually applied by polymethylmethacrylate is a relatively safe, effective, and long lasting procedure commonly performed in these situations. In this paper, we updated a review of biomechanics, indications, contraindications, surgical techniques, complications, and overall prognosis of these minimally invasive spinal procedures. PMID:25379561

  17. Cardiac resynchronisation therapy after percutaneous mitral annuloplasty

    PubMed Central

    Swampillai, Janice

    2016-01-01

    Percutaneous approaches to reduce mitral regurgitation in ischemic cardiomyopathy have stirred interest recently. Patients with ischemic cardiomyopathy and functional mitral regurgitation often meet criteria for cardiac resynchronisation therapy to improve left ventricular function as well as mitral regurgitation, and alleviate symptoms. This case shows that implantation of a pacing lead in the coronary sinus to restore synchronous left and right ventricular contraction is feasible, despite the presence of a remodeling device in the coronary sinus. PMID:27182527

  18. A Percutaneous Knotless Technique for SLAP Repair

    PubMed Central

    Tennent, Duncan; Pearse, Eyiyemi

    2016-01-01

    We describe a percutaneous technique for repair of type II SLAP lesions. Through the Neviaser portal, a spinal needle is used to pass a FiberStick suture (Arthrex, Naples, FL) through the labrum to create 2 mattress sutures that are secured with PushLock anchors (Arthrex). This technique is simple, reproducible, and knotless and requires no cannulas. At the end of the procedure, minimal suture material remains in the joint. PMID:27073775

  19. Percutaneous Transhepatic Biliary Drainage Complicated by Bilothorax

    PubMed Central

    Kim, Stephanie H.; Zangan, Steven M.

    2015-01-01

    Percutaneous transhepatic biliary drainage (PTBD) is a well-established and safe technique for the management of biliary obstructions and leaks. While approach is variable based on operator preference, patient anatomy, and indications; PTBD is commonly performed via a right-sided intercostal route. With a right-sided approach, pleural complications may be encountered. The authors describe a case of a right PTBD complicated by a leak into the pleural space, with the subsequent development of bilothorax.

  20. Evolution of Percutaneous Coronary Intervention in Patients with Diabetes

    PubMed Central

    Rana, Jamal S.; Venkitachalam, Lakshmi; Selzer, Faith; Mulukutla, Suresh R.; Marroquin, Oscar C.; Laskey, Warren K.; Holper, Elizabeth M.; Srinivas, Vankeepuram S.; Kip, Kevin E.; Kelsey, Sheryl F.; Nesto, Richard W.

    2010-01-01

    OBJECTIVE To evaluate the association of successive percutaneous coronary intervention (PCI) modalities with balloon angioplasty (BA), bare-metal stent (BMS), drug-eluting stents (DES), and pharmacotherapy over the last 3 decades with outcomes among patients with diabetes in routine clinical practice. RESEARCH DESIGN AND METHODS We examined outcomes in 1,846 patients with diabetes undergoing de novo PCI in the multicenter, National Heart, Lung, and Blood Institute–sponsored 1985–1986 Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry and 1997–2006 Dynamic Registry. Multivariable Cox regression models were used to estimate the adjusted risk of events (death/myocardial infarction [MI], repeat revascularization) over 1 year. RESULTS Cumulative event rates for postdischarge (31–365 days) death/MI were 8% by BA, 7% by BMS, and 7% by DES use (P = 0.76) and for repeat revascularization were 19, 13, and 9% (P < 0.001), respectively. Multivariable analysis showed a significantly lower risk of repeat revascularization with DES use when compared with the use of BA (hazard ratio [HR] 0.41 [95% CI 0.29–0.58]) and BMS (HR 0.55 [95% CI 0.39–0.76]). After further adjustment for discharge medications, the lower risk for death/MI was not statistically significant for DES when compared with BA. CONCLUSIONS In patients with diabetes undergoing PCI, the use of DES is associated with a reduced need for repeat revascularization when compared with BA or BMS use. The associated death/MI benefit observed with the DES versus the BA group may well be due to greater use of pharmacotherapy. PMID:20519661

  1. Percutaneous Cryoablation of Small Hepatocellular Carcinoma with US Guidance and CT Monitoring: Initial Experience

    SciTech Connect

    Orlacchio, Antonio Bazzocchi, Gabriele; Pastorelli, Daniela; Bolacchi, Francesca; Angelico, Mario; Almerighi, Cristiana; Masala, Salvatore; Simonetti, Giovanni

