Technical aspects of venous stenting in high-grade stenoses using a long guidewire between dual venous access sites

We describe the technical benefits of the dual-access technique for venous stenting in high-grade stenosis. Stents were implanted successfully with this technique in all patients, although the preceding transfemoral interventions had failed. The dual-access technique is useful to facilitate the intervention when the stenoses are too severe to place the stent through just a single access point. Received: 21 October 1998; Revised: 23 February 1999; Accepted: 3 May 1999     

Flexible tantalum stents for the treatment of renovascular hypertension: a 10-year experience

The aim of this study was to determine long-term success of flexible tantalum stents for the treatment of ostial and truncal renal artery stenosis. Since 1989, flexible tantalum stents (type Strecker) were implanted in 34 patients (36 arteries, 25 ostial lesions, 11 truncal lesions) with uncontrollable renovascular hypertension, 9 of them in association with renal insufficiency. Stents were placed unilaterally in 32 patients, and bilaterally in 2 patients for the treatment of renal artery stenosis. Thirty-five of 36 lesions were atherosclerotic, including 5 recurrencies after previous percutaneous transluminal renal angioplasty (PTRA). One patient had Takayasu arteritis. Stents were implanted after unsuccessful PTRA of 11 truncal and 23 ostial lesions, and as a primary procedure in 2 ostial lesions. Follow-up examinations included blood pressure measurement, determination of serum creatinine level, color duplex sonography, or angiography. The technical success rate was 92 %. Technical failure included incorrect stent placement (1 of 36 lesions, 2.8 %), and stent dislocation (2 of 36 lesions, 5.6 %), and two stents were retrieved percutaneously. In one case of Takayasu arteritis, residual stenosis of 40 % was observed. After technically successful stent placement, 77 % of patients became normotensive with or without medication. In the remaining patients there was partial improvement with blood pressure between 140 and 180 mmHg. Renal function improved in 76 % of patients (completely in 3 of 8, 38 %; and partially in 3 of 8, 38 %). Primary patency rate including all stented lesions and initial technical failures was 82.4 % ± 6.8 (1 year) and 82.4 % ± 9.2 (3 years). After technically successful stent placement, patency rates were 89.9 ± 5.6 % (1 year), and 89.9 ± 7.6 % (3 years). For ostial lesions, primary patency rate was 87.9 ± 6.7 % (1 year) and 87.9 ± 9.2 % (3 years). Placement of flexible tantalum stents in renal arteries is technically demanding, especially in ostial lesions. Once placed successfully, stent patency rate is excellent. Received: 8 December 1999; Accepted: 23 February 2000     

Total versus tube-related additional work of breathing in ventilator-dependent patients

BACKGROUND: In tracheally intubated or tracheostomized spontaneously breathing patients, tube resistance can highly increase the patient's work of breathing. In this study we focused upon the relationship between total (WOBtot) and tube-related additional inspiratory work of breathing (WOBadd) and compared different ventilatory modalities for proper tube compensation. METHODS: In ten tracheostomized spontaneously breathing patients we measured WOBtot and WOBadd in the continuous positive airway pressure (CPAP) mode, under inspiratory pressure support of 5, 10, and 15 cmH2O in the pressure support ventilation (PSV) mode, and under flow-adjusted pressure support in the automatic tube compensation (ATC) mode. WOBadd and WOBtot were calculated on the basis of measured tracheal pressure and esophageal pressure, respectively. Inspiratory peak tracheal pressure above PEEP was taken as an estimate of pressure support beyond mere tube compensation (i.e., overcompensation). RESULTS: The percentage of the tube-related WOBadd on WOBtot in the CPAP mode was 52%. It decreased with increasing pressure support in the PSV mode from 32% (PSV 5 cmH2O) to 17% (PSV 15 cmH2O). WOBadd was only 15% of WOBtot in the ATC mode. In contrast to the other ventilatory modes, reduction of WOBadd in the ATC mode was achieved with the smallest amount of overcompensation, i.e. with minimal pressure assist beyond mere tube compensation. CONCLUSION: In tracheally intubated or tracheostomized spontaneously breathing patients, adequate compensation of tube resistance (i.e. with minimal overcompensation and minimal undercompensation) is best done by the ATC mode.     

Pressure flow analysis may aid in identifying women with outflow obstruction

PURPOSE: We refined recently developed pressure flow cutoff values for female bladder outlet obstruction and applied these values in a consecutive group of women undergoing urodynamic testing for various lower urinary tract symptoms. MATERIALS AND METHODS: A total of 87 women with clinical obstruction determined by history and presenting complaint were enrolled in our prospective evaluation of pressure flow studies. We identified 3 groups of participants according to the suspected cause of obstruction, including prolapse in 33, previous incontinence surgery in 25, and no likely source of obstruction identified from history and physical examination only in 29. An additional 124 patients presenting for evaluation of stress urinary incontinence served as controls. Optimal cutoff values for determining obstruction were developed using receiver operating characteristic curves. To determine the prevalence of bladder outlet obstruction these values were prospectively applied to 106 women undergoing urodynamics for various voiding complaints. RESULTS: In controls the average maximum flow rate was 23 cc per second and average detrusor pressure was 21.9 cm. water, whereas the corresponding values in those with clinical obstruction were 10.7 cc per second and 40.8 cm. water (p <0.001). No differences were noted in the various obstruction groups. Receiver operating characteristics analysis revealed that cutoff values of 11 cc per second or less and 21 cm. water or more optimized the selection of patients with bladder outlet obstruction. Using these values we noted a bladder outlet obstruction prevalence of 20% in a consecutive cohort of women undergoing urodynamic studies at our center. CONCLUSIONS: We propose cutoff pressure flow values for identifying women with bladder outlet obstruction although they should be used only in conjunction with the overall clinical situation. Neither pressure flow data only nor clinical symptoms alone may be sufficient for diagnosing obstruction in women.     

