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[en] Purpose: We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm.Methods: Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route.Results: All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheterrelated phlebitis occurred.Conclusion: Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis.
[en] Full text: Porcine heart valves glutaraldehyde fixed are implanted in patients whose valves show deterioration. Mineralization may be the major factor in the long-term failure of tissue bio prostheses. The goal of this study is to detect the effects of different gamma radiation doses on the calcification process of glutaraldehyde fixed porcine aortic valves. Small pieces from glutaraldehyde fixed valves, irradiated to different doses: 25, 30 and 40 kGy (kilo Gray), with a 60Co source were implanted subcutaneously in rats for 30, 60 and 90 days. Calcium was evaluated by two methods: radiographic and atomic absorption spectrophotometry. Dose (kGy) 1-30 days, 60 days, 90 days. 2-25 88.7 9.0 (n=8); 177.4 3.0 (n=5); 182.0 3.0 (n=7) 3- 0 94.8 9.0 (n=6); 141.0 4.0 (n=6); 171.5 9.0 (n=8); 4- 40 72.0 6.0 (n=5); 157.8 .0 (n=5); 203.5 8.0 (n=4); 5- 0 80.4 3.0 (n=5); 173.2 9.0 (n=5); 206.0 4.0 (n=4); 6- 30 116.6 4.0 (n=5); 7- 0 206.0 4.0 (n=4). Calcium levels (mg /g dry tissue) by spectrophotometry, X D. The radiographic observation showed that there were no modification at the calcium deposition sequence between no-irradiated and irradiated samples after period of implantation. In our experimental condition and at the radiation doses used in these experiences the calcium measured on control and irradiated material were not significantly different. We conclude that, in these doses, the gamma radiation does not increase the calcification process. Thus, the gamma radiation could give a new way of bio prostheses processing
[en] Detailed knowledge of aortic root geometry is a prerequisite to anticipate complications of transcatheter aortic valve (TAV) implantation. We determined coronary ostial locations and aortic root dimensions in patients with aortic stenosis (AS) and compared these values with normal subjects using computed tomography (CT). One hundred consecutive patients with severe tricuspid AS and 100 consecutive patients without valvular pathology (referred to as the controls) undergoing cardiac dual-source CT were included. Distances from the aortic annulus (AA) to the left coronary ostium (LCO), right coronary ostium (RCO), the height of the left coronary sinus (HLS), right coronary sinus (HRS), and aortic root dimensions [diameters of AA, sinus of Valsalva (SV), and sino-tubular junction(STJ)] were measured. LCO and RCO were 14.9 ± 3.2 mm (8.2-25.9) and 16.8 ± 3.6 mm (12.0-25.7) in the controls, 15.5 ± 2.9 mm (8.8-24.3) and 17.3 ± 3.6 mm (7.3-26.0) in patients with AS. Controls and patients with AS had similar values for LCO (P = 0.18), RCO (P = 0.33) and HLS (P = 0.88), whereas HRS (P < 0.05) was significantly larger in patients with AS. AA (r = 0.55,P < 0.001), SV (r = 0.54,P < 0.001), and STJ (r = 0.52,P < 0.001) significantly correlated with the body surface area in the controls; whereas no correlation was found in patients with AS. Patients with AS had significantly larger AA (P < 0.01) and STJ (P < 0.01) diameters when compared with the controls. In patients with severe tricuspid AS, coronary ostial locations were similar to the controls, but a transverse remodelling of the aortic root was recognized. Owing to the large distribution of ostial locations and the dilatation of the aortic root, CT is recommended before TAV implantation in each patient. (orig.)
[en] Percutaneous ureteral stent insertion is a treatment of permanent or temporary urinary diversion to maintain continuity and function of the obstructed and injured ureter. We performed 31 cases of percutaneous double pig tall ureteral stent insertion in 21 patients, included 13 patients with malignant ureteral obstruction and eight patients with injured ureter as well as benign inflammatory stricture. Satisfactory resulted was obtained in all patients but one, who need percutaneous nephrostomy on week later for urinary diversion. No significant complication was encountered. The authors concluded that percutaneous ureteral stent insertion, an interventional procedure alternative to urologic retrograde method, is an effective method for urinary diversion
[en] Percutaneous transluminal angioplasty(PTA) with a balloon catheter is a standard method of treatment for membranous obstruction of inferior vena cava(MOIVC). But, correct therapeutic approach has not been established for MOIVC patients whose lesion is associated with extensive thrombotic IVC occlusion. We tried to treat MOIVC associated with or without thrombus. We treated 13 cases of MOIVC(associated with thrombus in 7 cases, no thrombus in 6 cases) with PTA, thrombolysis and self-expandable metallic stents. PTA was successful in 8 cases, but failed in 5 cases. The recurred cases were retreated with PTA, but follow-up study revealed recoiling restenosis in 4 cases and intimal hyperplasia in 1 case at previous PTA site which could be overcome with a self-expandable metallic stent. The complication were occurred in 3 cases which were hemothorax, hemopericardium, and hemoperitoneum respectively. However, those were resolved by conservative treatment only. Recanalization and dilatation could be done in MOIVC patients with or without thrombosis for improvement of patient's symptom. Gianturco self-expandable metallic stent is useful in treatment of recurred MOIVC after balloon dilatation and preventing reocclusion of the IVC after PTA
[en] The availability of large diameter stent-grafts is now allowing the endovascular treatment of thoracic aortic aneurysms. Most aneurysms are closely related to the distal arch and it is thus necessary to pass the delivery systems into the arch to effectively cover the proximal neck. Even with extra-stiff guidewires in position, it may still be difficult to achieve this, as a result of tortuosity at the iliac arteries and the aorta. We detail a technique where a stiff guidewire is passed from a brachial entry point through the aorta and out at the femoral arteriotomy site. This allows extra-support and may enable the delivery system to be passed further into the aortic arch than it could with just the regular guidewire position.