    2008-05-15

    The purpose of this study was to retrospectively determine the safety and effectiveness of percutaneous cryoablation, monitored with computed tomography (CT) and ultrasonographic (US) guidance, for the treatment of hepatocellular carcinoma (HCC). Four patients with small HCCs underwent one percutaneous cryoablation treatment session monitored with CT and US guidance. All patients underwent pretreatment blood chemistry testing and imaging evaluation. We treated lesions with simultaneous insertion of multiple 17-G cryoprobes (two or three) and defined technical success when the extension of a visible iceball was beyond 5 mm from the tumor margin. Intralesional enhancement or tumoral size increase was defined as local progression compared with that on images obtained immediately after ablation. We evaluated complications and follow-up (at 1, 3, and 6 months). All patients survived without short- or long-term complications. Cryoablation was technically successful in all patients at the end of the procedure. During follow-up two patients developed disease recurrence. One patient developed local tumor progression on the margin of the lesion; the other, a new HCC. In the case of local tumor progression a new elevation of {alpha}-fetoprotein ({alpha}FP) levels occurred at first follow-up control. In the other case levels of {alpha}FP remained stable during the first 3 months after the procedure, then demonstrated a progressive increase in {alpha}FP levels beginning at the fourth month, without tumor evidence during CT control at 3 months. We conclude that percutaneous cryotherapy with US guidance and CT monitoring is a feasible, safe, and effective for treatment of HCC. If local ablative procedures of hepatic lesions are to be performed, percutaneous cryoablation, not laparotomic, should be discussed as an alternative therapeutic measure. Longer follow-up should provide proof of the effectiveness of this technique.

  2. Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

    SciTech Connect

    Ozcan, Nevzat Kahriman, Guven Mavili, Ertugrul

    2012-06-15

    Purpose: To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient. Methods: Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14-92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. First, percutaneous transhepatic cholangiography was performed and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones were pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation. Results: Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 (6.8%) major complications, including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were seen after the procedure. There was no mortality. Conclusion: Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.

  3. Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

    SciTech Connect

    Ozcan, Nevzat Kahriman, Guven Mavili, Ertugrul

    2012-08-15

    Purpose: To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient. Methods: Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14-92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. Percutaneous transhepatic cholangiography was performed, and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones were pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation. Results: Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 major complications (6.8%), including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were observed after the procedure. There was no mortality. Conclusion: Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.

  4. Percutaneous nephrolithotomy for 1-2 cm lower-pole renal calculi

    PubMed Central

    Chibber, Percy Jal

    2008-01-01

    Objectives: The most appropriate management of patients with lower-pole calyceal (LC) stones remains controversial. In this review we discuss the role of percutaneous nephrolithotomy (PCNL) in the management of LC stones 1–2 cm in maximum dimension. Materials and Methods: A detailed literature review was performed to summarize the recent technical developments and controversies in PCNL. The results of PCNL for 1-2 cm LC calculi were reviewed. Results: PCNL is increasingly employed as a primary modality in the treatment of LC calculi. It has a high success rate and acceptably low percentage of major complications in experienced hands. Supine position is found to be as safe and effective as prone position. Urologist-acquired access is associated with fewer access-related complications and better stone-free rates. Ultrasound is increasingly employed as an imaging modality for obtaining access. There have been increasing reports of tubeless PCNL in the literature. Most patients undergoing tubeless PCNL do not need hemostatic agents as an adjuvant for hemostasis. Non-contrast computed tomography does not yield statistically valuable increase in the diagnosis of significant residual stones compared with that of plain X-ray and linear tomography. Comprehensive metabolic evaluation and aggressive medical management can control new stone recurrences and growth of residual fragments following PCNL. Conclusions: PCNL is a highly effective procedure with consistently high stone-free rates when compared with extracorporeal shockwave lithotripsy or retrograde intrarenal surgery. The results also do not depend on anatomic factors and stone size. It is associated with low morbidity in experienced hands. PMID:19468514