Metabolic risk factors in patients with ureteropelvic junction obstruction and renal calculi

PURPOSE: We performed a prospective study to determine the incidence and spectrum of metabolic abnormalities predisposing to stone formation in patients with ureteropelvic junction obstruction and renal calculi. MATERIALS AND METHODS: A total of 47 consecutive patients with congenital ureteropelvic junction obstruction underwent metabolic evaluation of stone risk factors. Of these patients 21 had associated stones (study group), while 26 did not (control group). Logistical regression, Wilcoxon rank sum and Fisher's exact tests were performed to determine whether there was a significant difference between these groups in regard to the presence of metabolic risk factors. RESULTS: Demographically and symptomatically the 2 groups were equivalent except that the study patients were older. The 24-hour urinary excretion of calcium was significantly higher in study than in the control patients (p = 0.007). While the incidence of hypercalciuria and hyperuricosuria was also higher in the study population, these differences were not significant (p = 0.08 and 0.07, respectively). CONCLUSIONS: Metabolic abnormalities predisposing to stone formation are present more frequently in patients with ureteropelvic junction obstruction who have associated stones compared to those who do not. As such, urinary stasis alone does not explain stone formation in these cases. Rather, the local physiological environment of urine likely has a predisposing role. In addition to restoring unobstructed urinary flow, consideration should be given to metabolic evaluation and prophylactic treatment for affected patients.     

83例女性肠梗阻临床分析

目的 分析肠梗阻原因，探讨妇产科手术与肠梗阻间的关系。方法 回顾分析1994年～2003年83例女性肠梗阻患者的梗阻原因、类型、梗阻处理方法以及再次手术时盆腔情况。结果 83例肠梗阻患者中24例(28．9％)有妇产科手术史，其中子宫全切术后15例，剖宫产术后4例。在小肠梗阻中42．6％有妇产科手术史，肠梗阻发生与妇产科手术的间隔时间平均6．7年。结论 手术后粘连是小肠梗阻的常见原因，手术后粘连性肠梗阻多见于子宫全切术后；肠梗阻可以发生在妇产科手术后较长时间段内。     

生长抑素在肠梗阻治疗中的作用

目的探讨生长抑素在肠梗阻治疗中的应用效果。方法将我科78例各型肠梗阻,随机分为常规治疗对照组40例及实验组38例,实验组常规治疗基础上加用生长抑素(6 mg,iv,gtt,qd),对比两组的疗效。结果实验组临床症状较对照组明显改善,腹胀、腹痛减轻,胃肠引流量减少,治疗后肛门开始排气时间明显的缩短。结论在常规治疗基础上加用生长抑素静脉滴注能改善肠梗阻患者临床症状,适于各型肠梗阻的治疗,但不能减少其必要手术治疗病例的比例。     

Tracheoesophageal fistula: New option in management

Tracheoesophageal fistula is a life threatening condition. Patients not managed surgically ultimately die of their disease. Surgical management is the treatment of choice. We present a case of a patient that developed a tracheoesophageal fistula after tracheostomy. Surgical repair was done which failed due to infection. The patient was managed with the help of an esophageal stent and Trichloroacetic Acid cautery. This approach can be used in selected patients, depending upon the size and site of TEE Larger fistulae and those situated lower down e.g. supra carinal cannot be managed by this technique.     

输卵管妊娠术后生殖状况及其影响因素分析

目的分析引起输卵管妊娠手术治疗后不同生殖状况的相关因素,探讨改善生殖状况,提高宫内妊娠率的方法.方法对自1999-01-2003-12在中山大学附属第一医院等两家医院的424例输卵管妊娠患者经腹腔镜或剖腹手术治疗后患者生殖状况及其相关影响因素进行多重Logistic回归分析及x2分析,找出引起术后不孕及重复性异位妊娠的原因.结果424例患者术后宫内妊娠177例,占41.7%;出现重复性异位妊娠102例,占24.1%;有145例患者术后仍然未孕,占34.2%.多重Logistic回归分析提示,盆腔炎、不孕、异位妊娠、输卵管手术、输卵管粘连、输卵管伞端闭锁是输卵管妊娠术后不孕及重复性异位妊娠的危险因素.结论积极预防盆腔病变,治疗不孕症是改善输卵管妊娠术后生殖状况的重要手段.     

改良可视双腔支气管导管塑形方法在胸科手术单肺通气中的应用

目的 观察改良可视双腔支气管导管（Visual Double-Lumen Tube,VDLT）塑形方法在胸外科手术单肺通气中的应用效果。方法 选取2020-08至2021-08我院胸外科择期手术单肺通气患者60例,美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级I～Ⅲ级,年龄24～80岁,性别不限,BMI 19～28 kg/m2。采用随机数字表法将患者分为传统塑形组（Tsaditional Shaping,TS组）和改良塑形组（Isproved Shaping,IS组）,每组30例。记录麻醉诱导前（T1）、麻醉诱导后即刻（T2）、插管后1 min(T3)的心率（Heart Rate,HR）及平均动脉血压（Mean Arterial Pressure,MAP）;记录插管时间、插管次数、支气管定位情况;记录术后咽喉部疼痛、声音嘶哑等并发症情况。结果 TS组插管时间（67.1±23.8）s明显长于IS组（38.9±10.0）s;TS组插管次数1.3±0.4次明显多于IS组1.0±0.0次（P<0.05）,两组可视双腔支气管导管支...