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《Techniques in Gastrointestinal Endoscopy》2018,20(3):130-134
Botulinum toxin (BT) injections have been proposed to treat achalasia and hypertensive esophageal motility disorders. They affect lower esophageal sphincter (LES) and esophageal muscle function by inhibiting acetylcholine release and thus preventing neuromuscular conduction. BT injection in the LES is effective to treat achalasia but the improvement is limited to few months. As a consequence, recent guidelines recommend BT in achalasia patients who are not good candidates for more definitive therapy with pneumatic dilation or myotomy. BT might be a good option for patients with esophago-gastric junction obstruction without a firm diagnosis of achalasia. However, response to BT injection is not predictive of response to a more invasive therapy. BT injection in both the LES and the esophageal body might have a short-term efficacy to relieve dysphagia in patients with diffuse esophageal spasm or nutcracker esophagus. Usually BT is administrated as 1 cc aliquots with 20 units of toxin per milliliter into the LES and/or the esophageal body for a total dose of 100 unit international. BT injections are usually safe. Moderate chest pain might be reported following the injection. Three cases of death were reported due to acute mediastinitis and pseudoaneurysm. Finally, there is a theoretical risk of increased difficulty to perform esophageal myotomy in patients who previously received BT therapy due to the potential risk of fibrosis. 相似文献
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D. W. Shaffer S. L. Dawson D. Meglan S. Cotin M. Ferrell A. Norbash 《Minimally invasive therapy & allied technologies》2013,22(2):75-82
Learning complex skills through simulation is a goal for training physicians in specialties such as interventional cardiology, where traditional training puts patients at risk. Intuitively, interactive simulation of anatomy, pathology and therapeutic actions should lead to shortening of the learning curve for novice or inexperienced physicians. An accurate recreation of the interactions among anatomy, pathology and therapeutic actions is a necessary, but not sufficient, condition for the development of a simulation-based training system. In addition to real-time graphic interactivity coupled with haptic response, a successful training tool will require features of a 'learning system' such as: an embedded curriculum, functionality that allows rehearsal and practice, hypertext links to educational information, personal archiving, and instructor review and testing capabilities. We describe how such a system might look for the field of interventional cardiology, and suggest that designing a simulation with both technical and pedagogical fidelity is essential in developing simulation-based training systems in any field of medicine. 相似文献