  5. Combating photoaging with percutaneous collagen induction.

    PubMed

    Fernandes, Desmond; Signorini, Massimo

    2008-01-01

    Medical clinicians are used to being consulted by patients who want to restore their youthful appearance. Although structural changes to the face and body may be achieved with surgery, for example, face lifts, the impression of youth also relies heavily on young-looking skin. It is desirable to have thicker and tighter skin to properly fulfill the desire for youth. Percutaneous collagen induction offers an antiaging effect to improve the appearance of old skin. It allows us to improve our patients' skin from the inside outward as well as from the surface. Experience has shown that percutaneous collagen induction works optimally when combined with a scientific skin care program to restore a youthful appearance. In addition, the same technique has proven to be very effective in minimizing acne scars and burn scars by removing scar collagen and replacing it with normal collagen. Consequently, scar contractures and depressed scars are improved. With the introduction of percutaneous collagen induction therapy in 1997, a simple and fast method was developed with regard to safely treating wrinkles and scars and producing lasting smoothness. As opposed to ablative laser treatments, the epidermis remains intact and is not damaged. For this reason, the operation can be safely repeated if needed, and it can be also applicable to regions where laser treatments or deep peelings cannot be done. PMID:18472060

  6. Use of novel 6 French intra-aortic balloon pump catheter for patients undergoing percutaneous coronary intervention.

    PubMed

    Yamada, Takeshi; Mizuguchi, Yukio; Sakamoto, Shingo; Taniguchi, Norimasa; Nakajima, Shunsuke; Takahashi, Akihiko

    2013-01-01

    This study aimed to evaluate the feasibility and safety of a new 6 French (6 Fr) intra-aortic balloon pumping (IABP) catheter for patients undergoing percutaneous coronary intervention (PCI). Sixty-nine consecutive patients who received a 6 Fr IABP catheter were retrospectively evaluated. Patients with height <162 cm were primary selected for the 6 Fr IABP catheter treatment because of limited balloon size (30 ml). These catheters were also used for patients for whom the femoral approach was contraindicated. The mean age of the patients was 76.9 years. The average height and body weight were 156.7 cm and 56.0 kg, respectively. The 6 Fr IABP catheters were successfully inserted in all 69 patients, including four patients treated via the brachial artery. No patient developed limb ischemia. Poor helium inflation due to kinking of the catheter shaft occurred in one patient and helium leakage in one patient. The other 67 patients were well supported, and no patient required the 6 Fr catheter to be exchanged with a larger balloon catheter. The current study demonstrates that using this novel and currently, the thinnest IABP catheter is feasible and safe for small-sized patients undergoing PCI and seems promising for reduction in vascular complications. Brachial insertion is also possible using the 6 Fr IABP catheter; this may solve access site limitations observed with existing conventional IABP catheters. PMID:23851454

  7. Percutaneous closure of interatrial communications in adults – prospective embolism prevention study with two- and three-dimensional echocardiography

    PubMed Central

    Knebel, Fabian; Gliech, Volker; Walde, Torsten; Panda, Alexander; Sanad, Wasiem; Eddicks, Stephan; Baumann, Gert; Borges, Adrian C

    2004-01-01

    Background Patients with interatrial communications after paradoxical embolic events are at risk for recurrent thromboembolism. We hypothesized that transcatheter closure of the defects would result in long-term prevention of systemic embolism and performed clinical and echocardiographic follow-up. Methods We included 161 patients (mean age 46.8 ± 11 years, 83 females) with patent foramen ovale or atrial septal defect and at least one documented paradoxical systemic thrombembolic event and/or a large atrial shunting. Results The implantation procedure was successfully performed without major complications in all patients and minor complications in 2.5%. Two and / or three dimensional echocardiography was performed before and after 4 weeks and 12 months using a multiplane transoesophageal probe. After 4 weeks and 6 months two patients had minimal shunting. These residual defects were closed with a second device implantation without shunting after further 4 weeks. During a follow-up of 324.3 patient years (range, 13 to 19 months), recurrent embolic events occurred in only 1 patient (0.6%). Conclusion After primary paradoxical systemic embolism, results of transcatheter occlusion of the interatrial communications are dependent on the closure device system and can prevent further secondary embolic events for up to 1 year after the percutaneous closure. Three dimensional echocardiography provides dynamic features of the defects and the post closure status and may lead to an improved understanding and diagnosis of the interatrial defect. PMID:15151699

  8. Access-Related Venous Stenoses and Occlusions: Treatment with Percutaneous Transluminal Angioplasty and Dacron-Covered Stents