[en] To discuss the technical aspects and adders the clinical results of treatment of malignant esophaged dysphagia by placement of a Wallstent prosthesis under fluoroscopic guidance. Over the past six years, we have implanted 63 Wallstent metallic prostheses in 40 patients with un operable malignant dysphagia of esophaged origin. The consisted of 36 men and 6 women with a mean age of 72 years. Seven of the neoplasms were associated with fistula.Six involved recurrent tumors at the point of the surgical anastomosis. Following implantation, the patients were evaluated clinically and radiologically at postoperative hour 48 and periodically thereafter until their death or until the study was completed in September 1996. The placement of the prostheses was achieved in all the patients. Immediate technical problems (malposition or failure to expand) in 27.5% of cases. Forty percent of the patients complained of plain, and there was one death due to massive hematemesis. A clear improvement in dysphagia was obtained was obtained in 79% of and only one of the 7 fistulas was closed. During follow-up, the main complication was obstruction of prosthesis (25%) as a result of tumor overgrowth (9 episodes in 8 patients) or due to food impaction (4 episodes in 3 patients). The rate of retreatment was 27.5%. The mean survival time after prosthesis implantation was 132 ±207 days and 62.5% of the devices were still permeable when the patient died. Implantation of Wallstent prosthesis in cases of malignant esophageal stenosis is easy and safe, and constitutes an effective treatment of dysphagia. Nevertheless, thorough knowledge of the technical aspects ensures better results and the strict assessment of the indications guarantees an improved cost-benefit ratio for this technique. (Author) 23 refs
[en] To evaluate the effectiveness and problems of Gianturco stent for treatment of esophagorespiratory fistulas caused by esophageal carcinoma. In a 6-year period, we have treated 95 patients of esophageal carcinomas with silicone-covered modified Gianturco stent. Among those patients, ten had an esophagorespiratory fistula. We retrospectively analyzed the effect of stent for the occlusion of esophagorespiratory fistula, food intake capacity of patients, clinical and procedural problems of the stent. After procedure, all fistulas were occluded successfully. Of the 10 patients, two could swallow all kinds of food, four most of foods, three soft foods, and one only liquid foods. In one patient, the fistula was reopened probably resulting from the reflux due to the presence of another lesion in the distal esophagus at 1 week after procedure. Two patients complained of dyspnea the to tracheal compression by the proximal tip of the stent and tracheal invasion of tumor after 4 and 11 weeks. In one patient, fistula was recurred due to tumor overgrowth on proximal and distal portion after 24 weeks. The fistulas recurred from the tumor overgrowth of reflux were successfully treated with another esophageal stent. The tracheal compression by the proximal tip of the stent and invasion by esophageal cancer was treated with tracheal stent and radiation therapy. Insertion of silicone-covered modified Gianturco stent was an effective method for the palliative treatment of esophagorespiratory fistula caused by esophageal cancer. Simultaneous use of tracheal stent is also recommended in patients with tracheal compression by the proximal tip of the stent and invasion by esophageal cancer
[en] Background: A method to describe pelvic rotations between pairs of standard sequential pelvic anteroposterior radiographs based on a pelvic phantom is described in a former study. Purpose: To expand this method into clinical use based on clinical data. Material and Methods: Teardrop distances were measured on 262 pelvic radiographs from 46 patients in a clinical material using a computer program designed to perform measurements on digital radiographs. Anthropometric data recorded from 141 pelvises in an anatomical collection were employed in a computer program designed to simulate radiographs of virtual objects. Virtual rotations of the pelvises were carried out with 4653 virtual radiographs obtained. Virtual radiographic measures were analyzed. Results: A statistically significant difference of 8 mm between mean teardrop distance in females (120 mm) and males (112 mm) was found in the clinical material. A set of formulas describing the relations between differences of two rotation ratios and pelvic rotations were derived. Four simple regression analyses were carried out with the use of virtual measures. Adjusted teardrop distances were implemented. Conclusion: A clinical method to describe pelvic rotations using standard pelvic radiographs was developed