Assessment of mitral valve commissural morphology by transoesophageal echocardiography predicts outcome after balloon mitral valvotomy

BackgroundBalloon mitral valvotomy (BMV) is a safe and an effective treatment in patients with symptomatic rheumatic mitral stenosis. This study was conducted to validate the importance of assessing the morphology of mitral valve commissures by transoesophageal echocardiography and thereby predicting the outcome after balloon mitral valvotomy [BMV].Materials and methodsStudy consisted of 100 patients with symptomatic mitral stenosis undergoing BMV. The Commissural Morphology and Wilkins score were assessed by transoesophageal echocardiography. Both the commissures (anterolateral and posteromedial) were scored individually according to whether non-calcified fusion was absent (0), partial (1), or extensive (2) and calcification (score 0) and combined giving an overall commissural score of 0–4. Outcome of BMV was correlated with commissural score and Wilkins score.ResultsThe commissural score and outcome after BMV correlated significantly. 66 of 70 patients (94%) with a commissural score of 3–4 obtained a good outcome compared with only six (20%) patients of 30 with a commissural score of 0–2 (positive and negative predictive accuracy 94% and 80%, respectively, p < 0.001). Increase in 2DMVA post BMV was more in patients with higher commissural score (score of 3–4). Wilkins score <8 usually predicts a good outcome but even in patients with Wilkins score >8 a commissural score >2 predicts a 50% chance of a good result.ConclusionsA higher commissural score predicts a good outcome after BMV hence it can be concluded that along with Wilkins score, commissural morphology and score should be assessed with TOE in patients undergoing BMV.     

Transseptal Catheterization without Needle Puncture

Objective - The aim was to see if probing the fossa ovalis for transseptal puncture during balloon mitral valvuloplasty will reduce time consumed for the procedure. Design - Twenty-five patients had probing of fossa ovalis for left atrial entry (group I). In 30 patients (group II), standard needle puncture was done for left atrial entry. Puncture time and fluoroscopy time were noted and oxymetry was done. Later, a further 60 patients underwent probing of fossa ovalis for validation of the technique. Results     

Technical aspects and access devices for preperitoneal and retroperitoneal endoscopic surgery

The main advantages of preperitoneal and retroperitoneal endoscopic surgery over conventional laparoscopy or open surgery are the decreased risk of injury to organs and reduced postoperative adhesion formation. Exact knowledge of anatomy, as well as correct positioning of the patient, is essential for its success. While a blunt dissection technique, using either the fingers or an endoscope under pneumodissection, is preferred for preperitoneal surgery, the introduction of a balloon dissection device directly into the retroperitoneal cavity simplifies this procedure for retroperitoneoscopy. Different general surgical procedures are described for preperitoneal (hernia) and retroperitoneal (adrenalectomy, neurectomy/ sympathectomy) surgery. Urological/gynaecological procedures (kidney, tumor biopsy, lymphadenectomy) are excluded from this review. In recent years, the number of possible preperitoneal and retroperitoneal surgical procedures has increased, mainly as a result of the development of commercially-available balloon trocars and balloon-tipped trocars, which create and maintain a working space.     

Pressure sensors for the monitoring of diseases in surgical care

Our 10-year experience of retroperitoneal laparoscopic pyelolithotomy, a rarely performed minimally invasive operative procedure, is presented. The results are compared with our own experience of percutaneous nephrolithotomy for larger renal stones. Forty-two patients with a mean age of 39.12 years underwent 43 retroperitoneal laparoscopic pyelolithotomies using Gaur's balloon technique. The total number of stones was 65 (44 pelvic and 21 calyceal) and they ranged in size between 5 and 48 mm. Two patients had chronic renal failure due to bilateral impacted renal calculi. Forty-eight percutaneous nephrolithotomies performed in the same unit during the last 2 years in patients with non-staghorn calculi > 2 cm were included for a comparative study. The open conversion rate and the drainage period for retroperitoneal laparoscopic pyelolithotomy were much higher. However, the operative time, blood loss, analgesic intake, hospital stay, residual stone rate, re-treatment rate and major complication rates were lower, compared with percutaneous nephrolithotomy.     

Risk taking and the triarchic model of psychopathy

Introduction: High risk behaviors, such as aggression, criminality, sexual promiscuity, drug use, and gambling, are often associated with psychopathic traits. Such behaviors might arise due to a lack of fear of the consequences (boldness) or due to impulsive actions (disinhibition). We examined risk taking behavior in the laboratory setting using the Balloon Analogue Risk Task (BART), where an individual can inflate a balloon to earn a reward, but will lose this accumulated reward if the balloon bursts. The task reflects the willingness to take risks under conditions where the risk-taking behavior is understood and is made clear to the individual. Method: BART performance was measured in a mixed community and offender sample, and psychopathy was characterized via the triarchic conceptualization of psychopathy, which proposes that psychopathy is a combination of boldness, meanness, and disinhibition. Results: Total psychopathy score was correlated with greater risk taking on the BART, and this effect was mainly due to the Boldness scale rather than the Meanness or Disinhibition scales. These relationships were not moderated by the nature of the sample (offender vs. community) or by gender. Conclusions: Individuals with high psychopathy scores appear more willing to take risks on this simple laboratory task, and this behavior appears due to boldness rather than being related to an impulsive disposition.     