    SciTech Connect

    Farber, Alexander; Barbey, Mark-Michael; Grunert, Jens-Holger; Gmelin, Ekkechardt

    1999-05-15

    Purpose: To determine the effectiveness of using Dacron-covered stents to treat access-related venous stenoses and occlusions. Methods: Twenty-two Dacron-covered stents were placed in 20 patients: in the basilic or axillary vein (n = 2), cephalic vein (n = 3), subclavian vein (n = 5), and at the venous anastomosis of the polytetrafluoroethylene (PTFE) implant graft (n 10). Results: Initial technical success was 100%. The cumulative primary and secondary patency rates were 57% and 83% at 6 months, 29% and 64% at 12 months, and 29% and 53% at 18 months. A statistically significant difference in the stent patency was revealed by comparing the patients with stents in the subclavian vein and patients with upper arm stents. The secondary patency rates of the upper arm stents were 73% after 6, 12, and 18 months. Conclusions: Percutaneous placement of Dacron-covered stents is a safe and effective procedure for salvage of a dialysis fistula. First results are promising, with a tendency to prolongation of the time interval between reinterventions.

  9. Percutaneous endoscopic management of intrahepatic stones in patients with altered biliary anatomy: A case series.

    PubMed

    Bhandari, Suryaprakash; Bathini, Rajesh; Sharma, Atul; Maydeo, Amit

    2016-03-01

    Incidence of primary intrahepatic stones (IHS) in India is very less as compared to the Far East. However patients with altered biliary anatomy are prone for IHS formation secondary to anastomotic stricture formation. Indian data on percutaneous endoscopic management of IHS is scare. Five patients with IHS were managed percutaneously. All patients had undergone Roux-en-Y hepaticojejunostomy and were not suitable for direct endoscopic intervention. All patients underwent percutaneous biliary drainage followed by cholangioscopy-guided laser lithotripsy. Crushed stones were pushed across the anastomotic site using basket/balloon and ductal clearance was achieved. Good stone pulverization could be achieved in five patients (100 %). Complete ductal clearance could be achieved in all patients (100 %). Cholangioscopy-guided treatment of IHS can be valuable alternative to surgery in select group of patients especially those having dilated biliary tree with absence of intrahepatic strictures. However long-term follow up studies are required to see for recurrence of stone formation. PMID:27041379

  10. Percutaneous Transhepatic Biliary Metal Stent for Malignant Hilar Obstruction: Results and Predictive Factors for Efficacy in 159 Patients from a Single Center

    SciTech Connect

    Li, Mingwu Bai, Ming Qi, Xingshun Li, Kai Yin, Zhanxin; Wang, Jianhong; Wu, Wenbing Zhen, Luanluan He, Chuangye; Fan, Daiming; Zhang, Zhuoli; Han, Guohong E-mail: Hangh@fmmu.edu.cn

    2015-06-15

    AimTo investigate and compare the efficacy and safety of percutaneous transhepatic biliary stenting (PTBS) using a one- or two-stage procedure and determine the predictive factors for the efficacious treatment of malignant hilar obstruction (MHO).Methods159 consecutive patients with MHO who underwent PTBS were enrolled between January 2010 and June 2013. Patients were classified into one- or two-stage groups. Independent predictors of therapeutic success were evaluated using a logistic regression model.Results108 patients were treated with one-stage PTBS and 51 patients were treated with two-stage PTBS. The stents were technically successful in all patients. Successful drainage was achieved in 114 patients (71.4 %). A total of 42 early major complications were observed. Re-interventions were attempted in 23 patients during follow-up. The cumulative primary patency rates at 3, 6, and 12 months were 88, 71, and 48 %, respectively. Stent placement using a one- or two-stage procedure did not significantly affect therapeutic success, early major complications, median stent patency, or survival. A stent placed across the duodenal papilla was an independent predictor of therapeutic success (odds ratio = 0.262, 95 % confidence interval [0.107–0.642]). Patients with stents across papilla had a lower rate of cholangitis compared with patients who had a stent above papilla (7.1 vs. 20.3 %, respectively, p = 0.03).ConclusionsThe majority of patients with MHO who underwent one-stage PTBS showed similar efficacy and safety outcomes compared with those who underwent two-stage PTBS. Stent placement across the duodenal papilla was associated with a higher therapeutic success rate.

  11. Acute endocarditis of a percutaneously placed pulmonary valve

    PubMed Central

    Ramakrishnan, Karthik V; Olivieri, Laura; Jonas, Richard A

    2015-01-01

    Endocarditis of percutaneously placed pulmonary valve is increasingly being recognized and reported as a potentially life-threatening complication. In this report, we discuss a 17-year-old male who presented with septic shock secondary to staphylococcal endocarditis of a percutaneously placed pulmonary valve. PMID:26556969

  12. Percutaneous unroofing of renal simple cysts: Experience from one centre

    PubMed Central

    Tehranchi, Ali; Hamedanchi, Sepehr; Badalzadeh, Afshin

    2011-01-01

    Objective To assess the efficacy of percutaneous unroofing (PU) for treating simple renal cysts, compared with laparoscopic decortication and open surgery. Patients and methods From November 2009 to October 2010, 11 patients with 12 simple cysts in renal units were managed by PU. All cysts were evaluated with ultrasonography and abdominal computed tomography. A standard transurethral resectoscope was used to resect the cyst wall, and the parenchymal portion of the cyst was subsequently cauterised. A drain was left in place for 2 days. Success was defined as a >50% reduction in cyst diameter. Results At the 5-month follow-up, patients were asked about their symptoms and assessed by ultrasonography. Of the 12 cyst units, eight were completely resolved, three were reduced to <50% in diameter and one was persistent, close to the original size. Conclusion Simple renal cysts can be managed safely by PU, with a success rate of >90%. This technique offers several advantages over open surgery, with a shorter hospital stay, improved convalescence and reduced risk of complications. PU also avoids the multiple trocar sites, extensive dissection, and technical difficulty associated with laparoscopy. PMID:26579308

  13. Percutaneous Ablation of Peripheral Pseudoaneurysms Using Thrombin: A Simple and Effective Solution

    SciTech Connect

    Owen, Richard J.T.; Haslam, Philip J.; Elliott, Simon T.; Rose, John D.G.; Loose, Henry W.

    2000-11-15

    Purpose: To assess the effectiveness of tissue adhesive and thrombin solution in the percutaneous ablation of peripheral artery pseudoaneurysms.Methods: Twenty-five pseudoaneurysms were treated over a 33-month period; all had failed ultrasound-guided compression. Tissue adhesive or thrombin solution was injected percutaneously, with needle tip position and changes within the aneurysm confirmed with color Doppler ultrasound. In 19 cases we utilized a protective balloon inflated across the aneurysm neck prior to the injection of tissue adhesive and in six cases used thrombin injection alone. Seven patients were anticoagulated. Patients were followed up after the procedure.Results: All 25 aneurysms were treated successfully; two patients required a return visit and there were no immediate complications or peripheral emboli detected. One patient developed a contralateral pseudoaneurysm.Conclusions: The percutaneous injection of pseudoaneurysms is a safe, a traumatic, and effective treatment for femoral artery pseudoaneurysms in the peripheral circulation. There are significant advantages over ultrasound-guided compression or surgical repair.

  14. Placement of vena cava filter via percutaneous puncture of the great saphenous vein

    PubMed Central

    JIN, YIQI; ZHOU, DAYONG; CHEN, LEI; HUANG, XIANCHEN; XU, GUOXIONG; HUANG, JIAN; SHEN, LIMING

    2013-01-01

    The aim of this study was to investigate the feasibility and safety of vena cava filter (VCF) placement via percutaneous puncture of the great saphenous vein (GSV) in the prevention of pulmonary embolisms. Using ultrasound positioning, VCF placement via percutaneous puncture of the GSV was performed on 12 patients with deep vein thrombosis (DVT) in the lower extremities. Transcatheter thrombolysis was conducted simultaneously. The postoperative filter position, puncture wound recovery and fluency of the GSV were observed. All filters were successfully released, with accurate positioning. No hematoma was observed at the puncture point during the perioperative period. In certain patients, local petechiae appeared around the puncture point during the thrombolysis period, which did not require special treatment. Re-examination using ultrasound revealed unobstructed blood flow in the GSV. VCF placement via percutaneous puncture of the GSV is a new filter placement method. The feasibility and safety of this method for the prevention of pulmonary embolisms has been demonstrated in a small number of sample cases. PMID:24137182