Studies on percutaneous transvenous mitral commissurotomy using a modified transseptal approach

Summary A modified version of Brockenbrough's trans-septal catheterization technique was carried out in 11 patients indicated for percutaneous transvenous mitral commissurotomy (PTMC). In 8/11 (72.7%), a coiled guide-wire was successfully inserted through theforamen ovale without atrial septal puncture. The Brockenbrough needle was used merely to maintain stiffness and the orientation of the dilator. PTMC was performed with an Inoue single balloon without incident.Patent foramen ovale was found by transesophageal echocardiography prior to the operation in only 1/11 patients (9.0%); nonetheless, it proved not to be a critical factor for the success of the procedure. This procedure seems to have much potential to enable the treatment of mitral stenosis with a lowered risk to the patient, as long as it is performed with precision and caution.     

大鼠胸主动脉球囊损伤后平滑肌细胞PCNA和P27表达的变化

目的探讨大鼠胸主动脉球囊损伤后增殖细胞核抗原(PCNA)、细胞周期蛋白依赖性激酶抑制蛋白P27表达变化规律。方法30只400～500g的雄性SD大鼠随机分为2组。手术组(n=24)行球囊损伤大鼠胸主动脉术;对照组(n=6)不行球囊损伤,作为正常对照。于术后2d、7d、14d、28d取胸主动脉应用HE染色、免疫组化和计算机图像分析法进行形态学、PCNA和P27表达水平检测。结果(1)正常动脉壁不表达PCNA,球囊损伤后开始表达,术后2d时中膜表达显著(24.08±2.35);术后7d出现新生内膜,PCNA在内膜高度表达(35.32±3.46)而中膜表达已明显下降(9.47±1.56);后内膜、中膜表达均逐渐下降,28d时形成显著的新生内膜(0.173±0.030)mm2,管腔狭窄;(2)正常动脉壁显著表达P27(19.29±1.54),球囊损伤后中膜表达迅速下降,2d达最低水平(2.93±0.55),后逐渐回升;14d、28d新生内膜中可见P27表达,并逐渐增多;(3)P27表达与PCNA表达呈显著负相关(r=0.868P<0.001)。结论球囊损伤大鼠主动脉后管壁P27表达下调伴随PCNA表达上调,血管平滑肌细胞恢复增殖能力并向内膜下迁移并过度增殖,从而形成显著的新生内膜、管腔狭窄。     

球囊扩张术对脑卒中后吞咽障碍康复疗效及不良并发症研究

目的:研究球囊扩张术对脑卒中后吞咽障碍的康复疗效及不良并发症的影响。方法:选取我院经吞咽造影检查确诊为脑卒中后环咽肌失弛缓导致的吞咽障碍患者50例,随机分为2组各25例。对照组接受常规吞咽功能训练、Vitalstim神经肌肉低频电刺激,观察组另外给予球囊扩张术治疗。比较2组患者的总有效率、吞咽功能、并发症发生率,同时比较治疗前和治疗后的咽通过时间、吞咽造影检查(VFSS)评分及功能性经口摄食评估(FOIS)评分。结果:观察组的可进水、可进食流质物、可进食糊状物、可进食固体食物比例均明显高于对照组(均P0.01);观察组的吸入性肺炎发生率明显低于对照组(P0.05);治疗后,观察组的咽通过时间明显低于对照组(P0.01),VFSS和FOIS评分均明显高于对照组(均P0.01);观察组的康复总有效率明显高于对照组(96.0%,72.0%,P0.05)。结论:球囊扩张术对脑卒中后吞咽障碍具有显著疗效,缩短患者康复时间,降低误吸等并发症的发生。     

“支柱块”置入与球囊扩张椎体后凸成形术治疗老年胸腰椎压缩骨折的疗效观察

目的分析"支柱块"置入与球囊扩张椎体后凸成形方法在老年胸腰椎压缩骨折患者治疗中的效果。方法将2012年1月~2013年6月期间150例老年胸腰椎压缩骨折患者依据随机数字表法分为两组,实验组使用"支柱块"置入治疗,对照组采用球囊扩张椎体后凸成形术治疗,观察两组效果。结果实验组与对照组手术时间、失血量之间比较差异有统计学意义(P<0.05)。实验组24 h疼痛目测类评分高于对照组,差异有统计学意义(P<0.05)。结论 "支柱块"置入与球囊扩张椎体后凸成形方法均对老年胸腰椎压缩骨折患者的影响小,且二者各具优点,依据患者具体状况进行选择。     

Percutaneous Papillary Large Balloon Dilation during Percutaneous Cholangioscopic Lithotripsy for the Treatment of Large Bile-Duct Stones: A Feasibility Study

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.

Graphical Abstract

相似文献