  15. Percutaneous Transhepatic Portography for the Treatment of Early Portal Vein Thrombosis After Surgery

    SciTech Connect

    Adani, Gian Luigi Baccarani, Umberto; Risaliti, Andrea; Sponza, Massimo; Gasparini, Daniele; Bresadola, Fabrizio; Anna, Dino de; Bresadola, Vittorio

    2007-11-15

    We treated three cases of early portal vein thrombosis (PVT) by minimally invasive percutaneous transhepatic portography. All patients developed PVT within 30 days of major hepatic surgery (one case each of orthotopic liver transplantation, splenectomy in a previous liver transplant recipient, and right extended hepatectomy with resection and reconstruction of the left branch of the portal vein for tumor infiltration). In all cases minimally invasive percutaneous transhepatic portography was adopted to treat this complication by mechanical fragmentation and pharmacological lysis of the thrombus. A vascular stent was also positioned in the two cases in which the thrombosis was related to a surgical technical problem. Mechanical fragmentation of the thrombus with contemporaneous local urokinase administration resulted in complete removal of the clot and allowed restoration of normal blood flow to the liver after a median follow-up of 37 months. PVT is an uncommon but severe complication after major surgery or liver transplantation. Surgical thrombectomy, with or without reconstruction of the portal vein, and retransplantation are characterized by important surgical morbidity and mortality. Based on our experience, minimally invasive percutaneous transhepatic portography should be considered an option toward successful recanalization of early PVT after major liver surgery including transplantation. Balloon dilatation and placement of a vascular stent could help to decrease the risk of recurrent thrombosis when a defective surgical technique is the reason for the thrombosis.

  16. A-scan ultrasound system for real-time puncture safety assessment during percutaneous nephrolithotomy

    NASA Astrophysics Data System (ADS)

    Rodrigues, Pedro L.; Rodrigues, Nuno F.; Fonseca, Jaime C.; von Krüger, M. A.; Pereira, W. C. A.; Vilaça, João. L.

    2015-03-01

    Background: Kidney stone is a major universal health problem, affecting 10% of the population worldwide. Percutaneous nephrolithotomy is a first-line and established procedure for disintegration and removal of renal stones. Its surgical success depends on the precise needle puncture of renal calyces, which remains the most challenging task for surgeons. This work describes and tests a new ultrasound based system to alert the surgeon when undesirable anatomical structures are in between the puncture path defined through a tracked needle. Methods: Two circular ultrasound transducers were built with a single 3.3-MHz piezoelectric ceramic PZT SN8, 25.4 mm of radius and resin-epoxy matching and backing layers. One matching layer was designed with a concave curvature to work as an acoustic lens with long focusing. The A-scan signals were filtered and processed to automatically detect reflected echoes. Results: The transducers were mapped in water tank and tested in a study involving 45 phantoms. Each phantom mimics different needle insertion trajectories with a percutaneous path length between 80 and 150 mm. Results showed that the beam cross-sectional area oscillates around the ceramics radius and it was possible to automatically detect echo signals in phantoms with length higher than 80 mm. Conclusions: This new solution may alert the surgeon about anatomical tissues changes during needle insertion, which may decrease the need of X-Ray radiation exposure and ultrasound image evaluation during percutaneous puncture.

  17. Percutaneous Valve Replacement: Significance of Different Delivery Systems In Vitro and In Vivo

    SciTech Connect

    Attmann, Tim; Lutter, Georg Quaden, Rene; Jahnke, Thomas; Rumberg, Kristin; Cremer, Jochen; Muller-Hulsbeck, Stefan

    2006-06-15

    Background and purpose. Percutaneous heart valve replacement is an exciting growing field in cardiovascular medicine yet still with some major problems. Only sophisticated improvement of the instruments could make it a real alternative to conventional surgery. Therefore, the aim of this study was to evaluate different delivery devices for percutaneous heart valve replacement in vitro and in vivo. Methods. A catheter prototype designed by our group, and two commercially available devices for the delivery of esophageal stents and aortic endoprostheses, were tested. After in vitro experiments, an ovine animal model of transfemoral pulmonary valve implantation was established using biological valved self-expanding stents. Only the delivery device for aortic endografts (Medtronic, Talent, Santa Rosa, CA, USA) allowed fast in vitro procedures without material fatigue. This device was chosen for the in vivo tests. Results. Technical success was achieved in 9 of 10 animals (90%). One animal died after perforation of the ventricular wall. Orthotopic pulmonary placement was performed in 6 animals and intentional supravalvular valved stent placement in 3 animals. Conclusions. An adequate in vitro model for this evolving field of interventional heart valve replacement is presented. Furthermore, the present study pinpoints the key characteristics that are mandatory for a delivery system in percutaneous pulmonary valve implantation. With regard to the delivery device's ductility observed during this 'venous' study, an approach to transfemoral aortic valve implantation seems feasible.

  18. Percutaneous external fixator pins with bactericidal micron-thin sol-gel films for the prevention of pin tract infection.

    PubMed

    Qu, Haibo; Knabe, Christine; Radin, Shula; Garino, Jonathan; Ducheyne, Paul

    2015-09-01

    Risk of infection is considerable in open fractures, especially when fracture fixation devices are used to stabilize the fractured bones. Overall deep infection rates of 16.2% have been reported. The infection rate is even greater, up to 32.2%, with external fixation of femoral fractures. The use of percutaneous implants for certain clinical applications, such as percutaneous implants for external fracture fixation, still represents a challenge today. Currently, bone infections are very difficult to treat. Very potent antibiotics are needed, which creates the risk of irreversible damage to other organs, when the antibiotics are administered systemically. As such, controlled, local release is being pursued, but no such treatments are in clinical use. Herein, the use of bactericidal micron-thin sol-gel films on metallic fracture fixation pins is reported. The data demonstrates that triclosan (2,4,4'-trichloro-2'-hydroxydiphenylether), an antimicrobial agent, can be successfully incorporated into micron-thin sol-gel films deposited on percutaneous pins. The sol-gel films continuously release triclosan in vitro for durations exceeding 8 weeks (longest measured time point). The bactericidal effect of the micron-thin sol-gel films follows from both in vitro and in vivo studies. Inserting percutaneous pins in distal rabbit tibiae, there were no signs of infection around implants coated with a micron-thin sol-gel/triclosan film. Healing had progressed normally, bone tissue growth was normal and there was no epithelial downgrowth. This result was in contrast with the results in rabbits that received control, uncoated percutaneous pins, in which abundant signs of infection and epithelial downgrowth were observed. Thus, well-adherent, micron-thin sol-gel films laden with a bactericidal molecule successfully prevented pin tract infection. PMID:26036176

  19. Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

    PubMed Central

    Healy, Kelly; Chamsuddin, Abbas; Spivey, James; Martin, Louis; Nieh, Peter

    2009-01-01

    Background and Objectives: Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. Methods: We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and postoperatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Results: Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted. Conclusions: Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach. PMID:19660213

  20. Graft Loss Due to Percutaneous Sclerotherapy of a Lymphocele Using Acetic Acid After Renal Transplantation

    SciTech Connect

    Adani, Gian Luigi Baccarani, Umberto; Bresadola, Vittorio; Lorenzin, Dario; Montanaro, Domenico; Risaliti, Andrea; Terrosu, Giovanni; Sponza, Massimo; Bresadola, Fabrizio

    2005-12-15

    Development of lymphoceles after renal transplantation is a well-described complication that occurs in up to 40% of recipients. The gold standard approach for the treatment of symptomatic cases is not well defined yet. Management options include simple aspiration, marsupialization by a laparotomy or laparoscopy, and percutaneous sclerotherapy using different chemical agents. Those approaches can be associated, and they depend on type, dimension, and localization of the lymphocele. Percutaneous sclerotherapy is considered to be less invasive than the surgical approach; it can be used safely and effectively, with low morbidity, in huge, rapidly accumulating lymphoceles. Moreover, this approach is highly successful, and the complication rate is acceptable; the major drawback is a recurrence rate close to 20%. We herewith report a renal transplant case in which the patient developed a symptomatic lymphocele that was initially treated by ultrasound-guided percutaneous sclerotherapy with ethanol and thereafter using acetic acid for early recurrence. A few hours after injection of acetic acid in the lymphatic cavity, the patient started to complain of acute pain localized to the renal graft and fever. An ultrasound of the abdomen revealed thrombosis of the renal vein and artery. The patient was immediately taken to the operating room, where the diagnosis of vascular thrombosis was confirmed and the graft was urgently explanted. In conclusion, we strongly suggest avoiding the use of acetic acid as a slerosating agent for the percutaneous treatment of post-renal transplant lymphocele because, based on our experience, it could be complicated by vascular thrombosis of the kidney, ending in graft loss.